Study protocol of Prednisone in episodic Cluster Headache (PredCH): a randomized, double-blind, placebo-controlled parallel group trial to evaluate the efficacy and safety of oral prednisone as an add-on therapy in the prophylactic treatment of episodic cluster headache with verapamil

PubMed Central

2013-01-01

Background Episodic cluster headache (ECH) is a primary headache disorder that severely impairs patient’s quality of life. First-line therapy in the initiation of a prophylactic treatment is verapamil. Due to its delayed onset of efficacy and the necessary slow titration of dosage for tolerability reasons prednisone is frequently added by clinicians to the initial prophylactic treatment of a cluster episode. This treatment strategy is thought to effectively reduce the number and intensity of cluster attacks in the beginning of a cluster episode (before verapamil is effective). This study will assess the efficacy and safety of oral prednisone as an add-on therapy to verapamil and compare it to a monotherapy with verapamil in the initial prophylactic treatment of a cluster episode. Methods and design PredCH is a prospective, randomized, double-blind, placebo-controlled trial with parallel study arms. Eligible patients with episodic cluster headache will be randomized to a treatment intervention with prednisone or a placebo arm. The multi-center trial will be conducted in eight German headache clinics that specialize in the treatment of ECH. Discussion PredCH is designed to assess whether oral prednisone added to first-line agent verapamil helps reduce the number and intensity of cluster attacks in the beginning of a cluster episode as compared to monotherapy with verapamil. Trial registration German Clinical Trials Register DRKS00004716 PMID:23889923

Sleep disturbances and cognitive decline in the Northern Manhattan Study

PubMed Central

Ramos, Alberto R.; Gardener, Hannah; Rundek, Tatjana; Elkind, Mitchell S.V.; Boden-Albala, Bernadette; Dong, Chuanhui; Cheung, Ying Kuen; Stern, Yaakov; Sacco, Ralph L.

2016-01-01

Objective: To examine frequent snoring, sleepiness, and sleep duration with baseline and longitudinal performance on neuropsychological (NP) battery. Methods: The analysis consists of 711 participants of the Northern Manhattan Study (NOMAS) with sleep data and NP assessment (age 63 ± 8 years, 62% women, 18% white, 17% black, 67% Hispanic) and 687 with repeat NP testing (at a mean of 6 ± 2 years). The main exposures were snoring, sleepiness, and sleep duration obtained during annual follow-up. Using factor analysis–derived domain-specific Z scores for episodic memory, language, executive function, and processing speed, we constructed multivariable regression models to evaluate sleep symptoms with baseline NP performance and change in performance in each NP domain. Results: In the cross-sectional analysis, adjusting for demographics and the NOMAS vascular risk score, participants with frequent snoring had worse executive function (β = −12; p = 0.04) and processing speed (β = −13; p = 0.02), but no difference in with episodic memory or language. Those with severe daytime sleepiness (β = −26; p = 0.009) had worse executive function, but no changes in the other NP domains. There was no cross-sectional association between sleep duration and NP performance. Frequent snoring (β = −29; p = 0.0007), severe daytime sleepiness (β = −29; p = 0.05), and long sleep duration (β = −29; p = 0.04) predicted decline in executive function, adjusting for demographic characteristics and NOMAS vascular risk score. Sleep symptoms did not explain change in episodic memory, language, or processing speed. Conclusions: In this race-ethnically diverse community-based cohort, sleep symptoms led to worse cognitive performance and predicted decline in executive function. PMID:27590286

Effects of the frame acquisition rate on the sensitivity of gastro-oesophageal reflux scintigraphy

PubMed Central

Codreanu, I; Chamroonrat, W; Edwards, K

2013-01-01

Objective: To compare the sensitivity of gastro-oesophageal reflux (GOR) scintigraphy at 5-s and 60-s frame acquisition rates. Methods: GOR scintigraphy of 50 subjects (1 month–20 years old, mean 42 months) were analysed concurrently using 5-s and 60-s acquisition frames. Reflux episodes were graded as low if activity was detected in the distal half of the oesophagus and high if activity was detected in its upper half or in the oral cavity. For comparison purposes, detected GOR in any number of 5-s frames corresponding to one 60-s frame was counted as one episode. Results: A total of 679 episodes of GOR to the upper oesophagus were counted using a 5-s acquisition technique. Only 183 of such episodes were detected on 60-s acquisition images. To the lower oesophagus, a total of 1749 GOR episodes were detected using a 5-s acquisition technique and only 1045 episodes using 60-s acquisition frames (these also included the high-level GOR on 5-s frames counted as low level on 60-s acquisition frames). 10 patients had high-level GOR episodes that were detected only using a 5-s acquisition technique, leading to a different diagnosis in these patients. No correlation between the number of reflux episodes and the gastric emptying rates was noted. Conclusion: The 5-s frame acquisition technique is more sensitive than the 60-s frame acquisition technique for detecting both high- and low-level GOR. Advances in knowledge: Brief GOR episodes with a relatively low number of radioactive counts are frequently indistinguishable from intense background activity on 60-s acquisition frames. PMID:23520226

Antecedents and consequences of binge eating episodes in women with an eating disorder.

PubMed

Kjelsås, E; Børsting, I; Gudde, C Buch

2004-03-01

The aim of this study was to explore antecedents and sequelae of binge eating episodes. A sample of eating disorders (n = 154 women) was selected from a total of 1849 female respondents (out of 2500) recruited as part of a general population-based survey. Included participants met DSM-III-R criteria for anorexia nervosa (AN), bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) based on the Survey for Eating Disorders (SEDs). Preliminary criteria for binge eating disorder (BED) were added. Results indicated that the most frequently reported antecedents and consequences of binge eating were emotional and physiological factors. There were significant differences between the different ED subgroups in their frequency of binge eating episodes. Regarding antecedents of a binge eating episode, the SEDs-defined ED subgroups had overall differences in frequency on "stomach feeling". In particular, the BN-group reported "euphoria" more frequently than the BED and EDNOS-groups. Concerning consequences of a binge eating episode, there were overall differences between the ED subgroups on "fall asleep", and in addition a borderline significance was found for "disturbed by others" (p = 0.059). None of the eight women in the AN group reported "euphoria" as a factor that terminated a binge eating episode. The findings may have important implications with regard to prevention and treatment of ED.

Long-term history and immediate preceding state affect EEG slow wave characteristics at NREM sleep onset in C57BL/6 mice.

PubMed

Cui, N; Mckillop, L E; Fisher, S P; Oliver, P L; Vyazovskiy, V V

2014-01-01

The dynamics of cortical activity across the 24-h day and at vigilance state transitions is regulated by an interaction between global subcortical neuromodulatory influences and local shifts in network synchrony and excitability. To address the role of long-term and immediate preceding history in local and global cortical dynamics, we investigated cortical EEG recorded from both frontal and occipital regions during an undisturbed 24-h recording in mice. As expected, at the beginning of the light period, under physiologically increased sleep pressure, EEG slow waves were more frequent and had higher amplitude and slopes, compared to the rest of the light period. Within discrete NREM sleep episodes, the incidence, amplitude and slopes of individual slow waves increased progressively after episode onset in both derivations by approximately 10-30%. Interestingly, at the beginning of NREM sleep episodes slow waves in the frontal and occipital derivations frequently occurred in isolation, as quantified by longer latencies between consecutive slow waves in the two regions. Notably, slow waves during the initial period of NREM sleep following REM sleep episodes were significantly less frequent, lower in amplitude and exhibited shallower slopes, compared to those that occurred in NREM episodes after prolonged waking. Moreover, the latencies between consecutive frontal and occipital NREM slow waves were substantially longer when they occurred directly after REM sleep compared to following consolidated wakefulness. Overall these data reveal a complex picture, where both time of day and preceding state contribute to the characteristics and dynamics of slow waves within NREM sleep. These findings suggest that NREM sleep initiates in a more "local" fashion when it occurs following REM sleep episodes as opposed to sustained waking bouts. While the mechanisms and functional significance of such a re-setting of brain state after individual REM sleep episodes remains to be investigated, we suggest that it may be an essential feature of physiological sleep regulation.

Clinical correlates of acute pulmonary events in children and adolescents with sickle cell disease*

PubMed Central

Paul, Rabindra; Minniti, Caterina P.; Nouraie, Mehdi; Luchtman-Jones, Lori; Campbell, Andrew; Rana, Sohail; Onyekwere, Onyinye; Darbari, Deepika S.; Ajayi, Olaid; Arteta, Manuel; Ensing, Gregory; Sable, Craig; Dham, Niti; Kato, Gregory J.; Gladwin, Mark T.; Castro, Oswaldo L.; Gordeuk, Victor R.

2013-01-01

Objectives We aimed to identify risk factors for acute pulmonary events in children and adolescents in the Pulmonary Hypertension and the Hypoxic Response in SCD (PUSH) study. Methods Patients with hemoglobin SS (n=376) and other sickle cell genotypes (n=127) aged 3-20 years were studied at four centers in a cross-sectional manner. A sub-group (n=293) was followed for a median of 21 months (range 9-35). Results A patient-reported history of one or more acute pulmonary events, either acute chest syndrome (ACS) or pneumonia, was obtained in 195 hemoglobin SS patients (52%) and 51 patients with other genotypes (40%). By logistic regression, history of acute pulmonary events was independently associated with patient-reported history of asthma (p<0.0001), older age (p=0.001), >3 severe pain episodes in the preceding 12 months (p=0.002), higher tricuspid regurgitation velocity (TRV) (p=0.028), and higher white blood cell (WBC) count (p=0.043) among hemoglobin SS patients. History of acute pulmonary events was associated with >3 severe pain episodes (p=0.009) among patients with other genotypes. During follow-up, 43 patients (15%) had at least one new ACS episode including 11 without a baseline history of acute pulmonary events. History of acute pulmonary events (odds ratio 5.4; p<0.0001) and younger age (odds ratio 0.9; p=0.010) were independently associated with developing a new episode during follow-up. Conclusions Asthma history, frequent pain and higher values for TRV and WBC count were independently associated with history of acute pulmonary events in hemoglobin SS patients and frequent pain was associated in those with other genotypes. Measures to reduce pain episodes and control asthma may help to decrease the incidence of acute pulmonary events in SCD. PMID:23560516

Familial Kleine-Levin Syndrome: A Specific Entity?

PubMed Central

Nguyen, Quang Tuan Remy; Groos, Elisabeth; Leclair-Visonneau, Laurène; Monaca-Charley, Christelle; Rico, Tom; Farber, Neal; Mignot, Emmanuel; Arnulf, Isabelle

2016-01-01

Study Objectives: Kleine-Levin syndrome (KLS) is a rare, mostly sporadic disorder, characterized by intermittent episodes of hypersomnia plus cognitive and behavior disorders. Although its cause is unknown, multiplex families have been described. We contrasted the clinical and biological features of familial versus sporadic KLS. Methods: Two samples of patients with KLS from the United States and France (n = 260) were studied using clinical interviews and human leukocyte antigen (HLA) genotyping. A multiplex family contained two or more first- or second-degree affected relatives (familial cases). Results: Twenty-one patients from 10 multiplex families (siblings: n = 12, including two pairs of monozygotic twins; parent-child: n = 4; cousins: n = 2; uncle-nephews: n = 3) and 239 patients with sporadic KLS were identified, yielding to 4% multiplex families and 8% familial cases. The simplex and multiplex families did not differ for autoimmune, neurological, and psychiatric disorders. Age, sex ratio, ethnicity, HLA typing, karyotyping, disease course, frequency, and duration of KLS episodes did not differ between groups. Episodes were less frequent in familial versus sporadic KLS (2.3 ± 1.8/y versus 3.8 ± 3.7/y, P = 0.004). Menses triggered more frequently KLS onset in the nine girls with familial KLS (relative risk, RR = 4.12, P = 0.03), but not subsequent episodes. Familial cases had less disinhibited speech (RR = 3.44, P = 0.049), less combined hypophagia/hyperphagia (RR = 4.38, P = 0.006), more abrupt termination of episodes (RR = 1.45, P = 0.04) and less postepisode insomnia (RR = 2.16, P = 0.008). There was similar HLA DQB1 distribution in familial versus sporadic cases and no abnormal karyotypes. Conclusion: Familial KLS is mostly present in the same generation, and is clinically similar to but slightly less severe than sporadic KLS. Citation: Nguyen QT, Groos E, Leclair-Visonneau L, Monaca-Charley C, Rico T, Farber N, Mignot E, Arnulf I. Familial Kleine-Levin syndrome: a specific entity? SLEEP 2016;39(8):1535–1542. PMID:27253765

Focus Group Study Exploring Factors Related to Frequent Sickness Absence

PubMed Central

van Rhenen, Willem

2016-01-01

Introduction Research investigating frequent sickness absence (3 or more episodes per year) is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves. Methods We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD–R) model as theoretical framework. Results Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills) were regarded as solutions to reduce frequent sickness absence. Conclusions The JD–R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance. PMID:26872050

Dealing with conflicts on knowledge in tutorial groups.

PubMed

Aarnio, Matti; Lindblom-Ylänne, Sari; Nieminen, Juha; Pyörälä, Eeva

2013-05-01

The aim of our study was to gain understanding of different types of conflicts on knowledge in the discussions of problem-based learning tutorial groups, and how such conflicts are dealt with. We examined first-year medical and dental students' (N = 33) conflicts on knowledge in four videotaped reporting phase tutorials. A coding scheme was created for analysing verbatim transcripts of 43 conflict episodes in order to find out whether the conflict episodes were about factual or conceptual knowledge and how the students elaborated the knowledge. Conflict episodes were relatively rare (taking up 7.6 % of the time) in the videotaped groups. Conflict episodes were more frequently about factual knowledge (58 %) than conceptual knowledge (42 %), but conflicts on conceptual knowledge lasted longer and were more often elaborated. Elaboration was, however, more frequently done individually than collaboratively. Conflict episodes were generally fairly short (mean duration 28 s). This was due to a lack of thorough argumentation and collaborative elaboration of conflicting ideas. The results suggest that students' skills to bring out differences in each other's conceptual thinking, the depth of argumentation and the use of questions that elicit elaboration need to be improved. Tutors' skills to facilitate the collaborative resolving of conflicts on knowledge call for further study.

Cutaneous allodynia is more frequent in chronic migraine, and its presence and severity seems to be more associated with the duration of the disease.

PubMed

Benatto, Mariana Tedeschi; Florencio, Lidiane Lima; Carvalho, Gabriela Ferreira; Dach, Fabíola; Bigal, Marcelo Eduardo; Chaves, Thaís Cristina; Bevilaqua-Grossi, Débora

2017-03-01

To evaluate cutaneous allodynia among patients with chronic and episodic migraine in a tertiary headache clinic. 80 subjects with episodic migraine and 80 with chronic migraine were assessed in a tertiary hospital. The 12-item Allodynia Symptom Checklist/Brazil questionnaire was applied to classify subjects according to the presence and severity of cutaneous allodynia. Cutaneous allodynia was identified in 81.3% of the episodic migraine group and 92.5% of the chronic migraine group (p = 0.03). No increased association could be attributed to chronic migraine when adjusted by years with disease (PR = 1.12; 95%CI = 0.99 to 1.27; p = 0.06). The groups also did not differ in the severity of allodynia, and severe presentation was the most frequent. Both groups seemed to be similarly affected in the cephalic and extracephalic regions, with the same severity. Cutaneous allodynia is more frequent in chronic migraine, and its presence and severity seems to be more associated with the duration of the disease.

Illness Progression, Recent Stress and Morphometry of Hippocampal Subfields and Medial Prefrontal Cortex in Major Depression

PubMed Central

Treadway, Michael T.; Waskom, Michael L.; Dillon, Daniel G.; Holmes, Avram J.; Park, Min Tae M.; Chakravarty, M. Mallar; Dutra, Sunny J.; Polli, Frida E.; Iosifescu, Dan V.; Fava, Maurizio; Gabrieli, John D.E.; Pizzagalli, Diego A.

2014-01-01

Background Longitudinal studies of illness progression in Major Depressive Disorder (MDD) indicate that the onset of subsequent depressive episodes becomes increasingly decoupled from external stressors. A possible mechanism underlying this phenomenon is that multiple episodes induce long-lasting neurobiological changes that confer increased risk for recurrence. Prior morphometric studies have frequently reported volumetric reductions in MDD—especially in medial prefrontal cortex (mPFC) and the hippocampus— but few studies have investigated whether these changes are exacerbated by prior episodes. Methods We used structural magnetic resonance imaging (sMRI) to examine relationships between number of prior episodes, current stress, and brain volume and cortical thickness in a sample of 103 medication-free depressed patients and never-depressed controls. Volumetric analyses of the hippocampus were performed using a recently-validated subfield segmentation approach, while cortical thickness estimates were obtained using Vertex-Based Cortical Thickness (VBCT). Participants were grouped on the basis of the number of prior depressive episodes as well as current depressive state. Results Number of prior episodes was associated with both lower reported stress levels as well as reduced volume in the dentate gyrus. Cortical thinning of the left medial prefrontal cortex (mPFC) was associated with a greater number of prior depressive episodes, but not current depressive state. Conclusions Collectively, these findings are consistent with preclinical models suggesting that the dentate gyrus and mPFC are especially vulnerable to stress exposure, and provide evidence for morphometric changes that are consistent with stress-sensitization models of recurrence in MDD. PMID:25109665

Illness progression, recent stress, and morphometry of hippocampal subfields and medial prefrontal cortex in major depression.

PubMed

Treadway, Michael T; Waskom, Michael L; Dillon, Daniel G; Holmes, Avram J; Park, Min Tae M; Chakravarty, M Mallar; Dutra, Sunny J; Polli, Frida E; Iosifescu, Dan V; Fava, Maurizio; Gabrieli, John D E; Pizzagalli, Diego A

2015-02-01

Longitudinal studies of illness progression in patients with major depressive disorder (MDD) indicate that the onset of subsequent depressive episodes becomes increasingly decoupled from external stressors. A possible mechanism underlying this phenomenon is that multiple episodes induce long-lasting neurobiological changes that confer increased risk for recurrence. Prior morphometric studies have frequently reported volumetric reductions in patients with MDD--especially in medial prefrontal cortex (mPFC) and the hippocampus--but few studies have investigated whether these changes are exacerbated by prior episodes. In a sample of 103 medication-free patients with depression and control subjects with no history of depression, structural magnetic resonance imaging was performed to examine relationships between number of prior episodes, current stress, hippocampal subfield volume and cortical thickness. Volumetric analyses of the hippocampus were performed using a recently validated subfield segmentation approach, and cortical thickness estimates were obtained using vertex-based methods. Participants were grouped on the basis of the number of prior depressive episodes and current depressive diagnosis. Number of prior episodes was associated with both lower reported stress levels and reduced volume in the dentate gyrus. Cortical thinning of the left mPFC was associated with a greater number of prior depressive episodes but not current depressive diagnosis. Collectively, these findings are consistent with preclinical models suggesting that the dentate gyrus and mPFC are especially vulnerable to stress exposure and provide evidence for morphometric changes that are consistent with stress-sensitization models of recurrence in MDD. Copyright © 2015 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

A longitudinal study on diarrhoea and vomiting in young dogs of four large breeds

PubMed Central

2012-01-01

Background Prospective studies to document the occurrence of canine diarrhoea and vomiting are relatively scarce in dogs, and the majority of published studies are based on information from clinical records. This study investigates the incidence risk of diarrhoea and vomiting as well as potential risk factors. Methods A cohort study of 585 privately owned dogs of four breeds: Newfoundland, Labrador retriever, Leonberger, and Irish wolfhound. The owners maintained a continuous log regarding housing, exercise, nutrition, and health of their dogs. Episodes of diarrhoea and vomiting were recorded in a consecutive manner in a booklet. The owners completed the questionnaires and reported information at three, four, six, 12, 18, and 24/25 months of age, called observational ages. Associations with potential risk factors for diarrhoea and vomiting were investigated in separate generalized estimating equation analyses. Results The incidence of both diarrhoea and vomiting was influenced by breed. Both diarrhoea and vomiting were relatively common in young dogs, occurring most frequently during the first months of life. After three months of age, the odds of diarrhoea were significantly lower when compared to the observational period seven weeks to three months (OR ranging from 0.31 to 0.70 depending on the period). More males than females suffered from diarrhoea (OR = 1.42). The occurrence of diarrhoea was more common in dogs that also experienced episode(s) of vomiting during the study period (OR = 5.43) and vice versa (OR = 5.50). In the majority of dogs episodes of diarrhoea and vomiting did not occur at the same time. Dogs in urban areas had higher odds (OR = 1.88) of getting diarrhoea compared to dogs living in rural areas. The occurrence of both diarrhoea and vomiting demonstrated a seasonal variation with higher incidence during the summer months. Conclusion Both diarrhoea and vomiting occurred most frequently during the first months of life. The incidence of diarrhoea and vomiting was significantly different between breeds. Diarrhoea occurred more frequently in males and in dogs living in urban areas. Also, a positive association between the occurrence of diarrhoea and vomiting in the same dog was found. PMID:22300688

Non-capsulated and capsulated Haemophilus influenzae in children with acute otitis media in Venezuela: a prospective epidemiological study.

PubMed

Naranjo, Laura; Suarez, Jose Antonio; DeAntonio, Rodrigo; Sanchez, Francis; Calvo, Alberto; Spadola, Enza; Rodríguez, Nicolás; Andrade, Omaira; Bertuglia, Francisca; Márquez, Nelly; Castrejon, Maria Mercedes; Ortega-Barria, Eduardo; Colindres, Romulo E

2012-02-15

Non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age. Between December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes). Overall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (S. pneumoniae, H. influenzae, S. pyogenes or M. catarrhalis) was cultured from 65.9% (60/91) of episodes. H. influenzae (55.5%; 35/63 episodes) and S. pneumoniae (34.9%; 22/63 episodes) were the most frequently reported bacteria. Among H. influenzae isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for H. influenzae was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six H. influenzae positive samples (66.7%) from recurrent episodes. We found H. influenzae and S. pneumoniae to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.

Pilot trial of osteopathic manipulative therapy for patients with frequent episodic tension-type headache.

PubMed

Rolle, Guido; Tremolizzo, Lucio; Somalvico, Francesco; Ferrarese, Carlo; Bressan, Livio C

2014-09-01

Osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) may be used for managing headache pain and related disability, but there is a need for high-quality randomized controlled trials to assess the effectiveness of this intervention. To explore the efficacy of OMTh for pain management in frequent episodic tension-type headache (TTH). Single-blind randomized placebo-controlled pilot study. Patients were recruited from 5 primary care settings. Forty-four patients who were affected by frequent episodic TTH and not taking any drugs for prophylactic management of episodic TTH were recruited. Patients were randomly allocated to an experimental or control group. The experimental group received corrective OMTh techniques, tailored for each patient; the control group received assessment of the cranial rhythmic impulse (sham therapy). The study included a 1-month baseline period, a 1-month treatment period, and a 3-month follow-up period. The primary outcome was the change in patient-reported headache frequency, and secondary outcomes included changes in headache pain intensity (discrete score, 1 [lowest perceived pain] to 5 [worst perceived pain]), over-the-counter medication use, and Headache Disability Inventory score. Forty patients completed the study (OMTh, n=21; control, n=19). The OMTh group had a significant reduction in headache frequency over time that persisted 1 month (approximate reduction, 40%; P<.001) and 3 months (approximate reduction, 50%; P<.001) after the end of treatment. Moreover, there was an absolute difference between the 2 treatment groups at the end of the study, with a 33% lower frequency of headache in the OMTh group (P<.001). This feasibility study demonstrated the efficacy of OMTh in the management of frequent episodic TTH, compared with sham therapy in a control group. Osteopathic manipulative therapy may be preferred over other treatment modalities and may benefit patients who have adverse effects to medications or who have difficulty complying with pharmacologic regimens. This protocol may serve as a model for future studies. © 2014 The American Osteopathic Association.

Persistent Genital Herpes Simplex Virus-2 Shedding Years Following the First Clinical Episode

PubMed Central

Saracino, Misty; Magaret, Amalia; Selke, Stacy; Remington, Mike; Huang, Meei-Li; Casper, Corey; Corey, Lawrence; Wald, Anna

2011-01-01

Background. Patients with newly acquired genital herpes simplex virus 2 (HSV-2) infection have virus frequently detected at the genital mucosa. Rates of genital shedding initially decrease over time after infection, but data on long-term viral shedding are lacking. Methods. For this study, 377 healthy adults with history of symptomatic genital HSV-2 infection collected anogenital swabs for HSV-2 DNA polymerase chain reaction for at least 30 consecutive days. Results. Time since first genital herpes episode was significantly associated with reduced genital shedding. Total HSV shedding occurred on 33.6% of days in participants <1 year, 20.6% in those 1–9 years, and 16.7% in those ≥10 years from first episode. Subclinical HSV shedding occurred on 26.2% of days among participants <1 year, 13.1% in those 1–9 years, and 9.3% in those ≥10 years from first episode. On days with HSV detection, mean quantity was 4.9 log10 copies/mL for those <1 year, 4.7 log10 copies/mL among those 1–9 years, and 4.6 log10 copies/mL among those ≥10 years since first episode. Conclusions. Rates of total and subclinical HSV-2 shedding decrease after the first year following the initial clinical episode. However, viral shedding persists at high rates and copy numbers years after infection, and therefore may pose continued risk of HSV-2 transmission to sexual partners. PMID:21288817

Timing of activities of daily life is jaggy: How episodic ultradian changes in body and brain temperature are integrated into this process.

PubMed

Blessing, William; Ootsuka, Youichirou

2016-01-01

Charles Darwin noted that natural selection applies even to the hourly organization of daily life. Indeed, in many species, the day is segmented into active periods when the animal searches for food, and inactive periods when the animal digests and rests. This episodic temporal patterning is conventionally referred to as ultradian (<24 hours) rhythmicity. The average time between ultradian events is approximately 1-2 hours, but the interval is highly variable. The ultradian pattern is stochastic, jaggy rather than smooth, so that although the next event is likely to occur within 1-2 hours, it is not possible to predict the precise timing. When models of circadian timing are applied to the ultradian temporal pattern, the underlying assumption of true periodicity (stationarity) has distorted the analyses, so that the ultradian pattern is frequently averaged away and ignored. Each active ultradian episode commences with an increase in hippocampal theta rhythm, indicating the switch of attention to the external environment. During each active episode, behavioral and physiological processes, including changes in body and brain temperature, occur in an integrated temporal order, confirming organization by programs endogenous to the central nervous system. We describe methods for analyzing episodic ultradian events, including the use of wavelet mathematics to determine their timing and amplitude, and the use of fractal-based procedures to determine their complexity.

Timing of activities of daily life is jaggy: How episodic ultradian changes in body and brain temperature are integrated into this process

PubMed Central

Blessing, William; Ootsuka, Youichirou

2016-01-01

ABSTRACT Charles Darwin noted that natural selection applies even to the hourly organization of daily life. Indeed, in many species, the day is segmented into active periods when the animal searches for food, and inactive periods when the animal digests and rests. This episodic temporal patterning is conventionally referred to as ultradian (<24 hours) rhythmicity. The average time between ultradian events is approximately 1–2 hours, but the interval is highly variable. The ultradian pattern is stochastic, jaggy rather than smooth, so that although the next event is likely to occur within 1–2 hours, it is not possible to predict the precise timing. When models of circadian timing are applied to the ultradian temporal pattern, the underlying assumption of true periodicity (stationarity) has distorted the analyses, so that the ultradian pattern is frequently averaged away and ignored. Each active ultradian episode commences with an increase in hippocampal theta rhythm, indicating the switch of attention to the external environment. During each active episode, behavioral and physiological processes, including changes in body and brain temperature, occur in an integrated temporal order, confirming organization by programs endogenous to the central nervous system. We describe methods for analyzing episodic ultradian events, including the use of wavelet mathematics to determine their timing and amplitude, and the use of fractal-based procedures to determine their complexity. PMID:28349079

Recent Alcohol Use and Episodic Heavy Drinking among Hispanic Youth

ERIC Educational Resources Information Center

King, Keith A.; Vidourek, Rebecca A.

2010-01-01

Background: A sizeable percentage of Hispanic youth are affected by alcohol use. Research is needed to identify specific factors placing Hispanic youth at elevated risk. Purpose: This study examined whether recent alcohol use (past 30 days) and frequent episodic heavy drinking among 7th - 12th grade Hispanic students (N = 946) in Greater…

Testing Extensions of Our Quantitative Daily of San Joaquin Wintertime Aerosols Using MAIAC and Meteorology Without Transport/Transformation Assumptions

NASA Technical Reports Server (NTRS)

Chatfield, Robert B.; Sorek Hamer, Meytar; Esswein, Robert F.

2017-01-01

The Western US and many regions globally present daunting difficulties in understanding and mapping PM2.5 episodes. We evaluate extensions of a method independent of source-description and transport/transformation. These regions suffer frequent few-day episodes due to shallow mixing; low satellite AOT and bright surfaces complicate the description. Nevertheless, we expect residual errors in our maps of less than 8 ug/m^3 in episodes reaching 60-100 ug/m^3; maps which detail pollution from Interstate 5. Our current success is due to use of physically meaningful functions of MODIS-MAIAC-derived AOD, afternoon mixed-layer height, and relative humidity for a basin in which the latter are correlated. A mixed-effects model then describes a daily AOT-to-PM2.5 relationship. (Note: in other published mixed-effects models, AOT contributes minimally. We seek to extend on these to develop useful estimation methods for similar situations. We evaluate existing but more spotty information on size distribution (AERONET, MISR, MAIA, CALIPSO, other remote sensing). We also describe the usefulness of an equivalent mixing depth for water vapor vs meteorological boundary layer height. Each has virtues and limitations. Finally, we begin to evaluate methods for removing the complications due to detached but polluted layers (which don't mix to the surface) using geographical, meteorological, and remotely sensed data.

Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections.

PubMed

D'Agata, Erika; Loeb, Mark B; Mitchell, Susan L

2013-01-01

To describe the presentation of suspected urinary tract infections (UTIs) in nursing home (NH) residents with advanced dementia and how they align with minimum criteria to justify antimicrobial initiation. Twelve-month prospective study. Twenty-five NHs. Two hundred sixty-six NH residents with advanced dementia. Charts were abstracted monthly for documentation of suspected UTI episodes to determine whether episodes met minimum criteria to initiate antimicrobial therapy according to consensus guidelines. Seventy-two residents experienced 131 suspected UTI episodes. Presenting symptoms and signs for these episodes are mental status change (44.3%), fever (20.6%), hematuria (6.9%), dysuria (3.8%), costovertebral tenderness (2.3%), urinary frequency (1.5%), rigor (1.5%), urgency (0%), and suprapubic pain (0%). Only 21 (16.0%) episodes met minimal criteria to initiate antimicrobial therapy based on signs and symptoms. Of the 110 episodes that lacked minimum criteria to justify antimicrobial initiation, 82 (74.5%) were treated with antimicrobial therapy. Urinalyses and urine culture results were available for 101 episodes, of which 80 (79.2%) had positive results on both tests. The proportion of episodes with a positive urinalysis and culture was similar for those that met (83.3%) and did not meet (78.3%) minimum criteria (P = .06). The symptoms and signs necessary to meet minimum criteria to support antimicrobial initiation for UTIs are frequently absent in NH residents with advanced dementia. Antimicrobial therapy is prescribed for the majority of suspected UTIs that do not meet these minimum criteria. Urine specimens are frequently positive regardless of symptoms. These observations underscore the need to reconsider the diagnosis and the initiation of treatment for suspected UTIs in advanced dementia. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Moral judgment in episodic amnesia.

PubMed

Craver, Carl F; Keven, Nazim; Kwan, Donna; Kurczek, Jake; Duff, Melissa C; Rosenbaum, R Shayna

2016-08-01

To investigate the role of episodic thought about the past and future in moral judgment, we administered a well-established moral judgment battery to individuals with hippocampal damage and deficits in episodic thought (insert Greene et al. 2001). Healthy controls select deontological answers in high-conflict moral scenarios more frequently when they vividly imagine themselves in the scenarios than when they imagine scenarios abstractly, at some personal remove. If this bias is mediated by episodic thought, individuals with deficits in episodic thought should not exhibit this effect. We report that individuals with deficits in episodic memory and future thought make moral judgments and exhibit the biasing effect of vivid, personal imaginings on moral judgment. These results strongly suggest that the biasing effect of vivid personal imagining on moral judgment is not due to episodic thought about the past and future. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Heart rate deceleration runs for postinfarction risk prediction.

PubMed

Guzik, Przemyslaw; Piskorski, Jaroslaw; Barthel, Petra; Bauer, Axel; Müller, Alexander; Junk, Nadine; Ulm, Kurt; Malik, Marek; Schmidt, Georg

2012-01-01

A method for counting episodes of uninterrupted beat-to-beat heart rate decelerations was developed. The method was set up and evaluated using 24-hour electrocardiogram Holter recordings of 1455 (training sample) and 946 (validation sample) postinfarction patients. During a median follow-up of 24 months, 70, 46, and 19 patients of the training sample suffered from total, cardiac, and sudden cardiac mortality, respectively. In the validation sample, these numbers were 39, 25, and 15. Episodes of consecutive beat-to-beat heart rate decelerations (deceleration runs [DRs]) were characterized by their length. Deceleration runs of 2 to 10 cycles were significantly less frequent in nonsurvivors. Multivariate model of DRs of 2, 4, and 8 cycles identified low-, intermediate-, and high-risk groups. In these groups of the training sample, the total mortalities were 1.8%, 6.1%, and 24%, respectively. In the validation sample, these numbers were 1.8%, 4.1%, and 21.9%. Infrequent DRs during 24-hour Holter indicate high risk of postinfarction mortality. Copyright © 2012 Elsevier Inc. All rights reserved.

Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit.

PubMed

Glassman, Alexander H; Bigger, J Thomas; Gaffney, Michael; Shapiro, Peter A; Swenson, J Robert

2006-03-01

Depression observed following acute coronary syndrome (ACS) is common and associated with an increased risk of death. The Sertraline Antidepressant Heart Attack Trial (SADHART) tested the safety and efficacy of a selective serotonin reuptake inhibitor in this population. No evidence of harm was seen, and sertraline hydrochloride had an overall beneficial effect on mood that occurred primarily in patients with a history of episodes of major depressive disorder (MDD). To determine how frequently the MDD began before ACS and whether onset of the current MDD episode before or after the ACS event influenced response to sertraline. A randomized, double-blind, placebo-controlled treatment of 369 patients with ACS and MDD was conducted in 40 outpatient clinics in 10 countries between April 1, 1997, and April 30, 2001. Diagnosis of MDD, number of previous episodes of depression, and episode onset before or after hospitalization were established using the Diagnostic Interview Schedule. Treatment response was measured with the Clinical Global Impression-Improvement scale. Fifty-three percent of MDD episodes began before hospitalization for the index episode of ACS (for 197 of 369 patients), and 94% of the MDD episodes began more than 30 days before the index ACS episode. Episodes of MDD that began prior to ACS responded more frequently to sertraline than to placebo (63% vs 46%, respectively; odds ratio, 2.0; 95% confidence interval, 1.13-3.55) whereas depression with onset beginning after hospitalization showed a high placebo response rate (69% vs 60%, respectively) and low sertraline-placebo response ratio (1.15). Multivariate analysis indicated that time of onset of the current episode, history of MDD, and baseline severity independently predicted the sertraline-placebo response ratio. Half of the episodes of major depression associated with ACS began long before ACS and therefore were not caused by ACS. Patients whose current episodes of MDD begin before ACS, those with a history of MDD, and those whose episodes are severe should be treated because they will benefit considerably from sertraline. Since these 3 predictors of sertraline response are independent, having more than 1 of them substantially increases the benefit of sertraline while reducing the chance of spontaneous recovery.

A case–control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI

PubMed Central

Riechers, Ronald George; Wang, Xiao-Feng; Piero, Traci; Ruff, Suzanne Smith

2012-01-01

Background Mild traumatic brain injury (mTBI) is a common injury among military personnel serving in Iraq or Afghanistan. The impact of repeated episodes of combat mTBI is unknown. Objective To evaluate relationships among mTBI, post-traumatic stress disorder (PTSD) and neurological deficits (NDs) in US veterans who served in Iraq or Afghanistan. Methods This was a case–control study. From 2091 veterans screened for traumatic brain injury, the authors studied 126 who sustained mTBI with one or more episodes of loss of consciousness (LOC) in combat. Comparison groups: 21 combat veterans who had definite or possible episodes of mTBI without LOC and 21 veterans who sustained mTBI with LOC as civilians. Results Among combat veterans with mTBI, 52% had NDs, 66% had PTSD and 50% had PTSD and an ND. Impaired olfaction was the most common ND, found in 65 veterans. The prevalence of an ND or PTSD correlated with the number of mTBI exposures with LOC. The prevalence of an ND or PTSD was >90% for more than five episodes of LOC. Severity of PTSD and impairment of olfaction increased with number of LOC episodes. The prevalence of an ND for the 34 combat veterans with one episode of LOC (4/34=11.8%) was similar to that of the 21 veterans of similar age and educational background who sustained civilian mTBI with one episode of LOC (2/21=9.5%, p-NS). Conclusions Impaired olfaction was the most frequently recognised ND. Repeated episodes of combat mTBI were associated with increased likelihood of PTSD and an ND. Combat setting may not increase the likelihood of an ND. Two possible connections between mTBI and PTSD are (1) that circumstances leading to combat mTBI likely involve severe psychological trauma and (2) that altered cerebral functioning following mTBI may increase the likelihood that a traumatic event results in PTSD. PMID:22431700

The effect of hyperactive bladder severity on healthcare utilization and labor productivity.

PubMed

Angulo, J C; Brenes, F J; Ochayta, D; Lizarraga, I; Arumí, D; Trillo, S; Rejas, J

2014-05-01

To explore the relationship between the severity of urinary urge incontinence (UUI) on healthcare resources utilization (HRU) and loss of labor productivity of subjects with overactive bladder (OAB) in the general population in Spain. Secondary analysis of a cross-sectional web-based study conducted in the general population >18 years, through a battery of HRU questions asked using an online method. Probable OAB subjects were identified using a previously validated algorithm and a score >8 in the OAB-V8 questionnaire. HRU questions included an assessment of concomitant medication used as a consequence of OAB/UUI, pad utilization, and medical office visits. Patients were grouped according to the number of UUI episodes into 0, 1, 2-3 or 4+ episodes. Of a total of 2,035 subjects participating from the general population, 396 patients [52.5% women, mean age: 55.3 (11.1) years, OAB-V8 mean score: 14.5 (7.9)] were analyzed; 203 (51.3%) with 0 episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with 4 or more episodes. A linear and significant adjusted association was observed between the number of UUI episodes and HRU; the higher the number of daily episodes the higher the HRU. Subjects with more episodes had medical visits more frequently at the primary care (P = .001) and specialist (P = .009) level as well. Consumption of day (P < .001) and night (P < .001) urinary absorbents, anxiolytic medicines (P = .021) and antibiotics (P = .05) was higher in patients with more UUI episodes. The severity of OAB in terms of frequency of daily urge incontinence episodes was significantly and linearly associated with higher healthcare resources utilization and a decrease in labor productivity in subjects with probable OAB in Spain. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

Assessment of nitric oxide production in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome with the use of a stable isotope tracer infusion technique

USDA-ARS?s Scientific Manuscript database

Mitochondrial disorders result from dysfunctional mitochondria that are unable to generate sufficient energy to meet the needs of various organs. Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is one of the most frequent maternally inherited mitochondrial...

[Mortality and morbidity from disasters in Spain].

PubMed

Arcos González, Pedro; Pérez-Berrocal Alonso, Jorge; Castro Delgado, Rafael; Cadavieco González, Beatriz

2006-01-01

To analyze disaster episodes in Spain between 1950 and 2005 in order to characterize their pattern and evaluate their impact on morbidity and mortality. We performed an observational retrospective study using the United Nations' definition of disaster. A disaster was considered as each episode, natural or technological, causing more than 15 deaths and/or more than 50 wounded persons. Epidemic and environmental disasters were excluded. The frequency of disasters has increased in Spain, especially during the four last decades. The frequency of disasters doubles in the second semester of the year and shows wide geographical variation. Spain has a mixed disaster pattern, with a predominance of technological disasters, which are 4.5 times more frequent than natural disasters. The most frequent type of natural disaster in Spain is flooding and most frequent technological disasters are traffic accidents.

Characteristics of symptomatic reflux episodes in Japanese proton pump inhibitor-refractory non-erosive reflux disease patients.

PubMed

Nakagawa, Kenichiro; Koike, Tomoyuki; Iijima, Katsunori; Saito, Masahiro; Kikuchi, Hiroki; Hatta, Waku; Ara, Nobuyuki; Uno, Kaname; Asano, Naoki; Shimosegawa, Tooru

2015-12-21

To clarify the pathogenesis of gastroesophageal reflux disease symptoms in non-erosive reflux disease (NERD) patients. Thirty-five NERD patients with persistent symptoms, despite taking rabeprazole 10 mg twice daily for at least 8 wk, were included in this study. All patients underwent 24 h combined impedance - pH on rabeprazole. The symptom index (SI) was considered to be positive if ≥ 50%, and proximal reflux episodes were determined when reflux reached 15 cm above the proximal margin of the lower esophageal sphincter. In 14 (40%) SI-positive patients, with liquid weakly acid reflux, the occurrence rate of reflux symptoms was significantly more frequent in proximal reflux episodes (46.7%) than in distal ones (5.7%) (P < 0.001). With liquid acid reflux, there were no significant differences in the occurrence rate of reflux symptoms between proximal reflux episodes (38.5%) and distal ones (20.5%) (NS). With mixed liquid-gas weakly acid reflux, the occurrence rate of reflux symptoms in proximal reflux episodes was significantly more frequent (31.0%) than in distal reflux ones (3.3%) (P < 0.001). With mixed liquid-gas acid reflux, there were no significant differences in the occurrence rate of reflux symptoms between proximal reflux episodes (29.4%) and distal ones (14.3%) (NS). The proximal extent of weakly acidic liquid and mixed liquid-gas reflux is a major factor associated with reflux perception in SI-positive patients on proton pump inhibitor therapy.

The Persistent Effects of Minimum Legal Drinking Age Laws on Drinking Patterns Later in Life

PubMed Central

Plunk, Andrew D.; Cavazos-Rehg, Patricia; Bierut, Laura J.; Grucza, Richard A.

2012-01-01

Background Exposure to permissive minimum legal drinking age (MLDA) laws not only affects young adults in the short term, but also later in life; for example, individuals who could legally purchase alcohol before age 21 are more likely to suffer from drinking problems as older adults, long after the laws had been changed. However, it is not known how permissive MLDA exposure affects specific drinking behavior. This present study uses changes in MLDA laws during the 1970s and 1980s as a natural experiment to investigate the potential impact of permissive MLDA exposure on average alcohol consumption, frequency of drinking, and on patterns of binging and more moderate, non-heavy drinking. Methods Policy exposure data were paired with alcohol use data from the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey and the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions. Past-year drinkers born between 1949 and 1972 (n = 24,088) were included. Average daily intake, overall drinking frequency, and frequency of both binge episodes (5+ drinks) and days without a binge episode (non-heavy drinking) for the previous year at the time of interview were tracked for each respondent. Results Exposure to permissive MLDAs was associated with higher odds to report frequent binging and lower odds to report any moderate drinking; these associations were largely driven by men and those who did not attend college. Overall drinking frequency and average alcohol consumption were not affected by MLDA exposure. Conclusions The ability to legally purchase alcohol before age 21 does not seem to increase overall drinking frequency, but our findings suggest that it is associated with certain types of problematic drinking behaviors that persist into later adulthood: more frequent binge episodes and less frequent non-heavy drinking. We also propose that policymakers and critics should not focus on college drinking when evaluating the effectiveness of MLDAs. PMID:23347177

Episodic memory impairment in systemic lupus erythematosus: involvement of thalamic structures.

PubMed

Zimmermann, Nicolle; Corrêa, Diogo Goulart; Netto, Tania Maria; Kubo, Tadeu; Pereira, Denis Batista; Fonseca, Rochele Paz; Gasparetto, Emerson Leandro

2015-02-01

Episodic memory deficits in systemic lupus erythematosus (SLE) have been frequently reported in the literature; however, little is known about the neural correlates of these deficits. We investigated differences in the volumes of different brain structures of SLE patients with and without episodic memory impairments diagnosed by the Rey Auditory Verbal Learning Test (RAVLT). Groups were paired based on age, education, sex, Mini Mental State Examination score, accumulation of disease burden (SLICC), and focused attention dimension score. Patients underwent magnetic resonance imaging (MRI). Cortical volumetric reconstruction and segmentation of the MR images were performed with the FreeSurfer software program. SLE patients with episodic memory deficits presented shorter time of diagnosis than SLE patients without episodic memory deficits. ANOVA revealed that SLE patients with episodic memory deficits had a larger third ventricle volume than SLE patients without episodic memory deficits and controls. Additionally, covariance analysis indicated group effects on the bilateral thalamus and on the third ventricle. Our findings indicate that episodic memory may be impaired in SLE patients with normal hippocampal volume. In addition, the thalamus may undergo volumetric changes associated with episodic memory loss in SLE.

Paracetamol (acetaminophen) for acute treatment of episodic tension-type headache in adults.

PubMed

Stephens, Guy; Derry, Sheena; Moore, R Andrew

2016-06-16

Tension-type headache (TTH) affects about 1 person in 5 worldwide. It is divided into infrequent episodic TTH (fewer than one headache per month), frequent episodic TTH (two to 14 headaches per month), and chronic TTH (15 headache days a month or more). Paracetamol (acetaminophen) is one of a number of analgesics suggested for acute treatment of headaches in frequent episodic TTH. To assess the efficacy and safety of paracetamol for the acute treatment of frequent episodic TTH in adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (CRSO), MEDLINE, EMBASE, and the Oxford Pain Relief Database to October 2015, and also reference lists of relevant published studies and reviews. We sought unpublished studies by asking personal contacts and searching online clinical trial registers and manufacturers' websites. We included randomised, double-blind, placebo-controlled studies (parallel-group or cross-over) using oral paracetamol for symptomatic relief of an acute episode of TTH. Studies had to be prospective, with participants aged 18 years or over, and include at least 10 participants per treatment arm. Two review authors independently assessed studies for inclusion and extracted data. We used the numbers of participants achieving each outcome to calculate the risk ratio (RR) and number needed to treat for one additional beneficial outcome (NNT) or one additional harmful outcome (NNH) for oral paracetamol compared to placebo or an active intervention for a range of outcomes, predominantly those recommended by the International Headache Society (IHS).We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created 'Summary of findings' tables. We included 23 studies, all of which enrolled adults with frequent episodic TTH. Twelve studies used the IHS diagnostic criteria or similar, six used the older classification of the Ad Hoc Committee, and five did not describe specific diagnostic criteria but generally excluded participants with migraines. Participants had moderate or severe pain at the start of treatment. While 8079 people with TTH participated in these studies, the numbers available for any analysis were lower than this because outcomes were inconsistently reported and because many participants received active comparators.None of the included studies were at low risk of bias across all domains considered, although for most studies and domains this was likely to be due to inadequate reporting rather than poor methods. We judged five studies to be at high risk of bias for incomplete outcome reporting, and seven due to small size.For the IHS preferred outcome of being pain free at two hours the NNT for paracetamol 1000 mg compared with placebo was 22 (95% confidence interval (CI) 15 to 40) in eight studies (5890 participants; high quality evidence), with no significant difference from placebo at one hour. The NNT was 10 (7.9 to 14) for pain-free or mild pain at two hours in five studies (5238 participants; high quality evidence). The use of rescue medication was lower with paracetamol 1000 mg than with placebo, with an NNTp to prevent an event of 7.8 (6.0 to 11) in six studies (1856 participants; moderate quality evidence). On limited data, the efficacy of paracetamol 500 mg to 650 mg was not superior to placebo, and paracetamol 1000 mg was not different from either ketoprofen 25 mg or ibuprofen 400 mg (low quality evidence).Adverse events were not different between paracetamol 1000 mg and placebo (RR 1.1 (0.94 to 1.3); 5605 participants; 11 studies; high quality evidence). Studies reported no serious adverse events.The quality of the evidence using GRADE comparing paracetamol 1000 mg with placebo was moderate to high. Where evidence was downgraded it was because a minority of studies reported the outcome. For comparisons of paracetamol 500 mg to 650 mg with placebo, and of paracetamol 1000 mg with active comparators, we downgraded the evidence to low quality or very low quality because of the small number of studies and events. Paracetamol 1000 mg provided a small benefit in terms of being pain free at two hours for people with frequent episodic TTH who have an acute headache of moderate or severe intensity.

Characterization of Aerosol Episodes in the Greater Mediterranean Sea Area from Satellite Observations (2000-2007)

NASA Technical Reports Server (NTRS)

Gkikas, A.; Hatzianastassiou, N.; Mihalopoulos, N.; Torres, O.

2015-01-01

An algorithm able to identify and characterize episodes of different aerosol types above sea surfaces of the greater Mediterranean basin (GMB), including the Black Sea and the Atlantic Ocean off the coasts of Iberia and northwest Africa, is presented in this study. Based on this algorithm, five types of intense (strong and extreme) aerosol episodes in the GMB are identified and characterized using daily aerosol optical properties from satellite measurements, namely MODIS-Terra, Earth Probe (EP)-TOMS and OMIAura. These aerosol episodes are: (i) biomass-burning/urban-industrial (BU), (ii) desert dust (DD), (iii) dust/sea-salt (DSS), (iv) mixed (MX) and (v) undetermined (UN). The identification and characterization is made with our algorithm using a variety of aerosol properties, namely aerosol optical depth (AOD), Angstrom exponent (a), fine fraction (FF), effective radius (reff) and Aerosol Index (AI). During the study period (2000e2007), the most frequent aerosol episodes are DD, observed primarily in the western and central Mediterranean Sea, and off the northern African coasts, 7 times/year for strong episodes and 4 times/year for extreme ones, on average. The DD episodes yield 40% of all types of strong aerosol episodes in the study region, while they account for 71.5% of all extreme episodes. The frequency of occurrence of strong episodes exhibits specific geographical patterns, for example the BU are mostly observed along the coasts of southern Europe and off the Atlantic coasts of Portugal, the MX episodes off the Spanish Mediterranean coast and over the Adriatic and northern Aegean Sea, while the DSS ones over the western and central Mediterranean Sea. On the other hand, the extreme episodes for all but DD aerosol display more patchy spatial patterns. The strong episodes exhibit AOD at 550 nm as high as 1.6 in the southernmost parts of central and eastern Mediterranean Sea, which rise up to 5 for the extreme, mainly DD and DSS, episodes. Although more than 90% of all aerosol episodes last 1 day, there are few cases, mainly extreme DD episodes, which last up to 4 days. Independently of their type, the Mediterranean aerosol episodes occur more frequently in spring (strong and extreme episodes) and summer (strong episodes) and most rarely during winter. A significant year by year variability of Mediterranean aerosol episodes has been identified, more in terms of their frequency than intensity. An analysis of 5-day back trajectories for the most extreme episodes provides confidence on the obtained results of the algorithm, based on the revealed origin and track of air masses causing the episodes. The 25 and 6% of all strong and extreme episodes, respectively, are MX, thus highlighting the co-existence of different aerosol types in the greater Mediterranean. The intensity of both MX and DSS episodes exhibits similar patterns to those of DD strong ones, indicating that desert dust is a determinant factor for the intensity of aerosol episodes in the Mediterranean, including DSS and MX episodes.

[Continuous glucose monitoring with type 1 diabetes mellitus].

PubMed

López-Siguero, J P; García Arias, M J; del Pino de la Fuente, A; Moreno Molina, J A

2003-03-01

Appropriate metabolic control of children with type 1 diabetes mellitus (DM) is based on frequent measurements of capillary glycemia. However, this method offers only partial information on fluctuations in glycemia during the day, while episodes of postprandial hyperglycemia and hypoglycemia, mainly nocturnal, go unnoticed. To analyze pre- and postprandial blood glucose levels, as well as the presence and duration of hypoglycemic episodes in diabetic children aged more than 8 years old with more than one year of disease duration. Seventeen patients of both sexes (mean age: 12 years old) with type 1 DM were monitored with the continuous glucose monitoring system (CGMS) during working days. Maximum values of pre- and postprandial glucose (1-3 hours after breakfast, lunch and dinner) were registered. Data were downloaded with a Com-station. The mean duration of sensor-wearing was 2.97 days. Pre- and postprandial values were high: mean preprandial values were between 144.9 and 160.5 mg % and mean postprandial values were between 230.4 and 248.8 mg %. The mean number of hypoglycemic episodes detected with the sensor was 4.9 compared with 1.8 detected with the glucometer (p < 0.05). Episodes of mainly nocturnal asymptomatic hypoglycemia were detected with a mean duration of 145 minutes during the night and 75 minutes during the day. The use of continuous subcutaneous glucose monitoring demonstrates that glycemic objectives are not achieved by conventional insulin therapy. It also shows that there are a high number of hypoglycemic episodes, most of which are asymptomatic.

Assessment of the Utility of Episodes of Illness as a Tool for Ambulatory Resource Allocation within the United States Military Health Care System,

DTIC Science & Technology

1991-08-09

episodes for obesity (Johnson et al. 1984), psychiatric care (Kessler et al. 1980), and otitis media and sore throat (Moscovice 1977, Salkever et al...particularly for persons aged 20 to 44 years. The most frequent diagnoses include mental disorders (neurotic depression, adjustment reaction), otitis media , and

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

PubMed Central

Wang, Jhi-Joung; Weng, Shih-Feng; Lin, Chih-Ching; Chien, Chih-Chiang

2017-01-01

Background Patients with advanced diabetic kidney disease (DKD) behave differently to diabetic patients without kidney disease. We aimed to investigate the associations of hypoglycemia and outcomes after initiation of dialysis in patients with advanced DKD on dialysis. Methods Using National Health Insurance Research Database, 20,845 advanced DKD patients beginning long-term dialysis between 2002 and 2006 were enrolled. We investigated the incidence of severe hypoglycemia episodes before initiation of dialysis. Patients were followed from date of first dialysis to death, end of dialysis, or 2008. Main outcomes measured were all-cause mortality, myocardial infarction (MI), and subsequent severe hypoglycemic episodes after dialysis. Results 19.18% patients had at least one hypoglycemia episode during 1-year period before initiation of dialysis. Advanced DKD patients with higher adapted Diabetes Complications Severity Index (aDCSI) scores were associated with more frequent hypoglycemia (P for trend < 0.001). Mortality and subsequent severe hypoglycemia after dialysis both increased with number of hypoglycemic episodes. Compared to those who had no hypoglycemic episodes, those who had one had a 15% higher risk of death and a 2.3-fold higher risk of subsequent severe hypoglycemia. Those with two or more episodes had a 19% higher risk of death and a 3.9-fold higher risk of subsequent severe hypoglycemia. However, previous severe hypoglycemia was not correlated with risk of MI after dialysis. Conclusions The rate of severe hypoglycemia was high in advanced DKD patients. Patients with higher aDCSI scores tended to have more hypoglycemic episodes. Hypoglycemic episodes were associated with subsequent hypoglycemia and mortality after initiation of dialysis. We studied the associations and further study is needed to establish cause. In addition, more attention is needed for hypoglycemia prevention in advanced DKD patients, especially for those at risk patients. PMID:28355264

Real-Time Continuous Glucose Monitoring Reduces the Duration of Hypoglycemia Episodes: A Randomized Trial in Very Low Birth Weight Neonates

PubMed Central

Uettwiller, Florence; Chemin, Aude; Bonnemaison, Elisabeth; Favrais, Géraldine; Saliba, Elie; Labarthe, François

2015-01-01

Objectives Hypoglycemia is frequent in very low birth weight (VLBW) neonates and compromises their neurological outcome. The aim of this study was to compare real-time continuous glucose monitoring system (RT-CGMS) to standard methods by intermittent capillary blood glucose testing in detecting and managing hypoglycemia. Study design Forty-eight VLBW neonates were enrolled in this prospective study. During their 3 first days of life, their glucose level was monitored either by RT-CGMS (CGM-group), or by intermittent capillary glucose testing (IGM-group) associated with a blind-CGMS to detect retrospectively missed hypoglycemia. Outcomes were the number and duration of hypoglycemic (≤50mg/dl) episodes per patient detected by CGMS. Results Forty-three monitorings were analyzed (IGM n = 21, CGM n = 22), with a median recording time of 72 hours. In the IGM group, blind-CGMS revealed a significantly higher number of hypoglycemia episodes than capillary blood glucose testing (1.2±0.4 vs 0.4±0.2 episode/patient, p<0.01). In the CGM-group, the use of RT-CGMS made it possible (i) to detect the same number of hypoglycemia episodes as blind-CGMS (1.2±0.4 episode/patient), (ii) to adapt the glucose supply in neonates with hypoglycemia (increased supply during days 1 and 2), and (iii) to significantly reduce the duration of hypoglycemia episodes per patient (CGM 44[10–140] min versus IGM 95[15–520] min, p<0.05). Furthermore, it reduced the number of blood samples (CGM 16.9±1.0 vs IGM 21.9±1.0 blood sample/patient, p<0.001). Conclusion RT-CGMS played a beneficial role in managing hypoglycemia in VLBW neonates by adjusting the carbohydrate supply to the individual needs and by reducing the duration of hypoglycemia episodes. The clinical significance of the biological differences observed in our study need to be explored. PMID:25590334

Focus Group Study Exploring Factors Related to Frequent Sickness Absence.

PubMed

Notenbomer, Annette; Roelen, Corné A M; van Rhenen, Willem; Groothoff, Johan W

2016-01-01

Research investigating frequent sickness absence (3 or more episodes per year) is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves. We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD-R) model as theoretical framework. Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills) were regarded as solutions to reduce frequent sickness absence. The JD-R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance.

Aggression in psychiatry wards: a systematic review.

PubMed

Cornaggia, Cesare Maria; Beghi, Massimiliano; Pavone, Fabrizio; Barale, Francesco

2011-08-30

Although fairly frequent in psychiatric in-patient, episodes of aggression/violence are mainly limited to verbal aggression, but the level of general health is significantly lower in nurses who report 'frequent' exposure to violent incidents, and there is disagreement between patients and staff concerning predictors of these episodes. We searched the Pubmed, Embase and PsychInfo databases for English, Italian, French or German language papers published between 1 January 1990 and 31 March 2010 using the key words "aggress*" (aggression or aggressive) "violen*" (violence or violent) and "in-patient" or "psychiatric wards", and the inclusion criterion of an adult population (excluding all studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescents or the elderly, men/women only, personality disorders and mental retardation). The variables that were most frequently associated with aggression or violence in the 66 identified studies of unselected psychiatric populations were the existence of previous episodes, the presence of impulsiveness/hostility, a longer period of hospitalisation, non-voluntary admission, and aggressor and victim of the same gender; weaker evidence indicated alcohol/drug misuse, a diagnosis of psychosis, a younger age and the risk of suicide. Alcohol/drug misuse, hostility, paranoid thoughts and acute psychosis were the factors most frequently involved in 12 studies of psychotic patients. Harmony among staff (a good working climate) seems to be more useful in preventing aggression than some of the other strategies used in psychiatric wards, such as the presence of male nurses. Copyright © 2010 Elsevier Ltd. All rights reserved.

Epidemiology of allergic conjunctivitis: clinical appearance and treatment patterns in a population-based study.

PubMed

Leonardi, Andrea; Castegnaro, Angela; Valerio, Alvise La Gloria; Lazzarini, Daniela

2015-10-01

To analyse the most recently published studies on the prevalence of allergic conjunctivitis alone or in association with allergic rhinitis, and the clinical and demographic aspects of the disease. Allergic conjunctivitis or conjunctival symptoms are present in 30-71% of patients with allergic rhinitis. Allergic conjunctivitis alone has been estimated in 6-30% of the general population and in up to 30% in children alone or in association with allergic rhinitis. Seasonal allergic conjunctivitis is the most frequent form; however, studies from tertiary, ophthalmology referral centers report that the chronic forms, such as vernal and atopic keratoconjunctivitis, are the most frequently seen by ophthalmologists. A recent large survey performed at a national level involving 304 ophthalmologists showed that the majority of patients with allergic conjunctivitis suffer annually of few episodes of mild ,intermittent conjunctivitis. However, 30% of patients are affected by frequent episodes with intense and persistent symptoms. Treatment is frequently not appropriate. Even though allergic conjunctivitis is often associated to allergic rhinitis, epidemiology studies frequently do not include specific ophthalmological evaluations. An understanding of allergic conjunctivitis disease, its prevalence, demographics and treatment paradigms will provide important information towards understanding its pharmacoeconomics and burden on the national health systems.

[Children as victims of homicide 1972-2005].

PubMed

Christiansen, Sanne; Rollmann, Dorte; Leth, Peter Mygind; Thomsen, Jørgen Lange

2007-11-19

Child homicides are rare but serious crimes. In this study the homicide rate and the development in the crime pattern will be investigated. The investigation is retrospective and comprises the 34 years during which the Institute of Forensic Medicine in Odense has existed. During this period 41 children under the age of 15 were killed in 30 episodes. The most frequent method of homicide was manual strangulation, and the second most frequent was blunt violence. It is demonstrated that the incidence of child homicide has decreased considerably compared to a previous investigation comprising all of Denmark. By far the largest decrease is in homicides committed by women against their own children, which have often been followed by suicide (family homicides). The decrease in family homicides committed by men is much less. Today men commit family homicides 8 times as frequently as women in the area under investigation. A possible explanation for the decreasing number of homicides committed by women against their own children is the decreased use of gas for cooking, whereby a frequent homicide method disappeared, and by improved socio-economic life conditions and gender balance. Men are now responsible for the majority of family homicides. Preventative measures for men in socially traumatic situations such as a divorce are recommended.

