ObjectiveTo identify similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC) around the world.MethodsWe collected and reviewed official national BD/DNC protocols from contacts around the world between January 2018 and April 2019.ResultsWe communicated with contacts in 136 countries and found that 83 (61% of countries with contacts identified, 42% of the world) had BD/DNC protocols, 78 of which were unique. Protocols addressed the following prerequisites and provided differing instructions: drug clearance (64, 82%), temperature (61, 78%), laboratory values (56, 72%), observation period (37, 47%), and blood pressure (34, 44%). Protocols did not consistently identify the same components for the clinical examination of brain death; 70 (90%) included coma, 70 (90%) included the pupillary reflex, 68 (87%) included the corneal reflex, 67 (86%) included the oculovestibular reflex, 64 (82%) included the gag reflex, 62 (79%) included the cough reflex, 58 (74%) included the oculocephalic reflex, 37 (47%) included noxious stimulation to the face, and 22 (28%) included noxious stimulation to the limbs. Apnea testing was mentioned in 71 (91%) protocols; there was variability in the technique and target across protocols. Ancillary testing was included as a requirement for all determinations of BD/DNC in 22 (28%) protocols.ConclusionsThere is considerable variability in BD/DNC determination protocols around the world. Medical standards for death should be the same everywhere. We recommend that a worldwide consensus be reached on the minimum standards for BD/DNC.

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Background and Purpose We sought to 1) identify countries in Asia and the Pacific that have protocols for the determination of brain death/death by neurologic criteria (BD/DNC) and 2) review the similarities and differences of these protocols in different countries. Methods Between January 2018 and April 2019, we attempted to communicate with contacts in the 57 countries in Asia and the Pacific to determine if they had official national BD/ DNC protocols. We reviewed and compared the identified protocols. Results We identified contacts for 40 (70%) of the 57 countries in Asia and the Pacific, and successfully communicated with 37 of them (93% of countries with contacts identified, 65% of countries in Asia and the Pacific). We found that 24 of the 37 countries had BD/DNC protocols. Two (13%) of the 16 protocols that provided a definition of death referred to brainstem death. Kazakhstan and Israel required only 1 examination to declare BD/DNC, while 10 (71%) of the other 14 protocols required 2 examinations separated by 6-48 hours. The prerequisites, clinical examination, apnea testing procedure, and indications for/selection of ancillary tests varied. Ancillary testing was required for all determinations of BD/DNC in five (21%) countries. Thirteen (54%) of the protocols included information about the time of death, while 12 (50%) of them provided instructions about discontinuation of organ support. Conclusions The protocols for conducting a BD/DNC determination vary markedly among countries in Asia and the Pacific. Since it is optimal to have internationally and intranationally consistent BD/DNC protocols, efforts should be made to harmonize protocols both within this region and worldwide.

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Context Anorexia nervosa (AN) is a psychiatric illness with considerable morbidity and no approved medical therapies. We have shown that relative androgen deficiency in AN is associated with greater depression and anxiety symptom severity. Objective To determine whether low-dose testosterone therapy is an effective endocrine-targeted therapy for AN. Design Double-blind, randomized, placebo-controlled trial. Setting Clinical research center. Participants Ninety women, 18 to 45 years, with AN and free testosterone levels below the median for healthy women. Intervention Transdermal testosterone, 300 μg daily, or placebo patch for 24 weeks. Main Outcome Measures Primary end point: body mass index (BMI). Secondary end points: depression symptom severity [Hamilton Depression Rating Scale (HAM-D)], anxiety symptom severity [Hamilton Anxiety Rating Scale (HAM-A)], and eating disorder psychopathology and behaviors. Results Mean BMI increased by 0.0 ± 1.0 kg/m2 in the testosterone group and 0.5 ± 1.1 kg/m2 in the placebo group (P = 0.03) over 24 weeks. At 4 weeks, there was a trend toward a greater decrease in HAM-D score (P = 0.09) in the testosterone vs placebo group. At 24 weeks, mean HAM-D and HAM-A scores decreased similarly in both groups [HAM-D: −2.9 ± 4.9 (testosterone) vs −3.0 ± 5.0 (placebo), P = 0.72; HAM-A: −4.5 ± 5.3 (testosterone) vs −4.3 ± 4.4 (placebo), P = 0.25]. There were no significant differences in eating disorder scores between groups. Testosterone therapy was safe and well tolerated with no increase in androgenic side effects compared with placebo. Conclusion Low-dose testosterone therapy for 24 weeks was associated with less weight gain—and did not lead to sustained improvements in depression, anxiety, or disordered eating symptoms—compared with placebo in women with AN.

Solid organ transplant (SOT) candidates and recipients are at risk of significant morbidity and mortality from infection due to receipt of immunosuppressive medications necessary to mitigate risk of allograft rejection after transplant. 1-4 Infection prevention measures are routinely incorporated into patient care before and after transplantation and include antibiotic prophylaxis, immunizations, and patient education. Transplant professionals must remain aware of regional infectious disease outbreaks and the associated potential risk for patients awaiting transplantation and for patients who have successfully undergone transplantation. The measles (rubeola) virus is the most contagious human pathogen and an important vaccine-preventable cause of morbidity and mortality around the world. 5 No specific treatment exists for measles infection. Complications and long-term sequelae of infection include pneumonia, vision loss. and subacute sclerosing panencephalitis.

As the novel coronavirus continues to affect over 200 countries, resulting in greater than 350,000 deaths to date, older age is known to confer increased risk for severe disease. However, younger patients may be affected by severe disease as well, and limited literature focuses on the characteristics of these patients. Within a cohort of the first 137 patients admitted to the intensive care unit (ICU) of a tertiary care public hospital in the first month of the outbreak in New York City, we found a higher proportion of younger patients than previously reported. This case series describes baseline demographics, ICU course, and outcomes of 29 consecutive, critically ill patients under age 50 with known COVID-19.