Prevalence and determinants of direct and generative modes of production of episodic future thoughts in the word cueing paradigm.

PubMed

Jeunehomme, Olivier; D'Argembeau, Arnaud

2016-01-01

Recent research suggests that episodic future thoughts can be formed through the same dual mechanisms, direct and generative, as autobiographical memories. However, the prevalence and determinants of the direct production of future event representations remain unclear. Here, we addressed this issue by collecting self-reports of production modes, response times (RTs), and verbal protocols for the production past and future events in the word cueing paradigm. Across three experiments, we found that both past and future events were frequently reported to come directly to mind in response to the cue, and RTs confirmed that events were produced faster for direct than for generative responses. When looking at the determinants of direct responses, we found that most past and future events that were directly produced had already been thought of on a previous occasion, and the frequency of previous thoughts predicted the occurrence of direct access. The direct production of autobiographical thoughts was also more frequent for past and future events that were judged important and emotionally intense. Collectively, these findings provide novel evidence that the direct production of episodic future thoughts is frequent in the word cueing paradigm and often involves the activation of personally significant "memories of the future."

Recent Alcohol Use and Episodic Heavy Drinking among American Indian Youths

ERIC Educational Resources Information Center

King, Keith A.; Vidourek, Rebecca A.; Hill, Mallory K.

2014-01-01

A total of 366 American Indian students in grades 7 through 12 completed the PRIDE questionnaire. Recent alcohol use was reported by 31.9% of students, whereas 26.7% reported frequent episodic heavy drinking. One in three students felt it was harmful/very harmful to use alcohol and less than half felt alcohol was easy/very easy to obtain. A series…

Macrophage activation syndrome in children with systemic juvenile idiopathic arthritis and systemic lupus erythematosus.

PubMed

Aytaç, Selin; Batu, Ezgi Deniz; Ünal, Şule; Bilginer, Yelda; Çetin, Mualla; Tuncer, Murat; Gümrük, Fatma; Özen, Seza

2016-10-01

Macrophage activation syndrome (MAS) is a hyper-inflammatory disorder secondary to a rheumatic disease such as systemic juvenile idiopathic arthritis (SJIA) and systemic lupus erythematosus (SLE). We aimed to present the characteristics of our pediatric MAS patients. Clinical features, laboratory parameters, treatment, and outcome of 34 patients (28 SJIA; six SLE; 37 MAS episodes) followed at a tertiary health center between 2009 and 2015 were retrospectively reviewed. The median age at MAS onset was 11 years. More SJIA patients had MAS at disease onset than SLE patients (53.6 vs. 16.7 %). Fever, high C-reactive protein and hyperferritinemia were present in all MAS episodes. Rash was less (p = 0.03), and fatigue was more frequent (p = 0.042) in SLE than SJIA patients. All received corticosteroids. Cyclosporine was given in 74.2 % of SJIA-MAS; 66.7 % of SLE-MAS episodes. Intravenous immunoglobulin, anakinra, or etoposide was administered during 67.7; 41.9; 32.3 % of SJIA-MAS and 33.3; 33.3; 50 % of SLE-MAS episodes, respectively. Plasmapheresis was performed during 41.9 % of SJIA-MAS and 33.3 % of SLE-MAS episodes. The mortality rate was 11.8 % (n = 4;3 SJIA, 1 SLE). Hepatosplenomegaly was more frequent (p = 0.005), and plasmapheresis was performed more frequently (p = 0.021) in the patients who died compared to the cured patients. The median duration between symptom onset and admission to our hospital was longer among the patients who died (16.5 vs. 7 days; p = 0.049). Our patients' characteristics were similar to the reported cases, but our mortality rate is slightly higher probably due to late referral to our center. Early diagnosis and effective treatment are crucial to prevent mortality.

Using low-frequency earthquake families on the San Andreas fault as deep creepmeters

NASA Astrophysics Data System (ADS)

Thomas, A.; Beeler, N. M.; Bletery, Q.; Burgmann, R.; Shelly, D. R.

2017-12-01

The San Andreas fault hosts tectonic tremor and low-frequency earthquakes (LFEs) similar to those in subduction zone environments. These LFEs are grouped into families based on waveform similarity and locate between 16 and 29 km depth along a 150-km-long section of the fault centered on Parkfield, CA. ­Within individual LFE families event occurrence is not steady. In some families, bursts of a few events recur on timescales of days while in other families there are nearly quiescent periods that often last for months followed by episodes where hundreds of events occur over the course of a few days. These two different styles of LFE occurrence are called continuous and episodic respectively. LFEs are often assumed to reflect persistent regions that periodically fail during the aseismic shear of the surrounding fault allowing them to be used as creepmeters. We test this idea by formalizing the definition of a creepmeter (the LFE occurrence rate is proportional to the local fault slip rate), determining whether this definition is consistent with the observations, and over what timescale. We use the recurrence intervals of LFEs within individual families to create a catalog of LFE bursts. For the episodic families, we consider both longer duration (multiday) inferred creep episodes (dubbed long-timescale episodic) as well as the frequent short-term bursts of events that occur many times during inferred creep episodes (dubbed short-timescale episodic). We then use the recurrence intervals of LFE bursts to estimate the timing, duration, recurrence interval, slip, and slip rate associated with inferred slow slip events. We find that continuous families and the short-timescale episodic families appear to be inconsistent with our definition of a creepmeter (defined on the recurrence interval timescale) because their estimated durations are not physically meaningful. A straight-forward interpretation of the frequent short-term bursts of the continuous and short-timescale episodic families is that they do not represent individual creep events but rather are persistent asperities that are driven to failure by quasi-continuous creep on the surrounding fault. In contrast, episodic families likely define sections of the fault where slip is distinctly episodic in well-defined SSEs that slip at 15 times the long-term rate.

Comparison of sick leave patterns between Norway and Denmark in the health and care sector: a register study.

PubMed

Krane, Line; Fleten, Nils; Stapelfeldt, Christina M; Nielsen, Claus Vinther; Jensen, Chris; Johnsen, Roar; Braaten, Tonje

2013-11-01

Sickness absence is of considerable concern in both Norway and Denmark. Labour Force Surveys indicate that absence in Norway is about twice that in Denmark and twice that of the mean reported by the Organisation for Economic Co-operation and Development. This study compares absence patterns according to age, percentage of employment, and occupation between municipal employees in the health and care sectors in two municipalities in Norway and Denmark. Data recorded in the personnel registers of the municipalities of Kristiansand, Norway and Aarhus, Denmark were extracted for the years 2004 and 2008, revealing 3498 and 7751 employee-years, respectively. We calculated absence rates together with number of sick leave episodes, and their association with the above-mentioned covariates. Gender-specific comparative descriptive statistics and negative binomial regression analysis were performed. The sickness absence rate in women was 11.3% in Norway (95% confidence interval [CI] 11.2-11.4) and 7.0% in Denmark (95% CI 7.0-7.1) whereas mean number of sick leave episodes among women was 2.4 in Denmark, compared to 2.3 in Norway (p = 0.02). Young employees in Denmark had more sick leave episodes than in Norway. Proportion of absentees was higher in Denmark compared to Norway (p < 0.0001). The finding of that more employees in Denmark have more frequent, but shorter sick leave episodes compared to Norway, for whatever reasons, may indicate that more frequent sick leaves episodes prevent higher sick leaves rates.

Frequent Respiratory Viral Infections in Children with Febrile Neutropenia - A Prospective Follow-Up Study.

PubMed

Söderman, Martina; Rhedin, Samuel; Tolfvenstam, Thomas; Rotzén-Östlund, Maria; Albert, Jan; Broliden, Kristina; Lindblom, Anna

2016-01-01

Febrile neutropenia is common in children undergoing chemotherapy for the treatment of malignancies. In the majority of cases, the cause of the fever is unknown. Although respiratory viruses are commonly associated with this condition, the etiologic significance of this finding remains unclear and is therefore the subject of this study. Nasopharyngeal aspirates were collected during 87 episodes of febrile neutropenia in children age 0-18 years, being treated at a children's oncology unit between January 2013 and June 2014. Real-time polymerase chain reaction was used to determine the presence of 16 respiratory viruses. Follow-up samples were collected from children who tested positive for one or more respiratory viruses. Rhinoviruses were genotyped by VP4/VP2 sequencing. Fisher's exact test and Mann-Whitney U test were used for group comparisons. At least one respiratory virus was detected in samples from 39 of 87 episodes of febrile neutropenia (45%), with rhinoviruses the most frequently detected. Follow-up samples were collected after a median of 28 days (range, 9-74 days) in 32 of the 39 virus-positive episodes. The respiratory viral infection had resolved in 25 episodes (78%). The same virus was detected at follow-up in one coronavirus and six rhinovirus episodes. Genotyping revealed a different rhinovirus species in two of the six rhinovirus infections. The frequency of respiratory viral infections in this group of patients suggests an etiologic role in febrile neutropenia. However, these findings must be confirmed in larger patient cohorts.

Paroxysmal Kinesigenic Dyskinesia.

PubMed

Mallik, Ritwika; Nandi, Sitansu Sekhar

2016-04-01

We present a case of paroxysmal kinesigenic dyskinesia (PKD) in a 21 year old girl, with no family history of similar episodes. The episodes were short (lasting less than a minute), frequent, occurring 5 to 10 times a day, self-limiting dystonia of her right upper limb precipitated by sudden movement. She also had a past history of partial seizures with secondary generalization in her childhood. She responded to phenytoin, with cessation of events after 1 month of treatment. This case impresses upon the hypothesis stating the association between seizure activity and PKD probably due to a common foci of origin. Awareness of this condition is required as it is easily treatable but frequently misdiagnosed. © Journal of the Association of Physicians of India 2011.

A comparative study of socio-demographic and substance use correlates in early onset psychosis

PubMed Central

Paruk, S; Jhazbhay, K; Singh, K; Sartorius, B; Burns, JK

2016-01-01

Background Comorbid substance use particularly cannabis among adolescents with mental illness is a major public health concern in developing countries with limited mental health resources. Better understanding of the association between cannabis use and other poly-substance use and early mental illness will provide for more targeted early interventions. Aim To examine the socio-demographic profile and cannabis use characteristics among adolescents with first episode early onset psychosis (EOP) and compare to age and gender matched adolescents with first episode non-psychotic mental illness (controls). Method Forty-five adolescents with first episode EOP and 45 controls were assessed using a clinical interview, PANSS and WHO ASSIST for substance related problems. Results There were significant socio-demographic differences among the adolescents with EOP (73% Black, 64% from low family income, 44% from rural areas) compared to controls (24% Black, 53% from low family income, 2% from rural areas). Whilst there was no difference in lifetime cannabis use, EOP adolescents differed in motivation for cannabis use, had increased current cannabis use (38%, p=0.01) and more frequent use (52%, p=0.04) compared to controls (16% current and 18% frequent use). EOP adolescents reported more hazardous use with higher ASSIST mean cannabis specific involvement scores (EOP 10,2; controls 2,3; p= 0.004). Conclusion The differences in socio-demographic variables may reflect the marked disparity in access to mental health care for rural Black youth. Psychotic youth may be more vulnerable to comorbid cannabis related problems than other mentally ill adolescents. The study highlights the need for early introduction of substance use interventions among adolescents with mental illness. PMID:27038079

Microbiology of peritonsillar abscess in the South Estonian population

PubMed Central

Vaikjärv, Risto; Kasenõmm, Priit; Jaanimäe, Liis; Kivisild, Ave; Rööp, Tiiu; Sepp, Epp; Mändar, Reet

2016-01-01

Objective The first aim of this study was to compare the microbiota of different locations (pus, tonsillar fossa, blood) in peritonsillar abscess (PTA) patients in order to optimize the sampling scheme. The second aim was to estimate the occurrence of tonsillitis episodes and macroscopic oropharyngeal signs characteristic of recurrent tonsillitis in PTA patients. Methods The study group consisted of 22 consecutive patients with PTA undergoing bilateral tonsillectomy. The PTA was punctured; pus and tonsillar fossa biopsy samples and the peripheral blood cultures were collected. The index of tonsillitis was calculated by multiplying the number of tonsillitis episodes per year by the morbidity period in years. Macroscopic oropharyngeal signs were evaluated and they were as follows: tonsillar sclerosis, obstruction of the tonsillar crypts, scar tissue on tonsils, cryptic debris, and lymphatic tissue aggregates. Results The cultures of the pus were positive in 16 out of 22 patients and the cultures of the tonsillar fossa samples were positive in all cases. In total, 62 different organisms were found from tonsillar fossa, pus, and blood samples, which belonged to 5 different phyla and 18 different families. In the tonsillar fossa, the most frequent bacteria found were Streptococcus spp. In pus samples, the most frequently found bacteria were Streptococcus spp. and bacteria from the Streptococcus milleri group. Conclusion PTA patients had mixed anaerobic and aerobic microbiota both in the tissue of the tonsillar fossa and the pus of the peritonsillar space. We demonstrated that the tonsillar fossa specimen is a better material for microbiological analyses, because it reveals more bacteria per culture. PTA patients usually have a low number of tonsillitis episodes in their previous history, but a relatively high number of macroscopic oropharyngeal signs, indicating the sclerotic process in palatal tonsils. PMID:27113570

Epicardial mapping of ventricular fibrillation over the posterior descending artery and left posterior papillary muscle of the swine heart

PubMed Central

Nielsen, Thomas D.; Huang, Jian; Rogers, Jack M.; Killingsworth, Cheryl R.

2008-01-01

Background Recent studies suggest that during ventricular fibrillation (VF) epicardial vessels may be a site of conduction block and the posterior papillary muscle (PPM) in the left ventricle (LV) may be the location of a “mother rotor.” The goal of this study was to obtain evidence to support or refute these possibilities. Methods Epicardial activation over the posterior LV and right ventricle (RV) was mapped during the first 20 s of electrically induced VF in six open-chest pigs with a 504 electrode plaque covering a 20 cm2 area centered over the posterior descending artery (PDA). Results The locations of epicardial breakthrough as well as reentry clustered in time and space during VF. Spatially, reentry occurred significantly more frequently over the LV than the RV in all 48 episodes, and breakthrough clustered near the PPM (p<0.001). Significant temporal clustering occurred in 79% of breakthrough episodes and 100% of reentry episodes. These temporal clusters occurred at different times so that there was significantly less breakthrough when reentry was present (p<0.0001). Conduction block occurred significantly more frequently near the PDA than elsewhere. Conclusions The PDA is a site of epicardial block which may contribute to VF maintenance. Epicardial breakthrough clusters near the PPM. Reentry also clusters in space but at a separate site. The fact that breakthrough and reentry cluster at different locations and at different times supports the possibility of a drifting filament at the PPM so that at times reentry is present on the surface but at other times the reentrant wavefront breaks through to the epicardium. PMID:18839296

Aeroallergen Sensitization in Wheezing Children From Rosario, Argentina

PubMed Central

Pendino, Patricia; Agüero, Claudio; Cavagnero, Paola; Lopez, Karina; Molinas, Jorge

2011-01-01

Background Wheezing is a highly frequent symptom in infants and children. Its major causes are respiratory infections and bronchial asthma. In this context, allergen sensitization plays an important role, and it can be detected by a skin prick test, a safe and effective technique that can be easily performed on any age-group. To assess the prevalence of aeroallergen sensitization in a pediatric population with recurrent episodes of wheezing. Materials and Methods Cross-sectional study that evaluated 100 patients, 50 (50%) girls and 50 (50%) boys, from 6 months to 10 years. These children had consulted frequently at the Allergy and Immunology Division of the Eva Perón School Hospital due to recurrent episodes of wheezing. Skin prick test were performed on all of them and also on 20 healthy children. Results Overall, 58% of the patients presented sensitization to dust mite, 13% to pollen, 9% to epithelium, 8% to fungi, 6% to cockroach, and 1% to soybean hull. Overall, 60% of the patients were positive to at least one of the extracts, and we observed a significant and gradual increase in the frequency of sensitization in older age-groups (P < 0.005). This increase persisted when analyzing separately the dust mite group and the pollen group. None of the cases presented any adverse local or systemic reaction during the procedure or the following 24 hours after the procedure. The 20 individuals in the control group turned out negative when tested. Conclusions This study found high aeroallergen sensitization prevalence in a pediatric population with recurrent episodes of wheezing examined in the Allergy and Immunology Division of the Eva Perón School Hospital, which is in the southern area of the province of Santa Fe in Argentina. PMID:23268433

First-episode psychosis and migration in Italy (PEP-Ita migration): a study in the Italian mental health services

PubMed Central

2014-01-01

Background It has been frequently reported a higher incidence of psychotic disorders in immigrants than in native populations. There is, however, a lack of knowledge about risk factors which may explain this phenomenon. A better understanding of the causes of psychosis among first-generation migrants is highly needed, particularly in Italy, a country with a recent massive migration. Methods/Design The “Italian study on first-episode psychosis and migration (PEP-Ita)” is a prospective observational study over a two-year period (1 January 2012–31 December 2013) which will be carried out in 11 Italian mental health centres. All participating centres will collect data about all new cases of migrants with first-episode psychosis. The general purpose (“core”) of the PEP-Ita study is to explore the socio-demographic and clinical characteristics, and the pathways to care of a population of first-episode psychosis migrants in Italy. Secondary aims of the study will be: 1) to understand risk and protective factors for the development of psychotic disorders in migrants; 2) to evaluate the correlations between psychopathology of psychotic disorders in migrants and socio-demographic characteristics, migration history, life experiences; 3) to evaluate the clinical and social outcomes of first-episode psychoses in migrants. Discussion The results of the PEP-Ita study will allow a better understanding of risk factors for psychosis in first-generation migrants in Italy. Moreover, our results will contribute to the development of prevention programmes for psychosis and to the improvement of early intervention treatments for the migrant population in Italy. PMID:24957972

A Population-Based Inquiry of Homeless Episode Characteristics and Early Educational Well-Being.

PubMed

Fantuzzo, John; Leboeuf, Whitney; Brumley, Benjamin; Perlman, Staci

2013-06-01

Child homelessness and educational well-being is an area of national research that requires more precise investigation to address mixed findings. The aim of this study was to extend the investigation of the relations between homelessness and educational well-being by determining if timing and frequency of homeless episodes are differentially associated with children's academic and classroom engagement outcomes. This investigation used a comprehensive research model to study the effects of these homeless episode characteristics within a large urban student cohort. Additionally, this study accounted for co-occurring early risk factors. Findings indicated that having a first homeless episode in early childhood was associated with non-proficiency in mathematics and academic engagement problems. Also more frequent homeless episodes were related to truancy in third grade. These results stress the importance of early intervention for homeless children and underscore the need to further understand the variation in young children's homeless experiences.

Phasic jaw motor episodes in healthy subjects with or without clinical signs and symptoms of sleep bruxism: a pilot study.

PubMed

Yoshizawa, Shuichiro; Suganuma, Takeshi; Takaba, Masayuki; Ono, Yasuhiro; Sakai, Takuro; Yoshizawa, Ayako; Kawana, Fusae; Kato, Takafumi; Baba, Kazuyoshi

2014-03-01

To investigate the association between each clinical diagnosis criterion for sleep bruxism (SB) and the frequency of jaw motor events during sleep. Video-polysomnography was performed on 17 healthy adult subjects (mean age, 26.7 ± 2.8 years), with at least one of the following clinical signs and symptoms of SB: (1) a report of frequent tooth grinding, (2) tooth attrition with dentine exposure through at least three occlusal surfaces, (3) morning masticatory muscle symptoms, and (4) masseter muscle hypertrophy. Episodes of rhythmic masticatory muscle activity (RMMA) and isolated tonic activity were scored visually. These variables were compared with regards to the presence or absence of each clinical sign and symptom. In 17 subjects, 4.0 ± 2.5/h (0.1-10.2) RMMA and 1.0 ± 0.8/h (0-2.4) isolated tonic episodes were observed (total episodes: 5.0 ± 2.4/h (1.2-11.6)). Subjects with self-reported grinding sounds (n=7) exhibited significantly higher numbers of RMMA episodes (5.7 ± 2.3/h) than those without (n=10; 2.8 ± 1.8/h) (p=0.011). Similarly, subjects with tooth attrition (n=6) showed significantly higher number of RMMA episodes (5.6 ± 3.1/h) than those without (n=11; 3.2 ± 1.6/h) (p=0.049). The occurrence of RMMA did not differ between the presence and absence of morning masticatory muscle symptoms or muscle hypertrophy. Clinical signs and symptoms frequently used for diagnosing SB can represent different clinical and physiological aspects of jaw motor activity during sleep.

Safety of Nonoperative Management After Acute Diverticulitis

PubMed Central

Amoza Pais, Sonia; Batlle Marin, Xavi; Oronoz Martinez, Begoña; Balen Ribera, Enrique; Yarnoz Irazabal, Concepción

2014-01-01

Purpose The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery. Methods We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode. Results Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated with elective surgery had a higher rate of stoma than patients treated non-operatively (7.2% vs. 1.4%; P = 0.028); this difference was not observed in the subgroup of patients with CAD (15.3% vs. 6.8%; P = 0.458). Conclusion After an episode of AD, nonoperative management is safe because fewer than 5% of patients will need an emergent procedure in a subsequent attack of AD. A first episode of CAD is the only risk factor for emergency surgery in patients managed conservatively. PMID:25360428

Efficacy of tilt training in patients with vasovagal syncope.

PubMed

Gajek, Jacek; Zyśko, Dorota; Mazurek, Walentyna

2006-06-01

Besides pharmacological therapy and pacemaker implantation, tilt training is a promising method of treatment in patients with vasovagal syncope (VVS). Tilt training is usually offered to patients with malignant or recurrent VVS which impairs their quality of life and carries a risk of injury. To assess the efficacy of tilt training in patients with VVS. The study group consisted of 40 patients (29 females, 11 males, aged 36.6+/-14 years, range 18-57 years) who underwent tilt training using tilt table testing according to the Westminster protocol. The mean number of syncopal episodes prior to the initiation of tilt training was 6.5+/-4.9 (range 0-20); 3 patients had a history of very frequent faints. According to the VASIS classification, type I VVS (mixed) was diagnosed in 17 patients, type II (cardioinhibitory) in 22 subjects, and type III (vasodepressive) in one patient. Mean follow-up duration was 35.1+/-13.5 months. The control group, which did not undergo the tilt testing programme, consisted of 29 patients with VVS (25 females, 4 males, mean age 44.2+/-15.0 years) who had a mean of 3.3+/-3.2 (range 0-12) syncopal episodes in the past (p <0.05 vs study group); 6 of these patients had only pre-syncopal episodes. Type I VVS was diagnosed in 23 controls and type II VVS in 6 control subjects (syncope occurred during the passive phase of tilt testing in 7 subjects, whereas the remaining 22 fainted during NTG infusion). Of the patients from the study group, 3 underwent pacemaker implantation at the time of the initiation of tilt training. At the end of follow-up, 31 (77.5%) patients remained free from syncope recurrences, 5 had syncopal episodes during the initial phase of tilt training, whereas the remaining 4 continued to suffer from syncopal episodes. Out of 3 patients with presyncope, 2 had no syncope recurrences whereas 1 patient continued to have presyncopal attacks. Out of 3 patients with pacemakers, 1 reported activation of pacing in the interventional mode. During the follow-up period, in 5 patients from the study group the diagnosis of VVS was not confirmed and another condition was diagnosed. In the control group, syncope recurrences occurred in 13 (44.5%) patients (p <0.05 vs study group). In patients with VVS, tilt training is effective in the majority of patients. Syncopal or presyncopal episodes and positive results of tilt testing take place more frequently in the early rather than in the late phase of training. Cessation of tilt training causes a recurrence of positive results of tilt testing in spite of the lack of spontaneous syncopal episodes. During long-term observation, a proper diagnosis, different from VVS, can be established in some patients.

Compulsive buying in bipolar disorder: is it a comorbidity or a complication?

PubMed

Kesebir, Sermin; Işitmez, Sema; Gündoğar, Duru

2012-02-01

The objective of this study was to investigate the frequency of compulsive buying in bipolar disorder (BD), to compare it with healthy controls, and to search if there is a difference between bipolar cases with and without compulsive buying in terms of sociodemographic qualities, temperament, clinical characteristics and comorbid diagnoses. One-hundred outpatient cases diagnosed as BD according to DSM-IV were evaluated consecutively. Following the diagnosis interview (SCID-I and II) the subjects completed the mood disorders registry form, Compulsive Buying Scale and TEMPS-A. Compulsive buying scores were higher in bipolar patients than healthy controls (p<0.001). Cases with compulsive buying revealed higher cyclothymic and irritable temperament scores than other bipolar patients (p=0.029 vs 0.045). Premenstrual syndrome and postpartum onset were more frequent, while psychotic symptoms were less in compulsive buyer bipolar patients (p=0.002, 0.009 vs 0.034). Severity of episode was lower (p=0.01), number of episodes was higher (p=0.009). Acute onset and remission before and after maintenance treatment were more frequent in patients with compulsive buying (p=0.011 and p=0.011). Full remission between episodes was 100%. Cases with axis-1 and axis-2 comorbidities demonstrated higher compulsive buying scores (p=0.025 and 0.005). Treatment regimen differences between patients are a limitation of the study. This is the first study to relate compulsive buying with the clinical characteristics of BD. Our results reveal that compulsive buying in BD occurs together with mood episodes which are not very severe, but frequent and with abrupt onset. Copyright © 2011 Elsevier B.V. All rights reserved.

[Impact of hypoglycemic episodes on nerves conduction and auditory and visual evoked potentials in children with type 1 diabetes].

PubMed

Wysocka-Mincewicz, Marta; Trippenbach-Dulska, Hanna; Emeryk-Szajewska, Barbara; Zakrzewska-Pniewska, Beata; Kochanek, Krzysztof; Pańkowska, Ewa

2007-01-01

Hypoglycemia is an acute disturbance of energy, especially impacting the central nervous system, but direct influence on peripheral nervous function is not detected. The aim of the study was to establish the influence of hypoglycemic moderate and severe episodes on the function of peripheral nerves, hearing and visual pathway. 97 children with type 1 diabetes (mean age 15.4+/-2.16 years, mean duration of diabetes 8.11+/-2.9 years, mean HbA1c 8,58+/-1.06%), at least 10 years old and with at least 3 years duration of diabetes, were included to study. Nerve conduction studies, visual (VEP) and auditory (ABR) evoked potentials were performed with standard surface stimulating and recording techniques. Moderate hypoglycemic episodes were defined as events of low glycemia requiring help of another person but without loss of consciousness and/or convulsions but recurrent frequently in at least one year. Severe hypoglycemia was defined as events with loss of consciousness and/or convulsions. Univariate ANOVA tests of significance or H Kruskal-Wallis test were used, depending on normality of distribution. The subgroups with a history of hypoglycemic episodes had significant delay in all conduction parameters in the sural nerve (amplitude p<0.05, sensory latency p<0.05, and velocity p<0.005) and in motor potential amplitude of tibial nerve (p<0.005). In ABR wave III latency and interval I-III in subgroups with episodes of hypoglycemia (p<0,05) were significantly prolonged. In analyses of VEP parameters no differences were detected. The study showed influence of hypoglycemic episodes on function of all sural nerve parameters and tibial motor amplitude, and in ABR on wave III and interval I-III. Frequent moderate hypoglycemic episodes were strong risk factors for damage of the peripheral and central nervous systems, comparable with impact of several severe hypoglycemias.

The course and character of sleepwalking in adulthood: a clinical and polysomnographic study.

PubMed

Bušková, Jitka; Piško, Juraj; Pastorek, Lukáš; Šonka, Karel

2015-01-01

To describe characteristics of adult sleepwalking (potential triggers and correlates with polysomnography), 52 patients were interviewed regarding their sleepwalking episodes and underwent video-polysomnography on two consecutive nights. Sleepwalking history averaged 12 years and frequent episodes (more than once per week) occurred in 62%. Higher frequency was associated with earlier onset of sleepwalking (p < 0.005) and 53.8% reported dangerous sleepwalking behavior. The most common self-reported triggers were sleep deprivation and stressful events, while no specific trigger was reported in 37% of patients. More awakening from slow-wave sleep was associated with a higher frequency of sleepwalking episodes (p < 0.001). A longer history of sleepwalking was associated with more sleepwalking episodes, even without the presence of sleep comorbidities or other known precipitating factors.

Factors associated with chloroquine-induced pruritus during malaria treatment in Mozambican university students.

PubMed

Gama, Helena; Ismael, Aldo; Sitoi, Felicidade; Matola, André; Barros, Henrique; Lunet, Nuno

2009-01-01

It has been suggested that reductions in chloroquine use may be followed by a resurgence of chloroquine-susceptible falciparum malaria, and chloroquine might once again be an effective treatment choice, which renews the importance of aspects related to its use and misuse. Therefore, we aimed to estimate the prevalence of chloroquine-induced pruritus and to identify risk factors for its occurrence in Mozambican University students. A cross-sectional study was conducted at a private University in Maputo. Students were approached in the classrooms to complete a self-administered questionnaire covering sociodemographic characteristics, number of previous malaria episodes, utilization of antimalarial drugs, and life prevalence of chloroquine induced pruritus. Among 795 respondents, 77.4% (601/777) reported at least one malaria episode and 73.2% (542/740) had used chloroquine before. The life-prevalence of chloroquine-induced pruritus was 30.1% (158/525). Pruritus tended to be more frequent when chloroquine was used for treatment compared with prophylaxis only (31.2% vs. 10.3%, p<0.05), and chloroquine use in the last malaria episode was less frequent in participants recalling chloroquine-induced pruritus (52.3% vs. 65.1%, p<0.05). About one third of the black population using chloroquine experienced chloroquine-induced pruritus at least once. This adverse reaction tended to be less frequent when lower doses of chloroquine were used and to influence future anti-malarial therapeutic choices.

Epidemiology and prognosis of candidaemia in elderly patients.

PubMed

Ramos-Martínez, Antonio; Vicente-López, Natalia; Sánchez-Romero, Isabel; Padilla, Belén; Merino-Amador, Paloma; Garnacho-Montero, José; Ruiz-Camps, Isabel; Montejo, Miguel; Salavert, Miguel; Mensa, José; Cuenca-Estrella, Manuel

2017-12-01

The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy-six episodes occurred in elderly patients (>75 years), 227 episodes in middle-aged patients (61-75 years) and 232 episodes in younger patients (16-60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle-aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30-day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality. © 2017 Blackwell Verlag GmbH.

A retrospective analysis of the costs and management of genital warts in Italy

PubMed Central

2013-01-01

Background In Italy the prevalence of genital warts in women (15–64 years) is approximately 0.6% with an incidence of 0.4% per year. Treatments for GW are usually long, with moderate success and high costs. The aim of the study was to evaluate the diagnostic-therapeutic pathway, duration and setting of treatment, costs of episodes of condyloma in a population attending a regional STI clinic in Piedmont. Methods This was a retrospective observational study conducted using medical records of outpatients who first visited the STI Clinic of San Lazzaro Dermatological Hospital in 2008. The patients’ medical histories were analysed for episodes that occurred and were cleared in 18 months following the initial visit. Data on screening methods for STIs, type of diagnosis for condyloma, treatment type, treatment setting, and anatomic lesion site were obtained from medical records. The costs were calculated for each episode. Results A total of 450 episodes were analysed (297 men,153 women). The most frequently affected anatomic site was the genital area (74%) in both genders. With regard to treatment setting, 78.44% of patients received outpatient treatment at the STI clinic, 4% were treated at home, and 0.22% were hospitalised; 11.11% were treated in multiple settings. The mean number of treatments per episode was 2.03; although many patients received only 1 treatment (n = 207, 46%), exspecially cryotherapy or diathermy coagulation (64.73% versus 28.02% of episodes, respectively). The mean episode duration was 80.74 days. The mean cost (in 2011 euros) for an episode was €158.46 ± 257.77; the mean costswere €79.13 ± 57.40 for diagnosis and €79.33 ± 233.60 for treatment. The mean cost for treatment in a STI-Clinic setting was €111.39 ± 76.72, that for home treatment was €160.88 ± 95.69, and that for hospital care was €2825.94. Conclusions The treatment of and associated costs for genital warts are significant. Several factors affect the cost, and internal STI clinic protocols, such as the 6 month window used to consider a recurrence or new diagnosis, create bias. Nonetheless, our findings how costs similar to those reported in the international literature and should be considered when deciding on which HPV vaccination programs should be provided by the public health system. PMID:24106891

Daily tadalafil for the chronic phase of stuttering priapism: a case report.

PubMed

Massenio, Paolo; D'Altilia, Nicola; Sanguedolce, Francesca; Carrieri, Giuseppe; Cormio, Luigi

2018-05-31

Recurrent (stuttering) ischemic priapism is a challenging clinical condition. Frequent recurrences result in frequent hospital admissions whereas treatment with a shunting procedure often results in erectile dysfunction. A 22-year-old man with stuttering idiopathic priapism developed erectile dysfunction (IIEF-5 score 12) following a Winter's shunt; he was given tadalafil, 5 mg/daily, for 6 months. This treatment resulted in progressive restoration of erectile function in the 6 months following the shunt as well as in preventing recurrence of priapic episodes over a 24-month follow-up. This is the first report in literature of chronic treatment of stuttering priapism with a phosphodiesterase-5 inhibitor being able not only to prevent recurrent priapic episodes but also to restore erectile function following a Winter's shunt.

Epidemiology of urticaria in Poland - nationally representative survey results.

PubMed

Raciborski, Filip; Kłak, Anna; Czarnecka-Operacz, Magdalena; Jenerowicz, Dorota; Sybilski, Adam; Kuna, Piotr; Samoliński, Bolesław; Wg, Eup

2018-02-01

The prevalence of urticaria is 15-20%. Women are twice as likely to be affected. To present the epidemiology of urticaria and angioedema in Poland. A questionnaire-based survey was conducted on a representative group of 4,897 individuals, aged 15-74 years. A total of 11.2% of respondents reported at least one episode of urticaria symptoms in their life, and the frequency was higher in females (OR = 1.46; p < 0.001). Single episodes accounted for 34.8%, while repeated episodes accounted for 65.2%. Acute urticaria was observed in 10.6% (more frequent in females; OR = 1.41; p < 0.001), chronic in 0.6%. Median age of the first episode was 15 years. Angioedema was observed in 3.2%. The last episode of urticaria symptoms and/or angioedema occurred within the previous week in 0.7% of subjects, the last month in 1%, and the last year in 2.2%. 8.8% had experienced urticaria symptoms or angioedema over 1 year prior to the survey. The impact of urticaria symptoms on patients' daily activities was rated with 3.8 points on a scale of 0-10. In addition, chronic urticaria was rated 6.5, and acute urticaria 3.6. Angioedema and urticaria had a negative impact of 5.7 points. Urticaria and angioedema are serious health problems in Poland, although their prevalence is below the mean rate for the global population. Females are more likely to suffer from these diseases. People affected by urticaria most frequently report contact with plants and substances, insect bites/stings, and food as the provoking factors.

Frequent Respiratory Viral Infections in Children with Febrile Neutropenia - A Prospective Follow-Up Study

PubMed Central

Söderman, Martina; Rhedin, Samuel; Tolfvenstam, Thomas; Rotzén-Östlund, Maria; Albert, Jan; Broliden, Kristina; Lindblom, Anna

2016-01-01

Objective Febrile neutropenia is common in children undergoing chemotherapy for the treatment of malignancies. In the majority of cases, the cause of the fever is unknown. Although respiratory viruses are commonly associated with this condition, the etiologic significance of this finding remains unclear and is therefore the subject of this study. Study design Nasopharyngeal aspirates were collected during 87 episodes of febrile neutropenia in children age 0–18 years, being treated at a children’s oncology unit between January 2013 and June 2014. Real-time polymerase chain reaction was used to determine the presence of 16 respiratory viruses. Follow-up samples were collected from children who tested positive for one or more respiratory viruses. Rhinoviruses were genotyped by VP4/VP2 sequencing. Fisher’s exact test and Mann-Whitney U test were used for group comparisons. Results At least one respiratory virus was detected in samples from 39 of 87 episodes of febrile neutropenia (45%), with rhinoviruses the most frequently detected. Follow-up samples were collected after a median of 28 days (range, 9–74 days) in 32 of the 39 virus-positive episodes. The respiratory viral infection had resolved in 25 episodes (78%). The same virus was detected at follow-up in one coronavirus and six rhinovirus episodes. Genotyping revealed a different rhinovirus species in two of the six rhinovirus infections. Conclusion The frequency of respiratory viral infections in this group of patients suggests an etiologic role in febrile neutropenia. However, these findings must be confirmed in larger patient cohorts. PMID:27309354

Recurrent vulvovaginitis.

PubMed

Powell, Anna M; Nyirjesy, Paul

2014-10-01

Vulvovaginitis (VV) is one of the most commonly encountered problems by a gynecologist. Many women frequently self-treat with over-the-counter medications, and may present to their health-care provider after a treatment failure. Vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis may occur as discreet or recurrent episodes, and have been associated with significant treatment cost and morbidity. We present an update on diagnostic capabilities and treatment modalities that address recurrent and refractory episodes of VV. Copyright © 2014 Elsevier Ltd. All rights reserved.

Chronic disorders with episodic manifestations: focus on epilepsy and migraine

PubMed Central

2006-01-01

Epilepsy and migraine are chronic neurological disorders with episodic manifestations that are commonly treated in neurological practice and frequently occur together. In this review we examine similarities and contrasts between these disorders, with focus on epidemiology and classification, temporal coincidence, triggers, and mechanistically based therapeutic overlap. This investigation draws attention to unique aspects of both epilepsy and migraine, while identifying areas of crossover in which each specialty could benefit from the experience of the other. PMID:16426991

Walkabout the Galaxy: Podcasting for Informal and Accessible Astronomy Outreach and Education

NASA Astrophysics Data System (ADS)

Colwell, J. E.; Dove, A.; Kehoe, A.; Becker, T. M.

2014-12-01

"Walkabout the Galaxy" is a weekly podcast we have been publishing since May 2014 discussing astronomical news that is in the popular media at the time of recording. Episodes are 25-30 minutes in length and are informal in style: we emphasize one or two basic points while engaging in a free-form discussion of the topic with frequent tangential asides. The target audience is the interested layperson rather than a student, professional, or amateur of astronomy. The informal style is deliberately chosen to keep the podcast from sounding like a classroom lesson and to improve the reach of the podcast to a broader public. Guests have included both experts and laypeople. The number of episode downloads varies by nearly a factor of two from episode to episode (~450 to 750). We will present statistics on downloads and subscriptions, and correlations with episode length, subject matter, and style of episode title. The style of the content cannot influence download statistics, however, and it is not possible to track actual listenership data once the episodes are downloaded. We will discuss lessons learned in creating and producing an educational podcast as well as listener feedback.

Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) may respond to adjunctive ketogenic diet.

PubMed

Steriade, Claude; Andrade, Danielle M; Faghfoury, Hanna; Tarnopolsky, Mark A; Tai, Peter

2014-05-01

Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome can present management challenges. Refractory seizures and stroke-like episodes leading to disability are common. We analyzed the clinical, electrophysiologic, and radiologic data of a 22-year-old woman with multiple episodes of generalized and focal status epilepticus and migratory cortical stroke-like lesions who underwent muscle biopsy for mitochondrial genome sequencing. Although initial mitochondrial genetic testing was negative, muscle biopsy demonstrated a mitochondrial DNA disease-causing mutation (m.3260A > G). New antiepileptic medications were added with each episode of focal status epilepticus with only temporary improvement, until a modified ketogenic diet and magnesium were introduced, leading to seizure freedom despite development of a new stroke-like lesion, and subsequent decrease in frequency of stroke-like episodes. We propose a metabolic model in which the ketogenic diet may lead to improvement of the function of respiratory chain complexes. The ketogenic diet may lead to improvement of mitochondrial dysfunction in MELAS, which in turn may promote better seizure control and less frequent stroke-like episodes. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Clinical symptoms of psychotic episodes and 25-hydroxy vitamin D serum levels in black first-generation immigrants.

PubMed

Dealberto, M-J

2013-12-01

Dark-skinned immigrants have a higher risk for schizophrenia and other psychoses than other immigrants. The first British studies reported that first-generation immigrants (FGIs) from the Caribbean presented atypical psychoses. This study examines the characteristics of psychotic episodes in black FGIs to Canada. The charts of 18 FGIs from Africa and Haiti, extracted from a series of 20 black patients consecutively admitted to Psychiatry, were retrospectively reviewed regarding clinical features, diagnoses and vitamin D levels. Young FGIs presented acute psychotic episodes with abrupt onset, florid positive symptoms, few negative symptoms and good evolution. The onset was more insidious in older FGIs. Overall, catatonia was very frequent (28%), and mood symptoms still more frequent (44%). No cognitive decline was observed during follow-up. Serum levels of 25-hydroxy vitamin D were in the insufficiency range. Supplementation at 1000 IU/day did not restore normal levels. The clinical features of psychotic episodes in black FGIs are similar to those reported in dark-skinned FGIs to other countries. They are also observed in other immigrants and in non-immigrants. These atypical psychoses are possibly related to a recent vitamin D deficit. This hypothesis should be tested by clinical trials of sufficient vitamin D supplementation. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Risk factors for acute exacerbations of COPD in a primary care population: a retrospective observational cohort study

PubMed Central

Müllerová, Hana; Shukla, Amit; Hawkins, Adam; Quint, Jennifer

2014-01-01

Objectives To evaluate risk factors associated with exacerbation frequency in primary care. Information on exacerbations of chronic obstructive pulmonary disease (COPD) has mainly been generated by secondary care-based clinical cohorts. Design Retrospective observational cohort study. Setting Electronic medical records database (England and Wales). Participants 58 589 patients with COPD aged ≥40 years with COPD diagnosis recorded between 1 April 2009 and 30 September 2012, and with at least 365 days of follow-up before and after the COPD diagnosis, were identified in the Clinical Practice Research Datalink. Mean age: 69 years; 47% female; mean forced expiratory volume in 1s 60% predicted. Outcome measures Data on moderate or severe exacerbation episodes defined by diagnosis and/or medication codes 12 months following cohort entry were retrieved, together with demographic and clinical characteristics. Associations between patient characteristics and odds of having none versus one, none versus frequent (≥2) and one versus frequent exacerbations over 12 months follow-up were evaluated using multivariate logistic regression models. Results During follow-up, 23% of patients had evidence of frequent moderate-to-severe COPD exacerbations (24% one; 53% none). Independent predictors of increased odds of having exacerbations during the follow-up, either frequent episodes or one episode, included prior exacerbations, increasing dyspnoea score, increasing grade of airflow limitation, females and prior or current history of several comorbidities (eg, asthma, depression, anxiety, heart failure and cancer). Conclusions Primary care-managed patients with COPD at the highest risk of exacerbations can be identified by exploring medical history for the presence of prior exacerbations, greater COPD disease severity and co-occurrence of other medical conditions. PMID:25524545

Violence against nurses in the triage area: An Italian qualitative study.

PubMed

Ramacciati, Nicola; Ceccagnoli, Andrea; Addey, Beniamino

2015-10-01

This qualitative study aims to investigate the feelings experienced by nurses following episodes of violence in the workplace. Numerous studies show that healthcare professionals are increasingly finding themselves victims of violence; of all professionals, nurses in the Emergency Department and especially those performing triage are one of the staff categories which most frequently experience these episodes during their work. In Italy, this phenomenon has been studied very little in comparison to other countries but has recently been gaining increasing attention. Few studies have investigated the feelings experienced by nurses following episodes of violence in the workplace. For this study a phenomenological approach was used. Assumptions and previous findings were set aside (bracketing). A purposive sample of 9 nurses coming from 7 different Emergency Department in the region of Tuscany, Italy was interviewed during a focus group meeting. The data analysis was carried out using the Colaizzi method. Data analysis revealed 10 significant themes/responses. The quality of reporting was guaranteed by adopting the COREQ criteria. Data analysis revealed that nurses feel that violent episodes are "inevitable" and that they feel they have grown accustomed to high levels of violence, that they suffer feelings of "inadequacy" but also that they are aware that they themselves can trigger conflict with patients, and again suffer the feeling of "being alone" in facing these problems and a sense of "being left on their own" by the institution and feeling "hurt", "scared", "angry" and have a sense that "it is not fair". Last but not least, "the gender difference" appears to play an important role in the emotional response. To suffer episodes of violence has serious and severe "hidden costs" which are just as important as the direct, tangible costs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Etiology and Clinical Course of Febrile Neutropenia in Children with Cancer

PubMed Central

Hakim, Hana; Flynn, Patricia M.; Knapp, Katherine M.; Srivastava, Deo Kumar; Gaur, Aditya

2009-01-01

Background The etiology, clinical course and outcome of fever and neutropenia (FN) in children with cancer using the current FN guidelines and diagnostic resources in the United States have not been well described. Patients and Methods Medical records of one randomly selected FN episode per patient during 2004–2005 at a pediatric oncology center were reviewed. Patients were managed as per institutional FN guidelines and blood cultures collected in continuously-read BACTEC™ bottles. Results Of 337 FN episodes, infection was proven in 86 (25%) and probable in 75 (22%). 177 episodes (53%) were judged fever of unknown origin (FUO). Bacteremia accounted for most (41) of the proven bacterial episodes, with viridans streptococci (13), Pseudomonas spp (6) and E. coli (6) the most frequently isolated organisms. The median time to positivity of blood cultures was 12 hrs (range 5.4 – 143.7) with 93% positive within 24 hours of incubation. Viral pathogens were identified in 29 (34%) episodes. Compared to other patients, those with FUO had shorter median duration of fever (0.5 vs. 2.0 days; p<0.0001) and hospitalization (3 vs. 6 days; p<0.0001), longer median duration since last chemotherapy (6.0 vs. 4.0 days; p=0.01) and were less likely to have a diagnosis of acute myelogenous leukemia (AML) (11% vs 22%; p=0.009) or develop a clinical complication (5.1% vs 24.4%; p<0.0001). Conclusion Despite currently available diagnostic resources, the majority of patients with FN have FUO marked by a low rate of clinical complications and no infection-related mortality. Emergence of viridans streptococci as the most common blood isolate has affected FN treatment recommendations. Study findings will help further development of strategies for risk stratified management of fever with neutropenia in pediatric patients. PMID:19644403

Use of antibiotics in children younger than two years in eight countries: a prospective cohort study

PubMed Central

Rogawski, Elizabeth T; Platts-Mills, James A; Seidman, Jessica C; John, Sushil; Mahfuz, Mustafa; Ulak, Manjeswori; Shrestha, Sanjaya K; Soofi, Sajid Bashir; Yori, Pablo Penataro; Mduma, Estomih; Svensen, Erling; Ahmed, Tahmeed; Lima, Aldo AM; Bhutta, Zulfiqar A; Kosek, Margaret N; Lang, Dennis R; Gottlieb, Michael; Zaidi, Anita KM; Kang, Gagandeep; Bessong, Pascal O; Houpt, Eric R; Guerrant, Richard L

2017-01-01

Abstract Objective To describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics. Methods Between 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers’ reports at twice-weekly visits over the children’s first two years of life. We estimated the incidence of antibiotic use and the associations of antibiotic use with child and household characteristics. We described treatment patterns for diarrhoea and respiratory illnesses, and identified factors associated with treatment and antibiotic class. Findings Over 1 346 388 total days of observation, 16 913 courses of antibiotics were recorded (an incidence of 4.9 courses per child per year), with the highest use in South Asia. Antibiotic treatment was given for 375/499 (75.2%) episodes of bloody diarrhoea and for 4274/9661 (44.2%) episodes of diarrhoea without bloody stools. Antibiotics were used in 2384/3943 (60.5%) episodes of fieldworker-confirmed acute lower respiratory tract illness as well as in 6608/16742 (39.5%) episodes of upper respiratory illness. Penicillins were used most frequently for respiratory illness, while antibiotic classes for diarrhoea treatment varied within and between sites. Conclusion Repeated antibiotic exposure was common early in life, and treatment of non-bloody diarrhoea and non-specific respiratory illnesses was not consistent with international recommendations. Rational antibiotic use programmes may have the most impact in South Asia, where antibiotic use was highest. PMID:28053364

The influence of comorbid disorders on the episodicity of bipolar disorder in youth.

PubMed

Yen, S; Stout, R; Hower, H; Killam, M A; Weinstock, L M; Topor, D R; Dickstein, D P; Hunt, J I; Gill, M K; Goldstein, T R; Goldstein, B I; Ryan, N D; Strober, M; Sala, R; Axelson, D A; Birmaher, B; Keller, M B

2016-04-01

Bipolar disorder (BP) frequently co-occurs with other psychiatric disorders. We examine whether course of anxiety disorders (ANX), attention deficit hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), and substance use disorders (SUD) influence likelihood of recovery and recurrence of depression and mania in BP youth. Weekly ratings of psychiatric disorder intensity were obtained from 413 participants of the Course and Outcome of BP Youth project, followed for an average of 7.75 years. Multiple-event Cox proportional hazards regression analyses examined worsening of comorbid disorders as predictors of mood episode recovery and recurrence. Increased severity in ANX and SUD predicted longer time to recovery and less time to next depressive episode, and less time to next manic episode. Multivariate models with ANX and SUD found that significant effects of ANX remained, but SUD only predicted longer time to depression recovery. Increased severity of ADHD and DBD predicted shorter time to recurrence for depressive and manic episodes. There are significant time-varying relationships between the course of comorbid disorders and episodicity of depression and mania in BP youth. Worsening of comorbid conditions may present as a precursor to mood episode recurrence or warn of mood episode protraction. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Something is wrong with climate theory.

PubMed

Walker, J C; Sloan, L C

1992-06-01

We frequently forget that there is more to science than the making of a more precise measurement or a more elaborate calculation. It is even more than applying to new problems the methods that worked on old problems. These activities, which keep most of us busy most of the time, are important, but the new and unexpected discoveries are more important. And many radically new discoveries arise from scientific puzzles, the "anomalies." We believe that studies of past climates have exposed an anomaly that deserves attention and that may result in a fundamentally new understanding of the climate system. The poles have been much warmer throughout much of Earth's history than they are now. Ice-age episodes with durations of millions of years have been separated by periods of hundreds of millions of years that have left little or no evidence of polar ice sheets. The data are best for the most recent of these ice-free episodes so we will concentrate on the Eocene.

Ibuprofen for acute treatment of episodic tension-type headache in adults.

PubMed

Derry, Sheena; Wiffen, Philip J; Moore, R Andrew; Bendtsen, Lars

2015-07-31

Tension-type headache (TTH) affects about one person in five worldwide. It is divided into infrequent episodic TTH (fewer than one headache per month), frequent episodic TTH (1 to 14 headaches per month), and chronic TTH (15 headaches a month or more). Ibuprofen is one of a number of analgesics suggested for acute treatment of headaches in frequent episodic TTH. To assess the efficacy and safety of oral ibuprofen for treatment of acute episodic TTH in adults. We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, and our own in-house database to January 2015. We sought unpublished studies by asking personal contacts and searching on-line clinical trial registers and manufacturers' websites. We included randomised, placebo-controlled studies (parallel-group or cross-over) using oral ibuprofen for symptomatic relief of an acute episode of TTH. Studies had to be prospective and include at least 10 participants per treatment arm. Two review authors independently assessed studies for inclusion, and extracted data. Numbers of participants achieving each outcome were used to calculate risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or number needed to treat for an additional harmful outcome (NNH) of oral ibuprofen compared to placebo for a range of outcomes, predominantly those recommended by the International Headache Society (IHS). We included 12 studies, all of which enrolled adult participants with frequent episodic TTH. Nine used the IHS diagnostic criteria, but two used the older classification of the Ad Hoc Committee, and one did not describe diagnostic criteria but excluded participants with migraines. While 3094 people with TTH participated in these studies, the numbers available for any form of analysis were lower than this; placebo was taken by 733, standard ibuprofen 200 mg by 127, standard ibuprofen 400 mg by 892, and fast-acting ibuprofen 400 mg by 230. Participants had moderate or severe pain at the start of treatment. Other participants were either in studies not reporting outcomes we could analyse, or were given one of several active comparators in single studies.For the IHS-preferred outcome of being pain free at 2 hours the NNT for ibuprofen 400 mg (all formulations) compared with placebo was 14 (95% confidence interval (CI), 8.4 to 47) in four studies, with no significant difference from placebo at 1 hour (moderate quality evidence). The NNT was 5.9 (4.2 to 9.5) for the global evaluation of 'very good' or 'excellent' in three studies (moderate quality evidence). No study reported the number of participants experiencing no worse than mild pain at 1 or 2 hours. The use of rescue medication was lower with ibuprofen 400 mg than with placebo, with the number needed to treat to prevent one event (NNTp) of 8.9 (5.6 to 21) in two studies (low quality evidence).Adverse events were not different between ibuprofen 400 mg and placebo; RR 1.1 (0.64 to 1.7) (high-quality evidence). No serious adverse events were reported. Ibuprofen 400 mg provides an important benefit in terms of being pain free at 2 hours for a small number of people with frequent episodic tension-type headache who have an acute headache with moderate or severe initial pain. There is no information about the lesser benefit of no worse than mild pain at 2 hours.

Internet Searching About Disease Elicits a Positive Perception of Own Health When Severity of Illness Is High: A Longitudinal Questionnaire Study

PubMed Central

Greving, Hannah

2016-01-01

Background The Internet is one of the primary sources for health information. However, in research, the effects of Internet use on the perception of one’s own health have not received much attention so far. Objective This study tested how Internet use for acquiring health information and severity of illness influence patients with a chronic disease with regard to the perception of their own health. Negative psychological states are known to lead to preferential processing of positive information. In particular, the self-directed nature of Internet use provides room for such biases. Therefore, we predicted that patients experiencing negative health states more frequently, due to more frequent episodes of a chronic illness, will gain a more positive perception of their health if they use the Internet frequently to gain health information, but not if they use the Internet rarely. This effect was not expected for other sources of information. Methods A longitudinal questionnaire study with two measurement points—with a 7-month time lag—tested the hypothesis in a sample of patients with chronic inflammatory bowel disease (n=208). This study assessed patients’ frequency of Internet use, their participation in online social support groups, their use of other sources of health information, and several indicators of the participants’ perceptions of their own health. A structure equation model (SEM) was used to test the predictions separately for Internet searches and other sources of information. Results Data analysis supported the prediction; the interaction between frequency of health-related information searches and frequency of episodes at the first measurement point (T1) was related to participants’ positive perceptions of their own health at the second measurement point (T2) (B=.10, SE=.04, P=.02) above and beyond the perceptions of their own health at T1. When participants used the Internet relatively rarely (-1 SD), there was no relationship between frequency of episodes and positive perceptions of their own health (B=-.11, SE=.14, t 203=-0.82, P=.41). In contrast, when participants used the Internet relatively often (+1 SD), the more frequently they had those episodes the more positive were the perceptions of their own health (B=.36, SE=.15, t 203=2.43, P=.02). Additional SEM analyses revealed that this effect occurs exclusively when information is searched for on the Internet, but not when other sources of information are consulted, nor when online social support groups are joined. Conclusions The results of this study suggest that patients might process information from the Internet selectively, in an unbalanced, biased fashion, with the formation of a self-serving (ie, positive) perception of own health. At the same time, this bias contributes to the ability of patients to cope psychologically with their disease. PMID:26944335

[Study of etiologic factors of infectious diseases of respiratory tract in school-age children during period of remission of a respiratory disease].

PubMed

Maĭorov, R V; Chereshneva, M V; Chereshnev, V A

2013-01-01

Detect features of microflora of upper respiratory tract on the example of flora of palatine tonsils and level of antibodies against intracellular parasites as markers of etiologic factors of respiratory infections in school-age children in remission period. 466 children from frequently and episodically ill groups were examined. Bacteriologic study of smears from the surface of palatine tonsils was carried out in all the children. By using EIA with the corresponding commercial test systems IgG level against Herpes simplex virus, Cytomegalovirus, Chlamydophila pneumoniae, Mycoplasma pneumoniae, Human respiratory syncytial virus was determined in blood sera according to instruction manual. During remission period of infectious process in the structure of microflora of upper respiratory tract in frequently ill children characteristic differences from their episodically ill peers were detected. In children with frequent respiratory infections a higher occurrence of antibodies against intracellular causative agents of these diseases was also detected. In the group of frequently ill, a direct correlation between frequency of infectious diseases of respiratory tract and occurrence of carriage of pathogenic and opportunistic microorgan isms as well as increase of antibodies against Herpesviridae, Cytomegalovirus, C. pneumoniae and M. pneumoniae was detected. Higher occurrence ofintra- and extra-cellular infectious agents as well as their associations may be considered as one of the reasons of insufficient effectiveness of prophylaxis measures in frequently ill children.

Chronic Daily Headache: Mechanisms and Principles of Management.

PubMed

Voigt, Amy W; Gould, Harry J

2016-02-01

Primary headache is a common malady that is often under-recognized and frequently inadequately managed in spite of the fact that it affects up to 95 % of the population in a lifetime. Many forms of headache, including episodic tension and migraine headaches, if properly diagnosed, are reasonably amenable to treatment, but a smaller, though not insignificant, percent of the population suffer daily from a chronic, intractable form of headache that destroys one's productivity and quality of life. These patients are frequently seen in neurological practices at a point when treatment options are limited and largely ineffective. In the following review, we will discuss mechanisms drawn from recent studies that address the transition from acute to chronic pain that may apply to the transformation from episodic to chronic daily headaches which may offer opportunities for preempting headache transformation.

Intraoperative pulse oximetry: frequency and distribution of discrepant data.

PubMed

Pan, P H; Gravenstein, N

1994-01-01

To determine the types of discrepant data during intraoperative pulse oximetry and their frequency and duration. Prospective study. University medical center. 46 consecutive ASA physical status I-III patients undergoing general anesthesia for elective surgical operations. With an integrated computer algorithm on the pulse oximeter and another computer linked to it, data were screened and the frequency and distribution of the following oximeter signals recorded: absent; low quality or interrupted, as detected by the pulse oximeter algorithm; nonphysiologic, identified by the personal computer as a heart rate change greater than 10 beats per minute within 2 consecutive 2-second samples, with no similar abrupt change reported simultaneously on ECG. The number of episodes per hour of discrepant oximeter data and the duration of the episodes were recorded by phase of anesthesia: induction, maintenance, and emergence. Discrepant data occurred most frequently and lasted longest during emergence (p < 0.05); the majority of episodes of discrepant data during emergence lasted less than 12 seconds. Excluding discrepant data that lasted less than 12 seconds decreased the frequency of discrepant data by 63% and excluding those that lasted less than 30 seconds decreased the frequency of discrepant data by 93%. Pulse oximeters frequently report discrepant data intraoperatively, most frequently during emergence from anesthesia. An alarm delay triggered by discrepant data and lasting 12 to 30 seconds would keep most discrepant data from becoming false alarms and, thus, may reduce distracting sound pollution in the operating room.

Differential effects of sex on substance use between first episode psychosis patients and healthy people.

PubMed

Núñez, Christian; Ochoa, Susana; Huerta-Ramos, Elena; Baños, Iris; Barajas, Ana; Dolz, Montserrat; Sánchez, Bernardo; Del Cacho, Núria; Usall, Judith

2016-08-01

Substance use in psychosis is an important field of study given that it can be a risk factor for the development of psychosis and can give rise to psychotic symptoms. Studies of substance use in first episode psychosis patients do not frequently assess non-pathological substance consumption among patients, but rather the prevalence of substance abuse or dependence disorders. Moreover, most of these studies do not address the effects of sex in sufficient depth, and the consumption of caffeine or tobacco, which are two of the most frequently used substances, is often not assessed. The aim of this study was to compare patterns and quantities of substance use between first episode psychosis patients and healthy controls and between men and women, and explore the potential interactive effects between group (patients or controls) and sex. A total of 158 participants (82 first episode psychosis patients and 76 healthy controls) were included in the study. Both adults and adolescents were included in the study. Frequency and amount of use of caffeine, tobacco, alcohol, cannabis, cocaine, hallucinogens, stimulants, and opiates were gathered. A significant main effect of sex was found for the frequency of use of tobacco (p=.050). Main effects of group were found for the quantity of tobacco (p<.001) and cannabis (p<.001) consumed, as well as main effects of sex for the quantity of alcohol (p=.003) and cannabis (p=.017) consumed. There were also interaction effects between group and sex for the frequency of use of tobacco (p=.005) and cannabis (p=.009), and for the amount of cannabis consumed (p=.049). Qualitative differences between males and females regarding combined substance use are also reported. Among patients, men used tobacco more frequently than women, but this sex difference was not the same for the control group, in which women smoked more often than men. Regarding cannabis, men smoked cannabis more frequently and in larger amounts than women, but only in the patients group, whereas no sex differences for cannabis were found for the controls. Main effects of group and sex for tobacco and alcohol, as well as the lack of differences for the frequency and amount of use of caffeine, are also commented. This is the first study to assess the different effects of sex on substance use in first episode psychosis patients and healthy controls. Copyright © 2016 Elsevier Inc. All rights reserved.

Method Choice in Nonfatal Self-Harm as a Predictor of Subsequent Episodes of Self-Harm and Suicide: Implications for Clinical Practice

PubMed Central

Hempstead, Katherine; Nguyen, Tuan; Barber, Catherine; Rosenberg-Wohl, Sarah; Azrael, Deborah

2013-01-01

Objectives. We examined time-varying and time-invariant characteristics of nonfatal intentional self-harm episodes in relation to subsequent episodes of self-harm and suicide. Methods. We conducted a follow-up cohort study through 2007 of 3600 patients discharged from hospitals in New Jersey with a primary diagnosis of intentional self-harm in 2003. We determined repetition of self-harm from hospital records and suicide from state registers. Results. Use of methods other than drug overdose and cutting in self-harm events, greater medical severity of nonfatal episodes, and a history of multiple self-harm episodes increased the risk of suicide. However, most suicides occurred without these risk factors. Most suicides took place without intervening episodes of self-harm, and most persons used a low-lethality method (drug overdose or cutting) in their index episode, but switched to a more lethal method in their fatal episode. Conclusions. Our findings suggest that preventing suicide among persons with a history of self-harm must account for the possibility that they will adopt methods with higher case-fatality ratios than they previously tried. PMID:23597351

Is colchicine more effective to prevent periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis episodes in Mediterranean fever gene variants?

PubMed

Gunes, Muhammed; Cekic, Sukru; Kilic, Sara Sebnem

2017-06-01

Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is the most frequent repetitive fever syndrome in childhood. It is characterized by fever episodes lasting for approximately 3-6 days, once every 3-8 weeks. Clinical and laboratory data for PFAPA syndrome patients between January 2010 and December 2014 followed up at a tertiary pediatric care hospital were reviewed. Four hundred children (256 male, 144 female; mean age at diagnosis, 4.2 ± 2.2 years), were enrolled in the study. During the episodes, mean leukocyte number was high (12 725/mm 3 ) with predominant neutrophils. The mean number of monocytes was 1256/mm 3 , and 90.2% had monocytosis. Serum amyloid A and C-reactive protein were high in 84.6% and in 77.8% of the patients, respectively. Mediterranean fever (MEFV) gene heterozygous mutation was identified in 57 of the 231 patients (24.7%) in whom genetic analysis had been performed. The most frequent mutation was heterozygous M694V (10%, n = 23). Extension of between-episode interval following prophylaxis was noted in 85% of those on regular colchicine treatment (n = 303). In the colchicine group, between-episode interval was prolonged from 18.8 ± 7.9 days (before colchicine treatment) to 49.5 ± 17.6 days on prophylactic colchicine therapy; also, prophylactic treatment was more effective in reducing episode frequency in patients with MEFV gene variant (n = 54, 96%) than in those without (n = 122, 80%; P = 0.003). This study has involved the largest number of PFAPA syndrome patients in the literature. It is particularly important to assess and to demonstrate the high rate of response to colchicine prophylaxis in PFAPA syndrome patients, especially those with MEFV variant. On blood screening, neutrophilia associated with monocytosis and low procalcitonin could contribute to diagnosis. © 2017 Japan Pediatric Society.

Injuries from combat explosions in Iraq: injury type, location, and severity.

PubMed

Eskridge, Susan L; Macera, Caroline A; Galarneau, Michael R; Holbrook, Troy L; Woodruff, Susan I; MacGregor, Andrew J; Morton, Deborah J; Shaffer, Richard A

2012-10-01

Explosions have caused a greater percentage of injuries in Iraq and Afghanistan than in any other large-scale conflict. Improvements in body armour and field medical care have improved survival and changed the injury profile of service personnel. This study's objective was to determine the nature, body region, and severity of injuries caused by an explosion episode in male service personnel. A descriptive analysis was conducted of 4623 combat explosion episodes in Iraq between March 2004 and December 2007. The Barell matrix was used to describe the nature and body regions of injuries due to a combat explosion. A total of 17,637 International Classification of Diseases, Ninth Revision (ICD-9) codes were assigned to the 4623 explosion episodes, with an average of 3.8 ICD-9 codes per episode. The most frequent single injury type was a mild traumatic brain injury (TBI; 10.8%). Other frequent injuries were open wounds in the lower extremity (8.8%) and open wounds of the face (8.2%), which includes tympanic membrane rupture. The extremities were the body regions most often injured (41.3%), followed by head and neck (37.4%) and torso (8.8%). The results of this study support previous observations of TBI as a pre-eminent injury of the wars in Iraq and Afghanistan, with mild TBI as the most common single injury in this large cohort of explosion episodes. The extremities had the highest frequency of injuries for any one body region. The majority of the explosion episodes resulted in more than one injury, and the variety of injuries across nearly every body region and injury type suggests a complex nature of explosion injuries. Understanding the constellation of injuries commonly caused by explosions will assist in the mitigation, treatment, and rehabilitation of the effects of these injuries. Copyright © 2012 Elsevier Ltd. All rights reserved.

Nicorandil Versus Nitroglycerin for Symptomatic Relief of Angina in Patients With Slow Coronary Flow Phenomenon: A Randomized Clinical Trial.

PubMed

Sani, Hashem Danesh; Eshraghi, Ali; Nezafati, Mohammad Hassan; Vojdanparast, Mohammad; Shahri, Bahram; Nezafati, Pouya

2015-07-01

Patients with the coronary slow flow phenomenon frequently experience angina episodes. The present study aimed to compare the efficacy of nicorandil versus nitroglycerin for alleviation of angina symptoms in slow flow patients. In a single-center, single-blind, parallel-design, comparator-controlled, randomized clinical trial (NCT02254252), 54 patients with slow flow and normal or near-normal coronary angiography who presented with frequent angina episodes were randomly assigned to 1-month treatment with nicorandil 10 mg, 2 times a day (n = 27) or sustained-release glyceryltrinitrate 6.4 mg 2 times a day (n =27). Frequency of angina episodes, pain intensity, and the Canadian Cardiovascular Society (CCS) grading of angina pectoris were assessed at baseline and after 1 month of treatment. In all, 25 patients in the nicorandil arm and 24 patients in the nitroglycerin arm were analyzed. After 1 month, patients treated with nicorandil had fewer angina episodes (adjusted mean number of episodes per week, nicorandil versus nitroglycerin; 1.68 ± 0.15 vs 2.29 ± 0.15, P = .007, effect size = 14.6%). Patients also reported greater reductions in pain intensity with nicorandil versus nitroglycerin (adjusted mean of self-reported pain score; 3.03 ± 0.29 vs 3.89 ± 0.30, P = .046, effect size = 8.4%). A significantly higher proportion of patients in the nicorandil arm were categorized in CCS class I (76% vs 33.3%, P = .004) or class II (16.0% vs 45.8%, P = .032). In slow flow patients, nicorandil provides better symptomatic relief of angina than nitroglycerin. © The Author(s) 2015.

Pain in Sleepwalking: A Clinical Enigma

PubMed Central

Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

2015-01-01

Study Objectives: Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. Design: Cross-sectional case-control study. Setting: Data were collected at the Sleep Disorders Center, Montpellier, France. Participants: One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. Measurements and Results: Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. Conclusion: Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive dysregulation. Citation: Lopez R, Jaussent I, Dauvilliers Y. Pain in sleepwalking: a clinical enigma. SLEEP 2015;38(11):1693–1698. PMID:25902807

Pain in Sleepwalking: A Clinical Enigma.

PubMed

Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

2015-11-01

Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. Cross-sectional case-control study. Data were collected at the Sleep Disorders Center, Montpellier, France. One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive dysregulation. © 2015 Associated Professional Sleep Societies, LLC.

Patterns of care received by Medicaid recipients with urinary tract infections.

PubMed

Fargason, C A; Bronstein, J M; Johnson, V A

1995-10-01

Urinary tract infections (UTIs) occur commonly in children and may lead to substantial morbidity. Most experts recommend urine cultures for diagnosing UTIs in children. In addition, most experts recommend imaging studies in a portion of children diagnosed with UTIs. The purpose of this study was to assess how rates of performance of urine cultures and imaging studies for children in the Alabama Medicaid program diagnosed with a UTI vary by patient demographics, provider characteristics, and service locations. The study design was a retrospective review of Alabama Medicaid claims data. Children were included as UTI cases if they had a Medicaid claim for urinary tract infections during 1991, were continuously enrolled in Medicaid for that year, and were younger than 8 years of age. Claims were grouped into episodes of care, and episodes were assigned to a diagnosing physician. Physician locations were classified as rural, suburban, or urban using demographic data. Specific laboratory and imaging procedures were identified using CPT codes (Physician's Current Procedural Technology Codes, 4th Edition). We identified 404 episodes of UTI occurring in 380 children. Only 47% of episodes were associated with claims for urine cultures. Claims for urine cultures were more frequently filed by pediatricians in urban locations. In the subset of 114 patients with multiple UTI episodes, only 68% had imaging studies specific for the urinary tract. Only 44% received both a voiding cystourethrogram and renal ultrasound. Claims data suggest that physicians underuse urine cultures in diagnosing UTIs in Alabama pediatric Medicaid recipients. Urban-based pediatricians perform better than other types of physicians. Imaging studies are also used less frequently than is commonly recommended.

Familial Kleine-Levin Syndrome: A Specific Entity?

PubMed

Nguyen, Quang Tuan Remy; Groos, Elisabeth; Leclair-Visonneau, Laurène; Monaca-Charley, Christelle; Rico, Tom; Farber, Neal; Mignot, Emmanuel; Arnulf, Isabelle

2016-08-01

Kleine-Levin syndrome (KLS) is a rare, mostly sporadic disorder, characterized by intermittent episodes of hypersomnia plus cognitive and behavior disorders. Although its cause is unknown, multiplex families have been described. We contrasted the clinical and biological features of familial versus sporadic KLS. Two samples of patients with KLS from the United States and France (n = 260) were studied using clinical interviews and human leukocyte antigen (HLA) genotyping. A multiplex family contained two or more first- or second-degree affected relatives (familial cases). Twenty-one patients from 10 multiplex families (siblings: n = 12, including two pairs of monozygotic twins; parent-child: n = 4; cousins: n = 2; uncle-nephews: n = 3) and 239 patients with sporadic KLS were identified, yielding to 4% multiplex families and 8% familial cases. The simplex and multiplex families did not differ for autoimmune, neurological, and psychiatric disorders. Age, sex ratio, ethnicity, HLA typing, karyotyping, disease course, frequency, and duration of KLS episodes did not differ between groups. Episodes were less frequent in familial versus sporadic KLS (2.3 ± 1.8/y versus 3.8 ± 3.7/y, P = 0.004). Menses triggered more frequently KLS onset in the nine girls with familial KLS (relative risk, RR = 4.12, P = 0.03), but not subsequent episodes. Familial cases had less disinhibited speech (RR = 3.44, P = 0.049), less combined hypophagia/hyperphagia (RR = 4.38, P = 0.006), more abrupt termination of episodes (RR = 1.45, P = 0.04) and less postepisode insomnia (RR = 2.16, P = 0.008). There was similar HLA DQB1 distribution in familial versus sporadic cases and no abnormal karyotypes. Familial KLS is mostly present in the same generation, and is clinically similar to but slightly less severe than sporadic KLS. © 2016 Associated Professional Sleep Societies, LLC.

Continuous determination of blood glucose in children admitted with malaria in a rural hospital in Mozambique.

PubMed

Madrid, Lola; Sitoe, Antonio; Varo, Rosauro; Nhampossa, Tacilta; Lanaspa, Miguel; Nhama, Abel; Acácio, Sozinho; Riaño, Isolina; Casellas, Aina; Bassat, Quique

2017-05-02

Hypoglycaemia is a frequent complication among admitted children, particularly in malaria-endemic areas. This study aimed to estimate the occurrence of hypoglycaemia not only upon admission but throughout the first 72 h of hospitalization in children admitted with malaria. A simple pilot study to continuously monitor glycaemia in children aged 0-10 years, admitted with malaria in a rural hospital was conducted in Southern Mozambique by inserting continuous glucose monitors (CGMs) in subcutaneous tissue of the abdominal area, producing glycaemia readings every 5 min. Glucose was continuously monitored during a mean of 48 h, in 74 children. Continuous measurements of blood glucose were available for 72/74 children (97.3%). Sixty-five of them were admitted with density-specific malaria diagnosis criteria (17 severe, 48 uncomplicated). Five children (7.7%) had hypoglycaemia (<54 mg/dL) on admission as detected by routine capillary determination. Analysing the data collected by the CGMs, hypoglycaemia episodes (<54 mg/dL) were detected in 10/65 (15.4%) of the children, of which 7 (10.8%) could be classified as severe (≤45 mg/dL). No risk factors were independently associated with the presence of at least one episode of hypoglycaemia (<54 mg/dL) during hospitalization. Only one death occurred among a normoglycaemic child. All episodes of hypoglycaemia detected by CGMs were subclinical episodes or not perceived by caregivers or clinical staff. Hypoglycaemia beyond admission in children with malaria appears to be much more frequent than what had been previously described. The clinical relevance of these episodes of hypoglycaemia in the medium or long term remains to be determined.

Is reactivation of toxoplasmic retinochoroiditis associated to increased annual rainfall?

PubMed Central

Rudzinski, Marcelo; Meyer, Alejandro; Khoury, Marina; Couto, Cristóbal

2013-01-01

Background: Reactivation of toxoplasmic retinochoroiditis is the most frequent form of uveitis in Misiones, Argentina. Fluctuations in the number of patients consulting with this type of uveitis were detected during the last decade. Since the province was consecutively exposed to rainy and dry periods over the last years, we decided to explore whether a relationship between reactivation of toxoplasmic retinochoroiditis and rain might be established according to the data registered during the 2004–2010 period. Results: The frequency of toxoplasmic reactivation episodes increases when precipitation increases (mostly in second and fourth trimesters of each year). Analysis of the independent variables demonstrates that precipitation is a significant predictor of the frequency of reactivation episodes. Although registered toxoplasmic reactivations were more frequent during the third trimester of the year, the association between the third trimester and the reactivation episodes did not reach statistical significance. Conclusion: Prolonged and intense rainfall periods were significantly associated with the reactivation of toxoplasmic retinochoroiditis. Changes promoted by this climatic condition on both the parasite survival in the soil as well as a putative effect on the host immune response due to other comorbidities are discussed. PMID:24225023

Assessing the calorific significance of episodes of human cannibalism in the Palaeolithic

PubMed Central

Cole, James

2017-01-01

Episodes of Palaeolithic cannibalism have frequently been defined as ‘nutritional’ in nature, but with little empirical evidence to assess their dietary significance. This paper presents a nutritional template that offers a proxy calorie value for the human body. When applied to the Palaeolithic record, the template provides a framework for assessing the dietary value of prehistoric cannibalistic episodes compared to the faunal record. Results show that humans have a comparable nutritional value to those faunal species that match our typical body weight, but significantly lower than a range of fauna often found in association with anthropogenically modified hominin remains. This could suggest that the motivations behind hominin anthropophagy may not have been purely nutritionally motivated. It is proposed here that the comparatively low nutritional value of hominin cannibalism episodes support more socially or culturally driven narratives in the interpretation of Palaeolithic cannibalism. PMID:28383521

Signs and Symptoms of a Bleeding Disorder in Women

MedlinePlus

... heavy bleeding after dental surgery, other surgery, or childbirth. I have experienced prolonged bleeding episodes that might ... a result of: Dental surgery, other surgery, or childbirth; Frequent nose bleeds (longer than 10 minutes); Bleeding ...

Frequent sleep-related bitemporal focal seizures in transient epileptic amnesia syndrome: Evidence from ictal video-EEG.

PubMed

Burkholder, David B; Jones, Amy L; Jones, David T; Fabris, Rachel R; Britton, Jeffrey W; Lagerlund, Terrence D; So, Elson L; Cascino, Gregory D; Worrell, Gregory A; Shin, Cheolsu; St Louis, Erik K

2017-06-01

Two patients who shared similar presenting clinical features of anterograde and retrograde autobiographical amnesia typical of transient epileptic amnesia (TEA) underwent prolonged video electroencephalogram (VEEG) monitoring and were found to have sleep-activated epileptiform activity and frequent subclinical bitemporal seizures predominantly during sleep. Case 1 is a 59-year-old woman whose presenting complaint was memory impairment. Over 18 months, she had three distinct 8-h-long episodes of confusion and disorientation with persistent anterograde and retrograde autobiographical amnesia. VEEG recorded frequent interictal bitemporal sharp waves confined to sleep, and 14 subclinical seizures, also mostly during sleep. Case 2 is a 50-year-old woman with known focal epilepsy also presented with memory complaints. Over the course of 1 year, she had two discrete 2-h-long episodes of amnesia, with ongoing anterograde and retrograde autobiographical amnesia. VEEG recorded independent bitemporal sharp waves, and 14 subclinical seizures during sleep and drowsiness. Memory impairment improved in both patients with successful treatment of their seizures. Although the etiology of accelerated long-term forgetting (ALF) and remote memory impairment (RMI) in transient epileptic amnesia (TEA) is unknown, these cases suggest frequent sleep-related seizures may contribute, and they highlight the importance of video-EEG monitoring.

Distinctions of bipolar disorder symptoms in adolescence.

PubMed

Gudiene, Devika; Leskauskas, Darius; Markeviciūte, Aurelija; Klimavicius, Dalius; Adomaitiene, Virginija

2008-01-01

Bipolar disorder in adolescents is a serious mental illness with problematic diagnosis that adversely affects social, academic, emotional, and family functioning. The objective of this study was to analyze features of premorbid and clinical symptoms, comorbidity, and course of bipolar disorder in adolescence. Data for analysis were collected from all case histories (N=6) of 14-18-year-old patients, hospitalized with diagnosis of bipolar disorder in the Unit of Children's and Adolescents' Psychiatry, Department of Psychiatry, Hospital of Kaunas University of Medicine, during the period from 2000 to 2005. Analysis of bipolar disorder course showed that five patients previously had been diagnosed with an episode of depression. The most frequent symptoms typical to bipolar disorder were disobedience and impulsive behavior, rapid changes of mood. The most common premorbid features were frequent changes of mood, being active in communication, hyperactive behavior. Adolescence-onset bipolar disorder was frequently comorbid with emotionally instable personality disorder, borderline type. Findings of the study confirm the notion that oppositional or impulsive behavior, rapid changes of mood without any reason, dysphoric mood and euphoric mood episodes with increased energy were cardinal symptoms of bipolar disorder with mania in adolescents. Most frequent premorbid features of these patients were quite similar to attention-deficit/hyperactivity disorder making differential diagnosis problematic.

The number of past manic episodes is the best predictor of antidepressant-emergent manic switch in a cohort of bipolar depressed patients.

PubMed

Gorwood, Philip; Richard-Devantoy, Stéphane; Sentissi, Othman; Le Strat, Yann; Olié, Jean Pierre

2016-06-30

The present study sought to identify factors associated with the onset of a manic or hypomanic episode during the month following a new antidepressant therapy in depressed bipolar patients. Patients receiving mood stabilizers for ≥3 months were screened from 400 French centers and were assessed for a 4-week period following prescription of a first or a new antidepressant. Of the 1242 included participants, 4.8% (n=60) experienced antidepressant-emergent manic switch (AEMS). AEMS was more frequently associated with lifetime manic, depressive, and total mood episodes, and with past AEMS. A higher score at two items of the Montgomery-Åsberg Depression Rating Scale (pessimistic and suicidal thoughts) were significantly associated with AEMS. Logistic regression analysis showed that the number of lifetime manic episodes and past AEMS were the two most factors associated with an AEMS. Having more than four past manic episodes was associated with a 2.84 fold increased risk of AEMS. Cumulative number of past mood episodes seems to be the most important factor for switching to a manic episode following antidepressants in patients with bipolar disorder. Longer-term studies are required to further delineate antidepressant causality from natural disease course. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Bacteremia and fungemia in pediatric versus adult cancer patients after chemotherapy: comparison of etiology, risk factors and outcome.

PubMed

Krupova, I; Kaiserova, E; Foltinova, A; Kovacicova, G; Kiskova, M; Krchnakova, A; Kunova, A; Trupl, J; West, D; Krcmery, V

1998-06-01

One hundred and eighteen (118) episodes of bacteremia and fungemia in children with cancer were compared to 401 episodes of bacteremia and fungemia in adults with cancer to assess differences in etiology, risk factors and outcome. A retrospective univariate analysis was performed of all episodes of bacteremia in national pediatric and adult cancer institutions appearing in 1990-1996. A total of 519 episodes of bacteremia were assessed and compared. Both cancer centers differed in prophylactic antibiotic policies. About 50% of adults but less than 5% of children received quinolone prophylaxis during neutropenia, even though the empiric antibiotic therapeutic strategy was similar. There were differences in etiology between the groups: staphylococci and Stenotrophomonas maltophilia were more frequently observed in children (P<0.01), Pseudomonas aeruginosa and Acinetobacter spp. in adults (P<0.05). Gram-positive bacteremia was surprisingly more commonly observed in adults (65.7% vs 33.3%, P<0.01). Mixed polymicrobial bacteremia occurred more commonly in adults (31.8% vs 7.6%, P<0.001) than in children. Analysis of risk factors did not observe differences in risk factors except for underlying disease (acute leukemia was more frequently observed in children -48.3% vs adults 33.7%, P<0.05 and prophylaxis: (prior prophylaxis with quinolones was more common in adults (47.5%) than in children (2.5%) P<0.0001). Overall and attributable mortality in pediatric bacteremia was significantly lower than in adults (P<0.03).

Cyst infection in autosomal dominant polycystic kidney disease: causative microorganisms and susceptibility to lipid-soluble antibiotics.

PubMed

Suwabe, T; Araoka, H; Ubara, Y; Kikuchi, K; Hazue, R; Mise, K; Hamanoue, S; Ueno, T; Sumida, K; Hayami, N; Hoshino, J; Imafuku, A; Kawada, M; Hiramatsu, R; Hasegawa, E; Sawa, N; Takaichi, K

2015-07-01

Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD). Lipid-soluble antibiotics like fluoroquinolones show good penetration into cysts and are recommended for cyst infection, but causative microorganisms are often resistant to these agents. This study investigated the profile of the microorganisms causing cyst infection in ADPKD, their susceptibility to lipid-soluble antibiotics, and clinical outcomes. This retrospective study reviewed all ADPKD patients admitted to Toranomon Hospital with a diagnosis of cyst infection from January 2004 to March 2014. All patients who underwent cyst drainage and had positive cyst fluid cultures were enrolled. Patients with positive blood cultures who satisfied our criteria for cyst infection or probable infection were also enrolled. There were 99 episodes with positive cyst fluid cultures and 93 episodes with positive blood cultures. The majority of patients were on dialysis. The death rate was high when infection was caused by multiple microorganisms or when there were multiple infected cysts. Gram-negative bacteria accounted for 74-79 % of the isolates in all groups, except for patients with positive hepatic cyst fluid cultures. The susceptibility of Escherichia coli to fluoroquinolones was very low in patients with hepatic cyst infection, especially those with frequent episodes and those with hepatomegaly. Fungi were detected in two episodes. Fluoroquinolone-resistant microorganisms showed a high prevalence in cyst infection. It is important to identify causative microorganisms to avoid the overuse of fluoroquinolones and to improve the outcome of cyst infection in ADPKD.

Retrograde Amnesia for Episodic and Semantic Memories in Amnestic Mild Cognitive Impairment.

PubMed

De Simone, Maria Stefania; Fadda, Lucia; Perri, Roberta; De Tollis, Massimo; Aloisi, Marta; Caltagirone, Carlo; Carlesimo, Giovanni Augusto

2017-01-01

Retrograde amnesia (RA), which includes loss of memory for past personal events (autobiographical RA) and for acquired knowledge (semantic RA), has been largely documented in patients with amnestic mild cognitive impairment (aMCI). However, previous studies have produced controversial results particularly concerning the temporal extent of memory impairment. Here we investigated whether, with the onset of hippocampal pathology, age of memory acquisition and retrieval frequency play different roles in modulating the progressive loss of semantic and episodic contents of retrograde memory respectively. For this purpose, aMCI patients and healthy controls were tested for the ability to recall semantic and autobiographical information related to famous public events as a function of both age of acquisition and retrieval frequency. In aMCI patients, we found that the impairment in recollecting past personal incidents was modulated by the combined action of memory age and retrieval frequency, because older and more frequently retrieved episodes are less susceptible to loss than more recent and less frequently retrieved ones. On the other side, we found that the loss of semantic information depended only on memory age, because the remoteness of the trace allows for better preservation of the memory. Our results provide evidence that the loss of the two components of retrograde memory is regulated by different mechanisms. This supports the view that diverse neural mechanisms are involved in episodic and semantic memory trace storage and retrieval, as postulated by the Multiple Trace Theory.

Orthostatic hypotension as an unusual clinical manifestation of pheochromocytoma: a case report.

PubMed

Bortnik, Miriam; Occhetta, Eraldo; Marino, Paolo

2008-08-01

Pheochromocytoma is a rare endocrine tumor which can have a highly variable presentation related to increased catecholamine secretion. We report the case of a 74-year-old man in whom recurrent episodes of syncope due to orthostatic hypotension were the only clinical manifestations of this challenging entity. Diagnosis of pheochromocytoma was achieved by biochemical test samples and computed tomography scans. Surgical excision of the tumor resulted in clinical improvement with normalization of catecholamine concentrations and no more episodes of orthostatic hypotension during a follow-up of 24 months. Although rare, pheochromocytoma may frequently cause disorders of orthostatic tolerance; because of its meaningful implications, screening for this entity should be considered in case of recurrent syncopal episodes due to new-onset orthostatic hypotension.

How do frequent users of crisis helplines differ from other users regarding their reasons for calling? Results from a survey with callers to Lifeline, Australia's national crisis helpline service.

PubMed

Middleton, Aves; Woodward, Alan; Gunn, Jane; Bassilios, Bridget; Pirkis, Jane

2017-05-01

Crisis helplines are designed to provide short-term support to people in an immediate crisis. However, there is a group of users who call crisis helplines frequently over an extended period of time. The reasons for their ongoing use remain unclear. The aim of this study was to investigate the differences in the reasons for calling between frequent and other users of crisis helplines. This was achieved by examining the findings from a brief survey completed by callers to Lifeline Australia at the end of their call between February and July 2015. In the survey, callers reported on their socio-demographics, reasons for their current call and number of calls made in the past month. Survey respondents were categorised as frequent, episodic and one-off users, and analyses were conducted using ordered logistic regression. Three hundred and fifteen callers completed the survey, which represented 57% of eligible callers. Twenty-two per cent reported calling 20 times or more in the past month (frequent users), 51% reported calling between 2 and 19 times (episodic users) and 25% reported calling once (one-off users). Two per cent were unable to recall the number of calls they made in the past month. Frequent users reported similar reasons for calling as other users but they were more likely to call regularly to talk about their feelings [OR = 6.0; 95% CI: 3.7-9.8]. This pattern of service use is at odds with the current model of care offered by crisis helplines which is designed to provide one-off support. There is a need to investigate further the factors that drive frequent users to call crisis helplines regularly. © 2016 John Wiley & Sons Ltd.

Manic symptoms and impulsivity during bipolar depressive episodes

PubMed Central

Swann, Alan C; Moeller, F Gerard; Steinberg, Joel L; Schneider, Laurie; Barratt, Ernest S; Dougherty, Donald M

2009-01-01

Objectives In contrast to the extensive literature on the frequent occurrence of depressive symptoms in manic patients, there is little information about manic symptoms in bipolar depressions. Impulsivity is a prominent component of the manic syndrome, so manic features during depressive syndromes may be associated with impulsivity and its consequences, including increased risk of substance abuse and suicidal behavior. Therefore, we investigated the prevalence of manic symptoms and their relationships to impulsivity and clinical characteristics in patients with bipolar depressive episodes. Methods In 56 bipolar I or II depressed subjects, we investigated the presence of manic symptoms, using Mania Rating Scale (MRS) scores from the Schedule for Affective Disorders and Schizophrenia (SADS), and examined its association with other psychiatric symptoms (depression, anxiety, and psychosis), age of onset, history of alcohol and/or other substance abuse and of suicidal behavior, and measures of impulsivity. Results MRS ranged from 0 to 29 (25th–75th percentile, range 4–13), and correlated significantly with anxiety and psychosis, but not with depression, suggesting the superimposition of a separate psychopathological mechanism. Impulsivity and history of substance abuse, head trauma, or suicide attempt increased with increasing MRS. Receiver-operating curve analysis showed that MRS could divide patients into two groups based on history of alcohol abuse and suicide attempt, with an inflection point corresponding to an MRS score of 6. Discussion Even modest manic symptoms during bipolar depressive episodes were associated with greater impulsivity, and with histories of alcohol abuse and suicide attempts. Manic symptoms during depressive episodes suggest the presence of a potentially dangerous combination of depression and impulsivity. PMID:17430294

Mitochondrial disorder caused Charles Darwin’s cyclic vomiting syndrome

PubMed Central

Finsterer, Josef; Hayman, John

2014-01-01

Background Charles Darwin (CD), “father of modern biology,” suffered from multisystem illness from early adulthood. The most disabling manifestation was cyclic vomiting syndrome (CVS). This study aims at finding the possible cause of CVS in CD. Methods A literature search using the PubMed database was carried out, and CD’s complaints, as reported in his personal writings and those of his relatives, friends, colleagues, biographers, were compared with various manifestations of mitochondrial disorders (MIDs), known to cause CVS, described in the literature. Results Organ tissues involved in CD’s disease were brain, nerves, muscles, vestibular apparatus, heart, gut, and skin. Cerebral manifestations included episodic headache, visual disturbance, episodic memory loss, periodic paralysis, hysterical crying, panic attacks, and episodes of depression. Manifestations of polyneuropathy included numbness, paresthesias, increased sweating, temperature sensitivity, and arterial hypotension. Muscular manifestations included periods of exhaustion, easy fatigability, myalgia, and muscle twitching. Cardiac manifestations included episodes of palpitations and chest pain. Gastrointestinal manifestations were CVS, dental problems, abnormal seasickness, eructation, belching, and flatulence. Dermatological manifestations included painful lips, dermatitis, eczema, and facial edema. Treatments with beneficial effects to his complaints were rest, relaxation, heat, and hydrotherapy. Conclusion CVS in CD was most likely due to a multisystem, nonsyndromic MID. This diagnosis is based upon the multisystem nature of his disease, the fact that CVS is most frequently the manifestation of a MID, the family history, the variable phenotypic expression between affected family members, the fact that symptoms were triggered by stress, and that only few symptoms could not be explained by a MID. PMID:24453499

Episodic acyclovir therapy to abort recurrent attacks of genital herpes simplex infection.

PubMed

Whatley, J D; Thin, R N

1991-05-01

Frequent recurrence of genital herpes simplex infection can be a distressing condition. Continuous suppressive oral acyclovir is effective but expensive. Hitherto episodic therapy has given disappointing results. An open comparative study of patient initiated therapy is reported here. Acyclovir 200 mg five times daily for five days aborted 44% of recurrences and shortened 38% by greater than or equal to 50%, giving useful response in 82% of 34 recurrences. Acyclovir 400 mg twice daily for five days aborted 60% and shortened 17% giving useful benefit in 77% of 20 recurrences. Acyclovir 200 mg twice a day for five days gave unsatisfactory results. Patients were selected for frequent recurrences and a recognized prodrome, and care was taken to help to identify early prodromal symptoms. In these patients acyclovir in dosages of 200 mg five times daily for five days and 400 mg bd for five days proved convenient and cost effective.

Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis.

PubMed

Huling, Laura B; Baccaglini, Lorena; Choquette, Linda; Feinn, Richard S; Lalla, Rajesh V

2012-02-01

Recurrent aphthous stomatitis (RAS) is a common and painful oral mucosal disease. Possible etiologies include genetics, vitamin deficiencies, trauma, immune dysfunction, and stress. The goal of this study was to examine the relationship between the occurrence, type, and magnitude of stressful events and the onset and duration of RAS episodes. One hundred and sixty subjects with a history of RAS completed a weekly phone survey for up to 1 year, providing data on the occurrence of RAS episodes and details of any stressful events they experienced during the previous week. During RAS episodes, subjects also completed daily paper diaries that recorded incidence and duration of the RAS episode. Stressful events were quantified using the validated Recent Life Changes Questionnaire (RLCQ) and were classified as mental or physical stressors. Stressful life events were significantly associated with the onset of RAS episodes (P < 0.001), however, not with the duration of the RAS episodes. Experiencing a stressful life event increased the odds of an RAS episode by almost three times (OR = 2.72; 95% CI = 2.04-3.62). When controlled for each other, mental stressors had a larger effect (OR = 3.46, 95% CI = 2.54-4.72) than physical stressors (OR = 1.44; 95% CI = 1.04-1.99) on the occurrence of RAS episodes. RAS episodes did not occur more frequently or last longer with increasing stress severity. In patients with a history of RAS, stressful events may mediate changes involved in the initiation of new RAS episodes. Mental stressors are more strongly associated with RAS episodes than physical stressors. © 2011 John Wiley & Sons A/S.

Hypoxemia Episodes during Day and Night and Their Impact on Oxygen Saturation Targeting in Mechanically Ventilated Preterm Infants.

PubMed

Jain, Deepak; D'Ugard, Carmen; Bello, Jose; Bancalari, Eduardo; Claure, Nelson

2018-01-01

Hypoxemia episodes (HE) occur frequently in ventilated preterm infants and hinder the achievement of arterial oxygen saturation (SpO2) targets. These episodes may increase the risk for retinopathy of prematurity and neurodevelopmental disability. There are no data on the variation in HE and SpO2 targeting between day and night. The aim of this study was to evaluate the difference between day and night on the frequency and severity of HE and achievement of SpO2 targets. Twenty-four mechanically ventilated preterm infants with ≥4 episodes of SpO2 <75% over an 8-h period were enrolled. The fraction of inspired oxygen (FiO2), SpO2, and ventilator parameters were recorded over 24 h. Data from the day (9 a.m. to 5 p.m.) were compared to the night (9 p.m. to 5 a.m.) for the frequency of HE and proportion of time within and outside the target SpO2 range (90-95%). The frequency of severe HE (SpO2 <75, ≥20 s) and prolonged severe HE (SpO2 <75, ≥60 s) was lower during the night compared to the day (1.6 ± 1.0 vs. 2.4 ± 1.3 episodes/h, p = 0.008, and 0.53 ± 0.35 vs. 0.90 ± 0.54 episodes/h, p = 0.018). There was no difference in mean episode duration. The frequency and duration of mild HE (SpO2 <85, ≥20 s) were lower during the night compared to the day (5.9 ± 2.7 vs. 7.1 ± 2.5 episodes/h, p = 0.003, and 72 ± 15 vs. 87 ± 25 s, p = 0.01, respectively). The proportion of time in severe hypoxemia (SpO2 <75%) was smaller, whereas time in hyperoxemia (SpO2 >95%) was greater, during the night compared to the day. The mean FiO2 did not differ between day and night. In this group of infants with frequent HE, nighttime was associated with fewer episodes when compared to daytime. This is likely due to less handling and sensory stimulation during the night. The increase in time spent with hyperoxemia during the night is likely to be due to more tolerance of high SpO2 with less proactive weaning of FiO2. © 2017 S. Karger AG, Basel.

[Kleine-Levin syndrome: state of the art].

PubMed

Arnulf, I; Lecendreux, M; Franco, P; Dauvilliers, Y

2008-01-01

Kleine-Levin syndrome is a rare neurological disorder (1-2 cases per million inhabitants) primarily affecting young subjects. It is characterized by relapsing-remitting episodes of hypersomnia in association with cognitive and behavioral disturbances. Case-reports, small series, meta-analysis and a recent large, prospective trio study are consistent with a homogeneous, genuine disease entity. Patients are mostly male (68-78%) and adolescents (81%), with mean onset at 15 years (range 4-82 years). The first episode is triggered by an infection in 72% of patients. Patients experience an average of 7-19 episodes of 10-13 days each, relapsing every 3.5 months. Episodes recur more quickly in patients with childhood onset. The median disease course is 8-14 years, with longer course in men, in patients with hypersexuality, and when onset is after age 20. During episodes, all patients have hypersomnia (with sleep lasting 15-21 heures per day), cognitive impairment (apathy, confusion, slowness, amnesia) and a specific feeling of derealization (dreamy state, altered perception). Less frequently, patients experience hyperphagia (66%), hypersexuality (53%, principally men) and depressed mood (53%, predominantly women). Patients are remarkably similar to controls between episodes regarding sleep, vigilance, mood, and eating attitude, but have increased body mass index. Structural brain imaging, evaluation of the cerebrospinal fluid and serological inflammatory markers are unremarkable. EEG slowing is notable in 70% of cases during episodes, without epileptic activity. Sleep structure varies from harmonious hypersomnia to hypo-arousal with low sleep efficiency. The brain scintigraphy may show hypoperfusion, mostly focused on the thalamic, hypothalamic and fronto-temporal areas, especially when contrasted to images obtained between episodes. Newly identified factors include increased birth and developmental problems, Jewish heritage, genetics (5% multiplex families, suggesting autosomal recessive transmission). The association of KLS with HLA-DQ2, found in a small series, is not replicated in a larger independent sample. There is no increased family history for neuropsychiatric disorders. Some stimulants (amantadine, but more rarely modafinil or amphetamins) and mood stabilizers (lithium, valproate, but not carbamazepine) have marginal efficacy. In the 10% KLS cases secondary to various genetic, inflammatory, vascular or paraneoplasic conditions, patients are older, have more frequent and longer episodes, but their clinical symptoms, disease course and treatment response are similar to primary cases. The most promising findings are the familial clustering and a potential Jewish founder effect, supporting a role for genetic susceptibility factors. KLS is a puzzling and disabling disease. Until its cause will be identified, disease management should be primarily supportive and educational.

Short desynchronization episodes prevail in synchronous dynamics of human brain rhythms.

PubMed

Ahn, Sungwoo; Rubchinsky, Leonid L

2013-03-01

Neural synchronization is believed to be critical for many brain functions. It frequently exhibits temporal variability, but it is not known if this variability has a specific temporal patterning. This study explores these synchronization/desynchronization patterns. We employ recently developed techniques to analyze the fine temporal structure of phase-locking to study the temporal patterning of synchrony of the human brain rhythms. We study neural oscillations recorded by electroencephalograms in α and β frequency bands in healthy human subjects at rest and during the execution of a task. While the phase-locking strength depends on many factors, dynamics of synchrony has a very specific temporal pattern: synchronous states are interrupted by frequent, but short desynchronization episodes. The probability for a desynchronization episode to occur decreased with its duration. The transition matrix between synchronized and desynchronized states has eigenvalues close to 0 and 1 where eigenvalue 1 has multiplicity 1, and therefore if the stationary distribution between these states is perturbed, the system converges back to the stationary distribution very fast. The qualitative similarity of this patterning across different subjects, brain states and electrode locations suggests that this may be a general type of dynamics for the brain. Earlier studies indicate that not all oscillatory networks have this kind of patterning of synchronization/desynchronization dynamics. Thus, the observed prevalence of short (but potentially frequent) desynchronization events (length of one cycle of oscillations) may have important functional implications for the brain. Numerous short desynchronizations (as opposed to infrequent, but long desynchronizations) may allow for a quick and efficient formation and break-up of functionally significant neuronal assemblies.

Short desynchronization episodes prevail in synchronous dynamics of human brain rhythms

NASA Astrophysics Data System (ADS)

Ahn, Sungwoo; Rubchinsky, Leonid L.

2013-03-01

Neural synchronization is believed to be critical for many brain functions. It frequently exhibits temporal variability, but it is not known if this variability has a specific temporal patterning. This study explores these synchronization/desynchronization patterns. We employ recently developed techniques to analyze the fine temporal structure of phase-locking to study the temporal patterning of synchrony of the human brain rhythms. We study neural oscillations recorded by electroencephalograms in α and β frequency bands in healthy human subjects at rest and during the execution of a task. While the phase-locking strength depends on many factors, dynamics of synchrony has a very specific temporal pattern: synchronous states are interrupted by frequent, but short desynchronization episodes. The probability for a desynchronization episode to occur decreased with its duration. The transition matrix between synchronized and desynchronized states has eigenvalues close to 0 and 1 where eigenvalue 1 has multiplicity 1, and therefore if the stationary distribution between these states is perturbed, the system converges back to the stationary distribution very fast. The qualitative similarity of this patterning across different subjects, brain states and electrode locations suggests that this may be a general type of dynamics for the brain. Earlier studies indicate that not all oscillatory networks have this kind of patterning of synchronization/desynchronization dynamics. Thus, the observed prevalence of short (but potentially frequent) desynchronization events (length of one cycle of oscillations) may have important functional implications for the brain. Numerous short desynchronizations (as opposed to infrequent, but long desynchronizations) may allow for a quick and efficient formation and break-up of functionally significant neuronal assemblies.

[The migraine of Immanual Kant].

PubMed

Podoll, K; Hoff, P; Sass, H

2000-07-01

The German philosopher Immanuel Kant (1724-1804) suffered, since his forties, from a migraine with aura which showed a significant exacerbation in his seventies, coinciding with the onset of symptoms of a senile dementia of Alzheimer's type. Recorded symptoms of Kant's migraine include recurrent scintillating scotomas, one episode of diplopia, two episodes of complete amaurosis and frequent headaches described as oppressions of the head. The said symptoms of Kant's migraine can be traced not only in his letters and in accounts of his contemporary biographers, but also in the philosopher's published work.

Discrete-storm water-table fluctuation method to estimate episodic recharge.

USGS Publications Warehouse

Nimmo, John R.; Horowittz, Charles; Mitchell, Lara

2015-01-01

We have developed a method to identify and quantify recharge episodes, along with their associated infiltration-related inputs, by a consistent, systematic procedure. Our algorithm partitions a time series of water levels into discrete recharge episodes and intervals of no episodic recharge. It correlates each recharge episode with a specific interval of rainfall, so storm characteristics such as intensity and duration can be associated with the amount of recharge that results. To be useful in humid climates, the algorithm evaluates the separability of events, so that those whose recharge cannot be associated with a single storm can be appropriately lumped together. Elements of this method that are subject to subjectivity in the application of hydrologic judgment are values of lag time, fluctuation tolerance, and master recession parameters. Because these are determined once for a given site, they do not contribute subjective influences affecting episode-to-episode comparisons. By centralizing the elements requiring scientific judgment, our method facilitates such comparisons by keeping the most subjective elements openly apparent, making it easy to maintain consistency. If applied to a period of data long enough to include recharge episodes with broadly diverse characteristics, the method has value for predicting how climatic alterations in the distribution of storm intensities and seasonal duration may affect recharge.

Risk factors for acute exacerbations of COPD in a primary care population: a retrospective observational cohort study.

PubMed

Müllerová, Hana; Shukla, Amit; Hawkins, Adam; Quint, Jennifer

2014-12-18

To evaluate risk factors associated with exacerbation frequency in primary care. Information on exacerbations of chronic obstructive pulmonary disease (COPD) has mainly been generated by secondary care-based clinical cohorts. Retrospective observational cohort study. Electronic medical records database (England and Wales). 58,589 patients with COPD aged ≥40 years with COPD diagnosis recorded between 1 April 2009 and 30 September 2012, and with at least 365 days of follow-up before and after the COPD diagnosis, were identified in the Clinical Practice Research Datalink. Mean age: 69 years; 47% female; mean forced expiratory volume in 1s 60% predicted. Data on moderate or severe exacerbation episodes defined by diagnosis and/or medication codes 12 months following cohort entry were retrieved, together with demographic and clinical characteristics. Associations between patient characteristics and odds of having none versus one, none versus frequent (≥2) and one versus frequent exacerbations over 12 months follow-up were evaluated using multivariate logistic regression models. During follow-up, 23% of patients had evidence of frequent moderate-to-severe COPD exacerbations (24% one; 53% none). Independent predictors of increased odds of having exacerbations during the follow-up, either frequent episodes or one episode, included prior exacerbations, increasing dyspnoea score, increasing grade of airflow limitation, females and prior or current history of several comorbidities (eg, asthma, depression, anxiety, heart failure and cancer). Primary care-managed patients with COPD at the highest risk of exacerbations can be identified by exploring medical history for the presence of prior exacerbations, greater COPD disease severity and co-occurrence of other medical conditions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cognitive behavioral therapy in patients with sickle cell disease.

PubMed

Daniels, Sheena

2015-01-01

Sickle cell disease (SCD) is an inherited autosomal recessive disorder. In the United States, most individuals with SCD are African Americans, withan incidence of 1 in 400 to 1 in 500 live births. SCD is a lifelong disorder with no known cure. SCD causes anemia, frequent painful episodes, and reduced life ex- pectancy. The most disturbing clinical problem associated with SCD is severe pain episodes, the most common reason for hospitalization. Pharmacological interventions have been the mainstream for treatment; however, psychological interventions such as cognitive behavioral therapy (CBT) may complement current medical treatment, lead- ing to better coping and overall improved quality of life. In a quasi-experimental one-group pretest-posttest study, 9 African American individuals with SCD completed 3 weekly educational sessions learning CBT methods. Participants demonstrated increased frequency of use of CBT methods post-intervention, including diverting attention, coping self-statements, and behavioral activities, leading to better pain control. However, quality of life and role limitation did not show significant improvement. CBT may be beneficial to those suffering from SCD when combined with conventional treatment options; however, there are still barriers to incorporating psychological interventions into practice. CBT shows promise for individuals with chronic conditions such as SCD, but more investigation into its efficacy is needed with larger sample sizes over longer periods of time.

Aspirin for acute treatment of episodic tension-type headache in adults.

PubMed

Derry, Sheena; Wiffen, Philip J; Moore, R Andrew

2017-01-13

Tension-type headache (TTH) affects about 1 person in 5 worldwide. It is divided into infrequent episodic TTH (fewer than one headache per month), frequent episodic TTH (two to 14 headache days per month), and chronic TTH (15 headache days per month or more). Aspirin is one of a number of analgesics suggested for acute treatment of episodic TTH. To assess the efficacy and safety of aspirin for acute treatment of episodic tension-type headache (TTH) in adults compared with placebo or any active comparator. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and the Oxford Pain Relief Database from inception to September 2016, and also reference lists of relevant published studies and reviews. We sought unpublished studies by asking personal contacts and searching online clinical trial registers and manufacturers' websites. We included randomised, double-blind, placebo-controlled studies (parallel-group or cross-over) using oral aspirin for symptomatic relief of an acute episode of TTH. Studies had to be prospective, with participants aged 18 years or over, and include at least 10 participants per treatment arm. Two review authors independently assessed studies for inclusion and extracted data. For various outcomes (predominantly those recommended by the International Headache Society (IHS)), we calculated the risk ratio (RR) and number needed to treat for one additional beneficial outcome (NNT), one additional harmful outcome (NNH), or to prevent one event (NNTp) for oral aspirin compared to placebo or an active intervention.We assessed the evidence using GRADE and created a 'Summary of findings' table. We included five studies enrolling adults with frequent episodic TTH; 1812 participants took medication, of which 767 were included in comparisons of aspirin 1000 mg with placebo, and 405 in comparisons of aspirin 500 mg or 650 mg with placebo. Not all of these participants provided data for outcomes of interest in this review. Four studies specified using IHS diagnostic criteria; one predated commonly recognised criteria, but described comparable characteristics and excluded migraine. All participants treated headaches of at least moderate pain intensity.None of the included studies were at low risk of bias across all domains considered, although for most studies and domains this was likely to be due to inadequate reporting rather than poor methods. We judged one study to be at high risk of bias due to small size.There were no data for aspirin at any dose for the IHS preferred outcome of being pain free at two hours, or for being pain free at any other time, and only one study provided data equivalent to having no or mild pain at two hours (very low quality evidence). Use of rescue medication was lower with aspirin 1000 mg than with placebo (2 studies, 397 participants); 14% of participants used rescue medication with aspirin 1000 mg compared with 31% with placebo (NNTp 6.0, 95% confidence interval (CI) 4.1 to 12) (low quality evidence). Two studies (397 participants) reported a Patient Global Evaluation at the end of the study; we combined the top two categories for both studies to determine the number of participants who were 'satisfied' with treatment. Aspirin 1000 mg produced more satisfied participants (55%) than did placebo (37%) (NNT 5.7, 95% CI 3.7 to 12) (very low quality evidence).Adverse events were not different between aspirin 1000 mg and placebo (RR 1.1, 95% CI 0.8 to 1.5), or aspirin 500 mg or 650 mg and placebo (RR 1.3, 95% CI 0.8 to 2.0) (low quality evidence). Studies reported no serious adverse events.The quality of the evidence using GRADE comparing aspirin doses between 500 mg and 1000 mg with placebo was low or very low. Evidence was downgraded because of the small number of studies and events, and because the most important measures of efficacy were not reported.There were insufficient data to compare aspirin with any active comparator (paracetamol alone, paracetamol plus codeine, peppermint oil, or metamizole) at any of the doses tested. A single dose of aspirin between 500 mg and 1000 mg provided some benefit in terms of less frequent use of rescue medication and more participants satisfied with treatment compared with placebo in adults with frequent episodic TTH who have an acute headache of moderate or severe intensity. There was no difference between a single dose of aspirin and placebo for the number of people experiencing adverse events. The amount and quality of the evidence was very limited and should be interpreted with caution.

The intersection between asthma and acute chest syndrome in children with sickle-cell anaemia

PubMed Central

DeBaun, Michael R; Strunk, Robert C

2016-01-01

Acute chest syndrome is a frequent cause of acute lung disease in children with sickle-cell disease. Asthma is common in children with sickle-cell disease and is associated with increased incidence of vaso-occlusive pain events, acute chest syndrome episodes, and earlier death. Risk factors for asthma exacerbation and an acute chest syndrome episode are similar, and both can present with shortness of breath, chest pain, cough, and wheezing. Despite overlapping risk factors and symptoms, an acute exacerbation of asthma or an episode of acute chest syndrome are two distinct entities that need disease-specific management strategies. Although understanding has increased about asthma as a comorbidity in sickle-cell disease and its effects on morbidity, substantial gaps remain in knowledge about best management. PMID:27353685

Reassessing the Effects of Early Adolescent Alcohol Use on Later Antisocial Behavior: A Longitudinal Study of Students in Victoria, Australia and Washington State, United States

PubMed Central

Hemphill, Sheryl A.; Heerde, Jessica A.; Scholes-Balog, Kirsty E.; Smith, Rachel; Herrenkohl, Todd I.; Toumbourou, John W.; Catalano, Richard F.

2013-01-01

The effect of early adolescent alcohol use on antisocial behavior was examined at one- and two-year follow-up in Washington, United States and Victoria, Australia. Each state used the same methods to survey statewide representative samples of students (N = 1,858, 52% female) in 2002 (Grade 7 [G7]), 2003 (Grade 8 [G8]), and 2004 (Grade 9 [G9]). Rates of lifetime, current, frequent, and heavy episodic alcohol use were higher in Victoria than Washington State, whereas rates of five antisocial behaviors were generally comparable across states. After controlling for established risk factors, few associations between alcohol use and antisocial behavior remained, except that G7 current use predicted G8 police arrests and stealing and G9 carrying a weapon and stealing; G7 heavy episodic use predicted G8 and G9 police arrests; and G7 lifetime use predicted G9 carrying a weapon. Hence, risk factors other than alcohol were stronger predictors of antisocial behaviors. PMID:25132702

The role of lifetime anxiety history in the course of bipolar spectrum disorders.

PubMed

Titone, Madison K; Freed, Rachel D; O'Garro-Moore, Jared K; Gepty, Andrew; Ng, Tommy H; Stange, Jonathan P; Abramson, Lyn Y; Alloy, Lauren B

2018-06-01

Individuals with bipolar spectrum disorder (BSD) frequently meet criteria for comorbid anxiety disorders, and anxiety may be an important factor in the etiology and course of BSDs. The current study examined the association of lifetime anxiety disorders with prospective manic/hypomanic versus major depressive episodes. Participants were 244 young adults (aged 17-26) with milder forms of BSDs (i.e., bipolar-II, cyclothymia, BD-NOS). First, bivariate analyses assessed differences in baseline clinical characteristics between participants with and without DSM-IV anxiety diagnoses. Second, negative binomial regression analyses tested whether lifetime anxiety predicted number of manic/hypomanic or major depressive episodes developed during the study. Third, survival analyses evaluated whether lifetime anxiety predicted time to onset of manic/hypomanic and major depressive episodes. Results indicated that anxiety history was associated with greater illness severity at baseline. Over follow-up, anxiety history predicted fewer manic/hypomanic episodes, but did not predict number of major depressive episodes. Anxiety history also was associated with longer time to onset of manic/hypomanic episodes, but shorter time to onset of depressive episodes. Findings corroborate past studies implicating anxiety disorders as salient influences on the course of BSDs. Moreover, results extend prior research by indicating that anxiety disorders may be linked with reduced manic/hypomanic phases of illness. Copyright © 2018 Elsevier B.V. All rights reserved.

The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care

PubMed Central

2014-01-01

Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis. When treating bipolar patients, the primary care physician has an integral role in coordinating the multidisciplinary network. Pharmacologic treatment underpins both short- and long-term management of bipolar disorder. Maintenance treatment to prevent relapse is frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms. Regardless of the treatment approach that is selected, monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health. This article describes key decision-making steps in the management of bipolar disorder from the primary care perspective: from initial clinical suspicion to confirmation of the diagnosis to decision-making in acute and longer-term management and the importance of patient monitoring. PMID:25317368

Air swallowing, belching, acid and non-acid reflux in patients with functional dyspepsia.

PubMed

Conchillo, J M; Selimah, M; Bredenoord, A J; Samsom, M; Smout, A J P M

2007-04-15

Frequent belching is a common symptom in patients with functional dyspepsia with a reported incidence up to 80%. We hypothesized that patients with functional dyspepsia possibly have a higher frequency of belching than healthy subjects secondary to frequent air swallowing. To assess air swallowing, belching, acid and non-acid reflux patterns of patients with functional dyspepsia. Combined 24-h oesophageal impedance and pH monitoring was performed in 10 functional dyspepsia patients and 10 controls. Analysis of the impedance-pH signals included incidence of air swallows, belching, acid and non-acid reflux. The incidence of air swallows in functional dyspepsia patients were significantly higher compared with controls (153 +/- 15 vs. 79 +/- 10, P < 0.001), while the incidence of liquid-only swallows were not significantly increased. The proportions of gas-containing reflux episodes (belches) and non-acid reflux episodes in functional dyspepsia patients were significantly higher when compared with controls (66.4 vs. 44.4%, P = 0.04 and 70.1 vs. 45.9%, P = 0.009, respectively). Patients with functional dyspepsia swallow air more frequently than controls and this is associated with an increased incidence of non-acid gaseous gastro-oesophageal reflux.

Severe exacerbation of Andersen-Tawil syndrome secondary to thyrotoxicosis.

PubMed

Díaz-Manera, Jordi; Querol, Luis; Alejaldre, Aída; Rojas-García, Ricard; Ramos-Fransi, Alba; Gallardo, Eduard; Illa, Isabel

2014-08-01

Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by episodes of weakness. Although TPP has been described in patients all over the world, it is especially frequent in Asiatic patients. Recently, two genomewide association studies have found a susceptibility locus on chromosome 17q24.3 near the KCNJ2 gene, which is responsible for another cause of periodic paralysis, the Andersen-Tawil syndrome (ATS). We report the first patient diagnosed with ATS with a de novo c.G899C mutation in the KCNJ2 gene in 2010 who developed an autoimmune hyperthyroidism and TPP in 2013. At the time of the ATS diagnosis other causes of periodic paralysis, including thyroid dysfunction, were ruled out. The condition of the patient, who had mild episodes of proximal weakness at follow-up, deteriorated dramatically in 2013, presenting continuous episodes of severe generalized weakness associated with low levels of potassium requiring frequent admissions to the hospital. After a few months, he also presented signs of hyperthyroidism, and a diagnosis of Grave's disease was made. In our opinion, this case clearly demonstrates that a dysfunction of the Kir2.1 potassium channel encoded by the KCNJ2 gene is a risk factor to develop TPP, and can be a useful tool to identify patients at risk in daily clinics.

CFTR and/or pancreatitis susceptibility genes mutations as risk factors of pancreatitis in cystic fibrosis patients?

PubMed

Gaitch, Natacha; Hubert, Dominique; Gameiro, Christine; Burgel, Pierre-Régis; Houriez, Florence; Martinez, Brigitte; Honoré, Isabelle; Chapron, Jeanne; Kanaan, Reem; Dusser, Daniel; Girodon, Emmanuelle; Bienvenu, Thierry

2016-01-01

Currently, factors that promote the occurrence of pancreatitis episodes in patients affected with cystic fibrosis (CF) and pancreatic sufficiency (PS) are largely unknown. Six genes involved in pancreatitis or in ion transport into the pancreatic duct were investigated by next generation sequencing in 59 adult CF-PS patients with two identified CF mutations. Data on predisposing environmental factors were also recorded. 19 experienced at least one episode of acute pancreatitis (AP) (AP+) and 40 patients did not (AP-). No influence of environmental factor was evidenced. No specific CFTR genotype was found predictive of pancreatitis. Patients sharing the same CFTR genotype may or may not experience AP episodes. Frequent and rare missense variants were found in 78.9% patients in group AP+ and 67.5% in group AP- but a few of them were pathogenic. AP or recurrent AP (RAP) is a frequent complication in our series of adult CF-PS patients. The majority of mild CFTR mutations found in group AP+ were located in the first transmembrane region. No clear other genetic factor could be found predictive of AP/RAP. Further experiments in large homogenous cohorts of CF-PS patients, including whole genome sequencing, may identify genetic predisposing factors to pancreatitis. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

[Musculoskeletal disorders and temporary disability. Characteristics and duration. Catalonia, 2007-2010].

PubMed

Manent Bistué, Ignasi; Ramada Rodilla, José Mª; Serra Pujadas, Consol

Musculoskeletal disorders (MSD) are the leading cause of sickness absence (SA) in Spain and the second in Catalonia. A greater knowledge of this field could allow the refocusing of social protection policies and interventions to reduce their frequency and duration. The objective of the study was to describe the characteristics and duration of SA due to MSD in Catalonia between 2007 and 2010. The study population included all incident SA episodes due to MSD during the period 2007-2010, registered in the Institut Català d'AvaluacionsMèdiques (ICAM) database.We selected the 10 most frequentMSD (824.646 episodes) and extracted 607.732 (74%) SA episodes. We calculated the median duration of SA and analyzed the differences with Mann-Whitney U or Kruskal-Wallis tests, and studied the differences with a post-hoc test. We also conducted a survival analysis using Kaplan-Meier curves. The most frequent MSD were low back pain and neck pain. Median duration was greater for gonarthrosis and calcific tendonitis of the shoulder. The median duration of SA episodes was greater when pain was due to an organic disorder, in women (Z=51770950,5; p<0,001), increased with age (K=17335,72; p<0,001), and was longer in self-employed workers (Z=20965263,1; p<0.001) and in those working in agriculture and livestock (K=736,822; p<0,001). This study shows that the median duration of SA caused by MSD is influenced by the diagnosis, sex, age, type of work and type of social protection. Copyright belongs to the Societat Catalana de Salut Laboral.

[Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study].

PubMed

Sueiras, M; Sahuquillo, J; García-López, B; Sánchez-Guerrero, Á; Poca, M A; Santamarina, E; Riveiro, M; Fabricius, M; Strong, A J

2014-10-01

To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy. A descriptive observational study was carried out during 19 months. Neurocritical patients. Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment. A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex. An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs. Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration. Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Psychogenic amnesia--a malady of the constricted self.

PubMed

Staniloiu, Angelica; Markowitsch, Hans J; Brand, Matthias

2010-09-01

Autobiographical-episodic memory is the conjunction of subjective time, autonoetic consciousness and the experiencing self. Understanding the neural correlates of autobiographical-episodic memory might therefore be essential for shedding light on the neurobiology underlying the experience of being an autonoetic self. In this contribution we illustrate the intimate relationship between autobiographical-episodic memory and self by reviewing the clinical and neuropsychological features and brain functional imaging correlates of psychogenic amnesia - a condition that is usually characterized by severely impaired retrograde memory functioning, in absence of structural brain damage as detected by standard imaging. We demonstrate that in this disorder the autobiographical-episodic memory deficits do not exist in isolation, but occur with impairments of the autonoetic self-consciousness, emotional processing, and theory of mind or executive functions. Furthermore functional and metabolic brain alterations involving regions that are agreed upon to exert crucial roles in memory processes were frequently found to accompany the psychogenic memory "loss". Copyright © 2010 Elsevier Inc. All rights reserved.

Sexual Activity and Cognitive Decline in Older Adults.

PubMed

Allen, Mark S

2018-05-16

This prospective study tested whether sexual activity and emotional closeness during partnered sexual activity relate to cognitive decline (episodic memory performance) in older adulthood. In total, 6016 adults aged 50 and over (2672 men, 3344 women; M age = 66.0 ± 8.8 years) completed an episodic memory task and self-report questions related to health, sexual activity, and emotional closeness. Two years later, participants again completed the episodic memory task. After controlling for demographic and health-related lifestyle factors, more frequent sexual activity and greater emotional closeness during partnered sexual activity were associated with better memory performance. The association between sexual activity and memory performance was stronger among older participants in the sample. Memory performance worsened over 2 years, but change in memory performance was unrelated to sexual activity or emotional closeness during partnered sexual activity. These findings build on experimental research that has found sexual activity enhances episodic memory in non-human animals. Further research using longer timeframes and alternative measures of cognitive decline is recommended.

Prevalence and clinical characteristics of patients with obsessive-compulsive disorder in first-episode psychosis.

PubMed

Hagen, Kristen; Hansen, Bjarne; Joa, Inge; Larsen, Tor Ketil

2013-05-30

Obsessive-compulsive disorder (OCD) in patients with psychotic disorders has been reported to be a frequent co-morbid disorder in patients with psychotic disorders. The aim of the study determine the prevalence of OCD in first-episode psychosis and the relationship with clinical characteristics. First-episode psychosis patients (N = 246) consecutively admitted to a comprehensive early psychosis program were assessed for OCD with the Structured Clinical Interview for DSM-IV. Symptom assessment measures were the Positive and Negative Syndrome Scale, Global Assessment of Functioning, and the Clinician Rating Scale. Twenty-six patients (10.6%) fulfilled the criteria for OCD. Patients with comorbid OCD were younger, had more depressive symptoms and a higher rate of suicidal plans or attempts at index point compared to patients without OCD. The two groups did not differ with respect to other demographic variables or severity of psychotic symptoms. OCD is a significant comorbid disorder in patients with first-episode psychosis. Since treatment procedures are different, systematic screening for OCD is warranted.

Episodic accretion in binary protostars emerging from self-gravitating solar mass cores

NASA Astrophysics Data System (ADS)

Riaz, R.; Vanaverbeke, S.; Schleicher, D. R. G.

2018-06-01

Observations show a large spread in the luminosities of young protostars, which are frequently explained in the context of episodic accretion. We tested this scenario with numerical simulations that follow the collapse of a solar mass molecular cloud using the GRADSPH code, thereby varying the strength of the initial perturbations and temperature of the cores. A specific emphasis of this paper is to investigate the role of binaries and multiple systems in the context of episodic accretion and to compare their evolution to the evolution in isolated fragments. Our models form a variety of low-mass protostellar objects including single, binary, and triple systems in which binaries are more active in exhibiting episodic accretion than isolated protostars. We also find a general decreasing trend in the average mass accretion rate over time, suggesting that the majority of the protostellar mass is accreted within the first 105 years. This result can potentially help to explain the surprisingly low average luminosities in the majority of the protostellar population.

Use of an intravitreal sustained-release cyclosporine delivery device for treatment of equine recurrent uveitis.

PubMed

Gilger, B C; Wilkie, D A; Davidson, M G; Allen, J B

2001-12-01

To evaluate the use of an intravitreal sustained-release cyclosporine (CsA) delivery device for treatment of horses with naturally occurring recurrent uveitis. 16 horses with recurrent uveitis. Horses with frequent recurrent episodes of uveitis or with disease that was progressing despite appropriate medication were selected for this study. Additional inclusion criteria included adequate retinal function as determined by use of electroretinography, lack of severe cataract formation, and no vision-threatening ocular complications (eg, retinal detachment, severe retinal degeneration, and posterior synechia). Sustained-release CsA delivery devices (4 microg of CsA/d) were implanted into the vitreous through a sclerotomy at the pars plana. Reexaminations were performed 1, 3, 6, and 12 months after implantation, then continued annually. Ophthalmic changes, number of recurrent episodes of uveitis, and vision were recorded. The rate of recurrent episodes after device implantation (0.36 episodes/y) was less than prior to surgery (75 episodes/y). In addition, only 3 horses developed episodes of recurrent uveitis after surgery. Vision was detected in 14 of 16 affected eyes at a mean follow-up time of 13.8 months (range, 6 to 24 months). This intravitreal sustained-release CsA delivery device may be a safe and important tool for long-term treatment of horses with chronic recurrent uveitis.

The Mutual Relationship Between Peritonitis and Peritoneal Transport

PubMed Central

van Esch, Sadie; van Diepen, Anouk T.N.; Struijk, Dirk G.; Krediet, Raymond T.

2016-01-01

♦ Background: Preservation of the peritoneum is required for long-term peritoneal dialysis (PD). We investigated the effect of multiple peritonitis episodes on peritoneal transport. ♦ Methods: Prospectively collected data from 479 incident PD patients treated between 1990 and 2010 were analyzed, using strict inclusion criteria: follow-up of at least 3 years with the availability of a Standard Peritoneal Permeability Analysis (SPA) in the first year after start of PD and within the third year of PD, without peritonitis preceding the first SPA. For the purpose of the study, we only included patients who remained peritonitis-free (n = 28) or who experienced 3 or more peritonitis episodes (n = 16). ♦ Results: At baseline the groups were similar with regard to small solute and fluid transport. However, the frequent peritonitis group had lower peritoneal protein clearances compared to the no peritonitis group, resulting in lower dialysate concentrations of proteins: albumin 196.5 mg/L vs 372.5 mg/L, IgG 36.4 mg/L vs 65.0 mg/L, and α-2-macroglobulin (A2M) 1.9 mg/L vs 3.6 mg/L, p <0.01. No differences in serum concentrations were present. A comparison between the transport slopes over time in both groups showed a positive time trend of mass transfer area coefficient (MTAC) creatinine (p = 0.03) and glucose absorption (p = 0.09) and a negative trend of transcapillary ultrafiltration (p = 0.06), when compared to the no peritonitis group. Frequent peritonitis did not affect free water transport. ♦ Conclusions: Slow initial peritoneal transport rates of serum proteins result in lower dialysate concentrations, and likely a lower opsonic activity, which is a risk factor for peritonitis. Patients with frequent peritonitis show an increase in small solute transport and a concomitant decrease of ultrafiltration. In long-term peritonitis-free PD patients, small solute transport decreased, while ultrafiltration increased. This suggests that frequent peritonitis leads to an increase of the vascular peritoneal surface area without all the structural membrane alterations that may develop after long-term PD. PMID:25395498

Guided episodic sampling for capturing and characterizing industrial plumes

NASA Astrophysics Data System (ADS)

Ou-Yang, Chang-Feng; Liao, Wei-Cheng; Chang, Chih-Chung; Hsieh, Hsin-Cheng; Wang, Jia-Lin

2018-02-01

An integrated sampling technique, dubbed trigger sampling, was developed to capture characteristic industrial emissions or plumes. In the field experiment, a hydrogen sulfide (H2S) analyzer was used as the triggering instrument at the boundary of a refinery plant due to frequent complaints of foul smell from local residents. Ten episodic samples were captured when the H2S level surpassed the prescribed trigger level of 8.5 ppbv over a three-day period. Three non-episodic (blank) samples and 23 road-side samples were also collected for comparison. All the 36 flask samples were analyzed by gas chromatography-mass spectrometry/flame ionization detection (GC-MS/FID) for 108 volatile organic compounds (VOCs). The total VOC abundance of the event samples was exceedingly higher than the non-episodic samples by over 80 times in the extreme case. Alkanes were found to be the dominant constituents in the event samples, amounting to over 90% of the total VOC concentrations vs. only 30-40% for the blank and metropolitan samples. In addition, light alkanes in the event samples were highly correlated with the trigger species H2S (R2 = 0.82), implying their common origin. The matrix of chemical composition vs. sample types permitted easy visualization of the dominance of light alkanes for the event samples compared to other types of samples. Principle component analysis (PCA) identified two major contributors to cover 93% of the total variance arising from the 36 samples, further quantifying the distinction of the triggered episodic samples from the contrast samples. The proposed trigger sampling is a coupling of fast-and-slow measurement techniques. In this example, the fast-response H2S analyzer served to "guide" sampling to capture industrial plumes which were then characterized by a relatively slow method of GC-MS/FID for detailed chemical composition representative of the prominent sources.

Sports- and Recreation-related Injury Episodes in the United States, 2011-2014.

PubMed

Sheu, Yahtyng; Chen, Li-Hui; Hedegaard, Holly

2016-11-01

Objective-Much of the research on sports- and recreation-related injuries focuses on a specific population, activity, or type of injury, and national estimates of the total burden of sports- and recreation-related injuries are limited. This study provides national estimates of the injury burden and examines the distribution of sports- and recreation-related injuries across demographic groups, activities, and injury circumstances. Methods-Information on medically attended injury episodes for persons aged 5 years and over were obtained from the 2011-2014 National Health Interview Survey. Sports- and recreation-related injuries are categorized by the associated activity using a classification scheme based on the International Classification of External Causes of Injury. Results-An average annual estimate of 8.6 million sports- and recreation-related injury episodes was reported, with an age-adjusted rate of 34.1 per 1,000 population. Males (61.3%) and persons aged 5-24 years (64.9%) accounted for more than one-half of injury episodes. Injury rates were higher among males, children aged 5-14 years, and non-Hispanic white persons than for their counterparts. One-half of the sports- and recreation-related injury episodes (50.0%) resulted in treatment at a doctor's office or other health clinic without an emergency department visit or hospitalization. Overall, general exercise was the most frequently mentioned activity associated with sports- and recreation-related injuries, but types of activities varied across sex and age groups. Body regions injured while engaging in sports and recreation activities included the lower extremity (42.0%), upper extremity (30.3%), and head and neck (16.4%). Conclusion-As the nation continues to recognize the importance of physical activity to maintain health, more research efforts are needed to examine sport and recreation injury across various activities, demographic groups, and health care settings, especially settings other than emergency departments and hospitals. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Posttraumatic growth following a first episode of psychosis: a mixed methods research protocol using a convergent design.

PubMed

Jordan, Gerald; Malla, Ashok; Iyer, Srividya N

2016-07-25

The suffering people experience following a first episode of psychosis is great, and has been well-investigated. Conversely, potential positive outcomes following a first episode of psychosis have been under-investigated. One such outcome that may result from a first episode of psychosis is posttraumatic growth, or a positive aftermath following the trauma of a first psychotic episode. While posttraumatic growth has been described following other physical and mental illnesses, posttraumatic growth has received very little attention following a first episode of psychosis. To address this research gap, we will conduct a mixed methods study aimed at answering two research questions: 1) How do people experience posttraumatic growth following a first episode of psychosis? 2) What predicts, or facilitates, posttraumatic growth following a first episode of psychosis? The research questions will be investigated using a mixed methods convergent design. All participants will be service-users being offered treatment for a first episode of psychosis at a specialized early intervention service for young people with psychosis, as well as their case managers.. A qualitative descriptive methodology will guide data-collection through semi-structured interviews with service-users. Service-users and case managers will complete questionnaires related to posttraumatic growth and its potential predictors using quantitative methods. These predictors include the impact a first episode of psychosis on service-users' lives, the coping strategies they use; the level of social support they enjoy; and their experiences of resilience and recovery. Qualitative data will be subject to thematic analysis, quantitative data will be subject to multiple regression analyses, and results from both methods will be combined to answer the research questions in a holistic way. Findings from this study are expected to show that in addition to suffering, people with a first episode of psychosis may experience positive changes. This study will be one of few to have investigated posttraumatic growth following a first episode of psychosis, and will be the first to do so with a mixed methods approach.

Discrete-storm water-table fluctuation method to estimate episodic recharge.

PubMed

Nimmo, John R; Horowitz, Charles; Mitchell, Lara

2015-01-01

We have developed a method to identify and quantify recharge episodes, along with their associated infiltration-related inputs, by a consistent, systematic procedure. Our algorithm partitions a time series of water levels into discrete recharge episodes and intervals of no episodic recharge. It correlates each recharge episode with a specific interval of rainfall, so storm characteristics such as intensity and duration can be associated with the amount of recharge that results. To be useful in humid climates, the algorithm evaluates the separability of events, so that those whose recharge cannot be associated with a single storm can be appropriately lumped together. Elements of this method that are subject to subjectivity in the application of hydrologic judgment are values of lag time, fluctuation tolerance, and master recession parameters. Because these are determined once for a given site, they do not contribute subjective influences affecting episode-to-episode comparisons. By centralizing the elements requiring scientific judgment, our method facilitates such comparisons by keeping the most subjective elements openly apparent, making it easy to maintain consistency. If applied to a period of data long enough to include recharge episodes with broadly diverse characteristics, the method has value for predicting how climatic alterations in the distribution of storm intensities and seasonal duration may affect recharge. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Civil and forensic patients in secure psychiatric settings: a comparison.

PubMed

Galappathie, Nuwan; Khan, Sobia Tamim; Hussain, Amina

2017-06-01

Aims and method To evaluate differences between male patients in secure psychiatric settings in the UK based on whether they are detained under civil or forensic sections of the Mental Health Act 1983. A cohort of patients discharged from a secure psychiatric hospital were evaluated for length of stay and frequency of risk-related incidents. Results Overall, 84 patients were included in the study: 52 in the forensic group and 32 in the civil group. Civil patients had more frequent incidents of aggression, sex offending, fire-setting and vulnerability, whereas forensic patients had more frequent episodes of self-harm. Clinical implications Secure hospitals should ensure treatment programmes are tailored to each patient's needs. Civil patients require greater emphasis on treatment of their mental illness, whereas forensic patients have additional offence-related treatment needs. Regular liaison between forensic and general adult services is essential to help ensure patients can return to appropriate settings at the earliest opportunity in their recovery.

Alcohol Content in the ‘Hyper-Reality’ MTV Show ‘Geordie Shore’

PubMed Central

Lowe, Eden; Britton, John

2018-01-01

Abstract Aim To quantify the occurrence of alcohol content, including alcohol branding, in the popular primetime television UK Reality TV show ‘Geordie Shore’ Series 11. Methods A 1-min interval coding content analysis of alcohol content in the entire DVD Series 11 of ‘Geordie Shore’ (10 episodes). Occurrence of alcohol use, implied use, other alcohol reference/paraphernalia or branding was recorded. Results All categories of alcohol were present in all episodes. ‘Any alcohol’ content occurred in 78%, ‘actual alcohol use’ in 30%, ‘inferred alcohol use’ in 72%, and all ‘other’ alcohol references occurred in 59% of all coding intervals (ACIs), respectively. Brand appearances occurred in 23% of ACIs. The most frequently observed alcohol brand was Smirnoff which appeared in 43% of all brand appearances. Episodes categorized as suitable for viewing by adolescents below the legal drinking age of 18 years comprised of 61% of all brand appearances. Conclusions Alcohol content, including branding, is highly prevalent in the UK Reality TV show ‘Geordie Shore’ Series 11. Two-thirds of all alcohol branding occurred in episodes age-rated by the British Board of Film Classification (BBFC) as suitable for viewers aged 15 years. The organizations OfCom, Advertising Standards Authority (ASA) and the Portman Group should implement more effective policies to reduce adolescent exposure to on-screen drinking. The drinks industry should consider demanding the withdrawal of their brands from the show. Short Summary Alcohol content, including branding, is highly prevalent in the MTV reality TV show ‘Geordie Shore’ Series 11. Current alcohol regulation is failing to protect young viewers from exposure to such content. PMID:29365032

Antibiotic Rotation for Febrile Neutropenic Patients with Hematological Malignancies: Clinical Significance of Antibiotic Heterogeneity

PubMed Central

Chong, Yong; Shimoda, Shinji; Yakushiji, Hiroko; Ito, Yoshikiyo; Miyamoto, Toshihiro; Kamimura, Tomohiko; Shimono, Nobuyuki; Akashi, Koichi

2013-01-01

Background Our unit adopted the single administration of cefepime as the initial treatment for febrile episodes in neutropenic patients with hematological malignancies. However, recently, cefepime-resistant gram-negative bacteremia, including those with extended-spectrum β-lactamase (ESBL)-producers, was frequently observed in these patients. Therefore, we instituted a rotation of primary antibiotics for febrile neutropenic patients in an attempt to control antibiotic resistance. Methods This prospective trial was performed from August 2008 through March 2011 at our unit. After a pre-intervention period, in which cefepime was used as the initial agent for febrile neutropenia, 4 primary antibiotics, namely, piperacillin-tazobactam, ciprofloxacin, meropenem, and cefepime, were rotated at 1-month intervals over 20 months. Blood and surveillance cultures were conducted for febrile episodes, in order to assess the etiology, the resistance pattern (particularly to cefepime), and the prognosis. Results In this trial, 219 patients were registered. A 65.9% reduction in the use of cefepime occurred after the antibiotic rotation. In the surveillance stool cultures, the detection rate of cefepime-resistant gram-negative isolates, of which ESBL-producers were predominant, declined significantly after the intervention (8.5 vs 0.9 episodes per 1000 patient days before and after intervention respectively, P<0.01). Interestingly, ESBL-related bacteremia was not detected after the initiation of the trial (1.7 vs 0.0 episodes per 1000 patient days before and after intervention respectively, P<0.01). Infection-related mortality was comparable between the 2 periods. Conclusions We implemented a monthly rotation of primary antibiotics for febrile neutropenic patients. An antibiotic heterogeneity strategy, mainly performed as a cycling regimen, would be useful for controlling antimicrobial resistance among patients treated for febrile neutropenia. PMID:23372683

The etiology of community-acquired pneumonia in Australia: why penicillin plus doxycycline or a macrolide is the most appropriate therapy.

PubMed

Charles, Patrick G P; Whitby, Michael; Fuller, Andrew J; Stirling, Robert; Wright, Alistair A; Korman, Tony M; Holmes, Peter W; Christiansen, Keryn J; Waterer, Grant W; Pierce, Robert J P; Mayall, Barrie C; Armstrong, John G; Catton, Michael G; Nimmo, Graeme R; Johnson, Barbara; Hooy, Michelle; Grayson, M L

2008-05-15

Available data on the etiology of community-acquired pneumonia (CAP) in Australia are very limited. Local treatment guidelines promote the use of combination therapy with agents such as penicillin or amoxycillin combined with either doxycycline or a macrolide. The Australian CAP Study (ACAPS) was a prospective, multicenter study of 885 episodes of CAP in which all patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods, and polymerase chain reaction). Antibiotic agents and relevant clinical outcomes were recorded. The etiology was identified in 404 (45.6%) of 885 episodes, with the most frequent causes being Streptococcus pneumoniae (14%), Mycoplasma pneumoniae (9%), and respiratory viruses (15%; influenza, picornavirus, respiratory syncytial virus, parainfluenza virus, and adenovirus). Antibiotic-resistant pathogens were rare: only 5.4% of patients had an infection for which therapy with penicillin plus doxycycline would potentially fail. Concordance with local antibiotic recommendations was high (82.4%), with the most commonly prescribed regimens being a penicillin plus either doxycycline or a macrolide (55.8%) or ceftriaxone plus either doxycycline or a macrolide (36.8%). The 30-day mortality rate was 5.6% (50 of 885 episodes), and mechanical ventilation or vasopressor support were required in 94 episodes (10.6%). Outcomes were not compromised by receipt of narrower-spectrum beta-lactams, and they did not differ on the basis of whether a pathogen was identified. The vast majority of patients with CAP can be treated successfully with narrow-spectrum beta-lactam treatment, such as penicillin combined with doxycycline or a macrolide. Greater use of such therapy could potentially reduce the emergence of antibiotic resistance among common bacterial pathogens.

Safety of live, attenuated oral vaccines in HIV-infected Zambian adults

PubMed Central

Banda, Rose; Yambayamba, Vera; Lalusha, Bwalya Daka; Sinkala, Edford; Kapulu, Melissa Chola; Kelly, Paul

2012-01-01

Background Current recommendations are that HIV-infected persons should not be given live vaccines. We set out to assess potential toxicity of three live, attenuated oral vaccines (against rotavirus, typhoid and ETEC) in a phase 1 study. Methods Two commercially available oral vaccines against rotavirus (Rotarix) and typhoid (Vivotif) and one candidate vaccine against Enterotoxigenic Escherichia coli (ACAM2017) were given to HIV seropositive (n = 42) and HIV seronegative (n = 59) adults. Gastrointestinal symptoms were sought actively by weekly interview up to 1 month of vaccination. In rotavirus vaccine recipients, intestinal biopsies were collected by endoscopy and evaluated for expression of IL-8 and pro-inflammatory cytokines. Results No difference was observed between symptoms in HIV infected and HIV uninfected vaccinees, except for diarrhoea reported more than 7 days after the last dose of vaccine. If only diarrhoea episodes within 7 days of vaccination are included, diarrhoea was not more frequent in HIV seropositive than in HIV seronegative vaccinees (OR 6.7, 95% CI 1.2–67; P = 0.09). However, if later episodes of diarrhoea are included, a significant increase in diarrhoea was demonstrated (OR 5.3, 95% CI 0.98–53; P = 0.04). All episodes were mild and transient. IL-8 was slowly up-regulated over the week following vaccination (P = 0.02), but IL-β, IFNγ or TNFα were not. Conclusions No evidence was found of adverse events following administration of these three vaccines, except for late episodes of diarrhoea which may not be attributable to vaccination. Our data do not support the need for a prohibition on oral administration of live, attenuated vaccines to all HIV infected adults, though further work on severely immunocompromised adults and children are required. PMID:22789509

Etiology of Childhood Diarrhea Following Rotavirus Vaccine Introduction: A Prospective, Population-Based Study in Nicaragua

PubMed Central

Becker-Dreps, Sylvia; Bucardo, Filemon; Vilchez, Samuel; Zambrana, Luis Enrique; Liu, Lan; Weber, David J.; Peña, Rodolfo; Barclay, Leslie; Vinjé, Jan; Hudgens, Michael G.; Nordgren, Johan; Svensson, Lennart; Morgan, Douglas R.; Espinoza, Félix; Paniagua, Margarita

2014-01-01

Background Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. Methods We followed a population-based sample of children less than 5 years in León, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial, and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. Results The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least one enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (EPEC, 11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%), and enterotoxigenic E.coli (ETEC, 7.7%), with rotavirus detected among 5.3% of diarrheal stools. EPEC and ETEC were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (< 2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months. Conclusions In this Central American community following RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease. PMID:24879131

Effects of Mediterranean diet in patients with recurring colds and frequent complications.

PubMed

Calatayud, F M; Calatayud, B; Gallego, J G; González-Martín, C; Alguacil, L F

In recent years, traditional diets enriched with fresh plant-based foods have been gradually abandoned, increasing the consumption of animal foods and highly processed food. The aim of this study was to assess the effects of a nutritional intervention with a Traditional Mediterranean Diet in patients with recurring colds (RC) and frequent inflammatory complications (IC). Prospective before-after comparison study of 63 girls and 65 boys aged 1-5 years were included over a year in the nutritional programme "Learning to eat from the Mediterranean". We studied clinical and therapeutic variables and various anthropometric parameters. All the studied indicators (number of catarrhal episodes CB, degree of intensity, emergency and hospital admissions) showed a positive and statistically significant evolution, evidenced from the first weeks of starting treatment, until the end of the year, after which 53.9% of patients had no CB, 25% had only one, and 16.4% had two episodes, compared to the 4.64 episodes on average in the previous year. Antibiotic use decreased by 87.4%, from 3.85±1.27 times/patient/year to 0.49±0.79 (p<0.001). Symptomatic treatment decreased by 56.7%, from 7.03±2.76 to 3.05±1.69 (p<0.001). The satisfaction of the families was very high. The Kidmed index, which assesses the quality of the Mediterranean Diet, increased from 7.8 to 10.9 points. The adoption of a Traditional Mediterranean Diet could be a major contribution to the improvement of patients with recurring colds and frequent inflammatory complications. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

A Calendar Savant with Episodic Memory Impairments

PubMed Central

Olson, Ingrid R.; Berryhill, Marian E.; Drowos, David B.; Brown, Lawrence; Chatterjee, Anjan

2010-01-01

Patients with memory disorders have severely restricted learning and memory. For instance, patients with anterograde amnesia can learn motor procedures as well as retaining some restricted ability to learn new words and factual information. However, such learning is inflexible and frequently inaccessible to conscious awareness. Here we present a case of patient AC596, a 25-year old male with severe episodic memory impairments, presumably due to anoxia during a preterm birth. In contrast to his poor episodic memory, he exhibits savant-like memory for calendar information that can be flexibly accessed by day, month, and year cues. He also has the ability to recollect the exact date of a wide range of personal experiences over the past 20 years. The patient appears to supplement his generally poor episodic memory by using memorized calendar information as a retrieval cue for autobiographical events. These findings indicate that islands of preserved memory functioning, such as a highly developed semantic memory system, can exist in individuals with severely impaired episodic memory systems. In this particular case, our patient’s memory for dates far outstripped that of normal individuals and served as a keen retrieval cue, allowing him to access information that was otherwise unavailable. PMID:20104390

Strategies to enhance patient recruitment and retention in research involving patients with a first episode of mental illness.

PubMed

Furimsky, Ivana; Cheung, Amy H; Dewa, Carolyn S; Zipursky, Robert B

2008-11-01

Recruitment and retention of research participants is often the most labor-intensive and difficult component of clinical trials. Poor recruitment and retention frequently pose as a major barrier in the successful completion of clinical trials. In fact, many studies are prematurely terminated, or their findings questioned due to low recruitment and retention rates. The conduct of clinical trials involving youth with a first episode of mental illness comes with additional challenges in recruitment and retention including barriers associated with engagement and family involvement. To develop effective early interventions for first episode mental illness, it is necessary to develop strategies to enhance recruitment and retention in this patient population. This article presents the recruitment and retention challenges experienced in two clinical trials: one involving participants experiencing a first episode of depression and one involving participants experiencing a first episode psychosis. Challenges with recruitment and retention are identified and reviewed at both the patient level and clinician level. Strategies that were implemented to enhance recruitment and retention in these two studies are also discussed. Finally, ethical issues to consider when implementing these strategies are also highlighted.

Impact of ultrasensitive cardiac troponin I dynamic changes in the new universal definition of myocardial infarction.

PubMed

Casals, Gregori; Filella, Xavier; Augé, Josep Maria; Bedini, Josep Lluis

2008-12-01

We evaluated the impact of using the new universal definition of myocardial infarction (MI) criteria implemented with a 20% increment between 2 cardiac troponin I (cTnI) measurements. The study included 284 consecutive episodes of patients admitted to the emergency department with suspected acute coronary syndrome (ACS) and an initial cTnI measurement of 0.10 ng/mL (0.10 microg/L) or less followed by 1 or more measurements within 24 hours. Episodes with a maximum cTnI above the 99th percentile (0.04 ng/mL [0.04 microg/L]) and a dynamic increase between 2 measurements of 20% or more were considered to meet MI criteria. Of the 284 episodes, 109 (38.4%) had a maximum cTnI higher than 0.04 ng/mL (0.04 microg/L). However, only 66 episodes (23.2%) also had an increase of 20% or more in the cTnI concentration and met MI criteria. These 66 episodes included 37 patients diagnosed with an MI and 29 patients not diagnosed with an MI. The 29 patients who also met MI criteria were more frequently readmitted for ACS within 6 months.

Motor-Behavioral Episodes in REM Sleep Behavior Disorder and Phasic Events During REM Sleep

PubMed Central

Manni, Raffaele; Terzaghi, Michele; Glorioso, Margaret

2009-01-01

Study Objectives: To investigate if sudden-onset motor-behavioral episodes in REM sleep behavior disorder (RBD) are associated with phasic events of REM sleep, and to explore the potential meaning of such an association. Design: Observational review analysis. Setting: Tertiary sleep center. Patients: Twelve individuals (11 males; mean age 67.6 ± 7.4 years) affected by idiopathic RBD, displaying a total of 978 motor-behavioral episodes during nocturnal in-laboratory video-PSG. Interventions: N/A Measurements and Results: The motor activity displayed was primitive in 69.1% and purposeful/semi-purposeful in 30.9% of the motor-behavioral episodes recorded. Sleeptalking was significantly more associated with purposeful/semi-purposeful motor activity than crying and/or incomprehensible muttering (71.0% versus 21.4%, P < 0.005). In 58.2% of the motor-behavioral episodes, phasic EEG-EOG events (rapid eye movements [REMs], α bursts, or sawtooth waves [STWs]) occurred simultaneously. Each variable (REMs, STWs, α bursts) was associated more with purposeful/semi-purposeful than with primitive movements (P < 0.05). Conclusions: Motor-behavioral episodes in RBD were significantly more likely to occur in association with phasic than with tonic periods of REM sleep. The presence of REMs, α bursts and STWs was found to be more frequent in more complex episodes. We hypothesize that motor-behavioral episodes in RBD are likely to occur when the brain, during REM sleep, is in a state of increased instability (presence of α bursts) and experiencing stronger stimulation of visual areas (REMs). Citation: Manni R; Terzaghi M; Glorioso M. Motor-behavioral episodes in REM sleep behavior disorder and phasic events during REM sleep. SLEEP 2009;32(2):241–245. PMID:19238811

Methicillin-Resistant Staphylococcus aureus in Foot Osteomyelitis.

PubMed

Ashong, Chester N; Raheem, Shazia A; Hunter, Andrew S; Mindru, Cezarina; Barshes, Neal R

Conflicting studies exist regarding the impact of methicillin-resistant Staphylococcus aureus (MRSA) on increased time to wound healing, future need for surgical procedures, and likelihood of treatment failure in patients with diabetic foot osteomyelitis. The purpose of this study is to determine the overall significance of MRSA in predicting treatment failure in bone infections of the foot and to determine an appropriate pre-operative and empiric post-operative antibiotic regimen. Patients presenting with an initial episode of "probable" or "definite" foot osteomyelitis were included for review and analysis if the following criteria were met: (1) Osteomyelitis occurred in the foot (i.e., distal to the malleoli of the ankle); episodes occurring above the ankle were excluded. (2) Patients received either no antibiotics or only oral antibiotics for long-term treatment; episodes managed with long-term parenteral antibiotics were excluded. (3) The infection was managed initially with medical therapy or conservative surgical therapy; episodes managed with major (above-ankle) amputation as the initial treatment were excluded. The primary objective of this study was to assess whether episodes of foot osteomyelitis associated with MRSA resulted in treatment failure more frequently than not. Of 178 episodes included in the study, 50 (28.1%) episodes had treatment failure. Median time-to-treatment failure was 60 days (range 7-598 days). In 28.1% (9/32 episodes) in which treatment failure occurred and 39.0% (41/105) episodes in which no treatment failure occurred, MRSA was present. The presence of MRSA was not significantly associated with treatment failure (p = 0.99). The presence of MRSA in bone culture and whether antibiotic use had anti-MRSA activity was not associated with increased treatment failure of diabetic foot osteomyelitis in our institution. Empiric antibiotic coverage of MRSA may not be necessary for many patients presenting with foot osteomyelitis.

No Reliable Evidence That Emotional Disorders Are Proximal Antecedents, Concomitants, or Short-Term Consequences of First Episode Alcohol Use Disorders in a Representative Community Sample.

PubMed

Farmer, Richard F; Seeley, John R; Kosty, Derek B; Gau, Jeff M; Duncan, Susan C; Sher, Kenneth J; Lewinsohn, Peter M

2017-03-01

Emotional disorders and alcohol use disorders (AUDs) frequently demonstrate significant 12-month and lifetime comorbid associations. This comorbidity has been incorporated into influential theories of addiction processes that posit direct or indirect causal associations between these disorder categories. There is currently no consensus, however, about the sequencing of these disorders. In this research, longitudinal data from a regionally representative community sample were used to evaluate whether emotional disorders constitute a proximal antecedent, concomitant, or short-term consequence of first episode (or index) AUDs. Participants were 131 persons with index AUD episodes lasting 12 months or more and 131 matched controls. For each participant with an AUD, the presence or absence of an emotional disorder was coded for three time intervals: (a) the 12 months preceding full syndrome AUD episode onset; (b) the last 12 months of the AUD episode; and (c) the 12 months following complete symptom AUD episode offset. These intervals, referenced to participant age, were matched to those of control participants, and emotional disorder rate comparisons subsequently performed both within and between groups. Findings indicated an absence of significant within- or between-subject differences in emotional disorder rates, suggesting that the association between AUDs and emotional disorders is neither directional nor systematic. There was also no indication that the length of the AUD episode increased risk for an emotional disorder in the year following AUD offset. Overall, this research suggests that emotional disorders are generally independent events in relation to the index AUD episode.

Further Studies on the Prevalence of Isolated Sleep Paralysis in Black Subjects

PubMed Central

Bell, Carl C.; Dixie-Bell, Dora D.; Thompson, Belinda

1986-01-01

In a previous study, one of the authors (C.C.B.) found isolated sleep paralysis was common in blacks. In this study, conducted by interviews, a recurrent pattern (one or more episodes per month) of isolated sleep paralysis episodes in blacks was described by at least 25 percent of the afflicted sample studied. Frequent episodes were associated with stress, and subjects with isolated sleep paralysis had an unusually high prevalence of panic disorder (15.5 percent). The genetic transmission of sleep paralysis was studied in a large black family, and in addition to stressful environmental factors being associated with the condition, there appears to be a dominant genetic factor associated with the predisposition for developing sleep paralysis. The implications of these findings for stress, anxiety, sleep, and psychophysiologic disorders are discussed. PMID:3746934

Outcomes of single organism peritonitis in peritoneal dialysis: gram negatives versus gram positives in the Network 9 Peritonitis Study.

PubMed

Bunke, C M; Brier, M E; Golper, T A

1997-08-01

The use of the "peritonitis rate" in the management of patients undergoing peritoneal dialysis is assuming importance in comparing the prowess of facilities, care givers and new innovations. For this to be a meaningful outcome measure, the type of infection (causative pathogen) must have less clinical significance than the number of infections during a time interval. The natural history of Staphylococcus aureus, pseudomonas, and fungal peritonitis would not support that the outcome of an episode of peritonitis is independent of the causative pathogen. Could this concern be extended to other more frequently occurring pathogens? To address this, the Network 9 Peritonitis Study identified 530 episodes of single organism peritonitis caused by a gram positive organism and 136 episodes caused by a single non-pseudomonal gram negative (NPGN) pathogen. Coincidental soft tissue infections (exit site or tunnel) occurred equally in both groups. Outcomes of peritonitis were analyzed by organism classification and by presence or absence of a soft tissue infection. NPGN peritonitis was associated with significantly more frequent catheter loss, hospitalization, and technique failure and was less likely to resolve regardless of the presence or absence of a soft tissue infection. Hospitalization and death tended to occur more frequently with enterococcal peritonitis than with other gram positive peritonitis. The outcomes in the NPGN peritonitis group were significantly worse (resolution, catheter loss, hospitalization, technique failure) compared to coagulase negative staphylococcal or S. aureus peritonitis, regardless of the presence or absence of a coincidental soft tissue infection. Furthermore, for the first time, the poor outcomes of gram negative peritonitis are shown to be independent of pseudomonas or polymicrobial involvement or soft tissue infections. The gram negative organism appears to be the important factor. In addition, the outcome of peritonitis caused by S. aureus is worse than that of other staphylococci. Thus, it is clear that all peritonitis episodes cannot be considered equivalent in terms of outcome. The concept of peritonitis rate is only meaningful when specific organisms are considered.

A longitudinal study on diarrhoea and vomiting in young dogs of four large breeds.

PubMed

Sævik, Bente K; Skancke, Ellen M; Trangerud, Cathrine

2012-02-02

Prospective studies to document the occurrence of canine diarrhoea and vomiting are relatively scarce in dogs, and the majority of published studies are based on information from clinical records. This study investigates the incidence risk of diarrhoea and vomiting as well as potential risk factors. A cohort study of 585 privately owned dogs of four breeds: Newfoundland, Labrador retriever, Leonberger, and Irish wolfhound. The owners maintained a continuous log regarding housing, exercise, nutrition, and health of their dogs. Episodes of diarrhoea and vomiting were recorded in a consecutive manner in a booklet. The owners completed the questionnaires and reported information at three, four, six, 12, 18, and 24/25 months of age, called observational ages.Associations with potential risk factors for diarrhoea and vomiting were investigated in separate generalized estimating equation analyses. The incidence of both diarrhoea and vomiting was influenced by breed. Both diarrhoea and vomiting were relatively common in young dogs, occurring most frequently during the first months of life. After three months of age, the odds of diarrhoea were significantly lower when compared to the observational period seven weeks to three months (OR ranging from 0.31 to 0.70 depending on the period). More males than females suffered from diarrhoea (OR = 1.42). The occurrence of diarrhoea was more common in dogs that also experienced episode(s) of vomiting during the study period (OR = 5.43) and vice versa (OR = 5.50). In the majority of dogs episodes of diarrhoea and vomiting did not occur at the same time. Dogs in urban areas had higher odds (OR = 1.88) of getting diarrhoea compared to dogs living in rural areas. The occurrence of both diarrhoea and vomiting demonstrated a seasonal variation with higher incidence during the summer months. Both diarrhoea and vomiting occurred most frequently during the first months of life. The incidence of diarrhoea and vomiting was significantly different between breeds. Diarrhoea occurred more frequently in males and in dogs living in urban areas. Also, a positive association between the occurrence of diarrhoea and vomiting in the same dog was found.

Maternal Caffeine Consumption and Infant Nighttime Waking: Prospective Cohort Study

PubMed Central

Santos, Iná S.; Matijasevich, Alicia

2012-01-01

OBJECTIVE: Coffee and other caffeinated beverages are commonly consumed in pregnancy. In adults, caffeine may interfere with sleep onset and have a dose-response effect similar to those seen during insomnia. In infancy, nighttime waking is a common event. With this study, we aimed to investigate if maternal caffeine consumption during pregnancy and lactation leads to frequent nocturnal awakening among infants at 3 months of age. METHODS: All children born in the city of Pelotas, Brazil, during 2004 were enrolled on a cohort study. Mothers were interviewed at delivery and after 3 months to obtain information on caffeine drinking consumption, sociodemographic, reproductive, and behavioral characteristics. Infant sleeping pattern in the previous 15 days was obtained from a subsample. Night waking was defined as an episode of infant arousal that woke the parents during nighttime. Multivariable analysis was performed by using Poisson regression. RESULTS: The subsample included 885 of the 4231 infants born in 2004. All but 1 mother consumed caffeine in pregnancy. Nearly 20% were heavy consumers (≥300 mg/day) during pregnancy and 14.3% at 3 months postpartum. Prevalence of frequent nighttime awakeners (>3 episodes per night) was 13.8% (95% confidence interval: 11.5%–16.0%). The highest prevalence ratio was observed among breastfed infants from mothers consuming ≥300 mg/day during the whole pregnancy and in the postpartum period (1.65; 95% confidence interval: 0.86–3.17) but at a nonsignificant level. CONCLUSIONS: Caffeine consumption during pregnancy and by nursing mothers seems not to have consequences on sleep of infants at the age of 3 months. PMID:22473365

Associations between meal patterns, binge eating and weight for Latinas

PubMed Central

Cachelin, Fary M.; Thomas, Colleen; Vela, Alyssa; Gil-Rivas, Virginia

2016-01-01

Establishing a regular pattern of eating is a core element of treatment for binge eating, yet no research to date has examined meal patterns of Latina women. Objective Compare eating patterns of Latinas who binge eat and those who do not, and examine associations between meal patterns and binge episodes, associated distress and concerns, and body mass index (BMI). Method One-hundred fifty-five Latinas (65 BED, 22 Bulimia Nervosa [BN], 68 with no eating disorder) were assessed with the Eating Disorder Examination. Results There were no significant differences in eating patterns between groups. Breakfast was the least and dinner the most consumed meal. For the BED group: greater frequency of lunch consumption was associated with higher BMI while more frequent evening snacking was associated with lower BMI and with less weight importance; more frequent breakfast consumption, mid-morning snack consumption and total meals were associated with greater distress regarding binge eating. For the BN group: evening snack frequency was associated with less dietary restriction and more weight and shape concern; total snack frequency was associated with more weight concern. Regular meal eaters reported more episodes of binge eating than those who did not eat meals regularly. Discussion Associations with meal patterns differed by eating disorder diagnosis. Study findings mostly are not consistent with results from prior research on primarily White women. CBT treatments may need to be tailored to address the association between binge eating and regular meal consumption for Latinas. Culturally appropriate modifications that address traditional eating patterns should be considered. PMID:27436488

Loneliness, Daily Pain, and Perceptions of Interpersonal Events in Adults with Fibromyalgia

PubMed Central

Wolf, Laurie Dempsey; Davis, Mary C.

2014-01-01

Objective This study examined whether individual differences in loneliness and/or daily exacerbations in loneliness relate to daily pain and frequency and perception of interpersonal events among individuals with fibromyalgia (FM). Methods 118 participants with FM completed electronic diaries each evening for 21 days to assess the occurrence of positive and negative interpersonal events, event appraisals, and pain. Multilevel modeling was used to examine relations of chronic and transitory loneliness to daily life outcomes, controlling for daily depressive symptoms. Results Chronic and transitory loneliness were associated with more frequent reports of negative and less frequent reports of positive interpersonal daily events, higher daily stress ratings and lower daily enjoyment ratings, and higher daily pain levels. Neither chronic nor transitory loneliness moderated the relations between daily negative events and either stress appraisals or pain. However, both chronic and transitory loneliness moderated the relation between daily positive events and enjoyment appraisals. Specifically, on days of greater numbers of positive events than usual, lonely people had larger boosts in enjoyment than did nonlonely people. Similarly, days with greater than usual numbers of positive events were related to larger boosts in enjoyment if an individual was also experiencing higher than usual loneliness levels. Conclusions Chronic and transient episodes of loneliness are associated with more negative daily social relations and pain. However, boosts in positive events yield greater boosts in day-to-day enjoyment of social relations for lonely versus nonlonely individuals, and during loneliness episodes, a finding that can inform future interventions for individuals with chronic pain. PMID:25180546

Envisioning the times of future events: The role of personal goals.

PubMed

Ben Malek, Hédi; Berna, Fabrice; D'Argembeau, Arnaud

2018-05-25

Episodic future thinking refers to the human capacity to imagine or simulate events that might occur in one's personal future. Previous studies have shown that personal goals guide the construction and organization of episodic future thoughts, and here we sought to investigate the role of personal goals in the process of locating imagined events in time. Using a think-aloud protocol, we found that dates were directly accessed more frequently for goal-related than goal-unrelated future events, and the goal-relevance of events was a significant predictor of direct access to temporal information on a trial-by-trial basis. Furthermore, when an event was not directly dated, references to anticipated lifetime periods were more frequently used as a strategy to determine when a goal-related event might occur. Together, these findings shed new light on the mechanisms by which personal goals contribute to the location of imagined events in future times. Copyright © 2018 Elsevier Inc. All rights reserved.

[Community-acquired bacteremia in adult patients attending the emergency service of a teaching hospital].

PubMed

Artico, Muriel J; Rocchi, Marta; Gasparotto, Ana; Ocaña Carrizo, Valeria; Navarro, Mercedes; Mollo, Valeria; Avilés, Natalia; Romero, Vanessa; Carrillo, Sonia; Monterisi, Aída

2012-01-01

Bacteremia is an important cause of morbimortality. This study describes the episodes of community-acquired bacteremia in adult patients registered at our hospital. Between January 2005, and December 2009, 271 episodes were studied. The diagnostic yield of blood cultures was 13.5 %. A total of 52 % of patients were male and 48 % female. The mean age was 60. The most frequent comorbidities were: diabetes (21 %), neoplasia (18 %), cardiopathy (11 %), and HIV infection (8 %). The focus was- respiratory (21 %), urinary (15 %), cutaneous (9 %), and others (13 %). Gram-positive bacteria prevailed (51.4%). The most frequent microorganisms were Escherichia coli (25 %), Streptococcus pneumoniae (22.9 %), and Staphylococcus aureus (12.3 %). Bacteremia was polymicrobial in 7 % of the cases. Thirty three percent of E. coli isolates were resistant to ciprofloxacin and 6 % to ceftazidime. Fourteen percent of S. aureus strains were resistant to oxacillin whereas only 7 % of S. pneumoniae expressed high resistance to penicillin with MICs = 2 ug/ml, according to meningitis breakpoints.

Nosocomial infections in the general pediatric wards of a hospital in Turkey.

PubMed

Balaban, Ismail; Tanır, Gönül; Metin Timur, Ozge; Oz, Fatma Nur; Aydın Teke, Türkan; Bayhan, Gülsüm Iclal; Sözak, Nejla; Göl, Neşe

2012-07-01

The aims of this study were to determine the prevalence, type, and clinical features of nosocomial infections (NIs), their etiological distribution, and the antibiotic resistance patterns of causative organisms in the general pediatric wards of a hospital in Turkey over a 3-year period. The Hospital Infection Control Committee NI surveillance reports were used as a database. NIs were detected in 171 (2.25%) of the 7,594 hospitalized patients. Some of these patients experienced more than 1 episode, and thus, the total NI episodes were 229. Patients' age varied from 1 to 144 months (mean ± standard deviation, 14.5 ± 23.6 months). The NI rate was 3.02%, and the NI density was 3.17/1,000 patient days. The most frequent NIs were lower respiratory system infections, blood stream infections, and urinary tract infections. Gram-negative organisms were the most frequently isolated agents. Of the 171 patients with NIs, 47 (27.5%) died.

Understanding access and use of technology among youth with first-episode psychosis to inform the development of technology-enabled therapeutic interventions.

PubMed

Abdel-Baki, Amal; Lal, Shalini; D-Charron, Olivier; Stip, Emmanuel; Kara, Nadjia

2017-02-01

Computers, video games and technological devices are part of young people's everyday lives. However, their use in first-episode psychosis (FEP) treatment is rare. The purpose of this study was to better understand the access and use of technology among individuals with FEP, including gaming activities, to inform future development of technology-enabled therapeutic applications. Self-administered survey on use of technological tools in 71 FEP individuals. PCs/laptops were used by all participants; cellphones/smartphones by 92%, consoles by 83% (mainly male and younger participants). Women texted and used social networks more frequently; men played games (mainly action) more often. The younger individuals reported playing games frequently (32% daily) with less use of the Web and social networks (favourite: Facebook). These data will be useful for developing Web-based psychoeducation tools and cognitive remediation video games for youth with FEP. © 2015 Wiley Publishing Asia Pty Ltd.

A retrospective analysis of the costs and management of genital warts in Italy.

PubMed

Gianino, Maria Michela; Delmonte, Sergio; Lovato, Emanuela; Martinese, Morena; Rondoletti, Sabrina; Bernengo, Maria Grazia; Zotti, Carla Maria

2013-10-09

In Italy the prevalence of genital warts in women (15-64 years) is approximately 0.6% with an incidence of 0.4% per year. Treatments for GW are usually long, with moderate success and high costs. The aim of the study was to evaluate the diagnostic-therapeutic pathway, duration and setting of treatment, costs of episodes of condyloma in a population attending a regional STI clinic in Piedmont. This was a retrospective observational study conducted using medical records of outpatients who first visited the STI Clinic of San Lazzaro Dermatological Hospital in 2008. The patients' medical histories were analysed for episodes that occurred and were cleared in 18 months following the initial visit. Data on screening methods for STIs, type of diagnosis for condyloma, treatment type, treatment setting, and anatomic lesion site were obtained from medical records. The costs were calculated for each episode. A total of 450 episodes were analysed (297 men,153 women). The most frequently affected anatomic site was the genital area (74%) in both genders. With regard to treatment setting, 78.44% of patients received outpatient treatment at the STI clinic, 4% were treated at home, and 0.22% were hospitalised; 11.11% were treated in multiple settings. The mean number of treatments per episode was 2.03; although many patients received only 1 treatment (n = 207, 46%), exspecially cryotherapy or diathermy coagulation (64.73% versus 28.02% of episodes, respectively). The mean episode duration was 80.74 days. The mean cost (in 2011 euros) for an episode was €158.46 ± 257.77; the mean costs were €79.13 ± 57.40 for diagnosis and €79.33 ± 233.60 for treatment. The mean cost for treatment in a STI-Clinic setting was €111.39 ± 76.72, that for home treatment was €160.88 ± 95.69, and that for hospital care was €2825.94. The treatment of and associated costs for genital warts are significant. Several factors affect the cost, and internal STI clinic protocols, such as the 6 month window used to consider a recurrence or new diagnosis, create bias. Nonetheless, our findings how costs similar to those reported in the international literature and should be considered when deciding on which HPV vaccination programs should be provided by the public health system.

Reduction of frequent otitis media and pressure-equalizing tube insertions in children after introduction of pneumococcal conjugate vaccine.

PubMed

Poehling, Katherine A; Szilagyi, Peter G; Grijalva, Carlos G; Martin, Stacey W; LaFleur, Bonnie; Mitchel, Ed; Barth, Richard D; Nuorti, J Pekka; Griffin, Marie R

2007-04-01

Streptococcus pneumoniae is an important cause of otitis media in children. In this study we estimated the effect of routine childhood immunization with heptavalent pneumococcal conjugate vaccine on frequent otitis media (3 episodes in 6 months or 4 episodes in 1 year) and pressure-equalizing tube insertions. The study population included all children who were enrolled at birth in TennCare or selected upstate New York commercial insurance plans as of July 1998 and continuously followed until 5 years old, loss of health plan enrollment, study outcome, or end of the study. We compared the risk of developing frequent otitis media or having pressure-equalizing tube insertion for 4 birth cohorts (1998-1999, 1999-2000, 2000-2001, and 2001-2002) by using Cox regression analysis. We used data from the National Immunization Survey to estimate the heptavalent pneumococcal conjugate vaccine uptake for children in these 4 birth cohorts in Tennessee and New York. The proportion of children in Tennessee and New York who received at least 3 doses of heptavalent pneumococcal conjugate vaccine by 2 years of age increased from < or = 1% for the 1998-1999 birth cohort to approximately 75% for the 2000-2001 birth cohort. By age 2 years, 29% of Tennessee and New York children born in 2000-2001 had developed frequent otitis media, and 6% of each of these birth cohorts had pressure-equalizing tubes inserted. Comparing the 2000-2001 birth cohort to the 1998-1999 birth cohort, frequent otitis media declined by 17% and 28%, and pressure-equalizing tube insertions declined by 16% and 23% for Tennessee and New York children, respectively. For the 2000-2001 to the 2001-2002 birth cohort, frequent otitis media and pressure-equalizing tubes remained stable in New York but increased in Tennessee. After heptavalent pneumococcal conjugate vaccine introduction, children were less likely to develop frequent otitis media or have pressure-equalizing tube insertions.

Clinical presentation of invasive pneumococcal disease in Spain in the era of heptavalent conjugate vaccine.

PubMed

de Sevilla, Maria F; García-García, Juan-José; Esteva, Cristina; Moraga, Fernando; Hernández, Sergi; Selva, Laura; Coll, Francisco; Ciruela, Pilar; Planes, Ana Maria; Codina, Gemma; Salleras, Luis; Jordan, Iolanda; Domínguez, Angela; Muñoz-Almagro, Carmen

2012-02-01

The aim of this study was to analyze the rate of incidence, clinical presentation, serotype, and clonal distribution of invasive pneumococcal disease (IPD) in the era of heptavalent pneumococcal conjugate vaccine (PCV7) in Barcelona, Spain. This was a prospective study comprising all children <5 years with IPD who were managed in 2 tertiary-care, pediatric hospitals between January 2007 and December 2009. IPD was defined as the presence of clinical findings of infection together with isolation or detection of DNA of Streptococcus pneumoniae in a sterile fluid sample. In this study, 319 patients (53.3% male), mean age 29.6 months, were included. Comparing rates in 2007 and 2009 (76.2 and 109.9 episodes/100,000 population, respectively), an increase of 44% (95% confidence interval, 10%-89%) was observed. The main clinical presentation was pneumonia (254 episodes, 79.6%), followed by meningitis (29, 9.1%), and bacteremia (25, 7.8%).The diagnosis was made by positive culture in 123 (38.6%) patients and in 196 (61.4%) by real-time polymerase chain reaction. Serotype study was performed in 300 episodes, and 273 (91%) were non-PCV7 serotypes. The most frequent serotypes were 1 (20.7%), 19A (15.7%), and 3 (12.3%). A minimal inhibitory concentration ≥0.12 μg/mL to penicillin was detected in 34.4% of isolates. Sequence type 306 expressing serotype 1 was the most frequent clonal type detected (20.3% of studied strains). IPD continues to increase in Barcelona, and the rate is higher than previously reported as a result of low sensitivity of bacterial culture. Non-PCV7 serotypes were responsible for 91% of episodes and pneumonia was the main clinical presentation.

[Peritonitis in pediatric patients receiving peritoneal dialysis].

PubMed

Jellouli, Manel; Ferjani, Meriem; Abidi, Kamel; Hammi, Yosra; Boutiba, Ilhem; Naija, Ouns; Zarrouk, Chokri; Ben Abdallah, Taieb; Gargah, Tahar

2015-12-01

Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

CO-OCCURRENCE OF OZONE AND ACIDIC CLOUD WATER IN HIGH-ELEVATION FORESTS

EPA Science Inventory

A chemical climatology for high-elevation forests was estimated from ozone and cloudwater acidity data collected in the eastern United States. esides frequent ozone-only and pH-only single-pollutant episodes, both simultaneous and sequential co-occurrence of ozone and acidic clou...

38 CFR 4.114 - Schedule of ratings-digestive system.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., adhesions of: Severe; definite partial obstruction shown by X-ray, with frequent and prolonged episodes of..., constipation (perhaps alternating with diarrhea) or abdominal distension 10 Mild 0 Note: Ratings for adhesions... peritoneal adhesions. 7311Residuals of injury of the liver: Depending on the specific residuals, separately...

38 CFR 4.114 - Schedule of ratings-digestive system.

Code of Federal Regulations, 2010 CFR

2010-07-01

... weight loss with malnutrition and anemia 60 Moderate; less frequent episodes of epigastric disorders with...: Pronounced; resulting in marked malnutrition, anemia, and general debility, or with serious complication as liver abscess 100 Severe; with numerous attacks a year and malnutrition, the health only fair during...

Kagan Structures, Processing, and Excellence in College Teaching

ERIC Educational Resources Information Center

Kagan, Spencer

2014-01-01

Frequent student processing of lecture content (1) clears working memory, (2) increases long-term memory storage, (3) produces retrograde memory enhancement, (4) creates episodic memories, (5) increases alertness, and (6) activates many brain structures. These outcomes increase comprehension of and memory for content. Many professors now…

Seizures in Infants and Young Children.

ERIC Educational Resources Information Center

McBrien, Dianne M.; Bonthius, Daniel J.

2000-01-01

This article reviews the most frequent causes of seizure disorders in young children and the classification of different seizure types. It discusses current therapies, including alternatives to medication. Emergency response to seizures is covered a well as non-epileptic episodes that may resemble seizures. Epilepsy's potential impact on the…

Patterns of Eating in Normal Men and Women.

ERIC Educational Resources Information Center

Green, Judith

1987-01-01

Individually observed ad libitum food and beverage consumption of 42 adults during several hours in time isolation laboratory. Men and women showed similar patterns of ingestion, including eating rates consistent with caloric need (men consuming siginificantly more calories than women). Observed frequent ingestion episodes, supporting ecological…

The influence of current mood state, number of previous affective episodes and predominant polarity on insight in bipolar disorder.

PubMed

de Assis da Silva, Rafael; Mograbi, Daniel C; Camelo, Evelyn Vieira Miranda; Peixoto, Ursula; Santana, Cristina Maria Teixeira; Landeira-Fernandez, Jesus; Morris, Robin G; Cheniaux, Elie

2017-11-01

Although many studies have explored the effect of current affective episodes on insight into bipolar disorder, the potential interaction between current mood state and previous affective episodes has not been consistently investigated. To explore the influence of dominant polarity, number of previous affective episodes and current affective state on insight in bipolar disorder patients in euthymia or mania. A total of 101 patients with bipolar disorder were recruited for the study, including 58 patients in euthymia (30 with no defined predominant polarity and 28 with manic predominant polarity) and 43 in mania (26 with no defined predominant polarity and 17 with manic predominant polarity). Patients underwent a clinical assessment and insight was evaluated through the Insight Scale for Affective Disorders. Bipolar disorder patients in mania had worse insight than those in euthymia, with no effect of dominant polarity. In addition, positive psychotic symptoms showed a significant effect on insight and its inclusion as a covariate eliminated differences related to mood state. Finally, the number of previous manic or depressive episodes did not correlate with insight level. Mania is a predictor of loss of insight into bipolar disorder. However, it is possible that its contribution is linked to the more frequent presence of psychotic symptoms in this state. Dominant polarity and number/type of previous affective episodes have a limited impact on insight.

Electrophysiological evidence for flexible goal-directed cue processing during episodic retrieval.

PubMed

Herron, Jane E; Evans, Lisa H; Wilding, Edward L

2016-05-15

A widely held assumption is that memory retrieval is aided by cognitive control processes that are engaged flexibly in service of memory retrieval and memory decisions. While there is some empirical support for this view, a notable exception is the absence of evidence for the flexible use of retrieval control in functional neuroimaging experiments requiring frequent switches between tasks with different cognitive demands. This absence is troublesome in so far as frequent switches between tasks mimic some of the challenges that are typically placed on memory outside the laboratory. In this experiment we instructed participants to alternate frequently between three episodic memory tasks requiring item recognition or retrieval of one of two different kinds of contextual information encoded in a prior study phase (screen location or encoding task). Event-related potentials (ERPs) elicited by unstudied items in the two tasks requiring retrieval of study context were reliably different, demonstrating for the first time that ERPs index task-specific processing of retrieval cues when retrieval goals change frequently. The inclusion of the item recognition task was a novel and important addition in this study, because only the ERPs elicited by unstudied items in one of the two context conditions diverged from those in the item recognition condition. This outcome constrains functional interpretations of the differences that emerged between the two context conditions and emphasises the utility of this baseline in functional imaging studies of retrieval processing operations. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Electrophysiological evidence for flexible goal-directed cue processing during episodic retrieval

PubMed Central

Herron, Jane E.; Evans, Lisa H.; Wilding, Edward L.

2016-01-01

A widely held assumption is that memory retrieval is aided by cognitive control processes that are engaged flexibly in service of memory retrieval and memory decisions. While there is some empirical support for this view, a notable exception is the absence of evidence for the flexible use of retrieval control in functional neuroimaging experiments requiring frequent switches between tasks with different cognitive demands. This absence is troublesome in so far as frequent switches between tasks mimic some of the challenges that are typically placed on memory outside the laboratory. In this experiment we instructed participants to alternate frequently between three episodic memory tasks requiring item recognition or retrieval of one of two different kinds of contextual information encoded in a prior study phase (screen location or encoding task). Event-related potentials (ERPs) elicited by unstudied items in the two tasks requiring retrieval of study context were reliably different, demonstrating for the first time that ERPs index task-specific processing of retrieval cues when retrieval goals change frequently. The inclusion of the item recognition task was a novel and important addition in this study, because only the ERPs elicited by unstudied items in one of the two context conditions diverged from those in the item recognition condition. This outcome constrains functional interpretations of the differences that emerged between the two context conditions and emphasises the utility of this baseline in functional imaging studies of retrieval processing operations. PMID:26892854

Neural activity associated with repetitive simulation of episodic counterfactual thoughts.

PubMed

De Brigard, Felipe; Parikh, Natasha; Stewart, Gregory W; Szpunar, Karl K; Schacter, Daniel L

2017-11-01

When people revisit past autobiographical events they often imagine alternative ways in which such events could have occurred. Often these episodic counterfactual thoughts (eCFT) are momentary and fleeting, but sometimes they are simulated frequently and repeatedly. However, little is known about the neural differences between frequently versus infrequently repeated eCFT. The current study explores this issue. In a three-session study, participants were asked to simulate alternative ways positive, negative, and neutral autobiographical memories could have occurred. Half of these eCFT were repeatedly re-simulated while the other half were not. Immediately after, participants were asked to simulate all these eCFT again while undergoing fMRI. A partial least squares analysis on the resultant fMRI data revealed that eCFT that were not frequently repeated preferentially engaged brain regions including middle (BA 21) and superior temporal gyri (BA 38/39), middle (BA 11) and superior frontal gyri (BA 9), and hippocampus. By contrast, frequently repeated eCFT preferentially engaged regions including medial frontal gyri (BA 10), anterior cingulate cortex, insula, and inferior parietal lobule (BA 40). Direct contrasts for each type of eCFT were also conducted. The results of these analyses suggest differential contributions of regions traditionally associated with eCFT, such as BA 10, anterior cingulate cortex, and hippocampus, as a function of kind of eCFT and frequency of repetition. Consequences for future research on eCFT and rumination are considered. Copyright © 2017 Elsevier Ltd. All rights reserved.

Biologic Disease-modifying Antirheumatic Drug (bDMARD)-induced Neutropenia: A Registry from a Retrospective Cohort of Patients with Rheumatic Diseases Treated with 3 Classes of Intravenous bDMARD.

PubMed

Espinoza, Francisco; Le Blay, Pierre; Combe, Bernard

2017-06-01

To examine the rate, risks factors, and consequences of neutropenia induced by intravenous (IV) biologic disease-modifying antirheumatic drugs (bDMARD). We conducted a retrospective cohort study in 499 patients with rheumatic diseases treated by IV abatacept (ABA), infliximab (IFX), or tocilizumab (TCZ). Rheumatoid arthritis (RA) was the most frequent diagnosis (72%). Fifty-two patients (10.4%) experienced at least 1 episode of neutropenia. No episodes of grade 4 neutropenia were documented. TCZ was more frequently related to neutropenia than ABA or IFX (18.6% vs 3.8% and 2.8%, respectively, p < 0.001). The following factors were identified as predictors of experiencing neutropenia with IV bDMARD: history of neutropenia with methotrexate (MTX; synthetic DMARD; OR 1.56, 95% CI 1.17-7.14), concomitant treatment by MTX (OR 1.21, 95% CI 1.01-2.64), and TCZ treatment (OR 2.72, 95% CI 1.53-9.05). Patients experiencing a TCZ-induced neutropenia did not show a higher risk of severe infections; however, this group had a shorter drug survival (9 mos vs 20 mos, p < 0.02) compared with TCZ patients without neutropenia. Among 3 different classes of IV bDMARD, TCZ is associated with the higher risk of neutropenia. No increased frequency of infection episodes was documented in this group.

Source Memory in Korsakoff Syndrome: Disentangling the Mechanisms of Temporal Confusion.

PubMed

Brion, Mélanie; de Timary, Philippe; Pitel, Anne-Lise; Maurage, Pierre

2017-03-01

Korsakoff syndrome (KS), most frequently resulting from alcohol dependence (ALC), is characterized by severe anterograde amnesia. It has been suggested that these deficits may extend to other memory components, and notably source memory deficits involved in the disorientation and temporal confusion frequently observed in KS. However, the extent of this source memory impairment in KS and its usefulness for the differential diagnosis between ALC and KS remain unexplored. Nineteen patients with KS were compared with 19 alcohol-dependent individuals and 19 controls in a source memory test exploring temporal context confusions ("continuous recognition task"). Episodic memory and psychopathological comorbidities were controlled for. While no source memory deficit was observed in ALC, KS was associated with a significant presence of temporal context confusion, even when the influence of comorbidities was taken into account. This source memory impairment did not appear to be related to performances on episodic memory or executive functions. Patients with KS displayed source memory deficits, as indexed by temporal context confusions. The absence of a relationship with episodic memory performances seems to indicate that source memory impairment is not a mere by-product of amnesia. As ALC was associated with preserved source memory, the presence of temporal context confusion may serve as a complementary tool for the differential diagnosis between ALC and KS. Copyright © 2017 by the Research Society on Alcoholism.

Neuropsychological and FDG-PET profiles in VGKC autoimmune limbic encephalitis.

PubMed

Dodich, Alessandra; Cerami, Chiara; Iannaccone, Sandro; Marcone, Alessandra; Alongi, Pierpaolo; Crespi, Chiara; Canessa, Nicola; Andreetta, Francesca; Falini, Andrea; Cappa, Stefano F; Perani, Daniela

2016-10-01

Limbic encephalitis (LE) is characterized by an acute or subacute onset with memory impairments, confusional state, behavioral disorders, variably associated with seizures and dystonic movements. It is due to inflammatory processes that selectively affect the medial temporal lobe structures. Voltage-gate potassium channel (VGKC) autoantibodies are frequently observed. In this study, we assessed at the individual level FDG-PET brain metabolic dysfunctions and neuropsychological profiles in three autoimmune LE cases seropositive for neuronal VGKC-complex autoantibodies. LGI1 and CASPR2 potassium channel complex autoantibody subtyping was performed. Cognitive abilities were evaluated with an in-depth neuropsychological battery focused on episodic memory and affective recognition/processing skills. FDG-PET data were analyzed at single-subject level according to a standardized and validated voxel-based Statistical Parametric Mapping (SPM) method. Patients showed severe episodic memory and fear recognition deficits at the neuropsychological assessment. No disorder of mentalizing processing was present. Variable patterns of increases and decreases of brain glucose metabolism emerged in the limbic structures, highlighting the pathology-driven selective vulnerability of this system. Additional involvement of cortical and subcortical regions, particularly in the sensorimotor system and basal ganglia, was found. Episodic memory and fear recognition deficits characterize the cognitive profile of LE. Commonalities and differences may occur in the brain metabolic patterns. Single-subject voxel-based analysis of FDG-PET imaging could be useful in the early detection of the metabolic correlates of cognitive and non-cognitive deficits characterizing LE condition. Copyright © 2016 Elsevier Inc. All rights reserved.

Pattern of poisoning in the elderly: an experience from Tehran.

PubMed

Karbakhsh, Mojgan; Zandi, Negar Salehian

2008-03-01

Poisoning is considered a significant health problem in the elderly. This study aimed to portray the pattern of poisoning in the elderly population of Tehran. This cross-sectional study included all patients aged 60 years and older with acute poisoning who attended the emergency department of the Loghman-Hakim hospital over a six-month period (n=299). Episodes of poisoning were more common in men (70.9%) and the majority of incidents took place in the patient's own home (84.3%). Most episodes were accidental (53.2%) followed by attempted suicide (32.4%). Opioids and opiate products accounted for 54.02% of the non-pharmaceutical substances that were involved in episodes of poisoning. Overdose with opioids and opiate products, was higher in male patients than in female patients. The most frequently involved drug groups were benzodiazepines, antidepressants, and analgesics. The most common cause of accidental poisoning was overdose by drug abusers. The Poisoning Severity Score was minor in 25.4%, moderate in 52.2%, and severe in 17.1% of patients. Asymptomatic patients accounted for 5.4% of the total. Unfortunately, 11.7% of patients died. The main agents involved in the fatal cases were opioids and opiate products. The commonest method of accidental poisoning was overdose in opioid and opiate abusers. Attempted suicide was also very common comprising about one third of all cases. The high mortality observed in this study warrants attention to the risk factors and prognostic factors of poisoning in elderly.

Numerical Study on the Stomatal Responses to Dry-Hot Wind Episodes and Its Effects on Land-Atmosphere Interactions.

PubMed

Wang, Shu; Zheng, Hui; Liu, Shuhua; Miao, Yucong; Li, Jing

2016-01-01

The wheat production in midland China is under serious threat by frequent Dry-Hot Wind (DHW) episodes with high temperature, low moisture and specific wind as well as intensive heat transfer and evapotranspiration. The numerical simulations of these episodes are important for monitoring grain yield and estimating agricultural water demand. However, uncertainties still remain despite that enormous experiments and modeling studies have been conducted concerning this issue, due to either inaccurate synoptic situation derived from mesoscale weather models or unrealistic parameterizations of stomatal physiology in land surface models. Hereby, we investigated the synoptic characteristics of DHW with widely-used mesoscale model Weather Research and Forecasting (WRF) and the effects of leaf physiology on surface evapotranspiration by comparing two land surface models: The Noah land surface model, and Peking University Land Model (PKULM) with stomata processes included. Results show that the WRF model could well replicate the synoptic situations of DHW. Two types of DHW were identified: (1) prevailing heated dry wind stream forces the formation of DHW along with intense sensible heating and (2) dry adiabatic processes overflowing mountains. Under both situations, the PKULM can reasonably model the stomatal closure phenomena, which significantly decreases both evapotranspiration and net ecosystem exchange of canopy, while these phenomena cannot be resolved in the Noah simulations. Therefore, our findings suggest that the WRF-PKULM coupled method may be a more reliable tool to investigate and forecast DHW as well as be instructive to crop models.

Numerical Study on the Stomatal Responses to Dry-Hot Wind Episodes and Its Effects on Land-Atmosphere Interactions

PubMed Central

Zheng, Hui; Liu, Shuhua; Miao, Yucong; Li, Jing

2016-01-01

The wheat production in midland China is under serious threat by frequent Dry-Hot Wind (DHW) episodes with high temperature, low moisture and specific wind as well as intensive heat transfer and evapotranspiration. The numerical simulations of these episodes are important for monitoring grain yield and estimating agricultural water demand. However, uncertainties still remain despite that enormous experiments and modeling studies have been conducted concerning this issue, due to either inaccurate synoptic situation derived from mesoscale weather models or unrealistic parameterizations of stomatal physiology in land surface models. Hereby, we investigated the synoptic characteristics of DHW with widely-used mesoscale model Weather Research and Forecasting (WRF) and the effects of leaf physiology on surface evapotranspiration by comparing two land surface models: The Noah land surface model, and Peking University Land Model (PKULM) with stomata processes included. Results show that the WRF model could well replicate the synoptic situations of DHW. Two types of DHW were identified: (1) prevailing heated dry wind stream forces the formation of DHW along with intense sensible heating and (2) dry adiabatic processes overflowing mountains. Under both situations, the PKULM can reasonably model the stomatal closure phenomena, which significantly decreases both evapotranspiration and net ecosystem exchange of canopy, while these phenomena cannot be resolved in the Noah simulations. Therefore, our findings suggest that the WRF-PKULM coupled method may be a more reliable tool to investigate and forecast DHW as well as be instructive to crop models. PMID:27648943

Intrusions in story recall: when over-learned information interferes with episodic memory recall. Evidence from Alzheimer's disease.

PubMed

De Anna, Francesca; Attali, Eve; Freynet, Laurence; Foubert, Lucie; Laurent, Aurore; Dubois, Bruno; Dalla Barba, Gianfranco

2008-03-01

Patients with Alzheimer's disease (AD) suffer from distortions of memory. Among such distortions, intrusions in memory tests are frequently observed. In this study we describe the performance of a group of mild AD patients and a group of normal controls on the recall of three different types of stories: a previously unknown story, a well-known fairy-tale (Cinderella), and a modified well-known fairy-tale (Little Red Riding Hood is not eaten by the wolf). The aim of our study was to test the hypothesis that in patients who tend to produce intrusions, over-learned information interferes with episodic recall, i.e., the retrieval of specific, unique past episodes. AD patients produced significantly more intrusions in the recall of the modified fairy-tale compared to the recall of the two other stories. Intrusions in the recall of the modified fairy-tale always consisted of elements of the original version of the story. We suggest that in AD patients intrusions may be traced back to the interference of strongly represented, over-learned information in episodic memory recall.

Attributes of advanced practice registered nurse care coordination for children with medical complexity.

PubMed

Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W

2014-01-01

Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Effects of handling procedures on pain responses of very low birth weight infants.

PubMed

Cameron, Emma Catherine; Raingangar, Veena; Khoori, Nawal

2007-01-01

The purpose of this study was to investigate the effects of handling on pain responses of infants with very low birth weight (VLBW) and the frequency, duration, and type of handling procedures used during a 24-hour period for infants with VLBW. Eighteen infants with VLBW were observed for two-hour periods. Infants' pain responses were recorded using the Neonatal Inventory Pain Scale before and after each handling episode. Twelve infants were observed once, six were observed twice. Variables relating to each handling episode observed were documented. Pain scores were significantly greater after handling. During a 24-hour period, infants were handled an average of 53 times for an average of 2.7 hours. Ten handling episodes included social touch. Handling infants with VLBW significantly alters their pain responses. In some infants with VLBW are handled frequently in the neonatal intensive care unit. The results have implications for the training of neonatal caregivers.

Role of parietal regions in episodic memory retrieval: the dual attentional processes hypothesis.

PubMed

Cabeza, Roberto

2008-01-01

Although parietal cortex is frequently activated during episodic memory retrieval, damage to this region does not markedly impair episodic memory. To account for these and other findings, a new dual attentional processes (DAP) hypothesis is proposed. According to this hypothesis, dorsal parietal cortex (DPC) contributes top-down attentional processes guided by retrieval goals, whereas ventral parietal cortex (VPC) contributes bottom-up attentional processes captured by the retrieval output. Consistent with this hypothesis, DPC activity increases with retrieval effort whereas VPC activity increases with confidence in old and new responses. The DAP hypothesis can also account for the overlap of parietal activations across different cognitive domains and for opposing effects of parietal activity on encoding vs. retrieval. Finally, the DAP hypothesis explains why VPC lesions yield a memory neglect syndrome: a deficit in spontaneously reporting relevant memory details but not in accessing the same details when guided by specific questions.

Kleine Levin syndrome in Malaysia: first typical case

PubMed Central

Bahari, Rafidah; Ahmad, Syed Hassan

2012-01-01

A 13-year-old boy presented with a 2 weeks history of tearfulness, childish behaviour, separation anxiety, hypersomnia, hyperphagia and sexual disinhibition following a brief episode of fever. He had been experiencing the episodes since he was seven. The episodes lasted from a few days to 3 weeks and would normally occur once in a year. Most of the time it started with fever and resolved spontaneously. In the past he described auditory hallucination but not this time. Examination revealed a slightly overweight adolescent male appearing appropriate to his age. During the session he was restless, sleepy and burst into tears frequently. He constantly asked his mother when he could go home to sleep. He was very childish and clung to his mother. He was given a trial of risperidone 1 mg to be taken once a day for 3 days. On follow-up he had completely recovered. PMID:22605587

Meta-cognitive skills training enhances computerized cognitive remediation outcomes among individuals with first-episode psychosis.

PubMed

Breitborde, Nicholas J K; Woolverton, Cindy; Dawson, Spencer C; Bismark, Andrew; Bell, Emily K; Bathgate, Christina J; Norman, Kaila

2017-06-01

Meta-cognitive skills training (MST) is a frequent component of cognitive remediation programmes for individuals with psychosis. However, no study has investigated whether incorporating such activities produces increased clinical benefits compared with computerized cognitive remediation alone. Individuals with first-episode psychosis who completed computerized cognitive remediation with concurrent meta-cognitive skills training (CCR + MST) were compared with a historical control group who received computerized cognitive remediation alone (CCR) and did not differ from the CCR + MST group with regard to pre-intervention cognition, diagnosis, age, duration of psychotic illness or sex. Participants completed assessments of cognition and real-world functioning before and after 6 months of treatment. Individual receiving CCR + MST experience greater gains in cognition and real-world functioning than individuals who received CCR. MST may be an important component within cognitive remediation programmes for first-episode psychosis. © 2015 Wiley Publishing Asia Pty Ltd.

Maternal prepregnancy obesity is an independent risk factor for frequent wheezing in infants by age 14 months.

PubMed

Guerra, Stefano; Sartini, Claudio; Mendez, Michelle; Morales, Eva; Guxens, Mònica; Basterrechea, Mikel; Arranz, Leonor; Sunyer, Jordi

2013-01-01

Maternal prepregnancy obesity has been linked to the offspring's risk for subsequent asthma. We determined whether maternal obesity is associated with increased risk of wheezing phenotypes early in life. We used data on 1107 mother-child pairs from two birth cohorts from the INMA-INfancia y Medio Ambiente project. Maternal height was measured and prepregnancy weight self-reported at enrolment (on average at 13.7 ± 2 weeks of gestation). Maternal prepregnancy body mass index was categorised as underweight, normal, overweight and obese according to WHO recommendations. Information on child's wheezing was obtained through questionnaires up to the age of 14 (± 1) months. Wheezing was classified as infrequent (<4 reported wheezing episodes) or frequent (≥ 4 episodes). Weight and length of infants were measured by trained study staff at 14.6 (± 1) months of age and weight-for-length z-scores computed. Although maternal obesity did not increase the risk of the child to have any or infrequent wheezing, children of obese mothers were more likely to have frequent wheezing than children of normal-weight mothers (11.8% vs. 3.8%; P = 0.002). In fully adjusted multinomial logistic regression models, including infants' weight-for-length z-scores and other covariates, maternal prepregnancy obesity was associated with increased risk of frequent [adjusted relative risk (RR) 4.18, 95% confidence interval (CI) 1.55, 11.3] but not infrequent (RR 1.05 [95% CI 0.55, 2.01]) wheezing in their children. Maternal prepregnancy obesity is independently associated with an increased risk of frequent wheezing in the infant by the age of 14 months. These findings add evidence on the potential effects of in utero exposures on asthma-related phenotypes. © 2012 Blackwell Publishing Ltd.

The Student with Sickle Cell Anemia.

ERIC Educational Resources Information Center

Tetrault, Sylvia M.

1981-01-01

Sickle cell anemia is the most common and severe of inherited chronic blood disorders. In the United States, sickle cell anemia is most common among the Black population. Among the most commonly occurring symptoms are: an enlarged spleen, episodes of severe pain, easily contracted infections, skin ulcers, and frequent urination. (JN)

Relationship-Enhancing Communication Skills in Prime-Time Family-Oriented Situation Comedies.

ERIC Educational Resources Information Center

Aust, Charles F.

Television situation comedies have been criticized for their portrayal of dysfunctional family behavior. An exploratory content analysis study assessed the extent of relationship-enhancing communication skills in family-oriented, prime-time situation comedies, a genre frequently targeted for both scorn and praise. Three episodes each of five shows…

Itinerant vending of medicines inside buses in Nigeria: vending strategies, dominant themes and medicine-related information provided

PubMed Central

Yusuff, Kazeem B.; Wassi Sanni, Abd’

Objective To determine vending strategies and marketing themes employed by itinerant bus vendors, and assess the accuracy and completeness of information provided on medicines being sold in an urban setting in Nigeria. Methods Cross-sectional study and content analysis of itinerant vending of medicines inside buses recorded with a mobile telephone on purposively selected routes in a mega city with an estimated 18 million residents in southwestern Nigeria over a 2-month period. Two coders independently assessed 192 vending episodes by 56 vendors for 147 OTC and prescription medicines. Inter-rater reliability (Gwet AC1 =0.924; p<0.0001). Results Fourteen thousands and four hundred potential consumers encountered 192 recorded episodes of vending of medicines inside 192 buses within the study periods. Forty-four (78•5%) of the 56 vendors were females in the 30-45 years age bracket, were mostly (75%) attired in the local ‘Iro and Buba’ Ankara fabric and showed laminated identity cards (97.5%) issued by the local association for ‘marketers’ of medicines inside buses, markets, and motor parks. Of the 14400 consumers encountered inside buses during the study period, between 6.7% and 48.3% purchased the medicines promoted. Prayers against death from road traffic accidents and diseases of physical and / or meta-physical origins were the most frequently used (76•8%) ice-breaking opening statement / strategy to gain consumers’ attention. Hematinics, multi-vitamins, simple analgesic, NSAIDs and corticosteroids were the most frequently vended medicines. Consumers’ enquiries were related to dosing for children (51.8%), elderly (28.6%), and pregnancy (52.7%); and contra-indications during pregnancy (8.9%). Factual medicines information such as dose, frequency, potential side effects and contra-indications were not provided in majority of vending episodes. Conclusions Itinerant vending of medicines and the use of misleading and melodramatic themes to secure high consumer patronage appear considerable in Nigeria. Majority of the vendors did not correctly respond to consumers medicine-related enquiries, or provide detailed factual medicines information to guide appropriate use. These misleading promotional activities could potentially encourage inappropriate purchase and probable self-medication by consumers. PMID:24367466

Source apportionments of PM2.5 organic carbon during the elevated pollution episodes in the Ordos region, Inner Mongolia, China.

PubMed

Khuzestani, Reza Bashiri; Schauer, James J; Shang, Jing; Cai, Tianqi; Fang, Dongqing; Wei, Yongjie; Zhang, Lulu; Zhang, Yuanxun

2018-05-01

The Ordos region in the southwestern part of Inner Mongolia experiences frequent PM concentrations in excess of the national PM 2.5 air quality standards. In order to determine the key sources of PM 2.5 contributing to these pollution episodes, the main sources of PM 2.5 OC during elevated PM episodes in the Inner Mongolia were analyzed and compared with non-polluted days. This will provide insight to the main sources of particulate matter pollution during the high-pollution episodes and the effective seasonal strategies to control sources of particulate matter during months and with the highest PM concentrations that need to be controlled. The PMF source contributions to OC demonstrated that the industrial/coal combustion (4762.77 ± 1061.54 versus 2726.49 ± 469.75 ng/m 3 ; p < 0.001) and mobile source factors (4651.14 ± 681.82 versus 2605.55 ± 276.50 ng/m 3 ; p value < 0.001) showed greater contributions to the elevated concentrations during the episode. The spatial analysis of secondary organic carbon (SOC) factors, regional biomass burning, and biogenic sources did not show significant difference in the pollution episodes and the non-polluted months. In addition, the bivariate polar plots and CWT maps of the industrial/coal combustion and mobile illustrated a regional long-range transport patterns from the external sources to the study area, however, adjacent areas were mostly controlling the contributions of these factors during the PM elevated episodes. The SOC sources, regional biomass burning, and biogenic sources illustrated a regional long-range transport with similar locations found during the elevated pollution episodes compared to the normal situations.

Charting the acquisition of semantic knowledge in a case of developmental amnesia

PubMed Central

Gardiner, John M.; Brandt, Karen R.; Baddeley, Alan D.; Vargha-Khadem, Faraneh; Mishkin, Mortimer

2009-01-01

We report the acquisition and recall of novel facts by Jon, a young adult with early onset developmental amnesia whose episodic memory is gravely impaired due to selective bilateral hippocampal damage. Jon succeeded in learning some novel facts but compared with a control group his intertrial retention was impaired during acquisition and, except for the most frequently repeated facts, he was also less accurate in correctly sourcing these facts to the experiment. The results further support the hypothesis that despite a severely compromised episodic memory and hippocampal system, there is nevertheless the capacity to accrue semantic knowledge available to recall. PMID:18589461

Charting the acquisition of semantic knowledge in a case of developmental amnesia.

PubMed

Gardiner, John M; Brandt, Karen R; Baddeley, Alan D; Vargha-Khadem, Faraneh; Mishkin, Mortimer

2008-09-01

We report the acquisition and recall of novel facts by Jon, a young adult with early onset developmental amnesia whose episodic memory is gravely impaired due to selective bilateral hippocampal damage. Jon succeeded in learning some novel facts but compared with a control group his intertrial retention was impaired during acquisition and, except for the most frequently repeated facts, he was also less accurate in correctly sourcing these facts to the experiment. The results further support the hypothesis that despite a severely compromised episodic memory and hippocampal system, there is nevertheless the capacity to accrue semantic knowledge available to recall.

Vestibular migraine: the most frequent entity of episodic vertigo.

PubMed

Dieterich, Marianne; Obermann, Mark; Celebisoy, Nese

2016-04-01

Vestibular migraine (VM) is the most common cause of episodic vertigo in adults as well as in children. The diagnostic criteria of the consensus document of the International Bárány Society for Neuro-Otology and the International Headache Society (2012) combine the typical signs and symptoms of migraine with the vestibular symptoms lasting 5 min to 72 h and exclusion criteria. Although VM accounts for 7% of patients seen in dizziness clinics and 9% of patients seen in headache clinics it is still underdiagnosed. This review provides an actual overview on the pathophysiology, the clinical characteristics to establish the diagnosis, the differential diagnosis, and the treatment of VM.

Friends or Foes: Social Anxiety, Peer Affiliation, and Drinking in Middle School *

PubMed Central

Anderson, Kristen G.; Tomlinson, Kristin; Robinson, Joanna M.; Brown, Sandra A.

2011-01-01

Objective: The relation between social anxiety and alcohol consumption suggests aspects of both risk and protection, but most research has focused on late adolescents and emerging adults. Method: We investigated the synergistic impact of social anxiety, a need for affiliation with others, and perceived peer alcohol use on drinking in a sample of more than 1,500 early adolescents from southern California (48% girls). Via school-wide surveys, middle school students completed the Social Anxiety Scale for Children-Revised, a modified version of the Interpersonal Orientation Scale, as well as measures of perceived peer drinking and self-reported lifetime and current drinking. Results: For socially anxious youths, high levels of perceived peer use in conjunction with high levels of affiliation need was associated with greater alcohol use on average and more frequent episodic drinking. Specific to heavy episodic drinking, the interaction of social anxiety and perceived peer drinking seemed to affect girls and boys differentially. Sex differences emerged for the moderation of social anxiety's influence on drinking initiation by perceived peer influence. Conclusions: These findings suggest that alcohol-related risks associated with social anxiety might be gender specific and more important in earlier stages of alcohol use than previously believed. PMID:21138712

What cues do nurses use to predict aggression in people with acquired brain injury?

PubMed

Pryor, Julie

2005-04-01

There is a paucity of research on the frequent and repeated episodes of aggression and violence experienced by nurses when working with people who have an acquired brain injury. The purpose of this study was to bring this issue into focus by identifying the cues nurses use to predict aggression in people with acquired brain injury. Twenty-eight nurses from 10 different inpatient brain injury rehabilitation units in Australia participated in the study. Participants were interviewed using the Critical Decision Method on a one to one basis for up to one and one half hours on two consecutive days. Transcripts of the interviews were analysed using thematic analysis. Results revealed that nurses identified five groups of cues that predict aggression in a patient: (1) what a patient is saying; (2) changes in a patient's voice; (3) changes in a patient's face; (4) changes in a patient's behavior; and (5) a patient's emotions. Nurses reported using multiple cues to predict aggression and highlighted the importance of personal knowledge of the patient in conjunction with identified cues when predicting aggression. Nurses caring for patients with acquired brain injury can predict many episodes of aggression, though not all, by identifying cues from the patient.

Zone specific fractal dimension of retinal images as predictor of stroke incidence.

PubMed

Aliahmad, Behzad; Kumar, Dinesh Kant; Hao, Hao; Unnikrishnan, Premith; Che Azemin, Mohd Zulfaezal; Kawasaki, Ryo; Mitchell, Paul

2014-01-01

Fractal dimensions (FDs) are frequently used for summarizing the complexity of retinal vascular. However, previous techniques on this topic were not zone specific. A new methodology to measure FD of a specific zone in retinal images has been developed and tested as a marker for stroke prediction. Higuchi's fractal dimension was measured in circumferential direction (FDC) with respect to optic disk (OD), in three concentric regions between OD boundary and 1.5 OD diameter from its margin. The significance of its association with future episode of stroke event was tested using the Blue Mountain Eye Study (BMES) database and compared against spectrum fractal dimension (SFD) and box-counting (BC) dimension. Kruskal-Wallis analysis revealed FDC as a better predictor of stroke (H = 5.80, P = 0.016, α = 0.05) compared with SFD (H = 0.51, P = 0.475, α = 0.05) and BC (H = 0.41, P = 0.520, α = 0.05) with overall lower median value for the cases compared to the control group. This work has shown that there is a significant association between zone specific FDC of eye fundus images with future episode of stroke while this difference is not significant when other FD methods are employed.

Relation of sexual risks and prevention practices with individuals' stigmatising beliefs towards HIV infected individuals: an exploratory study

PubMed Central

Liu, H; Li, X; Stanton, B; Fang, X; Mao, R; Chen, X; Yang, H

2005-01-01

Methods: A cross sectional survey was conducted to assess HIV related stigmatising beliefs, risk sexual behaviours, and preventive practices among sexually experienced rural to urban migrants aged 18–30 years in 2002 in Beijing and Nanjing, two large Chinese cities. Results: Among 2153 migrants, 7.2% reported having had more than one sexual partner in the previous month, 9.9% had commercial sex partners, and 12.5% had an episode of a sexually transmitted disease (STD). Only 18% reported frequently or always using condoms, with 20% sometimes or occasionally using them. 57% of the Chinese migrants were willing to take a voluntary HIV test, and 65% had HIV related stigmatising beliefs towards people living with HIV. Multiple logistic regression analysis depicts that individual's stigmatising beliefs towards people with HIV were positively associated with having had an episode of an STD, having multiple sex partners, or having had commercial sex partners, and were negatively associated with condom use and the willingness to accept an HIV test. Conclusion: The finding that one's own stigmatising belief is a potential barrier to HIV related preventive practices highlights the difficulties and challenges in implementing behavioural interventions. PMID:16326857

Gender differences in suicidal behaviour in patients with first-episode psychosis.

PubMed

Austad, Gudrun; Joa, Inge; Johannessen, Jan Olav; Larsen, Tor Ketil

2015-08-01

Prior research shows contradictory gender patterns in suicidal behaviour among patients with first-episode psychosis. The aim of this study was to investigate gender differences in the prevalence of suicidal behaviour (suicidal ideation, suicide plans and suicide attempts) and to delineate risk factors for suicidal behaviour among consecutively included male and female patients with first-episode psychosis in the TIPS II early detection study. Patients with first-episode psychosis (n = 246) from a hospital catchment area with a system for early detection were assessed and compared on baseline sociodemographical and clinical variables according to gender. Current (past 1 month) and lifetime prevalence of suicidal behaviour were assessed. Current and lifetime rates of suicidal behaviour were high (50.8% and 65.9%, respectively) and higher among females (lifetime: 78.3 %, past month: 64.2 %) versus males (lifetime: 56.4 %, past month: 40.7 %). Depressive symptoms and female gender were associated with both lifetime and current risk for suicidal behaviour. Lifetime prevalence was also associated with a longer duration of untreated psychosis and young age after controlling for other risk factors. Suicidal behaviour was frequent among patients with first-episode psychosis, with a higher prevalence of suicidal behaviour in females. Depressive symptoms and female gender were significantly associated with suicidal behaviour. © 2013 Wiley Publishing Asia Pty Ltd.

Molecular diversity of serial Cryptococcus neoformans isolates from AIDS patients in the city of São Paulo, Brazil.

PubMed

Martins, Marilena A; Pappalardo, Mara C S M; Melhem, Márcia S C; Pereira-Chioccola, Vera L

2007-11-01

Despite highly active anti-retroviral therapy, cryptococcal meningoencephalitis is the second most prevalent neurological disease in Brazilian AIDS patients, being frequently a defining condition with several episodes. As knowledge of Cryptococcus neoformans isolates in the same episode is critical for understanding why some patients develop several episodes, we investigated the genotype characteristics of C. neoformans isolates in two different situations. By pulsed field gel electrophoresis and random amplified polymorphic DNA analysis, 54 isolates from 12 patients with AIDS and cryptococcosis were analyzed. Group 1 comprised 39 isolates from nine patients with a single episode and hospitalization. Group 2 comprised 15 isolates from three patients with two episodes and hospitalizations. Except for three patients from group 1 probably infected with a single C. neoformans isolate, the other nine patients probably were infected with multiple isolates selected in different collection periods, or the infecting isolate might have underwent mutation to adapt and survive the host immune system and/or the antifungal therapy. However, the three patients from group 2 presented genetic diversity among isolates collected in both hospitalizations, possibly having hosted the initial isolate in both periods. These data, emphasize that Cryptococcus diversity in infection can contribute to strategies of treatment and prevention of cryptococcosis.

Exogenous reinfection of tuberculosis in a low-burden area.

PubMed

Schiroli, Consuelo; Carugati, Manuela; Zanini, Fabio; Bandera, Alessandra; Di Nardo Stuppino, Silvia; Monge, Elisa; Morosi, Manuela; Gori, Andrea; Matteelli, Alberto; Codecasa, Luigi; Franzetti, Fabio

2015-12-01

Recurrence of tuberculosis (TB) can be the consequence of relapse or exogenous reinfection. The study aimed to assess the factors associated with exogenous TB reinfection. Prospective cohort study based on the TB database, maintained at the Division of Infectious Diseases, Luigi Sacco Hospital (Milan, Italy). Time period: 1995-2010. (1) ≥2 episodes of culture-confirmed TB; (2) cure of the first episode of TB; (3) availability of one Mycobacterium tuberculosis isolate for each episode. Genotyping of the M. tuberculosis strains to differentiate relapse and exogenous reinfection. Logistic regression analysis was used to assess the influence of risk factors on exogenous reinfections. Of the 4682 patients with TB, 83 were included. Of these, exogenous reinfection was diagnosed in 19 (23 %). It was independently associated with absence of multidrug resistance at the first episode [0, 10 (0.01-0.95), p = 0.045] and with prolonged interval between the first TB episode and its recurrence [7.38 (1.92-28.32) p = 0.004]. However, TB relapses occurred until 4 years after the first episode. The risk associated with being foreign born, extrapulmonary site of TB, and HIV infection was not statistically significant. In the relapse and re-infection cohort, one-third of the patients showed a worsened drug resistance profile during the recurrent TB episode. Exogenous TB reinfections have been documented in low endemic areas, such as Italy. A causal association with HIV infection could not be confirmed. Relapses and exogenous reinfections shared an augmented risk of multidrug resistance development, frequently requiring the use of second-line anti-TB regimens.

Drinking Level, Drinking Pattern, and Twenty-Year Total Mortality Among Late-Life Drinkers.

PubMed

Holahan, Charles J; Schutte, Kathleen K; Brennan, Penny L; Holahan, Carole K; Moos, Rudolf H

2015-07-01

Research on moderate drinking has focused on the average level of drinking. Recently, however, investigators have begun to consider the role of the pattern of drinking, particularly heavy episodic drinking, in mortality. The present study examined the combined roles of average drinking level (moderate vs. high) and drinking pattern (regular vs. heavy episodic) in 20-year total mortality among late-life drinkers. The sample comprised 1,121 adults ages 55-65 years. Alcohol consumption was assessed at baseline, and total mortality was indexed across 20 years. We used multiple logistic regression analyses controlling for a broad set of sociodemographic, behavioral, and health status covariates. Among individuals whose high level of drinking placed them at risk, a heavy episodic drinking pattern did not increase mortality odds compared with a regular drinking pattern. Conversely, among individuals who engage in a moderate level of drinking, prior findings showed that a heavy episodic drinking pattern did increase mortality risk compared with a regular drinking pattern. Correspondingly, a high compared with a moderate drinking level increased mortality risk among individuals maintaining a regular drinking pattern, but not among individuals engaging in a heavy episodic drinking pattern, whose pattern of consumption had already placed them at risk. Findings highlight that low-risk drinking requires that older adults drink low to moderate average levels of alcohol and avoid heavy episodic drinking. Heavy episodic drinking is frequent among late-middle-aged and older adults and needs to be addressed along with average consumption in understanding the health risks of late-life drinkers.

Hospital treatment for fluid overload in the Medicare hemodialysis population.

PubMed

Arneson, Thomas J; Liu, Jiannong; Qiu, Yang; Gilbertson, David T; Foley, Robert N; Collins, Allan J

2010-06-01

Fluid overload in hemodialysis patients sometimes requires emergent dialysis, but the magnitude of this care has not been characterized. This study aimed to estimate the magnitude of fluid overload treatment episodes for the Medicare hemodialysis population in hospital settings, including emergency departments. Point-prevalent hemodialysis patients were identified from the Centers for Medicare and Medicaid Renal Management Information System and Standard Analytical Files. Fluid overload treatment episodes were defined by claims for care in inpatient, hospital observation, or emergency department settings with primary discharge diagnoses of fluid overload, heart failure, or pulmonary edema, and dialysis performed on the day of or after admission. Exclusion criteria included stays >5 days. Cost was defined as total Medicare allowable costs for identified episodes. Associations between patient characteristics and episode occurrence and cost were analyzed. For 25,291 patients (14.3%), 41,699 care episodes occurred over a mean follow-up time of 2 years: 86% inpatient, 9% emergency department, and 5% hospital observation. Heart failure was the primary diagnosis in 83% of episodes, fluid overload in 11%, and pulmonary edema in 6%. Characteristics associated with more frequent events included age <45 years, female sex, African-American race, causes of ESRD other than diabetes, dialysis duration of 1 to 3 years, fewer dialysis sessions per week at baseline, hospitalizations during baseline, and most comorbid conditions. Average cost was $6,372 per episode; total costs were approximately $266 million. Among U.S. hemodialysis patients, fluid overload treatment is common and expensive. Further study is necessary to identify prevention opportunities.

Inherited focal, episodic neuropathies: hereditary neuropathy with liability to pressure palsies and hereditary neuralgic amyotrophy.

PubMed

Chance, Phillip F

2006-01-01

Hereditary neuropathy with liability to pressure palsies (HNPP; also called tomaculous neuropathy) is an autosomal-dominant disorder that produces a painless episodic, recurrent, focal demyelinating neuropathy. HNPP generally develops during adolescence, and may cause attacks of numbness, muscular weakness, and atrophy. Peroneal palsies, carpal tunnel syndrome, and other entrapment neuropathies may be frequent manifestations of HNPP. Motor and sensory nerve conduction velocities may be reduced in clinically affected patients, as well as in asymptomatic gene carriers. The histopathological changes observed in peripheral nerves of HNPP patients include segmental demyelination and tomaculous or "sausage-like" formations. Mild overlap of clinical features with Charcot-Marie-Tooth (CMT) disease type 1 (CMT1) may lead patients with HNPP to be misdiagnosed as having CMT1. HNPP and CMT1 are both demyelinating neuropathies, however, their clinical, pathological, and electrophysiological features are quite distinct. HNPP is most frequently associated with a 1.4-Mb pair deletion on chromosome 17p12. A duplication of the identical region leads to CMT1A. Both HNPP and CMT1A result from a dosage effect of the PMP22 gene, which is contained within the deleted/duplicated region. This is reflected in reduced mRNA and protein levels in sural nerve biopsy samples from HNPP patients. Treatment for HNPP consists of preventative and symptom-easing measures. Hereditary neuralgic amyotrophy (HNA; also called familial brachial plexus neuropathy) is an autosomal-dominant disorder causing episodes of paralysis and muscle weakness initiated by severe pain. Individuals with HNA may suffer repeated episodes of intense pain, paralysis, and sensory disturbances in an affected limb. The onset of HNA is at birth or later in childhood with prognosis for recovery usually favorable; however, persons with HNA may have permanent residual neurological dysfunction following attack(s). Episodes are often triggered by infections, immunizations, the puerperium, and stress. Electrophysiological studies show normal or mildly prolonged motor nerve conduction velocities distal to the affected brachial plexus. Pathological studies have found axonal degeneration in nerves examined distal to the plexus abnormality. In some HNA pedigrees there are characteristic facial features, including hypotelorism. The prognosis for recovery of normal function of affected limbs in HNA is good, although recurrent episodes may cause residual deficits. HNA is genetically linked to chromosome 17q25, where mutations in the septin-9 (SEPT9) gene have been found.

Frequent alcohol drinking is associated with lower prevalence of self-reported common cold: a retrospective study

PubMed Central

2012-01-01

Background Alcohol intake has been associated with reduced incidence of common cold symptoms in 2 European studies. However, no study has addressed the association between the frequency of alcohol intake and the incidence of common cold. This study aimed to investigate the association between the amount and frequency of alcohol drinking and the retrospective prevalence of common cold in Japanese men. Methods This retrospective study included men who participated in an annual health examination conducted in Sendai, Japan. The frequency of common cold episodes in the previous year was self-reported. The weekly frequency and amount of alcohol consumed, as well as the type of alcoholic drink, were reported by a brief-type self-administered diet history questionnaire. Logistic regression models were used to analyze the association between the amount and frequency of alcohol intake and the retrospective prevalence of common cold. Results Among 899 men, 83.4% of the subjects reported drinking alcohol, and 55.4% of the subjects reported having experienced at least one episode of common cold in the previous year. Compared with non-drinkers, the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for having had 1 or more episodes of common cold during the past year across categories of alcohol intake frequency of 3 or less, 4–6, and 7 days/week were 0.827 (0.541–1.266), 0.703 (0.439–1.124), and 0.621 (0.400–0.965), respectively (P for trend = 0.025); the adjusted ORs with 95% CIs for having had of 2 or more episodes of common cold across the same categories were 0.642 (0.395–1.045), 0.557 (0.319–0.973), and 0.461 (0.270–0.787), respectively (P for trend = 0.006). Compared with subjects who consumed 11.5–35.8 g of alcohol per day, the non-drinkers were significantly more likely to experience 2 or more episodes of common cold (OR, 1.843; 95% CI, 1.115–3.047). Conclusion The frequency, not the amount, of alcohol intake was significantly related to lower prevalence of self-reported common cold episodes in Japanese men. PMID:23158193

Pre-attack signs and symptoms in cluster headache: Characteristics and time profile.

PubMed

Snoer, Agneta; Lund, Nunu; Beske, Rasmus; Jensen, Rigmor; Barloese, Mads

2018-05-01

Introduction In contrast to the premonitory phase of migraine, little is known about the pre-attack (prodromal) phase of a cluster headache. We aimed to describe the nature, prevalence, and duration of pre-attack symptoms in cluster headache. Methods Eighty patients with episodic cluster headache or chronic cluster headache, according to ICHD-3 beta criteria, were invited to participate. In this observational study, patients underwent a semi-structured interview where they were asked about the presence of 31 symptoms/signs in relation to a typical cluster headache attack. Symptoms included previously reported cluster headache pre-attack symptoms, premonitory migraine symptoms and accompanying symptoms of migraine and cluster headache. Results Pre-attack symptoms were reported by 83.3% of patients, with an average of 4.25 (SD 3.9) per patient. Local and painful symptoms, occurring with a median of 10 minutes before attack, were reported by 70%. Local and painless symptoms and signs, occurring with a median of 10 minutes before attack, were reported by 43.8% and general symptoms, occurring with a median of 20 minutes before attack, were reported by 62.5% of patients. Apart from a dull/aching sensation in the attack area being significantly ( p < 0.05) more frequent among men and episodic patients, compared with women and chronic patients respectively, no other differences in the prevalence of pre-attack symptoms were identified between groups. Conclusion Pre-attack symptoms are frequent in cluster headache. Since the origin of cluster headache attacks is still unresolved, studies of pre-attack symptoms could contribute to the understanding of cluster headache pathophysiology. Furthermore, identification and recognition of pre-attack symptoms could potentially allow earlier abortive treatment.

Impaired category fluency in medial temporal lobe amnesia: the role of episodic memory.

PubMed

Greenberg, Daniel L; Keane, Margaret M; Ryan, Lee; Verfaellie, Mieke

2009-09-02

Memory tasks are often classified as semantic or episodic, but recent research shows that these types of memory are highly interactive. Category fluency, for example, is generally considered to reflect retrieval from semantic memory, but behavioral evidence suggests that episodic memory is also involved: participants frequently draw on autobiographical experiences while generating exemplars of certain categories. Neuroimaging studies accordingly have reported increased medial temporal lobe (MTL) activation during exemplar generation. Studies of fluency in MTL amnesics have yielded mixed results but were not designed to determine the precise contributions of episodic memory. We addressed this issue by asking MTL amnesics and controls to generate exemplars of three types of categories. One type tended to elicit autobiographical and spatial retrieval strategies (AS). Another type elicited strategies that were autobiographical but nonspatial (AN). The third type elicited neither autobiographical nor spatial strategies (N). Amnesic patients and control participants generated exemplars for eight categories of each type. Patients were impaired on all category types but were more impaired on AS and AN categories. After covarying for phonemic fluency (total FAS score), the N category impairment was not significant, but the impairment on AS and AN categories remained. The same results were obtained for patients with lesions restricted to the MTL and those with more extensive lesions. We conclude that patients' episodic memory impairment hindered their performance on this putatively semantic task. This interaction between episodic and semantic memory might partially account for fluency deficits seen in aging, mild cognitive impairment, and Alzheimer's disease.

Persistent genital herpes simplex virus-2 shedding years following the first clinical episode.

PubMed

Phipps, Warren; Saracino, Misty; Magaret, Amalia; Selke, Stacy; Remington, Mike; Huang, Meei-Li; Warren, Terri; Casper, Corey; Corey, Lawrence; Wald, Anna

2011-01-15

Patients with newly acquired genital herpes simplex virus 2 (HSV-2) infection have virus frequently detected at the genital mucosa. Rates of genital shedding initially decrease over time after infection, but data on long-term viral shedding are lacking. For this study, 377 healthy adults with history of symptomatic genital HSV-2 infection collected anogenital swabs for HSV-2 DNA polymerase chain reaction for at least 30 consecutive days. Time since first genital herpes episode was significantly associated with reduced genital shedding. Total HSV shedding occurred on 33.6% of days in participants <1 year, 20.6% in those 1-9 years, and 16.7% in those ≥10 years from first episode. Subclinical HSV shedding occurred on 26.2% of days among participants <1 year, 13.1% in those 1-9 years, and 9.3% in those ≥10 years from first episode. On days with HSV detection, mean quantity was 4.9 log₁₀ copies/mL for those <1 year, 4.7 log₁₀ copies/mL among those 1-9 years, and 4.6 log₁₀ copies/mL among those ≥10 years since first episode. Rates of total and subclinical HSV-2 shedding decrease after the first year following the initial clinical episode. However, viral shedding persists at high rates and copy numbers years after infection, and therefore may pose continued risk of HSV-2 transmission to sexual partners.

Cannabis use and first manic episode.

PubMed

Bally, Nathalie; Zullino, Daniele; Aubry, Jean-Michel

2014-08-01

Cannabis is the most commonly abused drug among patients with bipolar disorder. Available data has shown that the risk of psychotic disorders increases with the frequency and intensity of cannabis abuse. The present purpose was to review relevant studies to investigate whether cannabis use can be linked to the onset of mania in bipolar disorder. Articles published between 1972 and December 2013 were searched on Medline and PsychInfo using the following keywords: first manic episode, or onset mania, or bipolar disorder and cannabis. Relevant papers cited in the references of selected articles were further considered for inclusion into the review. Lifetime use of cannabis among bipolar patients appears to be around 70% and approximately 30% of patients with a bipolar disorder present a comorbidity of cannabis abuse or dependence. Cannabis use is associated with younger age at onset of first mania and with more frequent depressive or manic episodes, although the evidence is somewhat inconsistent. Likewise cannabis consumption is related to poorer outcome and an increased risk of rapid cycling or mixed episodes. In contrast, neuro-cognitive functioning seems to be positively affected in patients with psychiatric comorbidity. While cannabis use often precedes first manic episodes, the causal direction remains to be determined. Variations in definition of cannabis use/dependence. Lack of controlled studies limiting definite conclusions about a putative causal relationship between cannabis and onset of mania. Further investigations are needed to clarify the relationships between cannabis use and first manic episode. Copyright © 2014 Elsevier B.V. All rights reserved.

SU110. Meaning-Making, Self-identity, and Ambivalence Around Antipsychotics in First-Episode Psychosis

PubMed Central

Berkhout, Susan; Zaheer, Juveria

2017-01-01

Abstract Background: An issue throughout all areas of medicine, nonadherence to medications is particularly challenging in first-episode psychosis (FEP), where discontinuation of medications has been found to be one of the most reliable predictors of relapse after symptom remission (Haddad et al, 2014; Alvarez-Jimenez et al, 2012). And while medication factors and patient expectancies are frequently employed to understand challenges surrounding adherence, there are limits to their explanatory power. Methods: Utilizing ethnographic methodologies, we collected and analyzed narratives of FEP clinic users in order to explore relationships between experiences of illness, contacts with the mental health system, and medication nonadherence. Data were composed of text materials relating to early intervention and first-episode psychosis and antipsychotic medications, longitudinal key informant interviews, and participant observation in a FEP clinic setting in Toronto, Canada. An interpretive thematic analysis of interview transcripts, field notes, and texts was subsequently undertaken, and emerging themes developed iteratively through multiple readings of the texts; the use of multiple coders, member checks, and the range of data sources enabled triangulation of the established themes. Results: The imperative to consistently ingest or inject psychiatric medications can, at times, clash with the lived experience of those struggling to reorient a sense of self in the aftermath of a psychotic illness. Frictions exist between subjective meanings attached to experiences of psychosis and their biomedical framing, leading to ruptures in the clinical setting that are dramatized around medication use. Conclusion: This pilot study demonstrates that a much broader scope of subjective and intersubjective experience is salient to issues surrounding medication use in first-episode psychosis. Moreover, meanings attached to medications are continually shifting, imbued with ambivalence, and overdetermined. As such, limiting analyses of antipsychotic adherence to medication-centric factors and cross-sectional methodologies fail to encapsulate the breadth of relevant meanings and experiences to medications and their mutable nature. These findings offer insights that may further facilitate engagement of individuals around medications and within first-episode services more broadly.

Transcriptome-based phylogeny of endemic Lake Baikal amphipod species flock: fast speciation accompanied by frequent episodes of positive selection.

PubMed

Naumenko, Sergey A; Logacheva, Maria D; Popova, Nina V; Klepikova, Anna V; Penin, Aleksey A; Bazykin, Georgii A; Etingova, Anna E; Mugue, Nikolai S; Kondrashov, Alexey S; Yampolsky, Lev Y

2017-01-01

Endemic species flocks inhabiting ancient lakes, oceanic islands and other long-lived isolated habitats are often interpreted as adaptive radiations. Yet molecular evidence for directional selection during species flocks radiation is scarce. Using partial transcriptomes of 64 species of Lake Baikal (Siberia, Russia) endemic amphipods and two nonendemic outgroups, we report a revised phylogeny of this species flock and analyse evidence for positive selection within the endemic lineages. We confirm two independent invasions of amphipods into Baikal and demonstrate that several morphological features of Baikal amphipods, such as body armour and reduction in appendages and sensory organs, evolved in several lineages in parallel. Radiation of Baikal amphipods has been characterized by short phylogenetic branches and frequent episodes of positive selection which tended to be more frequent in the early phase of the second invasion of amphipods into Baikal when the most intensive diversification occurred. Notably, signatures of positive selection are frequent in genes encoding mitochondrial membrane proteins with electron transfer chain and ATP synthesis functionality. In particular, subunits of both the membrane and substrate-level ATP synthases show evidence of positive selection in the plankton species Macrohectopus branickii, possibly indicating adaptation to active plankton lifestyle and to survival under conditions of low temperature and high hydrostatic pressures known to affect membranes functioning. Other functional categories represented among genes likely to be under positive selection include Ca-binding muscle-related proteins, possibly indicating adaptation to Ca-deficient low mineralization Baikal waters. © 2016 John Wiley & Sons Ltd.

Conjugal violence: a comparison of violence against men by women and women by men.

PubMed

Thureau, S; Le Blanc-Louvry, I; Thureau, S; Gricourt, C; Proust, B

2015-04-01

Because few studies demonstrated the types of violence performed by women, the aim of our study was to access violence men against women as well as women against men. A retrospective study was performed based on all the medical certificates for victims who consulted our centre specialized in assault victims. Eleven percent of the victims were men (81 men, 626 women). Episodes of violence were most often repeated against women than men (p < 0.05). Injuring, in most cases mild, were more frequently found in men than women (p < 0.01). They were primarily cutaneous in 66% of cases (85% men, 64% women) and severe in 5% of cases i.e. fractures, with no difference in gender. Three cases of sexual assault and one case of chemical submission was observed in women. Insults were made more often by men than by women (p < 0.002). A psychological impact was more frequently found in women than in men (p < 0.01). The duration of the total incapacity (incapacité totale de travail = ITT) was less than 0-3 days in most cases, and this occurred more often in 91% men than in 65% women (p < 0.01). Consultations for domestic violence occur less frequently in men than in women. Men present more often with injuries that are less severe compared to those observed in women. In contrast, the psychological impact is less frequent in men. Also episodes of violence were most often repeated when the aggressor was a man. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Polymicrobial Infective Endocarditis: Clinical Features and Prognosis

PubMed Central

García-Granja, Pablo Elpidio; López, Javier; Vilacosta, Isidre; Ortiz-Bautista, Carlos; Sevilla, Teresa; Olmos, Carmen; Sarriá, Cristina; Ferrera, Carlos; Gómez, Itziar; Román, José Alberto San

2015-01-01

Abstract To describe the profile of left-sided polymicrobial endocarditis (PE) and to compare it with monomicrobial endocarditis (ME). Among 1011 episodes of left-sided endocarditis consecutively diagnosed in 3 tertiary centers, between January 1, 1996 and December 31, 2014, 60 were polymicrobial (5.9%), 821 monomicrobial (81.7%), and in 123 no microorganism was detected (12.2%). Seven patients (0.7%) were excluded from the analysis because contamination of biologic tissue could not be discarded. The authors described the clinical, microbiologic, echocardiographic, and outcome of patients with PE and compared it with ME. Mean age was 64 years SD 16 years, 67% were men and 30% nosocomial. Diabetes mellitus (35%) were the most frequent comorbidities, fever (67%) and heart failure (43%) the most common symptoms at admission. Prosthetic valves (50%) were the most frequent infection location and coagulase-negative Staphylococci (48%) and enterococci (37%) the leading etiologies. The most repeated combination was coagulase-negative Staphylococci with enterococci (n = 9). Polymicrobial endocarditis appeared more frequently in patients with underlying disease (70% versus 56%, P = 0.036), mostly diabetics (35% versus 24%, P = 0.044) with previous cardiac surgery (15% versus 8% P = 0.049) and prosthetic valves (50% versus 37%, P = 0.038). Coagulase-negative Staphylococci, enterococci, Gram-negative bacilli, anaerobes, and fungi were more frequent in PE. No differences on age, sex, symptoms, need of surgery, and in-hospital mortality were detected. Polymicrobial endocarditis represents 5.9% of episodes of left-sided endocarditis in our series. Despite relevant demographic and microbiologic differences between PE and ME, short-term outcome is similar. PMID:26656328

Daily corticosteroids reduce infection-associated relapses in frequently relapsing nephrotic syndrome: a randomized controlled trial.

PubMed

Gulati, Ashima; Sinha, Aditi; Sreenivas, Vishnubhatla; Math, Aparna; Hari, Pankaj; Bagga, Arvind

2011-01-01

Relapses of nephrotic syndrome often follow minor infections, commonly of the upper respiratory tract. Daily administration of maintenance prednisolone during intercurrent infections was examined to determine whether the treatment reduces relapse rates in children with frequently relapsing nephrotic syndrome. In a randomized controlled trial (nonblind, parallel group, tertiary-care hospital), 100 patients with idiopathic, frequently relapsing nephrotic syndrome eligible for therapy with prolonged low-dose, alternate-day prednisolone with or without levamisole were randomized to either receive their usual dose of alternate-day prednisolone daily for 7 days during intercurrent infections (intervention group) or continue alternate-day prednisolone (controls). Primary outcome was assessed by comparing the rates of infection-associated relapses at 12-month follow-up. Secondary outcomes were the frequency of infections and the cumulative amount of prednisolone received in both groups. Patients in the intervention group showed significantly lower infection-associated (rate difference, 0.7 episodes/patient per year; 95% confidence intervals [CI] 0.3, 1.1) and lower total relapse rates (0.9 episodes/patient per year, 95% CI 0.4, 1.4) without increase in steroid toxicity. Poisson regression, adjusted for occurrence of infections, showed that daily administration of prednisolone during infections independently resulted in 59% reduction in frequency of relapses (rate ratio, 0.41; 95% CI 0.3, 0.6). For every six patients receiving this intervention, one showed a reduction of relapse frequency to less than three per year. Daily administration of maintenance doses of prednisolone, during intercurrent infections, significantly reduces relapse rates and the proportion of children with frequently relapsing nephrotic syndrome.

Using Glossaries to Increase the Lexical Coverage of Television Programs

ERIC Educational Resources Information Center

Webb, Stuart

2010-01-01

This study examined the extent to which glossaries may affect the percentage of known words (coverage) in television programs. The transcripts of 51 episodes of 2 television programs ("House" and "Grey's Anatomy") were analyzed using Range (Heatley, Nation, & Coxhead, 2002) to create glossaries consisting of the low-frequency (less frequent than…

A Powerful Partnership: Principal and External Provider Lead the Turnaround at a Low-Performing Urban School

ERIC Educational Resources Information Center

Marrapodi, Maryann; Beard, Ora

2013-01-01

In September 2009, the Detroit public school now known as Dixon Educational Learning Academy was best described by terms too often used to characterize persistently low-performing urban schools--frequent leadership turnover, demoralized staff, student violence, poor attendance, a physical plant in horrendous shape, episodic and irrelevant…

Psychological Factors in Diabetes Mellitus. A Review of the Literature with Emphasis on Adolescence.

ERIC Educational Resources Information Center

Greydanus, Donald E.; Hofmann, Adele D.

1979-01-01

Emphasis is given to the major role that emotional components play in the development and maintenance of the teenage diabetic with frequent ketoacidotic or hypoglycemic episodes. The integration of adolescent developmental issues into physician treatment plans is stressed. Journal availability: Medical Association, 535 N. Dearborn Street, Chicago,…

SOURCE IDENTIFICATION OF PM2.5 IN AN ARID NORTHWEST U.S. CITY BY POSITIVE MATRIX FACTORIZATION. (R827355C008)

EPA Science Inventory

Spokane, WA is prone to frequent particulate pollution episodes due to dust storms, biomass burning, and periods of stagnant meteorological conditions. Spokane is the location of a long-term study examining the association between health effects and chemical or physical consti...

Pain Coping Strategies and Depression in Rheumatoid Arthritis.

ERIC Educational Resources Information Center

Brown, Gregory K.; And Others

1989-01-01

Examined role of pain episodes and active and passive pain coping strategies in predicting depression in 287 patients with rheumatoid arthritis (RA). Findings revealed pain, passive coping, and interaction between the 2 accounted for higher depression. Results also indicated that frequent use of passive pain coping strategies in face of high pain…

Characteristics of Sexual Abuse Associated with Greater Psychological Impairment among Children.

ERIC Educational Resources Information Center

Nash, Michael R.; And Others

1993-01-01

Evaluation of the psychiatric histories and projective test responses of 102 sexually abused girls found that the following characteristics of abuse were significantly associated with greater psychological disturbance: more than one perpetrator, an early age of abuse onset, and periods of intense and frequent abuse episodes. A relatively stable…

Battle of the Brains: Election-Night Forecasting at the Dawn of the Computer Age

ERIC Educational Resources Information Center

Chinoy, Ira

2010-01-01

This dissertation examines journalists' early encounters with computers as tools for news reporting, focusing on election-night forecasting in 1952. Although election night 1952 is frequently mentioned in histories of computing and journalism as a quirky but seminal episode, it has received little scholarly attention. This dissertation asks how…

[Hospital Admissions due to cyanosis episodes in newborns with gestational age of 34 weeks or more].

PubMed

Casanueva, C Paulina; Cifuentes, R Javier

2015-01-01

A retrospective study was performed between January 2007 and December 2012 to assess the admission rates of newborns due to episodes of cyanosis Retrospective study that included all the newborns hospitalized with episodes of cyanosis between January 2007 and December 2012. In them were employed two study protocols that considered first and second line tests, the latter in view of recurrence of events. The first line protocol considered general biochemical tests, chest x-ray and echocardiography in selected cases, while the second line protocol included electroencephalogram, electrocardiogram, nuclear magnetic resonance of the brain, expanded metabolic screening, pyruvic acid, lactic acid, and in case of seizures, cytochemical, and culture of cerebrospinal fluid (CSF) and PCR (polymerase chain reaction) for herpes. A total of 98 (2.8%) out of 3,454 newborns were admitted due to episodes of cyanosis. Gestational age: 37.8+1.4 weeks, birth weight: 3,145+477 g. Maternal age: 32+4.8 years. Disease was present in 19.4% of mothers; gestational diabetes (8.1%), pregnancy induced hypertension (5.1%), intrahepatic cholestasis (3.1%), and intrauterine growth retardation (3.1%). Gender: 48.8% male, 51.2% female (NS). Birth: caesarean section, 68.4%, and vaginal delivery, 31.6%. Age on admission 1.9+1.4 days. Hospital stay: 4.2+4.2 days. First line tests were performed in 100% of patients with 39.8% fulfilling the criteria for second line study. A condition was detected in 21.4%, with convulsive syndrome was the most frequent (33%). Newborns with an identified condition had 3.8+2.7 episodes versus 1.5+2,4 in those without diagnosis (NS). A home oxygen monitor was given to 15.4%. There were no re-admissions. Most newborns admitted due to cyanosis are discharged with a condition of unknown origin. In this study, convulsive syndrome was the most frequent cause. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Two-Year Diagnostic Stability in Early-Onset First-Episode Psychosis

ERIC Educational Resources Information Center

Castro-Fornieles, Josefina; Baeza, Immaculada; de la Serna, Elena; Gonzalez-Pinto, Ana; Parellada, Mara; Graell, Montserrat; Moreno, Dolores; Otero, Soraya; Arango, Celso

2011-01-01

Background: Only one study has used a prospective method to analyze the diagnostic stability of first psychotic episodes in children and adolescents. The Child and Adolescent First-Episode Psychosis Study (CAFEPS) is a 2-year, prospective longitudinal study of early-onset first episodes of psychosis (EO-FEP). Aim: To describe diagnostic stability…

Population dynamics of the endangered Cape Sable seaside-sparrow

USGS Publications Warehouse

Curnutt, J.L.; Mayer, A.L.; Brooks, T.M.; Manne, L.; Bass, O.L.; Fleming, D.M.; Philip, Nott M.; Pimm, S.L.

1998-01-01

The Cape Sable seaside-sparrow (Ammodramus maritimus mirabilis) has disappeared from its only known breeding areas episodically since its discovery early this century. Systematic surveys across its range in the southern Everglades find the sparrow's range to be fragmented into six subpopulations. The sparrow population decreased by 58% between 1992 and 1995, with the near extinction of the western half of the population and the temporary local extinction of some eastern populations. Other similar grassland sparrows have populations that vary considerably from year to year. Yet the decline in the western subpopulation and the local extinction of some of the peripheral populations cannot be explained by natural variability alone. Hurricane Andrew passed over several subpopulations prior to the particularly poor year of 1993. However, the geographical and temporal patterns of subpopulation decline are not consistent with what would be expected following a hurricane. Frequent fires prevent successful breeding as does flooding during the breeding season. Better management can prevent frequent fires and episodic flooding. However, the long-term survival of the sparrow depends on managing the unanticipated risks that attend its small, fragmented population.

Cystinuria-a urologist's perspective.

PubMed

Thomas, Kay; Wong, Kathie; Withington, John; Bultitude, Matthew; Doherty, Angela

2014-05-01

Cystinuria is a genetic disease that leads to frequent formation of stones. In patients with recurrent stone formation, particularly patients <30 years old or those who have siblings with stone disease, urologists should maintain a high index of suspicion of the diagnosis of cystinuria. Patients with cystinuria require frequent follow-up and a multidisciplinary approach to diagnosis, prevention and management. Patients have reported success in preventing stone episodes by maintaining dietary changes using a tailored review from a specialist dietician. For patients who do not respond to conservative lifestyle measures, medical therapy to alkalinize urine and thiol-binding drugs can help. A pre-emptive approach to the surgical management of cystine stones is recommended by treating smaller stones with minimally invasive techniques before they enlarge to a size that makes management difficult. However, a multimodal approach can be required for larger complex stones. Current cystinuria research is focused on methods of monitoring disease activity, novel drug therapies and genotype-phenotype studies. The future of research is collaboration at a national and international level, facilitated by groups such as the Rare Kidney Stone Consortium and the UK Registry of Rare Kidney Diseases.

[Pulmonary hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations and prognosis].

PubMed

Finucci Curi, Pablo; Pierrestegui, Matilde; Ortiz, Alberto; Ceccato, Federico; Paira, Sergio

2015-11-06

Pulmonary hemorrhage (PH) in systemic lupus erythematosus (SLE) is a rare but potentially fatal complication that occurs most frequently in the context of active lupus with involvement of other organs. The objective of this study is to report the clinical features and prognosis of patients with SLE who had PH. Patients with SLE (1982 American College of Rheumatology criteria) and PH under monitoring between June 1999 and November 2011 were studied. Demographic, clinical, laboratory, treatment and prognosis data related to PH were analyzed. Eleven patients with SLE developed 14 episodes of PH. PH was the first manifestation of SLE in 2 patients. The most frequent symptoms and clinical signs were dyspnea, fever and cough, which occurred in 12 (85%), 11 (77%) and 7 (50%) patients, respectively. Hemoptysis was also observed in 5 (35%) episodes, tachycardia in 2 (14%), pallor in one (7%) and chest pain in one (7%). All patients had other concomitant organ involvement, and were treated with glucocorticoids. In addition, intravenous cyclophosphamide was indicated in 12 episodes and plasma exchange in 4. Overall mortality was 64%. Factors associated with mortality were infection, mechanical ventilation and dialysis. PH continues to be a rare and severe complication of SLE. Its suspected presence forces us to quickly study these patients, since early diagnosis and aggressive treatment have been shown to improve survival in them. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

[Diabetic foot osteomyelitis: is conservative treatment possible?].

PubMed

Jordano-Montañez, Queralt; Muñiz-Tatay, Montse; Viadé-Julià, Jordi; Jaen-Manzanera, Angeles; Royo-Serrando, Josep; Cuchí-Burgos, Eva; Anglada-Barceló, Jordi; de la Sierra-Iserte, Alejandro

2014-11-01

The aim of the present study is to determine the proportion of foot ulcers, complicated by osteomyelitis in diabetic patients, that heal without amputation. Furthermore, an attempt is made to analyze the main clinical and microbiological characteristics of episodes, and to identify potential predictive factors leading to the failure of conservative treatment. A prospective observational study was carried out between 2007 and 2009 on diabetic patients with a foot lesion and attending a diabetic foot clinic. A percutaneous bone biopsy was required to be included in the study. A total of 81 episodes of diabetic foot osteomyelitis in 64 patients were evaluated. Staphylococcus aureus (28/81) and coagulase negative Staphylococcus (22/81) were the most frequent organisms isolated. Among the gramnegative group (34/81), non-fermenting gram negative bacteria were the most prevalent organisms isolated (14/81). Conservative treatment was successful in 73% of episodes. After a logistic regression analysis using the most significant prognostic variables, only lesion size greater than 2cm independently predicted failure of conservative treatment. Culture guided antibiotic treatment was associated with a better prognosis. Conservative treatment, including culture-guided antibiotics, is successful without amputation in a large proportion of diabetic patients with diabetic foot osteomyelitis. Considering empiric therapy directed at non-fermenting gramnegative bacteria could be advisable in some cases, because they are frequently isolated in our setting. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Treatment options for mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome.

PubMed

Santa, Kristin M

2010-11-01

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare neurodegenerative disease caused by the decreased ability of cells to produce sufficient energy in the form of adenosine 5'-triphosphate. Although it is one of the most common maternally inherited mitochondrial disorders, its exact incidence is unknown. Caused most frequently by an A-to-G point mutation at the 3243 position in the mitochondrial DNA, MELAS syndrome has a broad range of clinical manifestations and a highly variable course. The classic neurologic characteristics include encephalopathy, seizures, and stroke-like episodes. In addition to its neurologic manifestations, MELAS syndrome exhibits multisystem effects including cardiac conduction defects, diabetes mellitus, short stature, myopathy, and gastrointestinal disturbances. Unfortunately, no consensus guidelines outlining standard drug regimens exist for this syndrome. Many of the accepted therapies used in treating MELAS syndrome have been identified through a small number of clinical trials or isolated case reports. Currently, the drugs most often used include antioxidants and various vitamins aimed at minimizing the demands on the mitochondria and supporting and maximizing their function. Some of the most frequently prescribed agents include coenzyme Q(10), l-arginine, B vitamins, and levocarnitine. Although articles describing MELAS syndrome are available, few specifically target education for clinical pharmacists. This article will provide pharmacists with a practical resource to enhance their understanding of MELAS syndrome in order to provide safe and effective pharmaceutical care.

Atypical microbial infections of digestive tract may contribute to diarrhea in mucopolysaccharidosis patients: a MPS I case study

PubMed Central

Węgrzyn, Grzegorz; Kurlenda, Julianna; Liberek, Anna; Tylki-Szymańska, Anna; Czartoryska, Barbara; Piotrowska, Ewa; Jakóbkiewicz-Banecka, Joanna; Węgrzyn, Alicja

2005-01-01

Background Mucopolysaccharidoses are heritable, metabolic diseases caused by deficiency in an activity of one of specific lysosomal enzymes involved in degradation of mucoplysaccharides (glycosaminoglycans). Among many medical problems of patients with mucopolysaccharidoses, there are frequent episodes of diarrhea of unknown etiology. Case presentation A girl, diagnosed enzymatically for mucopolysaccharidosis type I (deficiency of α-L-iduronidase) at the age of 3 years and 9 months, was investigated until the age of 5 years and 4 months. Frequent loose stools and episodes of diarrhea, often accompanied by vomiting, were encountered. Detailed microbiological analyses were performed and atypical microbial infections (most often enetropathogenic Escherichia coli, but also other species, like Pseudomonas aeruginosa or Staphylococcus aureus, as well as adenoviruses) of the digestive tract were found in most severe diarrhea episodes. Often, isolations of pathogenic bacterial strains from stools of the investigated patient suffering from diarrhea were not obvious during the first screening, and only detailed microbiological studies, including re-isolation of colonies, gave the results of isolation of particular pathogenic strains (especially in the case of enetropathogenic E. coli). Conclusion We conclude that atypical microbial infections of digestive tract may contribute significantly to diarrhea in mucopolysaccaridosis patients. Since isolated strains were not typical and their isolation was often possible only after detailed investigation (not during a standard screening), such atypical microbial infections of digestive tract of mucopolysaccharidosis patients could be usually overlooked to date. Importantly, these atypical infections could be effectively treated with antimicrobial agents. PMID:15882450

Clinical variables and implications of the personality on the outcome of bipolar illness: a pilot study

PubMed Central

Casas-Barquero, Nieves; García-López, Olga; Fernández-Argüelles, Pedro; Camacho-Laraña, Manuel

2007-01-01

Outcome in bipolar patients is affected by comorbidity. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. This pilot study examined a series of 40 euthymic bipolar patients (DSM-IV criteria) (bipolar I disorder 31, bipolar II disorder 9) to assess the effect of clinical variables and the influence of comorbid personality on the clinical course of bipolar illness. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with “pure” bipolar patients (n = 10) with regard to demographic, clinical, and course of illness variables. Comorbid personality disorder was diagnosed in 75% of patients according to ICD-10 criteria, with obsessive-compulsive personality disorder being the most frequent type. Sixty-three per cent of subjects had more than one comorbid personality disorder. Bipolar patients with and without comorbid personality disorder showed no significant differences regarding features of the bipolar illness, although the group with comorbid personality disorder showed a younger age at onset, more depressive episodes, and longer duration of bipolar illness. In subjects with comorbid personality disorders, the number of hospitalizations correlated significantly with depressive episodes and there was an inverse correlation between age at the first episode and duration of bipolar illness. These findings, however, should be interpreted taking into account the preliminary nature of a pilot study and the contamination of the sample with too many bipolar II patients. PMID:19300559

Care episode retrieval: distributional semantic models for information retrieval in the clinical domain.

PubMed

Moen, Hans; Ginter, Filip; Marsi, Erwin; Peltonen, Laura-Maria; Salakoski, Tapio; Salanterä, Sanna

2015-01-01

Patients' health related information is stored in electronic health records (EHRs) by health service providers. These records include sequential documentation of care episodes in the form of clinical notes. EHRs are used throughout the health care sector by professionals, administrators and patients, primarily for clinical purposes, but also for secondary purposes such as decision support and research. The vast amounts of information in EHR systems complicate information management and increase the risk of information overload. Therefore, clinicians and researchers need new tools to manage the information stored in the EHRs. A common use case is, given a--possibly unfinished--care episode, to retrieve the most similar care episodes among the records. This paper presents several methods for information retrieval, focusing on care episode retrieval, based on textual similarity, where similarity is measured through domain-specific modelling of the distributional semantics of words. Models include variants of random indexing and the semantic neural network model word2vec. Two novel methods are introduced that utilize the ICD-10 codes attached to care episodes to better induce domain-specificity in the semantic model. We report on experimental evaluation of care episode retrieval that circumvents the lack of human judgements regarding episode relevance. Results suggest that several of the methods proposed outperform a state-of-the art search engine (Lucene) on the retrieval task.

Care episode retrieval: distributional semantic models for information retrieval in the clinical domain

PubMed Central

2015-01-01

Patients' health related information is stored in electronic health records (EHRs) by health service providers. These records include sequential documentation of care episodes in the form of clinical notes. EHRs are used throughout the health care sector by professionals, administrators and patients, primarily for clinical purposes, but also for secondary purposes such as decision support and research. The vast amounts of information in EHR systems complicate information management and increase the risk of information overload. Therefore, clinicians and researchers need new tools to manage the information stored in the EHRs. A common use case is, given a - possibly unfinished - care episode, to retrieve the most similar care episodes among the records. This paper presents several methods for information retrieval, focusing on care episode retrieval, based on textual similarity, where similarity is measured through domain-specific modelling of the distributional semantics of words. Models include variants of random indexing and the semantic neural network model word2vec. Two novel methods are introduced that utilize the ICD-10 codes attached to care episodes to better induce domain-specificity in the semantic model. We report on experimental evaluation of care episode retrieval that circumvents the lack of human judgements regarding episode relevance. Results suggest that several of the methods proposed outperform a state-of-the art search engine (Lucene) on the retrieval task. PMID:26099735

Travelling activity and travel-related risks after allogeneic haematopoietic stem cell transplantation - a single centre survey.

PubMed

Hollenstein, Yvonne; Elzi, Luigia; Hatz, Christoph; Passweg, Jakob; Weisser, Maja; Stöckle, Marcel; Halter, Joerg P; Egli, Adrian

2015-01-01

Travel activity and travel-related risks of patients after allogeneic haematopoietic stem cell transplantation (allo-HSCT) remain largely unknown. The aim of our study was to examine travel activity after allo-HSCT including travel behaviour and travel patterns. We analysed travel characteristics of allo-HSCT recipients by using a retrospective cross-sectional survey. Allo-HSCT patients were asked to complete a questionnaire during their annual health visits from 2010 to 2012. Overall, 118/153 (77%) participating patients reported travel activity for a total of 201 travelling episodes. Travellers versus non-travellers were receiving immunosuppressive treatment in 35.6% versus 65.7% (p=0.002), and had graft-versus-host-disease (GvHD) in 52.5% versus 62.9% (p=0.17). In a multivariate analysis, the time between the transplantation and the survey was the only factor associated with travel activity (p<0.0001) and taking pretravel advice (p<0.0001). In 34.8% of travel episodes pretravel advice was sought. Patients with pretravel advice reported travel-related symptoms more frequently. Minor respiratory (27/201) and gastrointestinal (23/201) symptoms were most frequently indicated. Four percent (8/201) of the patients were hospitalised while travelling. We conclude that travelling after allo-HSCT is frequent and linked to the time since transplantation. We could not define specific risks for any destination. Nevertheless, pretravel advice and preparation are highly recommended for immunosuppressed patients.

Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

PubMed Central

Kwok, Wing-Yee; de Kwaadsteniet, Marjolein CE; Harmsen, Mirjam; van Suijlekom-Smit, Lisette WA; Schellevis, François G; van der Wouden, Johannes C

2006-01-01

Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral. PMID:16584577

The functional neuroanatomy of autobiographical memory: A meta-analysis

PubMed Central

Svoboda, Eva; McKinnon, Margaret C.; Levine, Brian

2007-01-01

Autobiographical memory (AM) entails a complex set of operations, including episodic memory, self-reflection, emotion, visual imagery, attention, executive functions, and semantic processes. The heterogeneous nature of AM poses significant challenges in capturing its behavioral and neuroanatomical correlates. Investigators have recently turned their attention to the functional neuroanatomy of AM. We used the effect-location method of meta-analysis to analyze data from 24 functional imaging studies of AM. The results indicated a core neural network of left-lateralized regions, including the medial and ventrolateral prefrontal, medial and lateral temporal and retrosplenial/posterior cingulate cortices, the temporoparietal junction and the cerebellum. Secondary and tertiary regions, less frequently reported in imaging studies of AM, are also identified. We examined the neural correlates of putative component processes in AM, including, executive functions, self-reflection, episodic remembering and visuospatial processing. We also separately analyzed the effect of select variables on the AM network across individual studies, including memory age, qualitative factors (personal significance, level of detail and vividness), semantic and emotional content, and the effect of reference conditions. We found that memory age effects on medial temporal lobe structures may be modulated by qualitative aspects of memory. Studies using rest as a control task masked process-specific components of the AM neural network. Our findings support a neural distinction between episodic and semantic memory in AM. Finally, emotional events produced a shift in lateralization of the AM network with activation observed in emotion-centered regions and deactivation (or lack of activation) observed in regions associated with cognitive processes. PMID:16806314

Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants

PubMed Central

Mussi-Pinhata, Marisa M; Motta, Fabrizio; Freimanis-Hance, Laura; de Souza, Ricardo; Szyld, Edgardo; Succi, Regina CM; Christie, Celia DC; Rolon, Maria J.; Ceriotto, Mariana; Read, Jennifer S.

2010-01-01

Objectives To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants. Methods HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight ≥ 2500 grams were followed from birth until six months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed. Results Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTIs (incidence=0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. The odds of LRTI in infants whose mothers had CD4%<14 were 4.4 times than that of those whose mothers had CD4%≥29 (p=0.003). The odds of LRTI were 16.0 times that of infants with a CD4+ count [cells/mm3] < 750 at birth compared to those with CD4+≥750 (p=0.002). Maternal CD4+ decline and Infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before six months of age. Conclusions Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged six months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed. PMID:20452798

Did Herbert Spencer have reading epilepsy?

PubMed

Raitiere, Martin N

2011-10-01

Herbert Spencer, the nineteenth-century philosopher, has frequently been dismissed as a "fantastical hypochondriac" (as his most recent biographer, Mark Francis, terms him). Yet he left a record in his Autobiography of symptoms that suggest a very different diagnosis. Abruptly at age 35, he found that the activity of reading, previously indulged in without difficulty, triggered paroxysmal episodes of disturbing "head-sensations" including "giddiness" (so Spencer described them); these severely curtailed his ability to carry out his philosophical studies. Of all possible explanations for such episodes, none seems as likely as reading epilepsy. Enduring preconceptions about Spencer's presumed neurosesmay have kept modern historians from appreciating that Spencer suffered from a legitimate, if esoteric, neurological malady.

Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors.

PubMed

Cheng, V C C; Chau, P H; Lee, W M; Ho, S K Y; Lee, D W Y; So, S Y C; Wong, S C Y; Tai, J W M; Yuen, K Y

2015-07-01

Unlike direct contact with patients' body, hand hygiene practice is often neglected by healthcare workers (HCWs) and visitors after contact with patients' environment. Contact with hospital environmental items may increase risk of pathogen transmission. To enumerate the number of hand-touch contacts by patients, HCWs and visitors with any hospital environmental items. All contact-episodes between person and item were recorded by direct observation in a six-bed cubicle of acute wards for 33 working days. High-touch and mutual-touch items with high contact frequencies by HCWs, patients, and visitors were analysed. In total, 1107 person-episodes with 6144 contact-episodes were observed in 66 observation hours (average: 16.8 person-episodes and 93.1 contact-episodes per hour). Eight of the top 10 high-touch items, including bedside rails, bedside tables, patients' bodies, patients' files, linen, bed curtains, bed frames, and lockers were mutually touched by HCWs, patients, and visitors. Bedside rails topped the list with 13.6 contact-episodes per hour (mean), followed by bedside tables (12.3 contact-episodes per hour). Using patients' body contacts as a reference, it was found that medical staff and nursing staff contacted bedside tables [rate ratio (RR): 1.741, 1.427, respectively] and patients' files (RR: 1.358, 1.324, respectively) more than patients' bodies, and nursing staff also contacted bedside rails (RR: 1.490) more than patients' bodies. Patients' surroundings may be links in the transmission of nosocomial infections because many are frequently touched and mutually contacted by HCWs, patients, and visitors. Therefore, the focus of hand hygiene education, environmental disinfection, and other system changes should be enhanced with respect to high-touch and mutual-touch items. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Acid and non-acid reflux in patients refractory to proton pump inhibitor therapy: is gastroparesis a factor?

PubMed

Tavakkoli, Anna; Sayed, Bisma A; Talley, Nicholas J; Moshiree, Baharak

2013-10-07

To determine whether an increased number and duration of non-acid reflux events as measured using the multichannel intraluminal impedance pH (MII-pH) is linked to gastroparesis (GP). A case control study was conducted in which 42 patients undergoing clinical evaluation for continued symptoms of gastroesophageal reflux disease (both typical and atypical symptoms) despite acid suppression therapy. MII-pH technology was used over 24 h to detect reflux episodes and record patients' symptoms. Parameters evaluated in patients with documented GP and controls without GP by scintigraphy included total, upright, and supine number of acid and non-acid reflux episodes (pH < 4 and pH > 4, respectively), the duration of acid and non-acid reflux in a 24-h period, and the number of reflux episodes lasting longer than 5 min. No statistical difference was seen between the patients with GP and controls with respect to the total number or duration of acid reflux events, total number and duration of non-acid reflux events or the duration of longest reflux episodes. The number of non-acid reflux episodes with a pH > 7 was higher in subjects with GP than in controls. In addition, acid reflux episodes were more prolonged (lasting longer than 5 min) in the GP patients than in controls; however, these values did not reach statistical significance. Thirty-five patients had recorded symptoms during the 24 h study and of the 35 subjects, only 9% (n = 3) had a positive symptom association probability (SAP) for acid/non-acid reflux and 91% had a negative SAP. The evaluation of patients with a documented history of GP did not show an association between GP and more frequent episodes of non-acid reflux based on MII-pH testing.

Extremely Rapid Crystal Fractionation During Episodes 30-31 of the Pu`u O`o Eruption: Implications for Magma Chamber Processes

NASA Astrophysics Data System (ADS)

Garcia, M. O.; Rhodes, J. M.; Pietruszka, A. J.; Rose, W. I.

2002-12-01

The Pu`u O`o eruption offers excellent opportunities to examine petrologic and geochemical processes in shallow, basaltic magma chamber due to the intense, multi-disciplinary monitoring of its activity, frequent sampling and repeated eruptions at the same vent. Strong compositional variations were observed during some of the high fire-fountaining (400 m) episodes in 1985. Following a 20-30 day hiatus in eruptive activity, the shallow magma chamber was largely evacuated during brief (1-2 day) eruptions. Samples collected during these episodes, especially at the beginning and end, document the compositional variation between and during eruptive episodes. Lavas and tephra from episodes 30 and 31 showed a remarkable and systematic variation (2 wt% increase in MgO; 7% decrease in incompatible elements like Ba) during and between these episodes. Most of the intra-episode lava compositional variation was observed during a brief period (<2 hours) with little variation before or after. Olivines in these weakly prophyritic Pu`u O`o lavas are in equilibrium with the host rock composition indicating that compositional variation is not related to magma mixing or accumulation of olivine. We interpret the variation to reflect crystal fractionation within the shallow (tens to hundreds of meter deep) Pu`u O`o magma chamber. This extremely high rate of crystallization (up to 0.3%/day) and cooling (2°C/day), compared to estimates of 1°C/year for the rift zone interior, must reflect the high surface area of the dike-shaped and open topped magma chamber. These features may represent the tapping of a diffusive interface separating well mixed zones of hotter and more primitive magma in the lower part of the chamber from cooler, somewhat evolved magma above.

Non-polio enterovirus association with persistent diarrhea in children as revealed by a follow-up study of an Indian cohort during the first two years of life.

PubMed

Rao, Durga C; Reddy, Harikrishna; Sudheendra, K; Raghavendra, A; Varadharaj, Vembuli; Edula, Surekha; Goparaju, Ramya; Ratnakar, Bharath; Srinivasa Rao, Arni S R; Maiya, Padmanabha P; Ananda Babu, M

2014-09-01

We recently reported significant association of non-polio enteroviruses (NPEVs) with acute diarrhea in children. Persistent diarrhea (PD) remains a major cause of morbidity and mortality in infants below two years of age in developing countries. Understanding age-dependent frequency and duration of NPEV infections is important to determine their association with persistent diarrhea and disease burden. A cohort of 140 infants was followed for 6 months to 2 years of age to determine the frequency, duration, and association with PD of NPEV infections in comparison with rotavirus and other agents. Stool samples were collected every 14 days, and diarrheal episodes and their duration were recorded. Enteroviruses were characterized by RT-PCR and VP1 gene sequence analysis, rotavirus by electropherotyping, and other agents by PCR. Of 4545 samples, negative for oral polio vaccine strains, 3907 (85.96%) and 638 (14.04%) were NPEV-negative and NPEV-positive, respectively, representing 403 (8.87%) infection episodes. About 68% of NPEV infections occurred during the first year with every child having at least one episode lasting between four days and four months. Approximately 38% and 22% of total diarrheal episodes were positive for NPEV and RV, respectively. While about 18% of NPEV infection episodes were associated with diarrhea, 6% being persistent, 13% of total diarrheal episodes were persistent involving infections by monotype NPEV strains or sequential infections by multiple strains and other agents. This is the first report revealing NPEVs as the single most frequently and persistently detected viral pathogen in every PD episode. Copyright © 2014 Elsevier B.V. All rights reserved.

Causative Pathogens of Febrile Neutropaenia in Children Treated for Acute Lymphoblastic Leukaemia.

PubMed

Lam, Joyce Cm; Chai, Jie Yang; Wong, Yi Ling; Tan, Natalie Wh; Ha, Christina Tt; Chan, Mei Yoke; Tan, Ah Moy

2015-11-01

Treatment of acute lymphoblastic leukaemia (ALL) using intensive chemotherapy has resulted in high cure rates but also substantial morbidity. Infective complications represent a significant proportion of treatment-related toxicity. The objective of this study was to describe the microbiological aetiology and clinical outcome of episodes of chemotherapy-induced febrile neutropaenia in a cohort of children treated for ALL at our institution. Patients with ALL were treated with either the HKSGALL93 or the Malaysia-Singapore (Ma-Spore) 2003 chemotherapy protocols. The records of 197 patients who completed the intensive phase of treatment, defined as the period of treatment from induction, central nervous system (CNS)-directed therapy to reinduction from June 2000 to January 2010 were retrospectively reviewed. There were a total of 587 episodes of febrile neutropaenia in 197 patients, translating to an overall rate of 2.98 episodes per patient. A causative pathogen was isolated in 22.7% of episodes. An equal proportion of Gram-positive bacteria (36.4%) and Gram-negative bacteria (36.4%) were most frequently isolated followed by viral pathogens (17.4%), fungal pathogens (8.4%) and other bacteria (1.2%). Fungal organisms accounted for a higher proportion of clinically severe episodes of febrile neutropaenia requiring admission to the high-dependency or intensive care unit (23.1%). The overall mortality rate from all episodes was 1.5%. Febrile neutropaenia continues to be of concern in ALL patients undergoing intensive chemotherapy. The majority of episodes will not have an identifiable causative organism. Gram-positive bacteria and Gram-negative bacteria were the most common causative pathogens identified. With appropriate antimicrobial therapy and supportive management, the overall risk of mortality from febrile neutropaenia is extremely low.

Internet Searching About Disease Elicits a Positive Perception of Own Health When Severity of Illness Is High: A Longitudinal Questionnaire Study.

PubMed

Sassenberg, Kai; Greving, Hannah

2016-03-04

The Internet is one of the primary sources for health information. However, in research, the effects of Internet use on the perception of one's own health have not received much attention so far. This study tested how Internet use for acquiring health information and severity of illness influence patients with a chronic disease with regard to the perception of their own health. Negative psychological states are known to lead to preferential processing of positive information. In particular, the self-directed nature of Internet use provides room for such biases. Therefore, we predicted that patients experiencing negative health states more frequently, due to more frequent episodes of a chronic illness, will gain a more positive perception of their health if they use the Internet frequently to gain health information, but not if they use the Internet rarely. This effect was not expected for other sources of information. A longitudinal questionnaire study with two measurement points-with a 7-month time lag-tested the hypothesis in a sample of patients with chronic inflammatory bowel disease (n=208). This study assessed patients' frequency of Internet use, their participation in online social support groups, their use of other sources of health information, and several indicators of the participants' perceptions of their own health. A structure equation model (SEM) was used to test the predictions separately for Internet searches and other sources of information. Data analysis supported the prediction; the interaction between frequency of health-related information searches and frequency of episodes at the first measurement point (T1) was related to participants' positive perceptions of their own health at the second measurement point (T2) (B=.10, SE=.04, P=.02) above and beyond the perceptions of their own health at T1. When participants used the Internet relatively rarely (-1 SD), there was no relationship between frequency of episodes and positive perceptions of their own health (B=-.11, SE=.14, t203=-0.82, P=.41). In contrast, when participants used the Internet relatively often (+1 SD), the more frequently they had those episodes the more positive were the perceptions of their own health (B=.36, SE=.15, t203=2.43, P=.02). Additional SEM analyses revealed that this effect occurs exclusively when information is searched for on the Internet, but not when other sources of information are consulted, nor when online social support groups are joined. The results of this study suggest that patients might process information from the Internet selectively, in an unbalanced, biased fashion, with the formation of a self-serving (ie, positive) perception of own health. At the same time, this bias contributes to the ability of patients to cope psychologically with their disease.

[Clinical Characteristics and Evolution of Recurrent Infectious Endocarditis in non Drug Addicts].

PubMed

Rodríguez, M; Anguita, M; Castillo, J M; Torres, F; Siles, J R; Mesa, D; Franco, M; García-Alegría, J; Concha, M; Vallés, F

2001-09-01

Recurrence of infection is observed in a high proportion of patients who have had infective endocarditis in the past. The aim of our study was to evaluate the possible differences between the first and the recurrent episodes of endocarditis, as well as to assess the outcome and prognosis of patients with recurrent endocarditis. We reviewed a series of 13 episodes of recurrent endocarditis from among 196 cases of infective endocarditis involving non-drug-addict patients in two hospitals from 1987 to 2000. There were no differences between recurrent and first episodes of endocarditis according to age, sex, heart valve involved or causal microorganisms. Prosthetic valve endocarditis was more common in patients with recurrent endocarditis (86% versus 27%; p < 0.001). Although there were no differences in the rate of complications or early surgery, overall mortality was significantly higher in patients with recurrent endocarditis (53% versus 27%: p < 0.05). When early and late mortality were analysed separately, the differences did not achieve significance. Recurrent endocarditis was frequent in our series (7% of all cases). The features were similar to those of the first episode except for a higher rate of prosthetic valve endocarditis and a higher overall mortality.

Obsessive-compulsive disorder with and without bipolar disorder.

PubMed

Mahasuar, Rajnarayan; Janardhan Reddy, Y C; Math, Suresh Bada

2011-08-01

Bipolar disorder (BD) is often comorbid with obsessive-compulsive disorder (OCD). In this study, we compared clinical profile and course of subjects with a primary diagnosis of OCD with and without BD. We compared 34 subjects with primary diagnosis of OCD with BD and 57 subjects with a diagnosis of OCD without BD. Structured interview schedules, clinical rating scales, and information from clinical charts were utilized to assess patients. OCD with BD was characterized by: (i) an episodic course; (ii) a higher number of depressive episodes, greater suicidality and a higher rate of hospitalization; (iii) fewer pathological doubts and more miscellaneous compulsions; and (iv) poorer insight into obsessive-compulsive symptoms. Episodic course appears to be typical of OCD with BD. Bipolarity has a pathoplastic effect on OCD and it is possible that some forms of OCD and BD are pathophysiologically related. Bipolar OCD is associated with a higher rate of depressive episodes, higher suicidality and more frequent hospitalizations, suggesting greater morbidity. Long-term prospective follow-up studies and studies addressing pathophysiology and genetic basis are needed to understand the complexity of such comorbidity. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

Catheter-associated bloodstream infections in pediatric hematology-oncology patients.

PubMed

Celebi, Solmaz; Sezgin, Melike Evim; Cakır, Deniz; Baytan, Birol; Demirkaya, Metin; Sevinir, Betul; Bozdemir, Sefika Elmas; Gunes, Adalet Meral; Hacimustafaoglu, Mustafa

2013-04-01

Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.

Herpes simplex virus type 2 (Mollaret's) meningitis: a case report.

PubMed

Abu Khattab, Mohammed; Al Soub, Hussam; Al Maslamani, Mona; Al Khuwaiter, Jameela; El Deeb, Yasser

2009-11-01

Mollaret's meningitis is an unusual and under-appreciated syndrome of benign, recurrent aseptic meningitis. The available literature indicates that the causative agent is herpes simplex virus type 2 (HSV-2) in the majority of cases and much less frequently herpes simplex virus type 1 (HSV-1). We report the case of a 49-year-old Indian female who had four attacks of recurrent lymphocytic meningitis (Mollaret's meningitis) occurring over a 7-year period. The diagnosis of herpes simplex meningitis was made at the time of the fourth episode by a positive PCR for herpes simplex virus infection in the cerebrospinal fluid. During the first three episodes, the patient was treated with anti-tuberculous drugs and antibiotics for bacterial meningitis; however for the last episode, once the diagnosis of herpes simplex meningitis was confirmed, only symptomatic treatment was given. No long-term suppressive therapy was given and no recurrence has been experienced so far. Mollaret's meningitis should be suspected in all cases of recurrent lymphocytic meningitis. Early diagnosis may prevent prolonged hospital admissions, unnecessary investigations, and exposure to unnecessary medications, with the associated considerable costs. Treatment with acyclovir may be beneficial in decreasing the severity and duration of attacks and in preventing further episodes. [Au?1].

Public Health and Budget Impact of Probiotics on Common Respiratory Tract Infections: A Modelling Study

PubMed Central

Lenoir-Wijnkoop, Irene; Gerlier, Laetitia; Bresson, Jean-Louis; Le Pen, Claude; Berdeaux, Gilles

2015-01-01

Objectives Two recent meta-analyses by the York Health Economics Consortium (YHEC) and Cochrane demonstrated probiotic efficacy in reducing the duration and number of common respiratory tract infections (CRTI) and associated antibiotic prescriptions. A health-economic analysis was undertaken to estimate the public health and budget consequences of a generalized probiotic consumption in France. Methods A virtual age- and gender-standardized population was generated using a Markov microsimulation model. CRTI risk factors incorporated into this model were age, active/passive smoking and living in a community setting. Incidence rates and resource utilization were based on the 2011-2012 flu season and retrieved from the French GPs Sentinelles network. Results of both meta-analyses were independently applied to the French population to estimate CRTI events, assuming a generalized probiotic use compared to no probiotics during winter months: -0.77 days/CRTI episode (YHEC scenario) or odds-ratio 0.58 for ≥1 CRTI episode (Cochrane scenario) with vs. without probiotics. Economic perspectives were National Health System (NHS), society, family. Outcomes included cost savings related to the reduced numbers of CRTI episodes, days of illness, number of antibiotic courses, sick leave days, medical and indirect costs. Results For France, generalized probiotic use would save 2.4 million CRTI-days, 291,000 antibiotic courses and 581,000 sick leave days, based on YHEC data. Applying the Cochrane data, reductions were 6.6 million CRTI days, 473,000 antibiotic courses and 1.5 million sick days. From the NHS perspective, probiotics’ economic impact was about €14.6 million saved according to YHEC and €37.7 million according to Cochrane. Higher savings were observed in children, active smokers and people with more frequent human contacts. Conclusions Public health and budget impact of probiotics are substantial, whether they reduce CRTI episodes frequency or duration. Noteworthy, the 2011-12 winter CRTI incidence was low and this analysis focused on the fraction of CRTI patients consulting a practitioner. PMID:25859849

e-HCL-32: a useful, valid and user friendly tool in the screening of bipolar II disorder.

PubMed

Hidalgo-Mazzei, Diego; Mateu, Ainoa; Undurraga, Juan; Rosa, Adriane R; Pacchiarotti, Isabella; Bonnin, Caterina del Mar; Sánchez-Moreno, José; Colom, Francesc; Vieta, Eduard

2015-01-01

Bipolar type II (BDII) is a frequent disorder with high morbidity and mortality, characterized by depressive and hypomanic episodes. Early diagnosis can be effective in improving long-term prognosis. However, diagnosing BDII is challenging due to the difficulty in detecting past hypomanic episodes. The HCL-32 is a widely used and reliable screening instrument for the detection of past hypomanic episodes. Making this tool available to more patients could help diagnose and treat undetected cases of BDII earlier. New technologies such as the Internet have been previously used for this purpose with favorable outcomes. Accordingly, the objective of this study is to evaluate the acceptability, validity, reliability and equivalence of an online version of this questionnaire. From May 2012 to March 2013, 52 participants attending an outpatient mental health clinic completed a paper version of the HCL-32 (HCL-32) and its online version (e-HCL-32) within two weeks. After its completion, they were asked to answer a brief satisfaction survey. No differences were found (HCL-32 mean total score=17.73 (SD=7.37), e-HCL-32 mean total score=18.28 (SD=7.09). T=-1.720, p=0.092, 95% CI=-1.21 to 0.09) between the results of the paper and pencil HCL-32 compared to its online version (e-HCL-32). The psychometric properties of the online version of the hypomania checklist (e-HCL-32) were good and comparable to the paper and pencil version. 80% of participants found online questionnaires to be easier to answer and more user-friendly. The results of this study support the use of an online screening tool for the detection of previous hypomanic episodes (necessary for BDII diagnosis) as it showed to have a similar validity and reliability to the traditional paper and pencil method. Copyright © 2014 Elsevier Inc. All rights reserved.

Prevalence and Incidence of Respiratory Syncytial Virus and Other Respiratory Viral Infections in Children Aged 6 Months to 10 Years With Influenza-like Illness Enrolled in a Randomized Trial

PubMed Central

Nolan, Terry; Borja-Tabora, Charissa; Lopez, Pio; Weckx, Lily; Ulloa-Gutierrez, Rolando; Lazcano-Ponce, Eduardo; Kerdpanich, Angkool; Weber, Miguel Angel Rodriguez; Mascareñas de Los Santos, Abiel; Tinoco, Juan-Carlos; Safadi, Marco Aurelio P.; Seng, Lim Fong; Hernandez-de Mezerville, Marcela; Faingezicht, Idis; Cruz-Valdez, Aurelio; Feng, Yang; Li, Ping; Durviaux, Serge; Haars, Gerco; Roy-Ghanta, Sumita; Vaughn, David W.; Taylor, Sylvia

2015-01-01

Background. The high burden of respiratory syncytial virus (RSV)-associated morbidity and mortality makes vaccine development a priority. Methods. As part of an efficacy trial of pandemic influenza vaccines (NCT01051661), RSV epidemiology in healthy children aged 6 months to <10 years at first vaccination with influenza-like illness (ILI) was evaluated in Australia, Brazil, Colombia, Costa Rica, Mexico, the Philippines, Singapore, and Thailand between February 2010 and August 2011. Active surveillance for ILI was conducted for approximately 1 year, with nasal and throat swabs analyzed by polymerase chain reaction. The prevalence and incidence of RSV among ILI episodes were calculated. Results. A total of 6266 children were included, of whom 2421 experienced 3717 ILI episodes with a respiratory sample available. RSV was detected for 359 ILI episodes, a prevalence of 9.7% (95% confidence interval: 8.7–10.7). The highest prevalence was in children aged 12–23 or 24–35 months in all countries except the Philippines, where it was in children aged 6–11 months. The incidence of RSV-associated ILI was 7.0 (6.3–7.7) per 100 person-years (PY). Eighty-eight ILI episodes resulted in hospitalization, of which 8 were associated with RSV (prevalence 9.1% [4.0–17.1]; incidence 0.2 [0.1–0.3] per 100 PY). The incidence of RSV-associated ILI resulting in medical attendance was 6.0 (5.4–6.7) per 100 PY. RSV B subtypes were observed more frequently than A subtypes. Conclusions. Active surveillance demonstrated the considerable burden of RSV-associated illness that would not be identified through hospital-based surveillance, with a substantial part of the burden occurring in older infants and children. PMID:25673560

Circadian misalignment affects sleep and medication use before and during spaceflight

PubMed Central

Flynn-Evans, Erin E; Barger, Laura K; Kubey, Alan A; Sullivan, Jason P; Czeisler, Charles A

2016-01-01

Sleep deficiency and the use of sleep-promoting medication are prevalent during spaceflight. Operations frequently dictate work during the biological night and sleep during the biological day, which contribute to circadian misalignment. We investigated whether circadian misalignment was associated with adverse sleep outcomes before (preflight) and during spaceflight missions aboard the International Space Station (ISS). Actigraphy and photometry data for 21 astronauts were collected over 3,248 days of long-duration spaceflight on the ISS and 11 days prior to launch (n=231 days). Sleep logs, collected one out of every 3 weeks in flight and daily on Earth, were used to determine medication use and subjective ratings of sleep quality. Actigraphy and photometry data were processed using Circadian Performance Simulation Software to calculate the estimated endogenous circadian temperature minimum. Sleep episodes were classified as aligned or misaligned relative to the estimated endogenous circadian temperature minimum. Mixed-effects regression models accounting for repeated measures were computed by data collection interval (preflight, flight) and circadian alignment status. The estimated endogenous circadian temperature minimum occurred outside sleep episodes on 13% of sleep episodes during preflight and on 19% of sleep episodes during spaceflight. The mean sleep duration in low-Earth orbit on the ISS was 6.4±1.2 h during aligned and 5.4±1.4 h (P<0.01) during misaligned sleep episodes. During aligned sleep episodes, astronauts rated their sleep quality as significantly better than during misaligned sleep episodes (66.8±17.7 vs. 60.2±21.0, P<0.01). Sleep-promoting medication use was significantly higher during misaligned (24%) compared with aligned (11%) sleep episodes (P<0.01). Use of any medication was significantly higher on days when sleep episodes were misaligned (63%) compared with when sleep episodes were aligned (49%; P<0.01). Circadian misalignment is associated with sleep deficiency and increased medication use during spaceflight. These findings suggest that there is an immediate need to deploy and assess effective countermeasures to minimize circadian misalignment and consequent adverse sleep outcomes both before and during spaceflight. PMID:28725719

Circadian misalignment affects sleep and medication use before and during spaceflight.

PubMed

Flynn-Evans, Erin E; Barger, Laura K; Kubey, Alan A; Sullivan, Jason P; Czeisler, Charles A

2016-01-01

Sleep deficiency and the use of sleep-promoting medication are prevalent during spaceflight. Operations frequently dictate work during the biological night and sleep during the biological day, which contribute to circadian misalignment. We investigated whether circadian misalignment was associated with adverse sleep outcomes before (preflight) and during spaceflight missions aboard the International Space Station (ISS). Actigraphy and photometry data for 21 astronauts were collected over 3,248 days of long-duration spaceflight on the ISS and 11 days prior to launch ( n =231 days). Sleep logs, collected one out of every 3 weeks in flight and daily on Earth, were used to determine medication use and subjective ratings of sleep quality. Actigraphy and photometry data were processed using Circadian Performance Simulation Software to calculate the estimated endogenous circadian temperature minimum. Sleep episodes were classified as aligned or misaligned relative to the estimated endogenous circadian temperature minimum. Mixed-effects regression models accounting for repeated measures were computed by data collection interval (preflight, flight) and circadian alignment status. The estimated endogenous circadian temperature minimum occurred outside sleep episodes on 13% of sleep episodes during preflight and on 19% of sleep episodes during spaceflight. The mean sleep duration in low-Earth orbit on the ISS was 6.4±1.2 h during aligned and 5.4±1.4 h ( P <0.01) during misaligned sleep episodes. During aligned sleep episodes, astronauts rated their sleep quality as significantly better than during misaligned sleep episodes (66.8±17.7 vs. 60.2±21.0, P <0.01). Sleep-promoting medication use was significantly higher during misaligned (24%) compared with aligned (11%) sleep episodes ( P <0.01). Use of any medication was significantly higher on days when sleep episodes were misaligned (63%) compared with when sleep episodes were aligned (49%; P <0.01). Circadian misalignment is associated with sleep deficiency and increased medication use during spaceflight. These findings suggest that there is an immediate need to deploy and assess effective countermeasures to minimize circadian misalignment and consequent adverse sleep outcomes both before and during spaceflight.

Stress Administered Prior to Encoding Impairs Neutral but Enhances Emotional Long-Term Episodic Memories

ERIC Educational Resources Information Center

Payne, Jessica D.; Jackson, Eric D.; Hoscheidt, Siobhan; Ryan, Lee; Jacobs, W. Jake; Nadel, Lynn

2007-01-01

Stressful events frequently comprise both neutral and emotionally arousing information, yet the impact of stress on emotional and neutral events is still not fully understood. The hippocampus and frontal cortex have dense concentrations of receptors for stress hormones, such as cortisol, which at high levels can impair performance on hippocampally…

Restoring composition and structure in Southwestern frequent-fire forests: A science-based framework for improving ecosystem resiliency

Treesearch

Richard T. Reynolds; Andrew J. Sanchez Meador; James A. Youtz; Tessa Nicolet; Megan S. Matonis; Patrick L. Jackson; Donald G. DeLorenzo; Andrew D. Graves

2013-01-01

Ponderosa pine and dry mixed-conifer forests in the Southwest United States are experiencing, or have become increasingly susceptible to, large-scale severe wildfire, insect, and disease episodes resulting in altered plant and animal demographics, reduced productivity and biodiversity, and impaired ecosystem processes and functions. We present a management framework...

Preschoolers Can Infer General Rules Governing Fantastical Events in Fiction

ERIC Educational Resources Information Center

Van de Vondervoort, Julia W.; Friedman, Ori

2014-01-01

Young children are frequently exposed to fantastic fiction. How do they make sense of the unrealistic and impossible events that occur in such fiction? Although children could view such events as isolated episodes, the present experiments suggest that children use such events to infer general fantasy rules. In 2 experiments, 2-to 4-year-olds were…

Fire history and pattern in a Cascade Range landscape.

Treesearch

Peter H. Morrison; Frederick J. Swanson

1990-01-01

Fire history from years 1150 to 1985 was reconstructed by analyzing forest stands in two 1940-hectare areas in the central-western Cascade Range of Oregon. Serving as records for major fire episodes, these stands revealed a highly variable fire regime. The steeper, more dissected, lower elevation Cook-Quentin study area experienced more frequent fires (natural fire...

A Predictive Screening Index for Posttraumatic Stress Disorder and Depression following Traumatic Injury

ERIC Educational Resources Information Center

O'Donnell, Meaghan L.; Creamer, Mark C.; Parslow, Ruth; Elliott, Peter; Holmes, Alexander C. N.; Ellen, Steven; Judson, Rodney; McFarlane, Alexander C.; Silove, Derrick; Bryant, Richard A.

2008-01-01

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during hospitalization, adults at high…

Excessive Picking in Prader-Willi Syndrome: A Pilot Study of Phenomenological Aspects and Comorbid Symptoms.

ERIC Educational Resources Information Center

Wigren, Margareta; Heimann, Mikael

2001-01-01

Interviews with parents of 37 individuals (ages 12-30) with Prader-Willi syndrome revealed two-thirds displayed skin picking with a frequency ranging from chronic to transient, episodic symptoms. Many individuals with skin picking also exhibited comorbid picking behaviors And individuals with excessive skin picking also had frequent tantrums and…

Can local adaptation explain varying patterns of herbivory tolerance in a recently introduced woody plant in North America?

USDA-ARS?s Scientific Manuscript database

Trends in tree mortality have been linked to global scale environmental changes, such as extreme drought and heat stress, more frequent and intense fires, and increased episodic outbreaks of insects and pathogens. Finer scale studies have also focused on survival and mortality in response to physiol...

Substance Abuse Treatment Admissions Aged 12 to 14. The TEDS Report

ERIC Educational Resources Information Center

Substance Abuse and Mental Health Services Administration, 2011

2011-01-01

This report uses data from the Treatment Episode Data Set (TEDS) for 2008 to provide information on the characteristics of youths aged 12 to 14 admitted to substance abuse treatment. In 2008, approximately 23,770 substance abuse treatment admissions were adolescents aged 12 to 14. The two most frequently reported primary substances of abuse among…

Recommending Learning Activities in Social Network Using Data Mining Algorithms

ERIC Educational Resources Information Center

Mahnane, Lamia

2017-01-01

In this paper, we show how data mining algorithms (e.g. Apriori Algorithm (AP) and Collaborative Filtering (CF)) is useful in New Social Network (NSN-AP-CF). "NSN-AP-CF" processes the clusters based on different learning styles. Next, it analyzes the habits and the interests of the users through mining the frequent episodes by the…

Neural Correlates of Conceptual Implicit Memory and Their Contamination of Putative Neural Correlates of Explicit Memory

ERIC Educational Resources Information Center

Voss, Joel L.; Paller, Ken A.

2007-01-01

During episodic recognition tests, meaningful stimuli such as words can engender both conscious retrieval (explicit memory) and facilitated access to meaning that is distinct from the awareness of remembering (conceptual implicit memory). Neuroimaging investigations of one type of memory are frequently subject to the confounding influence of the…

Microorganisms isolated from cultures and infection focus and antibiotic treatments in febrile neutropenic children from Şanlıurfa, Turkey.

PubMed

Özdemir, Z Canan; Koç, Ahmet; Ayçiçek, Ali

2016-01-01

Chemotherapy induced febrile neutropenia predisposes patients to life threatening infections. We aimed to determine the causative microorganisms, infection focus and antibiotic treatment success in febrile neutropenic children with leukemia. A total of 136 febrile neutropenic episodes in 48 leukemic children were reviewed retrospectively from records. Among 136 febrile neutropenic episodes, 68 (50%) episodes were microbiologically documented. Methicillin sensitive coagulase (-) Staphylococcus aureus were the most common isolates from hemoculture (20.5%). The most frequently documented infection focus was mucositis (31.9%). Ceftazidime plus amikacin was the most commonly used antimicrobial treatment for the empirical therapy (52.9%). The overall response rates were 70.5%, 86.9%, and 66.6% of first line, second line and third line therapies, respectively. The spectrum of isolates among febrile neutropenic children in our hematology clinic appears to be gram positive pathogens which are the most common agents. Therefore the, documentation of the flora in each unit could help to decide appropriate empirical therapy which is life saving.

Enhanced air pollution via aerosol-boundary layer feedback in China.

PubMed

Petäjä, T; Järvi, L; Kerminen, V-M; Ding, A J; Sun, J N; Nie, W; Kujansuu, J; Virkkula, A; Yang, X-Q; Fu, C B; Zilitinkevich, S; Kulmala, M

2016-01-12

Severe air pollution episodes have been frequent in China during the recent years. While high emissions are the primary reason for increasing pollutant concentrations, the ultimate cause for the most severe pollution episodes has remained unclear. Here we show that a high concentration of particulate matter (PM) will enhance the stability of an urban boundary layer, which in turn decreases the boundary layer height and consequently cause further increases in PM concentrations. We estimate the strength of this positive feedback mechanism by combining a new theoretical framework with ambient observations. We show that the feedback remains moderate at fine PM concentrations lower than about 200 μg m(-3), but that it becomes increasingly effective at higher PM loadings resulting from the combined effect of high surface PM emissions and massive secondary PM production within the boundary layer. Our analysis explains why air pollution episodes are particularly serious and severe in megacities and during the days when synoptic weather conditions stay constant.

An episode of reinflation of the Long Valley Caldera, eastern California: 1989-1991

USGS Publications Warehouse

Langbein, J.; Hill, D.P.; Parker, T.N.; Wilkinson, S.K.

1993-01-01

Following the episodes of inflation of the resurgent dome associated with the May 1980 earthquake sequence (four M 6 earthquakes) and the January 1983 earthquake swarm (two M 5.2 events), 7 years of frequently repeated two-color geodimeter measurements spanning the Long Valley caldera document gradually decreasing extensional strain rates from 5 ppm/yr in mid-1983, when the measurements began, to near zero in mid-1989. Early October 1989 marked a change in activity when measurements of the two-color geodimeter network showed a significant increase in extensional strain rate (9 ppm/yr) across the caldera. The seismic activity began exceeding 10 M ??? 1..2 per week in early December 1989 and rapidly increased to a sustained level of tens of M ??? 1.2 per week with bursts having hundreds of events per day. The episode of inflation can be modeled by a single Mogi point source located about 7 km beneath the center of the resurgent dome. -from Authors

Emotional intensity in episodic autobiographical memory and counterfactual thinking.

PubMed

Stanley, Matthew L; Parikh, Natasha; Stewart, Gregory W; De Brigard, Felipe

2017-02-01

Episodic counterfactual thoughts-imagined alternative ways in which personal past events might have occurred-are frequently accompanied by intense emotions. Here, participants recollected positive and negative autobiographical memories and then generated better and worse episodic counterfactual events from those memories. Our results suggest that the projected emotional intensity during the simulated remembered/imagined event is significantly higher than but typically positively related to the emotional intensity while remembering/imagining the event. Furthermore, repeatedly simulating counterfactual events heightened the emotional intensity felt while simulating the counterfactual event. Finally, for both the emotional intensity accompanying the experience of remembering/imagining and the projected emotional intensity during the simulated remembered/imagined event, the emotional intensity of negative memories was greater than the emotional intensity of upward counterfactuals generated from them but lower than the emotional intensity of downward counterfactuals generated from them. These findings are discussed in relation to clinical work and functional theories of counterfactual thinking. Copyright © 2017 Elsevier Inc. All rights reserved.

Chronic daily headache: identification of factors associated with induction and transformation.

PubMed

Bigal, Marcelo E; Sheftell, Fred D; Rapoport, Alan M; Tepper, Stewart J; Lipton, Richard B

2002-01-01

Chronic daily headache (CDH) is one of the more frequently encountered headache syndromes at major tertiary care centers. The analysis of factors related to the transformation from episodic to chronic migraine (CM) and to the de novo development of new daily persistent headache (NDPH) remain poorly understood. To identify somatic factors and lifestyle factors associated with the development of CM and NDPH. We used a randomized case-control design to study the following groups: 1) CM with analgesic overuse (ARH), n = 399; 2) CM without analgesic overuse, n = 158; and 3) NDPH, n = 69. These groups were compared with two control groups: 1) episodic migraine, n = 100; and 2) chronic posttraumatic headache (CPTH); n = 65. Associated medical conditions were assessed. We investigated the case groups for any association with somatic or behavioral factors. Data were analyzed by the two-sided Fischer's exact test, with the odds ratio being calculated considering a 95% confidence interval using the approximation of Woolf. When the active groups were compared with the episodic migraine group, the following associations were found: 1) ARH: hypertension and daily consumption of caffeine; 2) CM: allergies, asthma, hypothyroidism, hypertension, and daily consumption of caffeine; and 3) NDPH: allergies, asthma, hypothyroidism, and consumption of alcohol more than three times per week. The following associations were found when comparing the active groups with CPTH: 1) ARH: asthma and hypertension; 2) CM: allergies, asthma, hypothyroidism, hypertension, and daily consumption of caffeine; and 3) NDPH: allergies, asthma, hypothyroidism, and consumption of alcohol more than three times per week. Several strong correlations were obtained between patients with specific types of CDH and certain somatic conditions or behaviors; some have not been previously described. Transformation of previously episodic headache or development of a NDPH thus may be related to certain medical conditions and behaviors beyond the frequently incriminated precipitant analgesic overuse. As similar results were obtained when CPTH was used as a control, the correlation is more complex than simple comorbidity.

Catatonia in 26 patients with bipolar disorder: clinical features and response to electroconvulsive therapy.

PubMed

Medda, Pierpaolo; Toni, Cristina; Luchini, Federica; Giorgi Mariani, Michela; Mauri, Mauro; Perugi, Giulio

2015-12-01

We describe the clinical characteristics and short-term outcomes of a sample of inpatients with bipolar disorder with severe catatonic features resistant to pharmacological treatment. The study involved 26 catatonic patients, resistant to a trial of benzodiazepines, and then treated with electroconvulsive therapy (ECT). All patients were evaluated prior to and one week following the ECT course using the Bush-Francis Catatonia Rating Scale (BFCRS) and the Clinical Global Impression (CGI). In our sample, women were over-represented (n = 23, 88.5%), the mean (± standard deviation) age was 49.5 ± 12.5 years, the mean age at onset was 28.1 ± 12.8 years, and the mean number of previous mood episodes was 5.3 ± 2.9. The mean duration of catatonic symptoms was 16.7 ± 11.8 (range: 3-50) weeks, and personal history of previous catatonic episodes was present in 10 patients (38.5%). Seventeen (65.4%) patients showed abnormalities at cerebral computerized tomography and/or magnetic resonance imaging and neurological comorbidities were observed in 15.4% of the sample. Stupor, rigidity, staring, negativism, withdrawal, and mutism were observed in more than 90% of patients. At the end of the ECT course, 21 patients (80.8%) were classified as responders. The BFCRS showed the largest percentage of improvement, with an 82% reduction of the initial score. The number of previous mood episodes was significantly lower and the use of anticholinergic and dopamine-agonist medications was significantly more frequent in non-responders than in responders. Our patients with bipolar disorder had predominantly retarded catatonia, frequent previous catatonic episodes, indicating a recurrent course, and high rates of concomitant brain structure alterations. However, ECT was a very effective treatment for catatonia in this patient group that was resistant to benzodiazepines. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Syncope: electrocardiogram and autonomic function tests].

PubMed

Uribe, William; Baranchuk, Adrián; Botero, Federico

2016-12-23

Syncope represents one of the most frequent reasons for consultation in the emergency department. A proper identification will allow a precise etiologic approach and the optimization of delivery of health resources.
Once knowing the classification of syncope; it is the clinical interrogatory what enables to discriminate which of these patients present with a neurogenic mediated syncope or a cardiac mediated syncope. The use of diagnostic methods such as the tilt test, will clarify what type of neurally mediated syncope predominates in the patient.
The electrocardiogram is the cornerstone in the identification of those patients who had a true episode of self-limited or aborted sudden death as the first manifestation of their syncope, a fact which provides prognostic and therapeutic information that will impact the morbidity and mortality.

Symptomatic Dengue in Children in 10 Asian and Latin American Countries.

PubMed

L'Azou, Maïna; Moureau, Annick; Sarti, Elsa; Nealon, Joshua; Zambrano, Betzana; Wartel, T Anh; Villar, Luis; Capeding, Maria R Z; Ochiai, R Leon

2016-03-24

The control groups in two phase 3 trials of dengue vaccine efficacy included two large regional cohorts that were followed up for dengue infection. These cohorts provided a sample for epidemiologic analyses of symptomatic dengue in children across 10 countries in Southeast Asia and Latin America in which dengue is endemic. We monitored acute febrile illness and virologically confirmed dengue (VCD) in 3424 healthy children, 2 to 16 years of age, in Asia (Indonesia, Malaysia, the Philippines, Thailand, and Vietnam) from June 2011 through December 2013 and in 6939 children, 9 to 18 years of age, in Latin America (Brazil, Colombia, Honduras, Mexico, and Puerto Rico) from June 2011 through April 2014. Acute febrile episodes were determined to be VCD by means of a nonstructural protein 1 antigen immunoassay and reverse-transcriptase-polymerase-chain-reaction assays. Dengue hemorrhagic fever was defined according to 1997 World Health Organization criteria. Approximately 10% of the febrile episodes in each cohort were confirmed to be VCD, with 319 VCD episodes (4.6 episodes per 100 person-years) occurring in the Asian cohort and 389 VCD episodes (2.9 episodes per 100 person-years) occurring in the Latin American cohort; no trend according to age group was observed. The incidence of dengue hemorrhagic fever was less than 0.3 episodes per 100 person-years in each cohort. The percentage of VCD episodes requiring hospitalization was 19.1% in the Asian cohort and 11.1% in the Latin American cohort. In comparable age groups (9 to 12 years and 13 to 16 years), the burden of dengue was higher in Asia than in Latin America. The burdens of dengue were substantial in the two regions and in all age groups. Burdens varied widely according to country, but the rates were generally higher and the disease more frequently severe in Asian countries than in Latin American countries. (Funded by Sanofi Pasteur; CYD14 and CYD15 ClinicalTrials.gov numbers, NCT01373281 and NCT01374516.).

The characteristics of patients frequently admitted to academic medical centers in the United States

PubMed Central

Williams, Mark V.; Carrier, Danielle; Hensley, Laurie; Thomas, Stephen; Cerese, Julie

2015-01-01

BACKGROUND The recent intense attention to hospital readmissions and their implications for quality, safety, and reimbursement necessitates understanding specific subsets of readmitted patients. Frequently admitted patients, defined as patients who are admitted 5 or more times within 1 year, may have some distinguishing characteristics that require novel solutions. METHODS A comprehensive administrative database (University HealthSystem Consortium's Clinical Data Base/Resource Manager™) was analyzed to identify demographic, social, and clinical characteristics of frequently admitted patients in 101 US academic medical centers. RESULTS We studied 28,291 frequently admitted patients with 180,185 admissions over a 1‐year period (2011–2012). These patients comprise 1.6% of all patients, but account for 8% of all admissions and 7% of direct costs. Their admissions are driven by multiple chronic conditions; compared to other hospitalized patients, they have significantly more comorbidities (an average of 7.1 vs 2.5), and 84% of their admissions are to medical services. A minority, but significantly more than other patients, have comorbidities of psychosis or substance abuse. Moreover, although they are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% vs 21.6%), nearly three‐quarters have private or Medicare coverage. CONCLUSIONS Patients who are frequently admitted to US academic medical centers are likely to have multiple complex chronic conditions and may have behavioral comorbidities that mediate their health behaviors, resulting in acute episodes requiring hospitalization. This information can be used to identify solutions for preventing repeat hospitalization for this small group of patients who consume a highly disproportionate share of healthcare resources. Journal of Hospital Medicine 2015;10:563–568. © 2015 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine PMID:26018340

Gender differences in drinking patterns and alcohol-related problems in a community sample in São Paulo, Brazil.

PubMed

Silveira, Camila Magalhães; Siu, Erica Rosanna; Wang, Yuan-Pang; Viana, Maria Carmen; Andrade, Arthur Guerra de; Andrade, Laura Helena

2012-01-01

To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of São Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month non-heavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level.

[Infection in lung transplantation].

PubMed

Gavaldà, Joan; Román, Antonio

2007-12-01

Lung transplantation is now considered an established therapeutic option for patients with severe respiratory failure. Nevertheless, complications are frequent and can lead to intermediate- or long-term graft dysfunction and decreased survival. According to the registry of the International Society for Heart and Lung Transplantation, survival rates in these patients at one, two, and five years are 74%, 65%, and 47%, respectively. The main obstacle to long-term success of lung transplantation, however, is chronic rejection, which is characterized histologically as bronchiolitis obliterans and occurs in up to two-thirds of patients. One of the most important risk factors for the development of bronchiolitis obliterans, in addition to the number of previous acute rejection episodes and the incidence of persistent rejection, is cytomegalovirus infection and disease. Moreover, recent evidence has indicated a role for respiratory viruses as risk factors for the development of chronic rejection in lung transplant recipients. Infectious complications are a frequent cause of morbidity and mortality in these patients and are the cause of death in nearly half of them. Bacterial infection is the most frequent infectious complication in lung transplant patients. Among the total of infections, 35%-66% are bacterial and 50%-85% of patients present at least one episode. CMV is the second most frequent cause of infectious complications following lung transplantation. Despite the use of various preventive strategies, the risk of developing CMV disease in lung transplant recipients is over 5% during the first year. This is the only type of solid organ transplant in which the etiology of fungal infection is characteristically Aspergillus spp., in contrast to others in which infection by Candida spp. is most common. The incidence of invasive aspergillosis is about 4%.

Recurrence of superficial vein thrombosis in patients with varicose veins.

PubMed

Karathanos, Christos; Spanos, Konstantinos; Saleptsis, Vassileios; Tsezou, Aspasia; Kyriakou, Despina; Giannoukas, Athanasios D

2016-08-01

To investigate which factors other than history of superficial vein thrombosis (SVT) are associated with recurrent spontaneous SVT episodes in patients with varicose veins (VVs). Patients with a history of spontaneous SVT and VVs were followed up for a mean period of 55 months. Demographics, comorbidities, and thrombophilia screening test were analyzed. Patients were grouped according to the clinical-etiology-anatomy-pathophysiology classification. A multiple logistic regression analysis with the forward likelihood ratio method was undertaken. Thirteen patients out of 97 had a recurrence SVT episode during the follow-up period. All those patients were identified to have a thrombophilia defect. Protein C and S, antithrombin, and plasminogen deficiencies were more frequently present in patients without recurrence. Gene mutations were present in 38% in the nonrecurrence group and 77% in the recurrence group. After logistic regression analysis, patients with dislipidemia and mutation in prothrombin G20210A (FII) had an increased risk for recurrence by 5.4-fold and 4.6-fold, respectively. No deep vein thrombosis or pulmonary embolism occurred. Dislipidemia and gene mutations of F II are associated with SVT recurrence in patients with VVs. A selection of patients may benefit from anticoagulation in the short term and from VVs intervention in the long term. © The Author(s) 2015.

Effect of the emotional freedom technique on perceived stress, quality of life, and cortisol salivary levels in tension-type headache sufferers: a randomized controlled trial.

PubMed

Bougea, Anastasia M; Spandideas, Nick; Alexopoulos, Evangelos C; Thomaides, Thomas; Chrousos, George P; Darviri, Christina

2013-01-01

To evaluate the short-term effects of the emotional freedom technique (EFT) on tension-type headache (TTH) sufferers. We used a parallel-group design, with participants randomly assigned to the emotional freedom intervention (n = 19) or a control arm (standard care n = 16). The study was conducted at the outpatient Headache Clinic at the Korgialenio Benakio Hospital of Athens. Thirty-five patients meeting criteria for frequent TTH according to International Headache Society guidelines were enrolled. Participants were instructed to use the EFT method twice a day for two months. Study measures included the Perceived Stress Scale, the Multidimensional Health Locus of Control Scale, and the Short-Form questionnaire-36. Salivary cortisol levels and the frequency and intensity of headache episodes were also assessed. Within the treatment arm, perceived stress, scores for all Short-Form questionnaire-36 subscales, and the frequency and intensity of the headache episodes were all significantly reduced. No differences in cortisol levels were found in any group before and after the intervention. EFT was reported to benefit patients with TTH. This randomized controlled trial shows promising results for not only the frequency and severity of headaches but also other lifestyle parameters. Copyright © 2013 Elsevier Inc. All rights reserved.

Estimating the proportion of pneumonia attributable to pneumococcus in Kenyan adults: latent class analysis.

PubMed

Jokinen, Jukka; Scott, J Anthony G

2010-09-01

Community-acquired pneumonia is a common cause of hospitalization among African adults, and Streptococcus pneumoniae is assumed to be a frequent cause. Pneumococcal conjugate vaccine is currently being introduced into childhood immunization programs in Africa. The case for adult vaccination is dependent on the contribution of the pneumococcus to the hospital pneumonia burden. Pneumococcal diagnosis is complex because there is no gold standard, and culture methods are invalidated by antibiotic use. We used latent class analysis to estimate the proportion of pneumonia episodes caused by pneumococcus. Furthermore, we extended this methodology to evaluate the effect of antimicrobial treatment on test accuracies and the prevalence of the disease. The study combined data from 5 validation studies of pneumococcal diagnostic tests performed on 281 Kenyan adults with pneumonia. The proportion of pneumonia episodes attributable to pneumococcus was 0.46 (95% confidence interval = 0.36-0.57). Failure to account for the effect of antimicrobial exposure underestimates this proportion as 0.32. A history of antibiotic exposure was a poor predictor of antimicrobial activity in patients' urine. Blood culture sensitivity for pneumococcus was estimated at 0.24 among patients with antibiotic exposure, and 0.75 among those without. The large contribution of pneumococcus to adult pneumonia provides a strong case for the investigation of pneumococcal vaccines in African adults.

Evaluation of the quality of life and risk of suicide

PubMed Central

de Medeiros Alves, Verônica; de Lima Francisco, Leilane Camila Ferreira; Belo, Flaviane Maria Pereira; de-Melo-Neto, Valfrido Leão; Barros, Vinicius Gomes; Nardi, Antonio E

2016-01-01

OBJECTIVE: To identify the socio-demographic profiles, suicidal ideation, the presence of mental disorders and the quality of life of patients using mental health services in Arapiraca, Alagoas, Brazil. METHOD: Interviews were conducted in family health units and the Psychosocial Attention Center. The sample included 202 mental disorder patients with a risk of suicide attempts, 207 mental disorder patients without a risk of suicide attempts and 196 controls. This study used an identification questionnaire, the abbreviated World Health Organization Quality of Life questionnaire, Beck‘s Suicidal Ideation Scale and the Mini International Neuropsychiatric Interview. RESULTS: Patients who had a mental disorder and a risk of suicide attempts tended to be single, had less education and lower family income, were not working and showed lower scores in quality of life domains; 73 of these patients had suicidal ideation in the previous week. Depressive disorders, manic episodes, hypomanic episodes, social phobias, obsessive compulsive disorder, post-traumatic stress disorder, psychotic syndromes and generalized anxiety disorder were more frequent and statistically significant for patients at risk for suicide attempts. CONCLUSION: The management of patients with a risk of suicide attempts must focus on individual patients because this risk is directly linked to changes in quality of life and the improvement of these patients' prognosis. PMID:27074173

Effects of early adolescent alcohol use on mid-adolescent school performance and connection: A longitudinal study of students in Victoria, Australia and Washington State, United States

PubMed Central

Heerde, Jessica Anne; Scholes-Balog, Kirsty Elizabeth; Herrenkohl, Todd Ian; Toumbourou, John Winston; Catalano, Richard Francis

2014-01-01

BACKGROUND This paper examines the effect of early adolescent alcohol use on mid-adolescent school suspension, truancy, commitment, and academic failure in Washington State, United States (US) and Victoria, Australia. Also of interest was whether associations remain after statistically controlling for other factors known to predict school outcomes. METHODS State-representative student samples were surveyed in 2002 (grade 7; N = 1858) and followed up annually to 2004 (grade 9) in both venues. Students completed a modified version of the Communities That Care survey to report alcohol use, school outcomes and risk and protective factors. Response rates were above 74% and retention rates exceeded 98% in both places. RESULTS Controlling for grade 7 risk factors, grade 7 current alcohol use and heavy episodic drinking were associated with grade 8 school suspension. Grade 7 current and frequent alcohol use and heavy episodic drinking were linked to grade 9 truancy. In fully adjusted analyses, associations between early alcohol use and academic failure and low school commitment did not remain. CONCLUSIONS Although alcohol use is one factor influencing school performance and connection, there are other risk factors that need to be targeted to improve school outcomes. PMID:25274170

Associations between LGBTQ-Affirmative School Climate and Adolescent Drinking Behaviors

PubMed Central

Coulter, Robert W.S.; Birkett, Michelle; Corliss, Heather L.; Hatzenbuehler, Mark L.; Mustanski, Brian; Stall, Ron D.

2016-01-01

Background We investigated whether adolescents drank alcohol less frequently if they lived in jurisdictions with school climates that were more affirmative of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals. Methods Data from the 2010 School Health Profile survey, which measured LGBTQ school climate (e.g., percentage of schools with safe spaces and gay-straight alliances), were linked with pooled data from the 2005 and 2007 Youth Risk Behavior Survey, which measured sexual orientation identity, demographics, and alcohol use (number of drinking days, drinking days at school, and heavy episodic drinking days) in 8 jurisdictions. Two-level Poisson models tested the associations between school climate and alcohol use for each sexual-orientation subgroup. Results Living in jurisdictions with more (versus less) affirmative LGBTQ school climates was significantly associated with: fewer heavy episodic drinking days for gay/lesbian (incidence-rate ratio [IRR]=0.70; 95% confidence interval [CI]: 0.56, 0.87; p=0.001) and heterosexual (IRR=0.80; 95% CI: 0.76, 0.83; p<0.001) adolescents; and fewer drinking days at school for adolescents unsure of their sexual orientation (IRR=0.57; 95% CI: 0.35, 0.93; p=0.024). Conclusions Fostering LGBTQ-affirmative school climates may reduce some drinking behaviors for gay/lesbian adolescents, heterosexual adolescents, and adolescents unsure of their sexual orientation. PMID:26946989

Cervical pessary to reduce preterm birth before 34 weeks of gestation after an episode of preterm labor and a short cervix: a randomized controlled trial.

PubMed

Pratcorona, Laia; Goya, Maria; Merced, Carme; Rodó, Carlota; Llurba, Elisa; Higueras, Teresa; Cabero, Luis; Carreras, Elena

2018-04-25

To date, no intervention has proved effective in reducing the spontaneous preterm birth rate in singleton pregnancies following an episode of threatened preterm labor and short cervix remaining. This study was designed to ascertain whether cervical pessaries could be useful in preventing spontaneous preterm birth in women with singleton pregnancies and a short cervix after a threatened preterm labor episode. This open randomized controlled trial was conducted in 357 pregnant women (between 24 0 and 33 6 weeks) who had not delivered 48h after a threatened preterm labor episode and had a short cervix remaining (≤25 mm at 24 0 -29 6 weeks; ≤15mm at 30 0 -33 6 weeks). Patients were randomly assigned to cervical pessary (179) or routine management (178). The primary outcome was the spontaneous preterm birth rate before 34 weeks. Spontaneous preterm birth before 28 and 37 weeks and neonatal morbidity and mortality were also evaluated in an intention-to-treat analysis. No significant differences between the pessary and routine management groups were observed in the spontaneous preterm birth rate before 34 weeks (19/177 [10.7%] in the pessary group vs. 24/175 [13.7%] in the control group; relative risk, 0.78; 95% confidence interval, 0.45-1.38). Spontaneous preterm birth before 37 weeks occurred less frequently in the pessary group (26/175 [14.7%] vs 44/175 [25.1%]; relative risk, 0.58; 95% confidence interval 0.38-0.90; p=0.01). The preterm premature rupture of membranes rate was significantly lower in pessary carriers (4/177 [2.3%] vs. 14/175 [8.0%]; relative risk, 0.28; 95% confidence interval 0.09-0.84; p=0.01). The pessary group less frequently required readmission for new threatened preterm labor episodes (8/177 [4.5%] vs. 35/175 [20.0%]; relative risk, 0.23; 95% confidence interval, 0.11-0.47; p<0.0001. No serious adverse maternal events occurred; neonatal morbidity and mortality were similar in both groups. Pessary use did not significantly lower the spontaneous preterm birth rate before 34 weeks in women with a short cervix remaining after a threatened preterm labor episode but did significantly reduce the spontaneous preterm birth rate before 37 weeks, threatened preterm labor recurrence and the preterm premature rupture of membranes rate. Copyright © 2018 Elsevier Inc. All rights reserved.

Violence against physicians and nurses in a hospital: How does it happen? A mixed-methods study.

PubMed

Shafran-Tikva, Sigal; Chinitz, David; Stern, Zvi; Feder-Bubis, Paula

2017-10-31

Violence against medical personnel is unexpected in hospitals which are devoted to healing, and yet, it is frequent and of concern in the health system. Little is known about the factors that lead to hospital violence, and even less is known about the interactions among these factors. The aim of the study was to identify and describe the perceptions of staff and patients regarding the factors that lead to violence on the part of patients and those accompanying them. A mixed-methods study in a large, general, university tertiary hospital. A self-administered survey yielding 678 completed questionnaires, comprising 34% nurses and 66% physicians (93% response rate). Eighteen in-depth interviews were conducted separately with both victims and perpetrators of violent episodes, and four focus-groups (N = 20) were undertaken separately with physicians, staff nurses, head-nurses, and security personnel. Violence erupts as a result of interacting factors encompassing staff behavior, patient behavior, hospital setting, professional roles, and waiting times. Patients and staff reported similar perceptions and emotions regarding the episodes of violence in which they were involved. Of 4,047 statements elicited in the staff survey regarding the eruption of violence, 39% referred to staff behavior; 26 % to patient/visitor behavior; 17% to organizational conditions, and 10% to waiting times. In addition, 35% of the staff respondents reported that their own behavior contributed to the creation of the most severe violent episode in which they were involved, and 48% stated that staff behavior contributed to violent episodes. Half of the reasons stated by physicians and nurses for violence eruption were related to patient dissatisfaction with the quality of service, the degree of staff professionalism, or an unacceptable comment of a staff member. In addition, data from the focus groups pointed to lack of understanding of the hospital system on the part of patients, together with poor communication between patients and providers and expectations gaps. Our various and triangulated data sources show that staff and patients share conditions of overload, pressure, fatigue, and frustration. Staff also expressed lack of coping tools to prevent violence. Self-conscious awareness regarding potential interacting factors can be used to develop interventions aimed at prevention of and better coping with hospital violence for both health systems' users and providers.

Epicardial mapping of ventricular fibrillation over the posterior descending artery and left posterior papillary muscle of the swine heart.

PubMed

Nielsen, Thomas D; Huang, Jian; Rogers, Jack M; Killingsworth, Cheryl R; Ideker, Raymond E

2009-01-01

Recent studies suggest that during ventricular fibrillation (VF) epicardial vessels may be a site of conduction block and the posterior papillary muscle (PPM) in the left ventricle (LV) may be the location of a "mother rotor." The goal of this study was to obtain evidence to support or refute these possibilities. Epicardial activation over the posterior LV and right ventricle (RV) was mapped during the first 20 s of electrically induced VF in six open-chest pigs with a 504 electrode plaque covering a 20 cm(2) area centered over the posterior descending artery (PDA). The locations of epicardial breakthrough as well as reentry clustered in time and space during VF. Spatially, reentry occurred significantly more frequently over the LV than the RV in all 48 episodes, and breakthrough clustered near the PPM (p < 0.001). Significant temporal clustering occurred in 79% of breakthrough episodes and 100% of reentry episodes. These temporal clusters occurred at different times so that there was significantly less breakthrough when reentry was present (p < 0.0001). Conduction block occurred significantly more frequently near the PDA than elsewhere. The PDA is a site of epicardial block which may contribute to VF maintenance. Epicardial breakthrough clusters near the PPM. Reentry also clusters in space but at a separate site. The fact that breakthrough and reentry cluster at different locations and at different times supports the possibility of a drifting filament at the PPM so that at times reentry is present on the surface but at other times the reentrant wavefront breaks through to the epicardium.

[Neurovascular compression of the medulla oblongata: a rare cause of secondary hypertension].

PubMed

Nádas, Judit; Czirják, Sándor; Igaz, Péter; Vörös, Erika; Jermendy, György; Rácz, Károly; Tóth, Miklós

2014-05-25

Compression of the rostral ventrolateral medulla oblongata is one of the rarely identified causes of refractory hypertension. In patients with severe, intractable hypertension caused by neurovascular compression, neurosurgical decompression should be considered. The authors present the history of a 20-year-old man with severe hypertension. After excluding other possible causes of secondary hypertension, the underlying cause of his high blood pressure was identified by the demonstration of neurovascular compression shown by magnetic resonance angiography and an increased sympathetic activity (sinus tachycardia) during the high blood pressure episodes. Due to frequent episodes of hypertensive crises, surgical decompression was recommended, which was performed with the placement of an isograft between the brainstem and the left vertebral artery. In the first six months after the operation, the patient's blood pressure could be kept in the normal range with significantly reduced doses of antihypertensive medication. Repeat magnetic resonance angiography confirmed the cessation of brainstem compression. After six months, increased blood pressure returned periodically, but to a smaller extent and less frequently. Based on the result of magnetic resonance angiography performed 22 months after surgery, re-operation was considered. According to previous literature data long-term success can only be achieved in one third of patients after surgical decompression. In the majority of patients surgery results in a significant decrease of blood pressure, an increased efficiency of antihypertensive therapy as well as a decrease in the frequency of highly increased blood pressure episodes. Thus, a significant improvement of the patient's quality of life can be achieved. The case of this patient is an example of the latter scenario.

A 71-year-old man with anaphylaxis after eating grits

PubMed Central

Posthumus, Jonathon; Borish, Larry

2014-01-01

The allergist is frequently called on to evaluate patients after episodes of anaphylaxis to determine the cause and implement preventive measures that will reduce the patient’s risk from future episodes. The etiology of anaphylaxis can be the result of numerous causes that may go undiagnosed if a thorough evaluation is not performed. We present a 71-year-old man with no history of food allergy or atopy who presented to the emergency room and then our allergy clinic for evaluation after suffering anaphylaxis after a meal of grits and shrimp. The underlying diagnosis, which was subsequently determined, requires a high index of suspicion and should be included in the differential diagnosis of any patient presenting with unexplained anaphylaxis. PMID:22370536

Household Food Items Toxic to Dogs and Cats.

PubMed

Cortinovis, Cristina; Caloni, Francesca

2016-01-01

Several foods that are perfectly suitable for human consumption can be toxic to dogs and cats. Food-associated poisoning cases involving the accidental ingestion of chocolate and chocolate-based products, Allium spp. (onion, garlic, leek, and chives), macadamia nuts, Vitis vinifera fruits (grapes, raisins, sultanas, and currants), products sweetened with xylitol, alcoholic beverages, and unbaked bread dough have been reported worldwide in the last decade. The poisoning episodes are generally due to lack of public knowledge of the serious health threat to dogs and cats that can be posed by these products. The present review aims to outline the current knowledge of common food items frequently involved in the poisoning of small animals, particularly dogs, and provides an overview of poisoning episodes reported in the literature.

Prospective evaluation of the SeptiFAST multiplex real-time PCR assay for surveillance and diagnosis of infections in haematological patients after allogeneic stem cell transplantation compared to routine microbiological assays and an in-house real-time PCR method.

PubMed

Elges, Sandra; Arnold, Renate; Liesenfeld, Oliver; Kofla, Grzegorz; Mikolajewska, Agata; Schwartz, Stefan; Uharek, Lutz; Ruhnke, Markus

2017-12-01

We prospectively evaluated a multiplex real-time PCR assay (SeptiFast, SF) in a cohort of patients undergoing allo-BMT in comparison to an in-house PCR method (IH-PCR). Overall 847 blood samples (mean 8 samples/patient) from 104 patients with haematological malignancies were analysed. The majority of patients had acute leukaemia (62%) with a mean age of 52 years (54% female). Pathogens could be detected in 91 of 847 (11%) samples by SF compared to 38 of 205 (18.5%) samples by BC, and 57 of 847 (6.7%) samples by IH-PCR. Coagulase-negative staphylococci (n=41 in SF, n=29 in BC) were the most frequently detected bacteria followed by Escherichia coli (n=9 in SF, n=6 in BC). Candida albicans (n=17 in SF, n=0 in BC, n=24 in IH-PCR) was the most frequently detected fungal pathogen. SF gave positive results in 5% of samples during surveillance vs in 26% of samples during fever episodes. Overall, the majority of blood samples gave negative results in both PCR methods resulting in 93% overall agreement resulting in a negative predictive value of 0.96 (95% CI: 0.95-0.97), and a positive predictive value of 0.10 (95% CI: -0.01 to 0.21). SeptiFast appeared to be superior over BC and the IH-PCR method. © 2017 Blackwell Verlag GmbH.

Selected Executive Skills in Adolescents with Recent First Episode Major Depression

ERIC Educational Resources Information Center

Kyte, Zoe A.; Goodyer, Ian M.; Sahakian, Barbara J.

2005-01-01

Background: To investigate whether recent first episode major depression in adolescence is characterised by selected executive difficulties in attentional flexibility, behavioural inhibition and decision-making. Methods: Selected executive functions were compared in adolescents with recent (past year) first episode major depression (n = 30) and…

Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency.

PubMed

Hutul, Olivia A; Carpenter, Robert O; Tarpley, John L; Lomis, Kimberly D

2006-01-01

The Accreditation Council for Graduate Medical Education (ACGME) requires that "residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates." The authors sought to assess current methods of teaching and attitudes regarding communication skills in their surgical residency. After obtaining Institutional Review Board (IRB) exemption, voluntary anonymous surveys were completed by a sample of convenience at the Vanderbilt University Medical Center: surgical residents at Grand Rounds and attending surgeons in a faculty meeting. Data were evaluated from 49 respondents (33 of 75 total surgical residents, 16 representative attending surgeons). One hundred percent of respondents rated the importance of communication to the successful care of patients as "4" or "5" of 5. Direct attending observation of residents communicating with patients/families was confirmed by residents and faculty. Residents reported varying levels of comfort with different types of conversations. Residents were "comfortable" or "very comfortable" as follows: obtaining informed consent, 91%; reporting operative findings, 64%; delivering bad news, 61%; conducting a family conference, 40%; discussing do not resuscitate (DNR) orders, 36%; and discussing transition to comfort care, 24%. Resident receptiveness to communication skills education varied with proposed venues: 84% favored teaching in the course of routine clinical care, 52% via online resources, and 46% in workshops. Residents were asked how frequently they received feedback specific to their communication skills during the past 6 months: Most residents reported 0 (39%) or 1 (21%) feedback episode. Only 30% of resident respondents reported receiving feedback that they perceived helpful. Attending surgeons reported that they did provide residents feedback specific to their communication skills. When asked to estimate the number of feedback episodes in the last 6 months, 16 faculty members reported a total of 67 feedback episodes, whereas 33 residents reported a total of only 24 episodes. Most faculty members rated their comfort with providing feedback specific to communication skills as "very comfortable" (56%) or "comfortable" (19%). "Time constraints" was the most frequently cited barrier to teaching communication skills. Communication skills are valued as integral to patient care by both residents and faculty in this study. Residents are most receptive to teaching of communication skills in the clinical setting. Faculty members report they are providing feedback to residents. Although residents report direct observation by faculty, currently only a minority (30%) are receiving feedback regarding communication that they consider helpful. A need exists to facilitate the feedback process to resolve this discrepancy. The authors propose that an evaluation instrument regarding communication skills may strengthen the feedback process.

Load pattern and pressure pain threshold in the upper trapezius muscle and psychosocial factors in medical secretaries with and without shoulder/neck disorders.

PubMed

Hägg, G M; Aström, A

1997-01-01

A current hypothesis for the genesis of muscular complaints in the shoulder/neck region postulates that short periods with a completely relaxed muscle are essential to avoid complaints. Another hypothesis is that these disorders are related to psychosocial conditions at work. In order to test these hypotheses, 23 medical secretaries were investigated. The load pattern during work in the upper trapezius muscle bilaterally was assessed with electromyographic (EMG) technique and exposure variation analysis (EVA). In addition, pressure pain threshold (PPT) was measured on the trapezius muscle bilaterally and on the sternum. Psychosocial conditions at work were assessed with a questionnaire. The medical secretaries with complaints had significantly fewer episodes with totally or close to totally relaxed muscle compared with the healthy group. The group with complaints tended to have a more monotonous load pattern at low levels (approx. 1%-5% maximum voluntary contraction) while the healthy group had more frequent pauses but also somewhat more frequent short load peaks. The group with complaints showed lower PPT readings compared with the healthy group. However, the whole group had considerably lower PPTs than is usually reported in the literature. Of the 12 questions in the psychosocial questionnaire only one regarding work task satisfaction showed a significant difference between the two groups. Support is found for hypothesis that secretaries without complaints have more frequent episodes with totally relaxed muscle. A significant difference is found regarding work task satisfaction.

[Prospective evaluation of blood cultures in Medical Faculty Hospital of Blacksea Technical University].

PubMed

Sucu, Nurgün; Caylan, Rahmet; Aydin, Kemalettin; Yilmaz, Gürdal; Aktoz Boz, Gönülden; Köksal, Iftihar

2005-10-01

In this study, the rate of blood culture contamination, bacterial pathogens and their antimicrobial susceptibilities causing nosocomial and community acquired bloodstream infections were investigated prospectively during the period February 2003 to February 2004. In the study period, among the 5994 blood culture samples obtained from 3114 patients, 1091 (18%) yielded positive results. Seventy-four of them (1.2%) were evaluated as false positive, 514 (9%) were pseudobacteremia or contamination. According to patients' clinical features, 503 (8%) blood culture samples were associated with blood stream infections, and 358 of them (71%) were primary episodes. Twohundred and ninetyfour of primary episodes (82%) were hospital acquired and 64 were community acquired bloodstream infections. Staphylococcus aureus was the most frequently isolated agent in the hospital and community acquired bloodstream infections at the rates of 16% and 20%, respectively. In hospital acquired blood stream infections, Escherichia coil (9%) and Pseudomonas aeruginosa (8%); in community acquired bloodstream infections Streptococcus spp (17%) and E. coli (15%) were the other most frequently isolated bacterial agents. Methicillin resistance of S. aureus isolates was determined as 54% in hospital acquired blood stream infections and 25% in community acquired blood stream infections.

Molecular and Culture-Based Bronchoalveolar Lavage Fluid Testing for the Diagnosis of Cytomegalovirus Pneumonitis.

PubMed

Tan, Susanna K; Burgener, Elizabeth B; Waggoner, Jesse J; Gajurel, Kiran; Gonzalez, Sarah; Chen, Sharon F; Pinsky, Benjamin A

2016-01-01

Background.  Cytomegalovirus (CMV) is a major cause of morbidity and mortality in immunocompromised patients, with CMV pneumonitis among the most severe manifestations of infection. Although bronchoalveolar lavage (BAL) samples are frequently tested for CMV, the clinical utility of such testing remains uncertain. Methods.  Retrospective analysis of adult patients undergoing BAL testing via CMV polymerase chain reaction (PCR), shell vial culture, and conventional viral culture between August 2008 and May 2011 was performed. Cytomegalovirus diagnostic methods were compared with a comprehensive definition of CMV pneumonitis that takes into account signs and symptoms, underlying host immunodeficiency, radiographic findings, and laboratory results. Results.  Seven hundred five patients underwent 1077 bronchoscopy episodes with 1090 BAL specimens sent for CMV testing. Cytomegalovirus-positive patients were more likely to be hematopoietic cell transplant recipients (26% vs 8%, P < .0001) and less likely to have an underlying condition not typically associated with lung disease (3% vs 20%, P < .0001). Histopathology was performed in only 17.3% of CMV-positive bronchoscopy episodes. When CMV diagnostic methods were evaluated against the comprehensive definition, the sensitivity and specificity of PCR, shell vial culture, and conventional culture were 91.3% and 94.6%, 54.4% and 97.4%, and 28.3% and 96.5%, respectively. Compared with culture, PCR provided significantly higher sensitivity and negative predictive value (P ≤ .001), without significantly lower positive predictive value. Cytomegalovirus quantitation did not improve test performance, resulting in a receiver operating characteristic curve with an area under the curve of 0.53. Conclusions.  Cytomegalovirus PCR combined with a comprehensive clinical definition provides a pragmatic approach for the diagnosis of CMV pneumonitis.

Managing a patient with excessive belching.

PubMed

Disney, Benjamin; Trudgill, Nigel

2014-04-01

A 50-year-old man with end-stage renal failure was referred by his general practitioner with dyspeptic symptoms. On further questioning the patient complained of a 10-year history of frequent belching. This was noticeably worse after meals and during times of stress. He did not have nocturnal belching and episodes of belching were less frequent when the patient was talking or distracted. There was no history of gastro-oesophageal reflux, vomiting, dysphagia, loss of appetite or weight loss. He was diagnosed with excessive, probably supragastric, belching. Further investigation was not deemed necessary. His symptoms have since settled with simple reassurance and explanation of their origin provided during the clinic visit.

[Headache Treatment].

PubMed

Diener, Hans Christoph; Holle-Lee, Dagny; Nägel, Steffen; Gaul, Charly

2017-03-01

A precondition for the successful treatment of headaches is the correct headache diagnosis. Triptans are effective for attack treatment of migraine and cluster headache. However, there are not effective for the treatment of tension-type headache. For the prevention of frequent episodic migraine betablockers, flunarizine, topiramate and amitriptyline are recommended. For the prevention of chronic migraine evidence is only available for onabotulinumtoxinA and topiramate. For prophylactic treatment of tension-type headaches tricyclic antidepressants are used. In cluster headache verapamil (in combination with steroids) is the most frequently used prophylactic agent. This article focusses on the current acute and prophylactic treatment of common headache syndromes. © Georg Thieme Verlag KG Stuttgart · New York.

Neurological soft signs and gray matter changes: a longitudinal analysis in first-episode schizophrenia.

PubMed

Kong, Li; Bachmann, Silke; Thomann, Philipp A; Essig, Marco; Schröder, Johannes

2012-01-01

Neurological soft signs (NSS) - i.e. discrete deficits of sensory and motor function - are frequently found in schizophrenia and vary with psychopathological symptoms in the course of the disorder. Hence, persistence of NSS herald chronicity in first episode schizophrenia. To investigate the cerebral correlates of persisting NSS over time, 20 patients with first-episode schizophrenia underwent T1 magnetic resonance imaging (MRI) after remission of the acute symptoms and after 1 year of follow-up. NSS were rated on the Heidelberg Scale. Twenty age- and gender-matched control subjects were scanned once. Longitudinal gray matter (GM) changes were measured by using tensor based morphometry (TBM). At follow-up, patients demonstrated significantly decreased NSS scores. For further analysis, the patient sample was dichotomized into patients with decreasing NSS scores and patients with persistently increased scores, respectively. While patients with decreasing NSS exhibited only localized changes within the left frontal lobe, cerebellum, and cingulate gyrus, patients with persistently increased scores showed pronounced GM reductions of the sub-lobar claustrum, cingulate gyrus, cerebellum, frontal lobe, and middle frontal gyrus. Results were confirmed after correction for multiple comparisons. These findings support the hypothesis that persisting NSS refer to progressive cerebral changes in first-episode schizophrenia. Since NSS can be assessed in any clinical environment, this association facilitates the prospect that NSS can help to establish prognosis in first-episode patients with schizophrenia. Copyright © 2011 Elsevier B.V. All rights reserved.

MELAS syndrome: Clinical manifestations, pathogenesis, and treatment options.

PubMed

El-Hattab, Ayman W; Adesina, Adekunle M; Jones, Jeremy; Scaglia, Fernando

2015-01-01

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is one of the most frequent maternally inherited mitochondrial disorders. MELAS syndrome is a multi-organ disease with broad manifestations including stroke-like episodes, dementia, epilepsy, lactic acidemia, myopathy, recurrent headaches, hearing impairment, diabetes, and short stature. The most common mutation associated with MELAS syndrome is the m.3243A>G mutation in the MT-TL1 gene encoding the mitochondrial tRNA(Leu(UUR)). The m.3243A>G mutation results in impaired mitochondrial translation and protein synthesis including the mitochondrial electron transport chain complex subunits leading to impaired mitochondrial energy production. The inability of dysfunctional mitochondria to generate sufficient energy to meet the needs of various organs results in the multi-organ dysfunction observed in MELAS syndrome. Energy deficiency can also stimulate mitochondrial proliferation in the smooth muscle and endothelial cells of small blood vessels leading to angiopathy and impaired blood perfusion in the microvasculature of several organs. These events will contribute to the complications observed in MELAS syndrome particularly the stroke-like episodes. In addition, nitric oxide deficiency occurs in MELAS syndrome and can contribute to its complications. There is no specific consensus approach for treating MELAS syndrome. Management is largely symptomatic and should involve a multidisciplinary team. Unblinded studies showed that l-arginine therapy improves stroke-like episode symptoms and decreases the frequency and severity of these episodes. Additionally, carnitine and coenzyme Q10 are commonly used in MELAS syndrome without proven efficacy. Copyright © 2015 Elsevier Inc. All rights reserved.

Is Adolescent-Onset First-Episode Psychosis Different from Adult Onset?

ERIC Educational Resources Information Center

Ballageer, Trevor; Malla, Ashok; Manchanda, Rahul; Takhar, Jatinder; Haricharan, Raj

2005-01-01

Objective: To examine whether first-episode psychosis patients with onset during adolescence (ages 15-18) differ significantly from those with young-adult onset (ages 19-30). Method: Consecutive patients presenting with first-episode psychosis (N = 242) were assessed for demographic and illness characteristics such as duration of untreated…

Thinking lean: implementing DMAIC methods to improve efficiency within a cystic fibrosis clinic.

PubMed

Smith, Chad; Wood, Suzanne; Beauvais, Bradley

2011-01-01

The timely coordination of care in clinics that require frequent assessments by multiple specialists can be challenging for both patients and providers. The cornerstone of care at cystic fibrosis (CF) centers with superior clinical outcomes, as with reduced acuity of episodic disease and incidence of hospitalizations, is frequent clinical encounters coupled with aggressive therapies. However, inefficiencies in the clinical practice structure prevent optimal utilization of resources. To decrease non-value-added time, defined as time a patient spends alone in an examination room, without altering the time providers spend caring for a patient, the application of Lean methods was used to see whether reducing variation could significantly decrease lead time, considered the length of a patient visit, within a CF clinic setting. Baseline capability analyses revealed only 19.3% of patient visits were completed in 60min or less, with mean and median visit times of 84 and 81min, respectively. Final capability analyses demonstrated that 41.5% of patient visits were completed in 60min or less, 23% greater than the baseline capability. Mean and median visit times decreased by 10min per visit. Research efforts increased the available capacity by 500 patient visits per year, representing additional revenue of over US$165,000 annually with no additional administrative costs incurred. © 2011 National Association for Healthcare Quality.

Impairments in Episodic-Autobiographical Memory and Emotional and Social Information Processing in CADASIL during Mid-Adulthood.

PubMed

Staniloiu, Angelica; Woermann, Friedrich G; Markowitsch, Hans J

2014-01-01

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) - is the most common genetic source of vascular dementia in adults, being caused by a mutation in NOTCH3 gene. Spontaneous de novo mutations may occur, but their frequency is largely unknown. Ischemic strokes and cognitive impairments are the most frequent manifestations, but seizures affect up to 10% of the patients. Herein, we describe a 47-year-old male scholar with a genetically confirmed diagnosis of CADASIL (Arg133Cys mutation in the NOTCH3 gene) and a seemingly negative family history of CADASIL illness, who was investigated with a comprehensive neuropsychological testing battery and neuroimaging methods. The patient demonstrated on one hand severe and accelerated deteriorations in multiple cognitive domains such as concentration, long-term memory (including the episodic-autobiographical memory domain), problem solving, cognitive flexibility and planning, affect recognition, discrimination and matching, and social cognition (theory of mind). Some of these impairments were even captured by abbreviated instruments for investigating suspicion of dementia. On the other hand the patient still possessed high crystallized (verbal) intelligence and a capacity to put forth a façade of well-preserved intellectual functioning. Although no definite conclusions can be drawn from a single case study, our findings point to the presence of additional cognitive changes in CADASIL in middle adulthood, in particular to impairments in the episodic-autobiographical memory domain and social information processing (e.g., social cognition). Whether these identified impairments are related to the patient's specific phenotype or to an ascertainment bias (e.g., a paucity of studies investigating these cognitive functions) requires elucidation by larger scale research.

Impairments in Episodic-Autobiographical Memory and Emotional and Social Information Processing in CADASIL during Mid-Adulthood

PubMed Central

Staniloiu, Angelica; Woermann, Friedrich G.; Markowitsch, Hans J.

2014-01-01

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) – is the most common genetic source of vascular dementia in adults, being caused by a mutation in NOTCH3 gene. Spontaneous de novo mutations may occur, but their frequency is largely unknown. Ischemic strokes and cognitive impairments are the most frequent manifestations, but seizures affect up to 10% of the patients. Herein, we describe a 47-year-old male scholar with a genetically confirmed diagnosis of CADASIL (Arg133Cys mutation in the NOTCH3 gene) and a seemingly negative family history of CADASIL illness, who was investigated with a comprehensive neuropsychological testing battery and neuroimaging methods. The patient demonstrated on one hand severe and accelerated deteriorations in multiple cognitive domains such as concentration, long-term memory (including the episodic-autobiographical memory domain), problem solving, cognitive flexibility and planning, affect recognition, discrimination and matching, and social cognition (theory of mind). Some of these impairments were even captured by abbreviated instruments for investigating suspicion of dementia. On the other hand the patient still possessed high crystallized (verbal) intelligence and a capacity to put forth a façade of well-preserved intellectual functioning. Although no definite conclusions can be drawn from a single case study, our findings point to the presence of additional cognitive changes in CADASIL in middle adulthood, in particular to impairments in the episodic-autobiographical memory domain and social information processing (e.g., social cognition). Whether these identified impairments are related to the patient’s specific phenotype or to an ascertainment bias (e.g., a paucity of studies investigating these cognitive functions) requires elucidation by larger scale research. PMID:25009481

The effects of cervical traction, cranial rhythmic impulse, and Mckenzie exercise on headache and cervical muscle stiffness in episodic tension-type headache patients.

PubMed

Choi, Sung-Yong; Choi, Jung-Hyun

2016-03-01

[Purpose] The purpose of this study was to examine the effects of cervical traction treatment, cranial rhythmic impulse treatment, a manual therapy, and McKenzie exercise, a dynamic strengthening exercise, on patients who have the neck muscle stiffness of the infrequent episodic tension-type (IETTH) headache and frequent episodic tension-type headache(FETTH), as well as to provide the basic materials for clinical interventions. [Subjects] Twenty-seven subjects (males: 15, females: 12) who were diagnosed with IETTH and FETTH after treatment by a neurologist were divided into three groups: (a cervical traction group (CTG, n=9), a cranial rhythmic contractiongroup (CRIG, n=9), and a McKenzie exercise group (MEG, n=9). An intervention was conducted for each group and the differences in their degrees of neck pain and changes in muscle tone were observed. [Results] In the within-group comparison of each group, headache significantly decreased in CTG. According to the results of the analysis of the muscle tone of the upper trapezius, there was a statistically significant difference in MEG on the right side and in CRIG on the left side. According to the results of the analysis of the muscle tone of the sternocleidomastoid muscle, there was a statistically significant difference in MEG on the right side and in CRIG on the left side. [Conclusion] In the comparison of the splenius capitis muscle between the groups, there was a statistically significant difference on the right side. Hence, compared to the other methods, cervical traction is concluded to be more effective at reducing headaches in IETTH and FETTH patients.

The Efficacy of the Upright Position on Gastro-Esophageal Reflux and Reflux-Related Respiratory Symptoms in Infants With Chronic Respiratory Symptoms

PubMed Central

Jung, Woo Jin; Yang, Hyeon Jong; Min, Taek Ki; Jeon, You Hoon; Lee, Hae Won; Lee, Jun Sung

2012-01-01

Purpose Gastro-esophageal reflux (GER), particularly non-acid reflux, is common in infants and is a known cause of chronic respiratory symptoms in infancy. Recent guidelines recommended empirical acid suppression therapy and the head-up position in patients with suspected GER. However, the efficacy of the upright position in relieving GER and reflux-related respiratory symptoms in infants is unclear. We conducted this study to investigate the efficacy of the upright position on GER and reflux-related respiratory symptoms in infants with chronic respiratory symptoms. Methods Thirty-two infants (21 male; median age, 5 months; range, 0 to 19 months) with unexplained chronic respiratory symptoms underwent multi-channel intraluminal esophageal impedance and pH monitoring. We retrospectively compared the frequencies of GER and reflux-related symptoms according to body position. Results A mean of 3.30 episodes of reflux per hour was detected. Overall, refluxes were more frequent during the postprandial period than the emptying period (3.77 vs. 2.79 episodes/hour, respectively; P=0.01). Although there was no significant difference in the total refluxes per hour between the upright and recumbent positions (6.12 vs. 3.77 episodes, P=0.10), reflux-related respiratory symptoms per reflux were significantly fewer in infants kept in an upright position than in a recumbent position during the postprandial period (3.07% vs. 14.75%, P=0.016). Non-acid reflux was the predominant type of reflux in infants, regardless of body position or meal time. Conclusions The upright position may reduce reflux-related respiratory symptoms, rather than reflux frequency. Thus, it may be a useful non-pharmacological treatment for infantile GER disease resistant to acid suppressants. PMID:22211166

Drug-related acute renal failure in hospitalised patients.

PubMed

Iavecchia, Lujan; Cereza García, Gloria; Sabaté Gallego, Mònica; Vidal Guitart, Xavier; Ramos Terrades, Natalia; de la Torre, Judith; Segarra Medrano, Alfons; Agustí Escasany, Antònia

2015-01-01

The information available on the incidence and the characteristics of patients with acute renal failure (ARF) related to drugs is scarce. To estimate the incidence of drug-related ARF in hospitalised patients and to compare their characteristics with those of patients with ARF due to other causes. We selected a prospective cohort of patients with ARF during hospital admission (July 2010-July 2011). Information on patients' demographics, medical antecedents, ARF risk factors, ARF severity according to the RIFLE classification and hospital drug administration was collected. We analysed the relationship of drugs with the ARF episodes using Spanish Pharmacovigilance System methods and algorithm. A total of 194 cases had an episode of hospital-acquired ARF. The median age of patients was 72 years [IQR 20]; 60% were men. The ARF incidence during hospitalization was 9.6 per 1,000 admissions. According to the RIFLE classification, a risk of kidney damage or kidney injury was present in 77.8% of cases. In 105 (54.1%) cases, ARF was drug-related; the drugs most frequently involved were diuretics, agents acting on the renin-angiotensin system, immunosuppressants, β-blocking agents, calcium channel blockers, contrast media and non-steroid anti-inflammatory drugs. Patients with drug-related ARF had more multi-morbidity, fewer ARF risk factors and lower mortality. Half of ARF episodes during hospitalisation were drug related. Patients with drug-related ARF had higher cardiovascular morbidity than those with ARF related to other causes, but they had a lower frequency of ARF risk factors and mortality. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Multiple Norovirus Infections in a Birth Cohort in a Peruvian Periurban Community

PubMed Central

Saito, Mayuko; Goel-Apaza, Sonia; Espetia, Susan; Velasquez, Daniel; Cabrera, Lilia; Loli, Sebastian; Crabtree, Jean E.; Black, Robert E.; Kosek, Margaret; Checkley, William; Zimic, Mirko; Bern, Caryn; Cama, Vitaliano; Gilman, Robert H.; Xiao, L.; Kelleher, D.; Windle, H. J.; van Doorn, L. J.; Varela, M.; Verastegui, M.; Calderon, M.; Alva, A.; Roman, K.

2014-01-01

Background. Human noroviruses are among the most common enteropathogens globally, and are a leading cause of infant diarrhea in developing countries. However, data measuring the impact of norovirus at the community level are sparse. Methods. We followed a birth cohort of children to estimate norovirus infection and diarrhea incidence in a Peruvian community. Stool samples from diarrheal episodes and randomly selected nondiarrheal samples were tested by polymerase chain reaction for norovirus genogroup and genotype. Excretion duration and rotavirus coinfection were evaluated in a subset of episodes. Results. Two hundred twenty and 189 children were followed to 1 and 2 years of age, respectively. By 1 year, 80% (95% confidence interval [CI], 75%–85%) experienced at least 1 norovirus infection and by 2 years, 71% (95% CI, 65%–77%) had at least 1 episode of norovirus-associated diarrhea. Genogroup II (GII) infections were 3 times more frequent than genogroup 1 (GI) infections. Eighteen genotypes were found; GII genotype 4 accounted for 41%. Median excretion duration was 34.5 days for GII vs 8.5 days for GI infection (P = .0006). Repeat infections by the same genogroup were common, but repeat infections by the same genotype were rare. Mean length-for-age z score at 12 months was lower among children with prior norovirus infection compared to uninfected children (coefficient: −0.33 [95% CI, −.65 to −.01]; P = .04); the effect persisted at 24 months. Conclusions. Norovirus infection occurs early in life and children experience serial infections with multiple genotypes, suggesting genotype-specific immunity. An effective vaccine would have a substantial impact on morbidity, but may need to target multiple genotypes. PMID:24300042

[Use of procalcitonin and C-reactive protein as infection markers in febrile neutropenic patients undergoing haematopoietic stem cell transplant].

PubMed

Sánchez-Yepes, Marina; Aznar-Oroval, Eduardo; Lorente-Alegre, Pablo; García-Lozano, Tomás; Picón-Roig, Isabel; Pérez-Ballestero, Pilar; Ortiz-Muñoz, Blanca

2014-01-01

Neutropenia is a frequent sign in patients who are going to have a haematopoietic stem cell transplant (HSCT). Infection is an important complication in these patients, which is favoured by immunosuppression and the degree of neutropenia. This study aims to evaluate the diagnostic usefulness of procalcitonin (PCT) and C-reactive protein (CRP) in onco-haematological patients undergoing chemotherapy and HSCT to determine the origin of the fever. PCT and CRP values were measured in 30 episodes of febrile neutropenia: before starting chemotherapy, appearance of neutropenia, onset of fever, days 1, 2, 3 and 6 after the onset of fever, and when the febrile episode ended. The episodes were classified as 5 bacteraemia, 3 microbiologically documented infections, 10 clinical infections, and 12 fevers of unknown origin. The highest PCT mean values corresponded to the group of patients with bacteraemia. Statistically significant differences (P=.04) were found on the second day after the onset of fever. The cut-off point of 0.5ng/ml showed a sensitivity of 66% and a specificity of 75%. PCR results showed statistically significant differences on days 1, 2 and 3 after the onset of fever (P=.01, P=.003, and P=.002, respectively). The cut-off point of 7.5mg/L had a sensitivity of 88% and a specificity of 58%. The combination of PCT and CRP is an insufficient method to detect bacterial infections and may not replace the proper clinical and microbiological diagnosis. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Functional (dissociative) retrograde amnesia.

PubMed

Markowitsch, H J; Staniloiu, A

2016-01-01

Retrograde amnesia is described as condition which can occur after direct brain damage, but which occurs more frequently as a result of a psychiatric illness. In order to understand the amnesic condition, content-based divisions of memory are defined. The measurement of retrograde memory is discussed and the dichotomy between "organic" and "psychogenic" retrograde amnesia is questioned. Briefly, brain damage-related etiologies of retrograde amnesia are mentioned. The major portion of the review is devoted to dissociative amnesia (also named psychogenic or functional amnesia) and to the discussion of an overlap between psychogenic and "brain organic" forms of amnesia. The "inability of access hypothesis" is proposed to account for most of both the organic and psychogenic (dissociative) patients with primarily retrograde amnesia. Questions such as why recovery from retrograde amnesia can occur in retrograde (dissociative) amnesia, and why long-term new learning of episodic-autobiographic episodes is possible, are addressed. It is concluded that research on retrograde amnesia research is still in its infancy, as the neural correlates of memory storage are still unknown. It is argued that the recollection of episodic-autobiographic episodes most likely involves frontotemporal regions of the right hemisphere, a region which appears to be hypometabolic in patients with dissociative amnesia. © 2016 Elsevier B.V. All rights reserved.

Clinical aspects of juvenile myoclonic epilepsy.

PubMed

Genton, Pierre; Thomas, Pierre; Kasteleijn-Nolst Trenité, Dorothee G A; Medina, Marco Tulio; Salas-Puig, Javier

2013-07-01

Juvenile myoclonic epilepsy (JME) is a recognizable, frequent epileptic syndrome. The most typical ictal phenomenon is bilateral myoclonia without loss of consciousness (M), with most patients also presenting with generalized tonic-clonic seizures (GTCSs) and some with absence seizures (ASs). The most striking features of JME are its onset around the time of puberty and the fact that seizure episodes occur after awakening from a sleep period or in the evening relaxation period and are facilitated by sleep deprivation and sudden arousal. Photic sensitivity is common in the EEG laboratory but uncommon or unrecognized in daily life. The clinical features of JME make it easy to diagnose. In recent years, awareness of JME has increased, and patients are often accurately diagnosed clinically before confirmation by EEG. The typical circumstance at diagnosis is a first GTCS episode, and one learns during the interview that the patient has had M in the morning for some time before the GTCS episode. There are only few differential diagnoses: the adolescent-onset progressive myoclonus epilepsies, or other forms of idiopathic generalized epilepsies of adolescence. With JME being so common, we propose that a first GTCS episode in a teenager should be considered as revealing JME until proven otherwise. Copyright © 2013. Published by Elsevier Inc.

A microstructural analysis of schedule-induced polydipsia reveals incentive-induced hyperactivity in an animal model of ADHD

PubMed Central

Íbias, Javier; Pellón, Ricardo; Sanabria, Federico

2014-01-01

Recent research has suggested that frequent short bursts of activity characterize hyperactivity associated with attention deficit hyperactivity disorder (ADHD). This study determined whether such pattern is also visible in schedule-induced polydipsia (SIP) in the spontaneously hypertensive rat (SHR), an animal model of ADHD. Male SHR, Wistar Kyoto (WKY) and Wistar rats were exposed to 40 sessions of SIP using a multiple fixed-time (FT) schedule of food delivery with FT 30-s and FT 90-s components. Stable performance was analysed to determine the extent to which SIP-associated drinking is organized in bouts. The Bi-Exponential Refractory Model (BERM) of free-operant performance was applied to schedule-induced licks. A model comparison analysis supported BERM as a description of SIP episodes: licks were not produced at a constant rate but organized into bouts within drinking episodes. FT 30-s induced similar overall licking rates, latencies to first licks and episode durations across strains; FT 90-s induced longer episode durations in SHRs and reduced licking rate in WKY and Wistar rats to nearly baseline levels. Across schedules, SHRs made more and shorter bouts when compared to the other strains. These results suggest an incentive-induced hyperactivity in SHR that has been observed in operant behavior and in children with ADHD. PMID:25447297

Consistency of communication among intensive care unit staff as perceived by family members of patients surviving to discharge.

PubMed

Hwang, David Y; Yagoda, Daniel; Perrey, Hilary M; Tehan, Tara M; Guanci, Mary; Ananian, Lillian; Currier, Paul F; Cobb, J Perren; Rosand, Jonathan

2014-02-01

We hypothesize that intensive care unit (ICU) families frequently perceive that they have received inconsistent information from staff about their relatives and that these inconsistencies influence abilities to make medical decisions, as well as satisfaction. We performed a prospective cohort study in the neurosciences and medical ICU at a university hospital. One hundred twenty-four family members of adult patients surviving to ICU discharge completed a questionnaire regarding perceptions of inconsistent information. Of 193 eligible patients, 64.2% had family complete the survey. Thirty-one respondents (25.0%; 95% confidence interval, 7.7) reported at least 1 instance of inconsistent information during their family member's admission, with no difference between the neurosciences ICU (21.5%; 9.3) and the medical ICU (31.1%; 14.1; P = .28). Of those who did receive inconsistent information, 38.7% (95% confidence interval, 18.2) reported multiple episodes and 74.2% (16.3) indicated that episodes occurred within the first 48 hours of admission. These episodes had an adverse effect, with 19.4% (14.7) indicating that they affected satisfaction and 9.7% (11.0) indicating that they made decision making difficult. Episodes involving inconsistent information from staff as perceived by families may be quite prevalent and may influence decision-making abilities and satisfaction.

Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting

PubMed Central

SHEN, Hui; ZHANG, Li; XU, Chuchen; ZHU, Jinling; CHEN, Meijuan; FANG, Yiru

2018-01-01

Background Bipolar disorder is a mental illness with a high misdiagnosis rate and commonly misdiagnosed as other mental disorders including depression, schizophrenia, anxiety disorders, obsessive-compulsive disorders, and personality disorders, resulting in the mistreatment of clinical symptoms and increasing of recurrent episodes. Aims To understand the reasons for misdiagnosis of bipolar disorder in an outpatient setting in order to help clinicians more clearly identify the disease and avoid diagnostic errors. Methods Data from an outpatient clinic included two groups: those with a confirmed diagnosis of bipolar disorder (CD group) and those who were misdiagnosed (i.e. those who did in fact have bipolar disorder but received a different diagnoses and those without bipolar disorder who received a bipolar diagnosis [MD group]). Information between these two groups was compared. Results There were a total of 177 cases that met the inclusion criteria for this study. Among them, 136 cases (76.8%) were in the MD group and 41 cases (23.2%) were in the CD group. Patents with depression had the most cases of misdiagnosis (70.6%). The first episode of the patients in the MD group was more likely to be a depressive episode (χ2=5.206, p=0.023) and these patients had a greater number of depressive episodes during the course of the disease (Z=-2.268, p=0.023); the time from the onset of the disease to the first treatment was comparatively short (Z=-2.612, p=0.009) in the group with misdiagnosis; the time from the onset of disease to a confirmed diagnosis was longer (Z=-3.685, p<0.001); the overall course of disease was longer (Z=-3.274, p=0.001); there were more inpatients for treatment (χ2=4.539, p=0.033); and hospitalization was more frequent (Z=-2.164, p=0.031). The group with misdiagnosis had more psychotic symptoms (χ2=11.74, p= 0.001); particularly when depression occurred (χ2=7.63, p= 0.006), and the incidence of comorbidity was higher (χ2=5.23, p=0.022). The HCL-32 rating was lower in the misdiagnosis group (t=-2.564, p=0.011). There were more patients diagnosed with bipolar and other related disorders in the misdiagnosis group than in the confirmed diagnosis group (11.0% v. 4.9%) and there were more patients in the MD group diagnosed with depressive episodes who had a recent episode (78.7% v. 65.9%). Conclusions The rate of misdiagnosis of patients with bipolar receiving outpatient treatment was quite high and they often received a misdiagnosis of depression. In the misdiagnosis group the first episode tended to manifest as a depressive episode. In this group there were also a greater number of depressive episodes over the course of illness, accompanied by more psychotic symptoms and a higher incidence of comorbidity. Moreover, these patients apparently lacked insight into their own mania and hypomania symptoms, resulting in difficulties in early diagnosis, longer time needed to confirm the diagnosis, higher rate of hospitalization, and greater number of hospitalizations. PMID:29736129

Joan of Arc: Sanctity, witchcraft or epilepsy?

PubMed

Nicastro, Nicolas; Picard, Fabienne

2016-04-01

The objective of this article is to describe whether Joan of Arc had epilepsy and how that may have influenced her sense of mission and ability to encourage thousands of people to help her to chase the English out of France. Documentation of her Trial of Condemnation in 1431 provides a description of her episodes of experienced voices and visions. From the age of thirteen, Joan of Arc experienced frequent episodes of auditory hallucinations associated with elementary or complex visual hallucinations (e.g., a great light or human faces). These had sudden onset, lasting seconds or minutes at most, and occurred when awake or during sleep, arousing her. Some could be triggered by an auditory stimulus. She had no disorganized thought between the episodes. The semiology of the episodes is very suggestive of epileptic seizures, which have been considered as ecstatic by some authors or as partial epilepsy with auditory features by others, which seems more concordant with the ictal symptoms. The auditory and visual hallucinations could have had a religious content because during her childhood and adolescence, she was brought up in a religious environment, insomuch as this content first undefined only appeared after a few seizures. We can suppose that such hallucinations, without the knowledge of their medical origin, gave her a sense of divine mission, hence, a real strength to try to accomplish the orders she heard during the episodes. Her role during the Hundred Years' War and her narration of her strange episodes led her to be burned for heresy at the age of nineteen, yet rehabilitated 25 years later and to be canonized for her achievements in 1920. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity". Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical features of Candidiasis in patients with inherited interleukin 12 receptor β1 deficiency.

PubMed

Ouederni, Monia; Sanal, Ozden; Ikinciogullari, Aydan; Tezcan, Ilhan; Dogu, Figen; Sologuren, Ithaisa; Pedraza-Sánchez, Sigifredo; Keser, Melike; Tanir, Gonul; Nieuwhof, Chris; Colino, Elena; Kumararatne, Dinakantha; Levy, Jacov; Kutukculer, Necil; Aytekin, Caner; Herrera-Ramos, Estefanía; Bhatti, Micah; Karaca, Neslihan; Barbouche, Ridha; Broides, Arnon; Goudouris, Ekaterini; Franco, José Luis; Parvaneh, Nima; Reisli, Ismail; Strickler, Alexis; Shcherbina, Anna; Somer, Ayper; Segal, Anthony; Angel-Moreno, Alfonso; Lezana-Fernandez, José Luis; Bejaoui, Mohamed; Bobadilla-Del Valle, Miriam; Kachboura, Salem; Sentongo, Timothy; Ben-Mustapha, Imen; Bustamante, Jacinta; Picard, Capucine; Puel, Anne; Boisson-Dupuis, Stéphanie; Abel, Laurent; Casanova, Jean-Laurent; Rodríguez-Gallego, Carlos

2014-01-01

Interleukin 12Rβ1 (IL-12Rβ1)-deficient patients are prone to clinical disease caused by mycobacteria, Salmonella, and other intramacrophagic pathogens, probably because of impaired interleukin 12-dependent interferon γ production. About 25% of patients also display mucocutaneous candidiasis, probably owing to impaired interleukin 23-dependent interleukin 17 immunity. The clinical features and outcome of candidiasis in these patients have not been described before, to our knowledge. We report here the clinical signs of candidiasis in 35 patients with IL-12Rβ1 deficiency. Most (n = 71) of the 76 episodes of candidiasis were mucocutaneous. Isolated oropharyngeal candidiasis (OPC) was the most common presentation (59 episodes, 34 patients) and was recurrent or persistent in 26 patients. Esophageal candidiasis (n = 7) was associated with proven OPC in 2 episodes, and cutaneous candidiasis (n = 2) with OPC in 1 patient, whereas isolated vulvovaginal candidiasis (VVC; n = 3) was not. Five episodes of proven invasive candidiasis were documented in 4 patients; 1 of these episodes was community acquired in the absence of any other comorbid condition. The first episode of candidiasis occurred earlier in life (median age±standard deviation, 1.5 ± 7.87 years) than infections with environmental mycobacteria (4.29 ± 11.9 years), Mycobacterium tuberculosis (4 ± 3.12 years), or Salmonella species (4.58 ± 4.17 years) or other rare infections (3 ± 11.67 years). Candidiasis was the first documented infection in 19 of the 35 patients, despite the vaccination of 10 of these 19 patients with live bacille Calmette-Guérin. Patients who are deficient in IL-12Rβ1 may have candidiasis, usually mucocutaneous, which is frequently recurrent or persistent. Candidiasis may be the first clinical manifestation in these patients.

Accelerated Episodic LH Release Accompanies Blunted Progesterone Regulation in PCOS-like Female Rhesus Monkeys (Macaca mulatta) Exposed to Testosterone During Early-to-Mid Gestation.

PubMed

Abbott, David H; Vepraskas, Sarah H; Horton, Teresa H; Terasawa, Ei; Levine, Jon E

2018-06-15

Ovarian theca cell hyperandrogenism in women with PCOS is compounded by androgen receptor-mediated impairment of estradiol and progesterone negative feedback regulation of episodic LH release. The resultant LH hypersecretion, likely the product of accelerated episodic release of GnRH from the median eminence of the hypothalamus, hyperstimulates ovarian theca cell steroidogenesis, enabling testosterone (T) and androstenedione excess. Prenatally androgenized female monkeys (PA) exposed to fetal male levels of T during early-to-mid gestation, when adult, demonstrate PCOS-like traits, including high T and LH levels. This study tests the hypothesis that progesterone resistance-associated acceleration in episodic LH release contributes to PA monkey LH excess. 4 PA and 3 regularly cycling, healthy control adult female rhesus monkeys of comparable age and body mass index underwent (1) a 10 h, frequent intravenous sampling assessment for LH episodic release, immediately followed by (2) IV infusion of exogenous GnRH to quantify continuing pituitary LH responsiveness, and subsequently (3) an SC injection of a progesterone receptor antagonist, mifepristone, to examine LH responses to blockade of progesterone-mediated action. Compared to controls, the relatively hyperandrogenic PA females exhibited ~100% increase (p = 0.037) in LH pulse frequency, positive correlation of LH pulse amplitude (p = 0.017) with androstenedione, ~100% greater increase (p = 0.034) in acute (0--10 min) LH responses to exogenous GnRH, and an absence (p = 0.008) of modest LH elevation following acute progesterone receptor blockade suggestive of diminished progesterone negative feedback. Such dysregulation of LH release in PCOS-like monkeys implicates impaired feedback control of episodic release of hypothalamic GnRH reminiscent of PCOS neuroendocrinopathy. 2018 S. Karger AG, Basel.

[Recurrent wheezing: prevalence and associated factors in infants from Buenos Aires City, Argentina].

PubMed

Szulman, Gabriela Aída; Freilij, Héctor; Behrends, Ilse; Gentile, Ángela; Mallol, Javier

The episodes of bronchial obstruction at early age constitute a frequent problem in Pediatrics. The aim of this study was to evaluate the prevalence of recurrent wheezing in infants in Buenos Aires City, as well as to identify any associated factors. Cross-sectional study performed from 2011 to 2012 in the Children Hospital Ricardo Gutiérrez, Buenos Aires City, as part of the International Study of Wheezing in Infants. A validated questionnaire was applied to parents of infants aged between 12 and 15 months. The prevalence of wheezing, mostly the recurrent episodes (three or more), and their probable associated factors were evaluated. Data were statistically analyzed with χ 2 , Fisher's test, binary and logistics multiple regression analysis. The significance level was 0.05. Over 1063 infants, 58.9% (confidence interval (CI) 95% 55.9-61.9) presented at least one episode of wheezing and 26.3% (CI95% 23.8-29.9) three or more episodes (recurrent wheezing). Risk factors associated to wheezing were male gender (p=0.001), six or more episodes of cold during the first year of life (p <0.0001), age at first cold <4 months (p <0.0001); pneumonia (p <0.0001) and smoking during pregnancy (tobacco) (p=0.01). For recurrent wheezing, risk factors we considered as six or more episodes of cold during the first year of life (p <0.0001), early (< 4 month of age) onset wheezing (p <0.0001) and nocturnal wheezing (p <0.0001). The prevalence of recurrent wheezing among infants in Buenos Aires Ciy was high (26.3%). Some identified associated factors can be preventable. Copyright © 2017 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

The clinical and economic burden of pneumonia in patients enrolled in Medicare receiving dialysis: a retrospective, observational cohort study.

PubMed

Sibbel, Scott; Sato, Reiko; Hunt, Abigail; Turenne, Wendy; Brunelli, Steven M

2016-12-12

End-stage renal disease (ESRD) patients receiving dialysis are at particular risk for infection. We assessed the clinical and economic burden of pneumonia in a population of Medicare-enrolled ESRD patients with respect to incidence and case fatality rates, rates of all-cause and cardiovascular hospitalization, and costs. Patients received dialysis between 01 January 2009 and 31 December 2011 and were enrolled in Medicare Parts A and B. Pneumonia episodes were identified from institutional and supplier claims. Patients were considered at-risk from first date of Medicare coverage and were censored upon transplant, withdrawal from dialysis, recovery of renal function, loss of Medicare benefits, or death. Linear mixed-effects models were used to assess hospitalization rates and costs over the 3 months prior to and 12 months following pneumonia episodes. The pneumonia incidence rate for the study period was 21.4 events/100 patient-years; the majority of episodes (90.1%) required inpatient treatment. The 30-day case fatality rate was 10.7%. Compared to month -3 prior to event, rates of all-cause and cardiovascular hospitalization were higher in the month of the pneumonia episode (IRR, 4.61 and 4.30). All-cause admission rates remained elevated through month 12; cardiovascular admission rates remained elevated through month 6. Mean per-patient per-month costs were $10,976 higher in the month of index episode compared to month -3, largely driven by increased inpatient costs, and remained elevated through end of 12-month follow-up. Pneumonia episodes are frequent among ESRD patients and result in hospitalizations and greater overall costs to Medicare over the following year.

[Nocturnal hypoxic episodes and structural changes in left ventricular myocardium in patients with mild-to-moderate arterial hypertension].

PubMed

Zelveian, P A; Buniatian, M S; Oshchenkova, E V; Rogoza, A N; Sergakova, L M

2002-01-01

To study correlations between structural changes of the left ventricle (LV) in patients with mild and moderate arterial hypertension (AH) and severity of hypoxic night episodes. The examination of 50 patients (mean age 52 +/- 1 year) with mild and moderate hypertension included echocardiographic measurement of LV myocardial mass, calculation of LV myocardial mass index. LV hypertrophy was stated in the index 125 g/m2 for men and 110 g/m2 for women. 24-h monitoring of arterial pressure (TM-2425) and night monitoring of hemoglobin saturation of arterial blood with oxygen (SaO2) using pulsoxymeter NONIN 8500M were made. The data processing was performed with the use of original program ARM-SaO2. Dissaturation was stated if SaO2 fell by 4% and more compared to the previous stable level at initial SaO2 level above 90%. The patients were divided into two groups according to the number of dissaturation episodes: group 1 (more than 20 dissaturation episodes) and group 2 (less than 20 episodes). The groups were comparable by gender, duration of hypertension, body mass index, systolic and diastolic arterial pressure, heart rate. In group I, pulse arterial pressure, systolic arterial pressure load for 14 hours, day and night were significantly higher. Patients with dissaturation had a significantly higher LV myocardial mass and more frequent LV hypertrophy (128 +/- 6 and 106 +/- 5 g/m2 and 56 and 20%, respectively). The correlation and multifactor regression analysis showed a predictive value not only of the pressor parameters but also of indices of night hypoxia in relation to structural changes of LV myocardium. The presence of significant hypoxic episodes in sleep in AH patients indicates risk to develop structural changes of LV myocardium.

Phenomenology of manic episodes according to the presence or absence of depressive features as defined in DSM-5: Results from the IMPACT self-reported online survey.

PubMed

Vieta, Eduard; Grunze, Heinz; Azorin, Jean-Michel; Fagiolini, Andrea

2014-03-01

The aim of this study was to describe the phenomenology of mania and depression in bipolar patients experiencing a manic episode with mixed features as defined in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this multicenter, international on-line survey (the IMPACT study), 700 participants completed a 54-item questionnaire on demographics, diagnosis, symptomatology, communication of the disease, impact on life, and treatment received. Patients with a manic episode with or without DSM-5 criteria for mixed features were compared using descriptive and inferential statistics. Patients with more than 3 depressive symptoms were more likely to have had a delay in diagnosis, more likely to have experienced shorter symptom-free periods, and were characterized by a marked lower prevalence of typical manic manifestations. All questionnaire items exploring depressive symptomatology, including the DSM-5 criteria defining a manic episode as "with mixed features", were significantly overrepresented in the group of patients with depressive symptoms. Anxiety associated with irritability/agitation was also more frequent among patients with mixed features. Retrospective cross-sectional design, sensitive to recall bias. Two of the 6 DSM-5 required criteria for the specifier "with mixed features" were not explored: suicidality and psychomotor retardation. Bipolar disorder patients with at least 3 depressive symptoms during a manic episode self-reported typical symptomatology. Anxiety with irritability/agitation differentiated patients with depressive symptoms during mania from those with "pure" manic episodes. The results support the use of DSM-5 mixed features specifier and its value in research and clinical practice. Copyright © 2014 Elsevier B.V. All rights reserved.

Evaluation of tularaemia courses: a multicentre study from Turkey.

PubMed

Erdem, H; Ozturk-Engin, D; Yesilyurt, M; Karabay, O; Elaldi, N; Celebi, G; Korkmaz, N; Guven, T; Sumer, S; Tulek, N; Ural, O; Yilmaz, G; Erdinc, S; Nayman-Alpat, S; Sehmen, E; Kader, C; Sari, N; Engin, A; Cicek-Senturk, G; Ertem-Tuncer, G; Gulen, G; Duygu, F; Ogutlu, A; Ayaslioglu, E; Karadenizli, A; Meric, M; Ulug, M; Ataman-Hatipoglu, C; Sirmatel, F; Cesur, S; Comoglu, S; Kadanali, A; Karakas, A; Asan, A; Gonen, I; Kurtoglu-Gul, Y; Altin, N; Ozkanli, S; Yilmaz-Karadag, F; Cabalak, M; Gencer, S; Umut Pekok, A; Yildirim, D; Seyman, D; Teker, B; Yilmaz, H; Yasar, K; Inanc Balkan, I; Turan, H; Uguz, M; Kilic, S; Akkoyunlu, Y; Kaya, S; Erdem, A; Inan, A; Cag, Y; Bolukcu, S; Ulu-Kilic, A; Ozgunes, N; Gorenek, L; Batirel, A; Agalar, C

2014-12-01

In this multicentre study, which is the largest case series ever reported, we aimed to describe the features of tularaemia to provide detailed information. We retrospectively included 1034 patients from 41 medical centres. Before the definite diagnosis of tularaemia, tonsillitis (n = 653, 63%) and/or pharyngitis (n = 146, 14%) were the most frequent preliminary diagnoses. The most frequent clinical presentations were oropharyngeal (n = 832, 85.3%), glandular (n = 136, 13.1%) and oculoglandular (n = 105, 10.1%) forms. In 987 patients (95.5%), the lymph nodes were reported to be enlarged, most frequently at the cervical chain jugular (n = 599, 58%), submandibular (n = 401, 39%), and periauricular (n = 55, 5%). Ultrasound imaging showed hyperechoic and hypoechoic patterns (59% and 25%, respectively). Granulomatous inflammation was the most frequent histological finding (56%). The patients were previously given antibiotics for 1176 episodes, mostly with β-lactam/β-lactamase inhibitors (n = 793, 76%). Antituberculosis medications were provided in seven (2%) cases. The patients were given rational antibiotics for tularaemia after the start of symptoms, with a mean of 26.8 ± 37.5 days. Treatment failure was considered to have occurred in 495 patients (48%). The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment (n = 426, 86.1%), the formation of new lymphadenomegalies under treatment (n = 146, 29.5%), and persisting complaints despite 2 weeks of treatment (n = 77, 15.6%). Fine-needle aspiration was performed in 521 patients (50%) as the most frequent drainage method. In conclusion, tularaemia is a long-lasting but curable disease in this part of the world. However, the treatment strategy still needs optimization. © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.

Physical and numerical sources of computational inefficiency in integration of chemical kinetic rate equations: Etiology, treatment and prognosis

NASA Technical Reports Server (NTRS)

Pratt, D. T.; Radhakrishnan, K.

1986-01-01

The design of a very fast, automatic black-box code for homogeneous, gas-phase chemical kinetics problems requires an understanding of the physical and numerical sources of computational inefficiency. Some major sources reviewed in this report are stiffness of the governing ordinary differential equations (ODE's) and its detection, choice of appropriate method (i.e., integration algorithm plus step-size control strategy), nonphysical initial conditions, and too frequent evaluation of thermochemical and kinetic properties. Specific techniques are recommended (and some advised against) for improving or overcoming the identified problem areas. It is argued that, because reactive species increase exponentially with time during induction, and all species exhibit asymptotic, exponential decay with time during equilibration, exponential-fitted integration algorithms are inherently more accurate for kinetics modeling than classical, polynomial-interpolant methods for the same computational work. But current codes using the exponential-fitted method lack the sophisticated stepsize-control logic of existing black-box ODE solver codes, such as EPISODE and LSODE. The ultimate chemical kinetics code does not exist yet, but the general characteristics of such a code are becoming apparent.

Bloodstream infections in patients with solid tumors: epidemiology, antibiotic therapy, and outcomes in 528 episodes in a single cancer center.

PubMed

Marín, Mar; Gudiol, Carlota; Garcia-Vidal, Carol; Ardanuy, Carmen; Carratalà, Jordi

2014-05-01

Current information regarding bloodstream infection (BSI) in patients with solid tumors is scarce. We assessed the epidemiology, antibiotic therapy, and outcomes of BSI in these patients. We also compared patients who died with those who survived to identify risk factors associated with mortality. From January 2006 to July 2012 all episodes of BSI in patients with solid tumors at a cancer center were prospectively recorded and analyzed. A total of 528 episodes of BSI were documented in 489 patients. The most frequent neoplasms were hepatobiliary tumors (19%), followed by lung cancer (18%) and lower gastrointestinal malignancies (16%). Many patients had received corticosteroid therapy (41%), and 15% had neutropenia (<500 neutrophils/μL) at the time of BSI. The most common source of BSI was cholangitis (21%), followed by other abdominal (19.5%) and urinary tract infections (17%). Gram-negative BSI occurred in 55% of cases, mainly due to Escherichia coli (55%), Pseudomonas aeruginosa (18%), and Klebsiella pneumoniae (16%). Among gram-positive BSI (35%), viridans group streptococci were the most frequent causative organisms (22%), followed by Staphylococcus aureus (21%) and Enterococcus species (18%). We identified 61 multidrug-resistant (MDR) organisms (13%), mainly extended-spectrum β-lactamase-producing Enterobacteriaceae (n = 20) and AmpC-producing Enterobacteriaceae (n = 13). The majority of patients with BSI caused by MDR organisms had received antibiotics (70%), and they had been previously hospitalized (61.4%) more frequently than patients with BSI caused by susceptible strains. Inadequate empirical antibiotic therapy was given to 23% of patients, with a higher proportion in those with BSI due to a MDR strain (69%). Early (<48 h) and overall (30 d) case-fatality rates were 7% and 32%, respectively. The overall case-fatality rate was higher among cases caused by MDR organisms (39.3%). The only independent risk factors for the early case-fatality rate were the endogenous source of BSI (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.06-12.02), shock at presentation (OR, 3.63; 95% CI, 1.63-8.09), and corticosteroid therapy (OR, 3.245; 95% CI, 1.43-7.32). The independent risk factors for overall case-fatality rate were the presence of a chronic advanced cancer (OR, 35.39; 95% CI, 2.48-504.91), shock at presentation (OR, 25.84; 95% CI, 3.73-179.0), and corticosteroid therapy (OR, 6.98; 95% CI, 1.61-30.21).BSI in patients with solid tumors occurred mainly among those with hepatobiliary cancer, and cholangitis was the most frequent source; gram-negative bacilli were the most frequent causative agents. MDR organisms were relatively common, particularly in patients who had previously received antibiotics and had been hospitalized; these patients were frequently treated with inadequate empirical antibiotic therapy and had a poorer outcome. The case-fatality rate of patients with solid tumors and BSI was high and was associated with chronic advanced cancer, corticosteroid therapy, and shock at presentation.

The neuropsychological profile of Alzheimer disease.

PubMed

Weintraub, Sandra; Wicklund, Alissa H; Salmon, David P

2012-04-01

Neuropsychological assessment has featured prominently over the past 30 years in the characterization of dementia associated with Alzheimer disease (AD). Clinical neuropsychological methods have identified the earliest, most definitive cognitive and behavioral symptoms of illness, contributing to the identification, staging, and tracking of disease. With increasing public awareness of dementia, disease detection has moved to earlier stages of illness, at a time when deficits are both behaviorally and pathologically selective. For reasons that are not well understood, early AD pathology frequently targets large-scale neuroanatomical networks for episodic memory before other networks that subserve language, attention, executive functions, and visuospatial abilities. This chapter reviews the pathognomonic neuropsychological features of AD dementia and how these differ from "normal," age-related cognitive decline and from other neurodegenerative diseases that cause dementia, including cortical Lewy body disease, frontotemporal lobar degeneration, and cerebrovascular disease.

Absenteeism due to mental disorders in health professionals at a hospital in southern Brazil.

PubMed

Santana, Leni de Lima; Sarquis, Leila Maria Mansano; Brey, Christiane; Miranda, Fernanda Moura D'Almeida; Felli, Vanda Elisa Andres

2016-03-01

Objective To describe the health profile of mental and behavioral disorders in health professionals at a teaching hospital in southern Brazil. Methods This was a quantitative, retrospective cross-sectional epidemiological study whose data were collected through institutional documents used to feed the Health Monitoring System for Nursing Professionals and involved all absenteeism occurred in 2011. Results We found 55 records of absenteeism due to mental and behavioral disorders, a total of 317 days absent. Nursing technicians were the most absentee, with 29.09% of the records. The intensive care unit represented the sector with the highest number of days absent, 81%, and depressive episodes were the most frequent, representing 52.72% of mental disorders. Conclusion The results showed that mental disorders in health professionals are a cause for concern and urgently need intervention.

The Neuropsychological Profile of Alzheimer Disease

PubMed Central

Weintraub, Sandra; Wicklund, Alissa H.; Salmon, David P.

2012-01-01

Neuropsychological assessment has featured prominently over the past 30 years in the characterization of dementia associated with Alzheimer disease (AD). Clinical neuropsychological methods have identified the earliest, most definitive cognitive and behavioral symptoms of illness, contributing to the identification, staging, and tracking of disease. With increasing public awareness of dementia, disease detection has moved to earlier stages of illness, at a time when deficits are both behaviorally and pathologically selective. For reasons that are not well understood, early AD pathology frequently targets large-scale neuroanatomical networks for episodic memory before other networks that subserve language, attention, executive functions, and visuospatial abilities. This chapter reviews the pathognomonic neuropsychological features of AD dementia and how these differ from “normal,” age-related cognitive decline and from other neurodegenerative diseases that cause dementia, including cortical Lewy body disease, frontotemporal lobar degeneration, and cerebrovascular disease. PMID:22474609

A Research Update on Correlates of Heavy Episodic Drinking among Undergraduate College Students

ERIC Educational Resources Information Center

Montauti, Sara Barrows; Bulmer, Sandra Minor

2014-01-01

Background: Despite prevention efforts of colleges and universities across the nation, there have been no substantial decreases in heavy episodic drinking among undergraduates over the past 2 decades. Purpose: This study provides an update on correlates of heavy episodic drinking for a recent cohort of undergraduate college students. Methods: A…

Nonstationary signal analysis in episodic memory retrieval

NASA Astrophysics Data System (ADS)

Ku, Y. G.; Kawasumi, Masashi; Saito, Masao

2004-04-01

The problem of blind source separation from a mixture that has nonstationarity can be seen in signal processing, speech processing, spectral analysis and so on. This study analyzed EEG signal during episodic memory retrieval using ICA and TVAR. This paper proposes a method which combines ICA and TVAR. The signal from the brain not only exhibits the nonstationary behavior, but also contain artifacts. EEG data at the frontal lobe (F3) from the scalp is collected during the episodic memory retrieval task. The method is applied to EEG data for analysis. The artifact (eye movement) is removed by ICA, and a single burst (around 6Hz) is obtained by TVAR, suggesting that the single burst is related to the brain activity during the episodic memory retrieval.

Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the UK Dermatology Clinical Trials Network's PATCH II trial.

PubMed

Thomas, Kim; Crook, Angela; Foster, Katharine; Mason, James; Chalmers, Joanne; Bourke, John; Ferguson, Adam; Level, Nick; Nunn, Andrew; Williams, Hywel

2012-01-01

Cellulitis (erysipelas) of the leg is a common, painful infection of the skin and underlying tissue. Repeat episodes are frequent, cause significant morbidity and result in high health service costs. To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes. Double-blind, randomized controlled trial including patients recently treated for an episode of leg cellulitis. Recruitment took place in 20 hospitals. Randomization was by computer-generated code, and treatments allocated by post from a central pharmacy. Participants were enrolled for a maximum of 3 years and received their randomized treatment for the first 6 months of this period. Participants (n=123) were randomized (31% of target due to slow recruitment). The majority (79%) had suffered one episode of cellulitis on entry into the study. The primary outcome of time to recurrence of cellulitis included all randomized participants and was blinded to treatment allocation. The hazard ratio (HR) showed that treatment with penicillin reduced the risk of recurrence by 47% [HR 0·53, 95% confidence interval (CI) 0·26-1·07, P=0·08]. In the penicillin V group 12/60 (20%) had a repeat episode compared with 21/63 (33%) in the placebo group. This equates to a number needed to treat (NNT) of eight participants in order to prevent one repeat episode of cellulitis [95% CI NNT(harm) 48 to ∞ to NNT(benefit) 3]. We found no difference between the two groups in the number of participants with oedema, ulceration or related adverse events. Although this trial was limited by slow recruitment, and the result failed to achieve statistical significance, it provides the best evidence available to date for the prevention of recurrence of this debilitating condition. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

A retrospective review of anesthesia and perioperative care in children with medium-chain acyl-CoA dehydrogenase deficiency.

PubMed

Allen, Claire; Perkins, Russell; Schwahn, Bernd

2017-01-01

Medium-chain acyl-CoA dehydrogenase deficiency is the most common genetically determined disorder of mitochondrial fatty acid oxidation. Decompensation can result in hypoglycemia, seizures, coma, and death but may be prevented by ensuring glycogen stores do not become depleted. Perioperative care is of interest as surgery, fasting, and infection may all trigger decompensation and the safety of anesthetic agents has been questioned. Current guidelines from the British Inherited Metabolic Disease Group advise on administering fluid containing 10% glucose during the perioperative period. To review the management of anesthesia and perioperative care for children with medium-chain acyl-CoA dehydrogenase deficiency and determine the frequency and nature of any complications. A retrospective review of case notes of children with medium-chain acyl-CoA dehydrogenase deficiency undergoing anesthesia between 1997 and 2014. Fourteen patients underwent 21 episodes of anesthesia. In 20 episodes, the patient received a glucose-containing fluid during their perioperative fast, of which eight received fluid containing 10% dextrose throughout the entire perioperative period. No episodes of hypoglycemia or decompensation occurred, but perioperative hyperglycemia occurred in five episodes. A propofol bolus was administered at induction in 16 episodes and volatile agents were administered for maintenance of anesthesia in all episodes without any observed complications. In one episode, delayed offset of atracurium was reported. Perioperative metabolic decompensation and hypoglycemia appear to be uncommon in children who are well and receive glucose supplementation. Hyperglycemia may occur as a consequence of surgery and glucose supplementation. Propofol boluses and volatile anesthetic agents were used without any apparent complications. Prolonged action of atracurium was reported in one case, suggesting that nondepolarizing muscle relaxants may have delayed offset in this patient group. We do not recommend any particular approach to anesthesia but would advise administering glucose supplementation according to current guidelines, frequent monitoring of blood glucose perioperatively, and monitoring of neuromuscular blockade. © 2016 John Wiley & Sons Ltd.

Content of children's loss of control eating episodes assessed by self-report and laboratory test meal

PubMed Central

Theim, Kelly R.; Wilfley, Denise E.; Beach, Elizabeth; Tanofsky-Kraff, Marian; Goldschmidt, Andrea B.

2014-01-01

Pediatric loss of control (LOC) eating heightens risk for excessive weight gain and further disordered eating. Assessment of LOC typically involves self-report interview or laboratory test meal, although no study has concurrently examined data from both methods. We gathered eating episode data via interview (Child Eating Disorder Examination; ChEDE) and a laboratory test meal, among 22 overweight girls (aged 7-12 years) reporting LOC eating. Children consumed more energy during ChEDE episodes, although ChEDE and test meal episodes did not differ in macronutrient content. Episodes' correlation for amount consumed (grams) did not reach significance, p=.076. In exploratory analyses among the 7 children reporting LOC during the test meal, episodes were significantly correlated for grams consumed. Findings provide preliminary data to suggest that semi-structured interviews accurately capture children's LOC episode quantity. Episodes did not qualitatively differ, although children reported consuming more energy during self-reported episodes. Replication is warranted in larger studies. PMID:24019221

Self-Referential Tags in the Discourse of People with Alzheimer's Disease

ERIC Educational Resources Information Center

Asp, Elissa; Song, Xiaowei; Rockwood, Kenneth

2006-01-01

In a study of the discourse of 100 people with Alzheimer's disease treated for 12 months with donepezil, we observed that, as a group, they used a form of tag, described here as a self-referential tag (SRT), 14 times more frequently than did caregivers. Patients use SRTs to check propositions dependent on episodic memory as in I haven't seen the…

Contrasts in the Behavior of Tremor Episodes in Cascadia and Japan

NASA Astrophysics Data System (ADS)

Armbruster, J. G.

2016-12-01

Tectonic tremor is observed in episodes with varying duration, intensity and spatial extent. In Cascadia the POLARIS broadband deployment, 2003-2006, provides good coverage of the southern Vancouver Island region with strong, widely distributed tremor sources extending 100 km along the plate interface. There the tremor can be classified into major episodes occurring at 14 month intervals with duration 20-30 days and minor episodes lasting hours to 10 days. Within that shorter duration minor episodes can produce strong signals. There is a clear pattern that minor episodes are located at the deeper part of the plate interface, 43-50 km deep. Major episodes are mostly generated from the shallower, 33-43 km deep, portion of the plate interface with some activation of the deeper sources. This suggests a simple mechanism of stress loading from below, transmitted upward by the tremor/slow-slip episodes. We compare this to the northern Kii Peninsula region of southwest Japan which has strong tremor sources extending 100 km along strike covered by HINET stations and find differences. The spectrum of episode durations in Japan, from less than an hour to 13 days, are not easily classified into major and minor. The range in depth observed in Japan is narrower than in Cascadia, 34-45 km for 98% of the clustered events. Here we divide the episodes into three groups based on their spatial extent. Large episodes occur at intervals of 6 months and occupy the southern 2/3, northern 2/3 or whole of the 100 km long zone. The small episodes are predominately seen from paired sources at the top and bottom of the active zone located where large episodes terminate. Intermediate episodes are the fewest in number and extend from the bottom to the top, often encompassing pairs of small sources. The observations in Japan will require a more complex model of stress loading. These results were achieved with the cross-station location method. The envelope location method might not have sufficient resolution to resolve these patterns in Japan.

A structured reading algorithm improves telemetric detection of atrial fibrillation after acute ischemic stroke.

PubMed

Kallmünzer, Bernd; Breuer, Lorenz; Hering, Christiane; Raaz-Schrauder, Dorette; Kollmar, Rainer; Huttner, Hagen B; Schwab, Stefan; Köhrmann, Martin

2012-04-01

Anticoagulation is a highly effective secondary prevention in patients with cardioembolic stroke and atrial fibrillation/flutter (AF). However, the condition remains underdiagnosed, because paroxysmal AF may be missed by diagnostic tests in the acute phase. In this study, the sensitivity of AF detection was assessed for serial electrocardiographic recordings and continuous stroke unit telemetric monitoring with or without a structured algorithm to analyze telemetric data (SEA-AF). Three hundred forty-six consecutive patients with acute ischemic stroke were prospectively included and subjected to standard telemetric monitoring. In addition, telemetric data were separately analyzed following SEA-AF, consisting of a structured evaluation of episodes with high risk for AF and a chronological beat-to-beat screening of the full registration. Serial electrocardiograms were conducted in 24-hour intervals. Median effective telemetry monitoring time was 75.5 hours (interquartile range 64-86 hours). Overall, AF was diagnosed in 119 of 346 patients (34.4%). The structured reading algorithm was the most sensitive method to detected AF. Conventional telemetry and serial electrocardiographic assessments were less effective. However, only 35% of patients with previously documented paroxysmal AF and negative baseline electrocardiogram demonstrated AF episodes during monitoring. Continuous stroke unit telemetry using SEA-AF shows a significantly higher detection rate for AF compared with daily electrocardiographic assessments and standard telemetry without structured reading. The low overall probability to detect paroxysmal AF with either method during the first days after stroke demonstrates the urgent need for complementary diagnostic strategies such as long-term monitoring and frequent follow-up assessments. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT01177748.

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

PubMed Central

Munro, Malcolm G

2014-01-01

Postmenopausal uterine bleeding is defined as uterine bleeding after permanent cessation of menstruation resulting from loss of ovarian follicular activity. Bleeding can be spontaneous or related to ovarian hormone replacement therapy or to use of selective estrogen receptor modulators (eg, tamoxifen adjuvant therapy for breast carcinoma). Because anovulatory “cycles” with episodes of multimonth amenorrhea frequently precede menopause, no consensus exists regarding the appropriate interval of amenorrhea before an episode of bleeding that allows for the definition of postmenopausal bleeding. The clinician faces the possibility that an underlying malignancy exists, knowing that most often the bleeding comes from a benign source. Formerly, the gold-standard clinical investigation of postmenopausal uterine bleeding was institution-based dilation and curettage, but there now exist office-based methods for the evaluation of women with this complaint. Strategies designed to implement these diagnostic methods must be applied in a balanced way considering the resource utilization issues of overinvestigation and the risk of missing a malignancy with underinvestigation. Consequently, guidelines and recommendations were developed to consider these issues and the diverse spectrum of practitioners who evaluate women with postmenopausal bleeding. The guideline development group determined that, for initial management of spontaneous postmenopausal bleeding, primary assessment may be with either endometrial sampling or transvaginal ultrasonography, allowing patients with an endometrial echo complex thickness of 4 mm or less to be managed expectantly. Guidelines are also provided for patients receiving selective estrogen receptor modulators or hormone replacement therapy, and for an endometrial echo complex with findings consistent with fluid in the endometrial cavity. PMID:24377427

Clinical Classification and Prognosis of Isolated Right-Sided Infective Endocarditis

PubMed Central

Ortiz, Carlos; López, Javier; García, Héctor; Sevilla, Teresa; Revilla, Ana; Vilacosta, Isidre; Sarriá, Cristina; Olmos, Carmen; Ferrera, Carlos; García, Pablo Elpidio; Sáez, Carmen; Gómez, Itziar; San Román, José Alberto

2014-01-01

Abstract From an epidemiologic point of view, right-sided infective endocarditis (RSIE) affects different types of patients: intravenous drug users (IDUs), cardiac device carriers (pacemakers and implantable automatic defibrillators), and the “3 noes” endocarditis group: no left-sided, no IDUs, no cardiac devices. Our objective is to describe and compare the clinical profile and outcome of these groups of patients. Every episode of infective endocarditis (IE) consecutively diagnosed in 3 tertiary centers from 1996 to 2012 was included in an ongoing multipurpose database. We assessed 85 epidemiologic, clinical, echocardiographic, and outcome variables in patients with isolated RSIE. A bivariated comparative analysis between the 3 groups was conducted. Among 866 IE episodes, 121 were classified as isolated RSIE (14%): 36 IDUs (30%), 65 cardiac device carriers (54%), and 20 “3 noes” group (16%). IDUs were mainly young men (36 ± 7 years) without previous heart disease, few comorbidities, and frequent previous endocarditis episodes (28%). Human immunodeficiency virus infection was frequent (69%). Cardiac device carriers were older (66 ± 15 years) and had less comorbidities (34%). Removal of the infected device was performed in 91% of the patients without any death. The “3 noes” endocarditis group was composed mainly by middle-age men (56 ± 18 years), health care related infections (50%), and had many comorbidities (75%). Whereas Staphylococcus aureus were the most frequent cause in IDUs (72% vs 34% in device carriers and 34% in the “3 noes” group, P = 0.001), coagulase negative Staphylococci predominated in the device carriers (58% vs 11% in drug users and 35% in the “3 noes”, P < 0.001). Significant differences in mortality were found (17% in drug users, 3% in device carriers, and 30% in the “3 noes” group; P < 0.001). These results suggest that RSIE should be separated into 3 groups (IDUs, cardiac device carriers, and the “3 noes”) and considered as independent entities as there are relevant epidemiologic, clinical, microbiological, echocardiographic, and prognostic differences among them. PMID:25501052

[Infection due to Rothia mucilaginosa. A respiratory pathogen?].

PubMed

Ramos, José M; Mateo, Ignacio; Vidal, Inmaculada; Rosillo, Eva M; Merino, Esperanza; Portilla, Joaquín

2014-05-01

To describe the spectrum of infections caused by Rothia mucilaginosa. Retrospective study of 20 cases diagnosed with R. mucilaginosa from 2009 to 2012. Pulmonary infection was the most frequent clinical presentation (n=14, 70%): bronchiectasis infected (10), followed by pleural empyema (2), pneumonia (1) and acute bronchitis (1). Two episodes were of gastrointestinal origin: cholangitis secondary to biliary drainage and secondary peritonitis. Two episodes included bacteremia in patients with hematological malignancy. One patient had a surgical wound infection with bacteremia, and another had a bacteremic urinary tract infection in a patient with nephrostomy. R. mucilaginosa may be responsible for infections of the lower respiratory tract in predisposed patients. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

[Bacteremia and sepsis in patients hospitalized at the Dr. Fran Mihaljevíc Clinic for Infectious Diseases in Zagreb 1987-1991].

PubMed

Skerk, V; Schönwald, S; Bobinac, E; Bejuk, D; Zrinsćak, J

1995-01-01

A total number of 836 episodes of bacteremia and fungemia were examined in 823 hospitalized patients in the University Hospital of Infectious Diseases "Dr Fran Mihaljević" Zagreb from the beginning of 1987 to the end of 1991. Twenty-five percent of them were nosocomial bacteremias and 5% were polymicrobial bacteremias. The most frequently isolated causative agents were Salmonella spp. (26%), Escherichia coli (17%), Streptococcus pneumoniae (11%) and Staphylococcus aureus (8%). There were 34% of gram-positive bacteremias. The increased frequency of nosocomial bacteremias caused by coagulase-negative staphylococci was recorded. The frequency of coagulase-negative staphylococci strains resistant to gentamicin and Klebsiella spp. strains resistant to cefotaxime was increased. Shock was present in 19% of episodes. Relation between septic shock occurrence and causative agent of bacteremia was not proved. Mortality in patients with bacteremia was 13%, and total mortality was 20%. The outcome of the disease was in direct relation with causative agent of bacteremia. The initial empiric antimicrobial therapy was prolonged in 91% of episodes of bacteremia after blood culture results were known.

Theory of mind ability predicts prognosis of outpatients with major depressive disorder.

PubMed

Yamada, Kazuo; Inoue, Yumiko; Kanba, Shigenobu

2015-12-15

A theory of mind (ToM) deficit in patients with major depressive episodes is associated with difficulty in social adjustment, and thus may indicate a poorer prognosis. We investigated the association between ToM deficits and the outcome in patients who had recovered from major depressive episodes. We evaluated ToM abilities of 100 patients with major depressive disorder during a period of remission. The patients were followed up for one year and their outcomes observed. After one year, patients who had a ToM deficit according to a second-order false belief question relapsed significantly more frequently than did patients who did not have a deficit (Fisher's exact test P<0.0001; relative risk (RR)=8.286; CI 2.608, 26.324). Significant differences between these two groups were shown in scores of the Global Assessment of Functioning Scale (P<0.0001). Our results suggest that a ToM deficit after symptom remission in patients with major depressive disorder predicts a higher relapse rate and lower social function one year after recovering from a major depressive episode. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Current research on affective temperaments.

PubMed

Rihmer, Zoltán; Akiskal, Kareen K; Rihmer, Annamária; Akiskal, Hagop S

2010-01-01

The aim of this review is to highlight the relationship between affective temperaments and clinical mood disorders and to summarize the earlier and most recent studies on affective temperaments in both clinical and nonclinical populations. Current research findings show that specific affective temperament types (depressive, cyclothymic, hyperthymic, irritable and anxious) are the subsyndromal (trait-related) manifestations and commonly the antecedents of minor and major mood disorders. Up to 20% of the population has some kind of marked affective temperaments; depressive, cyclothymic and anxious temperament is more frequent in women, whereas hyperthymic and irritable temperaments predominate among men. Molecular genetic studies show a strong involvement of the central serotonergic (depressive, cyclothymic, irritable and anxious temperaments) and dopaminergic (hyperthymic temperament) regulation, suggesting that the genetic potential of major mood episodes lies in these temperaments. Premorbid affective temperament types have an important role in the clinical evolution of minor and major mood episodes including the direction of the polarity and the symptom formation of acute mood episodes. They can also significantly affect the long-term course and outcome including suicidality and other forms of self-destructive behaviours such as substance use and eating disorders.

Clinical characteristics and outcomes of the meningitides in systemic lupus erythematosus.

PubMed

Baizabal-Carvallo, José Fidel; Delgadillo-Márquez, German; Estañol, Bruno; García-Ramos, Guillermo

2009-01-01

The meningitides are rare but well-identified complications in patients with systemic lupus erythematosus (SLE). To determine the clinical characteristics, risk factors, prevalence and outcomes of the meningitides (septic and aseptic) in patients with SLE. From January 1988 to December 2006, we identified patients with SLE and septic or aseptic meningitis. We identified 25 episodes of meningitis in 23 patients with SLE, from a total of 1,411 SLE patients (1.63%); in 15 out of 25 episodes, a microorganism was identified. Mycobacterium tuberculosis, Listeria monocytogenes and Criptococcus neoformans represented the main microorganisms. In 10 episodes, aseptic meningitis was diagnosed. Lymphopenia, steroid use, chronic damage and systemic activity of SLE were frequent in both kinds of meningitis. Although the clinical presentation did not differ significantly, patients with septic meningitis had more residual neurological deficits (p = 0.04). Meningitis was observed in about 1.6% of the patients with SLE; in 40% of the cases, no microorganism could be isolated. A residual neurological deficit was more common in patients with septic meningitis. Copyright (c) 2008 S. Karger AG, Basel.

Risk for excessive alcohol use and drinking-related problems in college student athletes

PubMed Central

Yusko, David A.; Buckman, Jennifer F.; White, Helene R.; Pandina, Robert J.

2008-01-01

There is compelling evidence that college student athletes engage in frequent episodes of heavy drinking and are prone to negative consequences resulting from such use. This study sought to identify risk and protective factors associated with student-athlete drinking and determine if student-athlete risk factors differed from those of non-athletes. Athletes compared to non-athletes reported more exaggerated perceptions of peer heavy drinking and lower sensation seeking and coping and enhancement motives for drinking, suggesting a risk profile distinct from non-athletes. In the overall sample, higher sensation seeking, overestimation of peer heavy drinking, non-use of protective behaviors while drinking, and higher enhancement and coping drinking motives were associated with greater frequency of heavy episodic drinking and more negative drinking consequences. In athletes compared to non-athletes, sensation seeking was more strongly associated with heavy episodic drinking and drinking to cope was more strongly associated with negative alcohol-related consequences. Overall, the results suggest that already proven brief intervention strategies, with minor adaptations related to the roles of sensation seeking and drinking to cope, may be helpful for student athletes. PMID:18752900

Mollaret meningitis: case report with a familial association.

PubMed

Jones, Christopher W; Snyder, Graham E

2011-09-01

Mollaret meningitis is a syndrome characterized by recurrent bouts of meningitis that occur over a period of several years in an affected patient. Also known as recurrent lymphocytic meningitis, this entity involves repeated episodes of headache, stiff neck, fever, and cerebrospinal fluid pleocytosis. Herpes simplex virus type 2 is the most frequently implicated causative agent, and treatment involves the use of antiviral medications. We describe a case of Mollaret meningitis in a 47-year-old man who presented to the emergency department with his eighth episode of meningitis during a period of 20 years. Cerebrospinal fluid polymerase chain reaction testing for herpes simplex virus type 2 was positive, and further testing excluded other common viral, bacterial, and inflammatory causes of meningeal irritation. The patient's family history was significant for a brother who also had multiple episodes of aseptic meningitis during a period of several years. This represents the first published report of a possible familial association involving Mollaret meningitis. It is likely that Mollaret meningitis is underrecognized among emergency physicians, and improved recognition of this entity may limit unwarranted antibiotic use and shorten or eliminate unnecessary hospital admission.

Hypoglycemia in Type 2 Diabetes - More Common Than You Think

PubMed Central

Gehlaut, Richa Redhu; Dogbey, Godwin Y.; Schwartz, Frank L.; Marling, Cynthia R.; Shubrook, Jay H.

2015-01-01

Background: Hypoglycemia is often the limiting factor for intensive glucose control in diabetes management, however its actual prevalence in type 2 diabetes (T2DM) is not well documented. Methodology: A total of 108 patients with T2DM wore a continuous glucose monitoring system (CGMS) for 5 days. Rates and patterns of hypoglycemia and glycemic variability (GV) were calculated. Patient and medication factors were correlated with rates, timing, and severity of hypoglycemia. Results: Of the patients, 49.1% had at least 1 hypoglycemic episode (mean 1.74 episodes/patient/ 5 days of CGMS) and 75% of those patients experienced at least 1 asymptomatic hypoglycemic episode. There was no significant difference in the frequency of daytime versus nocturnal hypoglycemia. Hypoglycemia was more frequent in individuals on insulin (alone or in combination) (P = .02) and those on oral hypoglycemic agents (P < .001) compared to noninsulin secretagogues. CGMS analysis resulted in treatment modifications in 64% of the patients. T2DM patients on insulin exhibited higher glycemic variability (GV) scores (2.3 ± 0.6) as compared to those on oral medications (1.8 ± 0.7, P = .017). Conclusions: CGMS can provide rich data that show glucose excursions in diabetes patients throughout the day. Consequently, unwarranted onset of hypo- and hyperglycemic events can be detected, intervened, and prevented by using CGMS. Hypoglycemia was frequently unrecognized by the patients in this study (75%), which increases their potential risk of significant adverse events. Incorporation of CGMS into the routine management of T2DM would increase the detection and self-awareness of hypoglycemia resulting in safer and potentially better overall control. PMID:25917335

Hypoglycemia in Type 2 Diabetes--More Common Than You Think: A Continuous Glucose Monitoring Study.

PubMed

Gehlaut, Richa Redhu; Dogbey, Godwin Y; Schwartz, Frank L; Marling, Cynthia R; Shubrook, Jay H

2015-04-27

Hypoglycemia is often the limiting factor for intensive glucose control in diabetes management, however its actual prevalence in type 2 diabetes (T2DM) is not well documented. A total of 108 patients with T2DM wore a continuous glucose monitoring system (CGMS) for 5 days. Rates and patterns of hypoglycemia and glycemic variability (GV) were calculated. Patient and medication factors were correlated with rates, timing, and severity of hypoglycemia. Of the patients, 49.1% had at least 1 hypoglycemic episode (mean 1.74 episodes/patient/ 5 days of CGMS) and 75% of those patients experienced at least 1 asymptomatic hypoglycemic episode. There was no significant difference in the frequency of daytime versus nocturnal hypoglycemia. Hypoglycemia was more frequent in individuals on insulin (alone or in combination) (P = .02) and those on oral hypoglycemic agents (P < .001) compared to noninsulin secretagogues. CGMS analysis resulted in treatment modifications in 64% of the patients. T2DM patients on insulin exhibited higher glycemic variability (GV) scores (2.3 ± 0.6) as compared to those on oral medications (1.8 ± 0.7, P = .017). CGMS can provide rich data that show glucose excursions in diabetes patients throughout the day. Consequently, unwarranted onset of hypo- and hyperglycemic events can be detected, intervened, and prevented by using CGMS. Hypoglycemia was frequently unrecognized by the patients in this study (75%), which increases their potential risk of significant adverse events. Incorporation of CGMS into the routine management of T2DM would increase the detection and self-awareness of hypoglycemia resulting in safer and potentially better overall control. © 2015 Diabetes Technology Society.

Epidemiology, antibiotic therapy and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in cancer patients.

PubMed

Bodro, Marta; Gudiol, Carlota; Garcia-Vidal, Carolina; Tubau, Fe; Contra, Anna; Boix, Lucía; Domingo-Domenech, Eva; Calvo, Mariona; Carratalà, Jordi

2014-03-01

Infection due to the six ESKAPE pathogens has recently been identified as a serious emerging problem. However, there is still a lack of information on bacteremia caused by these organisms in cancer patients. We aimed to assess the epidemiology, antibiotic therapy and outcomes of bacteremia due to drug-resistant ESKAPE pathogens (rESKAPE) in patients with cancer. All episodes of bacteremia prospectively documented in hospitalized adults with cancer from 2006 to 2011 were analyzed. Of 1,148 episodes of bacteremia, 392 (34 %) were caused by ESKAPE pathogens. Fifty-four episodes (4.7 %) were due to rESKAPE strains (vancomycin-resistant Enterococcus faecium 0, methicillin-resistant Staphylococcus aureus (MRSA) 13, extended-spectrum beta-lactamase (ESLB)-producing Klebsiella pneumoniae 7, carbapenem-resistant Acinetobacter baumannii 4, carbapenem- and quinolone-resistant Pseudomonas aeruginosa 18 and derepression chromosomic ß-lactam and ESBL-producing Enterobacter species 12. Risk factors independently associated with rESKAPE bacteremia were comorbidities, prior antibiotic therapy, urinary catheter and urinary tract source. Inappropriate empirical antibiotic therapy was more frequent in patients with rESKAPE bacteremia than in the other cases (55.6 % vs. 21.5 %, p < 0.001). Persistence of bacteremia (25 % vs. 9.7 %), septic metastasis (8 % vs. 4 %) and early case-fatality rate (23 % vs. 11 %) were more frequent in patients with rESKAPE bacteremia than in patients with other etiologies (p < 0.05). Bacteremia due to rESKAPE pathogens in cancer patients occurs mainly among those with comorbidities who have received prior antibiotic therapy and have a urinary tract source. These patients often receive inappropriate empirical antibiotic therapy and have a poor outcome.

Infections during induction therapy for children with acute lymphoblastic leukemia. the role of sulfamethoxazole-trimethoprim (SMX-TMP) prophylaxis.

PubMed

Rungoe, Christine; Malchau, Emma Louise; Larsen, Line Nordahl; Schroeder, Henrik

2010-08-01

Bacteremias are frequent during induction therapy for acute lymphoblastic leukemia (ALL) in children. Antibacterial prophylaxis therapy may thus be warranted. The purpose of this study was to analyze the rate of infections during induction therapy in two cohorts of children with ALL where one cohort received prophylactic sulfamethoxazole-trimethoprim (SMX-TMP). All infections were registered through a retrospective non-randomized review of medical records of 171 consecutive children newly diagnosed with ALL below 15 years of age at diagnosis. A total of 85 children treated from 1992 to 2000 did not receive SMX-TMP, whereas 86 children treated from 2000 to 2008 received SMX-TMP 20 mg/kg in one daily oral dose during induction therapy. A total of 26% of all children had no febrile episodes during induction. Infections were more frequent in children below 5 years of age. Significantly fewer children receiving SMX-TMP developed fever (17% vs. 34%, P = 0.02) and bacteremia (20% vs. 45%, P = 0.0003). Especially children with non-high risk criteria had fewer infections when receiving prophylaxis. When adjusting for age, type of catheter, and SMX-TMP prophylaxis on the risk of bacteremia by a multiple Cox regression analysis, we found that age and prophylaxis, but not the type of catheter, were associated with a significantly reduced risk of bacteremia. Children with ALL receiving SMX-TMP prophylaxis during induction therapy experienced fewer febrile episodes, fewer days with fever demanding intravenous antibiotic treatment, and fewer episodes of bacteremia. Both SMX-TMP prophylaxis and age played significant independent roles for the occurrence of bacteremia. (c) 2010 Wiley-Liss, Inc.

Poor recovery from cystic fibrosis pulmonary exacerbations is associated with poor long-term outcomes.

PubMed

Sanders, Don B; Zhao, Qianqian; Li, Zhanhai; Farrell, Philip M

2017-10-01

People with CF treated with IV antibiotics for a pulmonary exacerbation (PEx) frequently fail to recover to baseline FEV 1 . The long-term impact of these events has not been studied. To determine if a patient's spirometric recovery after a PEx is associated with time to next PEx within 1 year, the spirometric recovery after the next PEx, and/or the number of PEx episodes in the next 3 years. We used data from the CF Foundation Patient Registry from 2004 to 2011. We randomly selected one PEx per patient that met inclusion/exclusion criteria. Patients were defined as Non-Responders if their best FEV 1 (in liters) recorded in the 3 months after the PEx was <90% of the best FEV 1 (in liters) in the 6 months before the PEx. We compared Responders and Non-Responders using multivariable regression models. We randomly chose 13 954 PEx episodes that met inclusion/exclusion criteria. A total of 2 762 (19.8%) patients were classified as Non-Responders. Non-Responders had a shorter median time to the next PEx, 235 (95%CI 218, 252) days, versus >365 days for Responders. Thirty-four percent of Non-Responders at the initial PEx were also Non-Reponders at the next PEx, versus 20% of Responders at the initial PEx. Non-Responders had more PEx episodes over the next 3 years, 4.99 (95%CI 4.84, 5.13), than Responders, 3.46 (95%CI 3.41, 3.51). Poor recovery after a PEx is associated with a shorter time to the next PEx, increased risk of poor recovery at a second PEx, and more frequent subsequent PEx treatments. © 2017 Wiley Periodicals, Inc.

GLP1 and glucagon co-secreting pancreatic neuroendocrine tumor presenting as hypoglycemia after gastric bypass

PubMed Central

Guimarães, Marta; Rodrigues, Pedro; Pereira, Sofia S; Nora, Mário; Gonçalves, Gil; Albrechtsen, Nicolai Wewer; Hartmann, Bolette; Holst, Jens Juul

2015-01-01

Summary Post-prandial hypoglycemia is frequently found after bariatric surgery. Although rare, pancreatic neuroendocrine tumors (pNET), which occasionally are mixed hormone secreting, can lead to atypical clinical manifestations, including reactive hypoglycemia. Two years after gastric bypass surgery for the treatment of severe obesity, a 54-year-old female with previous type 2 diabetes, developed post-prandial sweating, fainting and hypoglycemic episodes, which eventually led to the finding by ultrasound of a 1.8-cm solid mass in the pancreatic head. The 72-h fast test and the plasma chromogranin A levels were normal but octreotide scintigraphy showed a single focus of abnormal radiotracer uptake at the site of the nodule. There were no other clinical signs of hormone secreting pNET and gastrointestinal hormone measurements were not performed. The patient underwent surgical enucleation with complete remission of the hypoglycemic episodes. Histopathology revealed a well-differentiated neuroendocrine carcinoma with low-grade malignancy with positive chromogranin A and glucagon immunostaining. An extract of the resected tumor contained a high concentration of glucagon (26.707 pmol/g tissue), in addition to traces of GLP1 (471 pmol/g), insulin (139 pmol/g) and somatostatin (23 pmol/g). This is the first report of a GLP1 and glucagon co-secreting pNET presenting as hypoglycemia after gastric bypass surgery. Although pNET are rare, they should be considered in the differential diagnosis of the clinical approach to the post-bariatric surgery hypoglycemia patient. Learning points pNETs can be multihormonal-secreting, leading to atypical clinical manifestations.Reactive hypoglycemic episodes are frequent after gastric bypass.pNETs should be considered in the differential diagnosis of hypoglycemia after bariatric surgery. PMID:26266036

Panic symptoms in transient loss of consciousness: Frequency and diagnostic value in psychogenic nonepileptic seizures, epilepsy and syncope.

PubMed

Rawlings, G H; Jamnadas-Khoda, J; Broadhurst, M; Grünewald, R A; Howell, S J; Koepp, M; Parry, S W; Sisodiya, S M; Walker, M C; Reuber, M

2017-05-01

Previous studies suggest that ictal panic symptoms are common in patients with psychogenic nonepileptic seizures (PNES). This study investigates the frequency of panic symptoms in PNES and if panic symptoms, just before or during episodes, can help distinguish PNES from the other common causes of transient loss of consciousness (TLOC), syncope and epilepsy. Patients with secure diagnoses of PNES (n=98), epilepsy (n=95) and syncope (n=100) were identified using clinical databases from three United Kingdom hospitals. Patients self-reported the frequency with which they experienced seven symptoms of panic disorder in association with their episodes. A composite panic symptom score was calculated on the basis of the frequency of symptoms. 8.2% of patients with PNES reported "never" experiencing any of the seven panic symptoms in their episodes of TLOC. Patients with PNES reported more frequent panic symptoms in their attacks than those with epilepsy (p<0.001) or syncope (p<0.001), however, patients with PNES were more likely "rarely" or "never" to report five of the seven-ictal panic symptoms than "frequently" or "always" (45-69% versus 13-29%). A receiver operating characteristic analysis demonstrated that the composite panic symptom score distinguished patients with PNES from the other groups (sensitivity 71.1%, specificity 71.2%), but not epilepsy from syncope. Patients with PNES report TLOC associated panic symptoms more commonly than those with epilepsy or syncope. Although panic symptoms are reported infrequently by most patients with PNES, a composite symptom score may contribute to the differentiation between PNES and the other two common causes of TLOC. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Widespread Pressure Pain Hypersensitivity Is Similar in Women With Frequent Episodic and Chronic Tension-Type Headache: A Blinded Case-Control Study.

PubMed

Palacios Ceña, María; Castaldo, Matteo; Kelun Wang; Torelli, Paola; Pillastrini, Paolo; Fernández-de-Las-Peñas, César; Arendt-Nielsen, Lars

2017-02-01

To investigate differences in widespread pressure pain hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with frequent episodic (FETTH) and chronic (CTTH) tension-type headache. It seems that people with tension-type headache exhibit central sensitization. No study has investigated differences between FETTH and CTTH in terms of widespread pressure pain hypersensitivity. Forty-three women with FETTH, 42 with CTTH, and 45 women without headache diagnosis were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over trigeminal area (ie, temporalis muscle), extra-trigeminal (ie, C5/C6 zygapophyseal joint), and two distant points (ie, second metacarpal and tibialis anterior muscle) by a blinded assessor. Clinical features of the headache were collected with a 4-week headache diary. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). The ANCOVA revealed that PPTs were significantly decreased bilaterally over trigeminal (mean differences ranging from 97.5 to 101.5 kPa), extra-trigeminal (from 94.3 to 114.5 kPa), and distant points (from 99.4 to 208.6 kPa) in both FETTH and CTTH groups compared with controls (all, P < .001). No differences between FETTH and CTTH were observed (all points, P > .217). Anxiety (all, P > .803) or depression (P > .206) did not influence pressure pain hyperalgesia. No associations between widespread pressure hypersensitivity and headache features were observed (all, P > .110). Current results suggest the presence of similar local and widespread pressure hyperalgesia, not associated with anxiety or depression, in women with FETTH and CTTH supporting that localized and central manifestations are involved in both the episodic and chronic forms of tension-type headache. © 2016 American Headache Society.

Cardiac pacing for severe childhood neurally mediated syncope with reflex anoxic seizures

PubMed Central

McLeod, K; Wilson, N; Hewitt, J; Norrie, J; Stephenson, J

1999-01-01

OBJECTIVE—To determine whether permanent cardiac pacing could prevent syncope and seizures in children with frequent severe neurally mediated syncope, and if so whether dual chamber pacing was superior to single chamber ventricular pacing.
METHODS—Dual chamber pacemakers were implanted into 12 children (eight male, four female) aged 2-14 years (median 2.8 years) with frequent episodes of reflex anoxic seizures and a recorded prolonged asystole during an attack. The pacemaker was programmed to sensing only (ODO), single chamber ventricular pacing with hysteresis (VVI), and dual chamber pacing with rate drop response (DDD) for four month periods, with each patient allocated to one of the six possible sequences of these modes, according to chronological order of pacemaker implantation. The parent and patient were blinded to the pacemaker mode and asked to record all episodes of syncope or presyncope ("near miss" events). The doctor analysing the results was blinded to the patient and pacemaker mode.
RESULTS—One patient was withdrawn from the study after the pacemaker was removed because of infection. In the remaining children, both dual chamber and single chamber pacing significantly reduced the number of syncopal episodes compared with sensing only (p = 0.0078 for both). VVI was as effective as DDD for preventing syncope, but DDD was superior to VVI in reducing near miss events (p = 0.016).
CONCLUSIONS—Permanent pacing is an effective treatment for children with severe neurally mediated syncope and reflex anoxic seizures. VVI is as effective as DDD in preventing syncope and seizures, but DDD is superior in preventing overall symptoms.


Keywords: syncope; reflex anoxic seizures; pacing; paediatric cardiology PMID:10573501

Episodic Autobiographical Memories over the Course of Time: Cognitive, Neuropsychological and Neuroimaging Findings

ERIC Educational Resources Information Center

Piolino, Pascale; Desgranges, Beatrice; Eustache, Francis

2009-01-01

The critical attributes of episodic memory are self, autonoetic consciousness and subjectively sensed time. The aim of this paper is to present a theoretical overview of our already published researches into the nature of episodic memory over the course of time. We have developed a new method of assessing "autobiographical" memory (TEMPau task),…

Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel.

PubMed

Funk, Sidney; Miller, Michael M; Mishell, Daniel R; Archer, David F; Poindexter, Alfred; Schmidt, Juergen; Zampaglione, Edio

2005-05-01

The safety and efficacy of a single-rod implantable contraceptive containing etonogestrel (Implanontrade mark) were investigated in a multicenter clinical trial. Sexually active American women (N=330) with apparently normal menstrual cycles used the implant for up to 2 years. All subjects recorded bleeding and/or spotting daily in a diary. Safety was assessed through adverse experiences (AEs), laboratory tests and physical and gynecologic examinations. Total exposure was 474 woman-years (6186 cycles), and 68% of subjects had at least 1 year of exposure. No pregnancies occurred. The most common bleeding pattern observed throughout the study was infrequent bleeding, defined as less than three episodes of bleeding in a reference period (excluding amenorrhea). The least common pattern was frequent bleeding, defined as more than five episodes of bleeding in a reference period. Infrequent, prolonged and frequent bleeding patterns were most common early in the study and declined thereafter. During the 3-month Reference Periods 2-8 (Months 4-24), the incidence of amenorrhea ranged from 14% to 20%. Forty-three subjects (13%) withdrew from the study because of bleeding pattern changes and 76 subjects (23%) discontinued because of other AEs. Other common AEs leading to discontinuation, besides bleeding irregularities, were emotional lability (6.1%), weight increase (3.3%), depression (2.4%) and acne (1.5%). Use of Implanon (etonogestrel subdermal implant, referred to herein as ENG implant) for up to 2 years had no clinically significant effects on laboratory parameters, physical and pelvic examinations, vital signs or body mass index. The average length of time required for ENG implant insertion and that for removal were 0.5 and 3.5 min, respectively, and all the procedures were uncomplicated. The return to normal menstrual cycles and fertility was rapid after removal. Implanon is a safe, highly effective and rapidly reversible new method of contraception.

Behaviors associated with negative affect in the friendships of children with ADHD: An exploratory study.

PubMed

Normand, Sébastien; Ambrosoli, James; Guiet, Joanna; Soucisse, Marie Michèle; Schneider, Barry H; Maisonneuve, Marie-France; Lee, Matthew D; Tassi, Fulvio

2017-01-01

Our objective was to identify behaviors and contextual situations associated with negative affect observed in the interactions of children with and without ADHD and their real-life friends. We expected negative affect to be linked to rule violations and disagreements about the choice of games. Loss of game was associated with episodes of negative affect in a structured game. Negative appraisal of friend's ability was most frequently associated with negative affect during unstructured free play. Comparison children expressed greater frustration regarding their own abilities, whereas children with ADHD commented more frequently about the inabilities of their friends. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Tufted capuchin monkeys (Sapajus sp) learning how to crack nuts: does variability decline throughout development?

PubMed

Resende, Briseida Dogo; Nagy-Reis, Mariana Baldy; Lacerda, Fernanda Neves; Pagnotta, Murillo; Savalli, Carine

2014-11-01

We investigated the process of nut-cracking acquisition in a semi-free population of tufted capuchin monkeys (Sapajus sp) in São Paulo, Brazil. We analyzed the cracking episodes from monkeys of different ages and found that variability of actions related to cracking declined. Inept movements were more frequent in juveniles, which also showed an improvement on efficient striking. The most effective behavioral sequence for cracking was more frequently used by the most experienced monkeys, which also used non-optimal sequences. Variability in behavior sequences and actions may allow adaptive changes to behavior under changing environmental conditions. Copyright © 2014 Elsevier B.V. All rights reserved.

Mind wandering and retrieval from episodic memory: a pilot event-related potential study.

PubMed

Riby, Leigh Martin; Smallwood, Jonathan; Gunn, Valerie P

2008-06-01

The present study investigated the effects of mind wandering (task-unrelated thought) on the subcomponents of episodic memory as reflected by event-related potentials (ERPs). Specifically, individual differences in the pattern of ERP episodic 'old/new' effects (left-parietal, right-frontal and central-negativity effects) were examined across groups of participants experiencing either high or low frequencies of task-unrelated thought during encoding. Twenty participants studied lists of words and line drawings in one of two contexts (red versus green coloured boxes). At test, participants discriminated between target (old words or line drawings presented in one colour) and nontargets (old items from the other colour and new items). On completion of the memory task, participants completed the 'thinking' component of the Dundee Stress State Questionnaire to provide a retrospective measure of task-unrelated thought. Behavioural data indicated that irrespective of the presence of task-unrelated thought, participants were able to complete the memory task equally well. However, an analysis of ERPs across High and Low task-unrelated thought groups revealed differences in retrieval strategy. Those individuals with infrequent episodes of task-unrelated thought at study used a 'pure' recollection strategy (left-parietal effect only). Conversely, those participants experiencing frequent episodes of task-unrelated thought were unable to recollect the stimuli with ease, as indexed by a diminished parietal effect. As a consequence, these participants employed additional strategic processes for task completion, as indexed by an elevated amplitude of central negativity effects. These data are consistent with the decoupling hypothesis of mind wandering which suggests impaired recollection when attention becomes directed away from the task.

An insight into the formation of severe ozone episodes: modeling the 21/03/01 event in the ESCOMPTE region

NASA Astrophysics Data System (ADS)

Lasry, Fanny; Coll, Isabelle; Buisson, Emmanuel

2005-03-01

High ozone concentrations are observed more and more frequently in the lower troposphere. The development of such polluted episodes is linked to a complex set of chemical, physical and dynamical parameters that interact with each other. To improve air quality, it is necessary to understand and quantify the role of all these processes on the intensity of ozone formation. The ESCOMPTE program, especially dedicated to the numerical simulation of photochemical episodes, offers an ideal frame to investigate details of the roles of many of these processes through 3D modeling. This paper presents the analysis, with a 3D eulerian model, of a severe and local episode of ozone pollution that occurred on the 21st of March 2001 in the ESCOMPTE region. This episode is particularly interesting due to the intensity of the observed ozone peaks (450 μg/m 3 during 15 mn) but also because it did not occur in summer but at the beginning of spring. As part of the premodeling work of the ESCOMPTE program, this study focuses on the sensitivity of the simulated ozone peaks to various chemical and physical phenomena (long-range transport, industrial emissions, local dynamic phenomena…) to determine their influence on the rise of high local photooxidant concentrations and to better picture the photochemistry of the ESCOMPTE region. Through sensitivity tests to dynamical calculation resolution and emissions, this paper shows how the combination of sea and pond breezes with emissions of reactive VOCs can generate local intense ozone peaks.

Incidence and economic burden of acute otitis media in children aged up to 5years in three Middle Eastern countries and Pakistan: A multinational, retrospective, observational study.

PubMed

Mustafa, Ghulam; Al Aidaroos, Amal Y; Al Abaidani, Idris S; Meszaros, Kinga; Gopala, Kusuma; Ceyhan, Mehmet; Al-Tannir, Mohamad; DeAntonio, Rodrigo; Bawikar, Shyam; Schmidt, Johannes E

2017-06-01

Epidemiological data on acute otitis media (AOM), an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children ≤5years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children (Saudi Arabia=1023, Oman=998, Pakistan=1022, Turkey=1000) were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars (USD)]. The overall incidence of AOM episodes per 1000 person-years was: Saudi Arabia, 207 [95% confidence interval (CI): 178-238]; Oman, 105 (95% CI: 85-127); Pakistan, 138 (95% CI: 116-163); and Turkey, 99 (95% CI: 79-123). The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation (SD)=93.0], Oman USD16.1 (SD=16.4), Pakistan USD22.1 (SD=20.5), and Turkey USD33.6 (SD=44.9). The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies. Copyright © 2017 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

[Demand for hospitalization due to psychosocial causes in a pediatric hospital].

PubMed

Bella, Mónica E; Borgiattino, Vanesa

2016-06-01

Health care services show epidemiological changes and an increase in the number of consultations due to mental causes and violence without having the necessary capacity to respond to this increasing demand. To analyze and compare the demand for hospitalization due to psychosocial causes in a pediatric hospital during three different periods. Descriptive, retrospective study. The cases were children/adolescents hospitalized for psychosocial causes at Hospital de Niños de la Santísima Trinidad, Córdoba. The data were processed using frequency analysis and chi-square test. 221 records were analyzed. The hospitalization rate was 0.73% in the year 2000, 1.44% in 2005 and 1.26% in 2010. The hospitalization rate for psychosocial causes increased from 0.06 in 2000 to 0.10 in the years 2005 and 2010. The most common reasons for admission were: suspected child abuse in 44.2% (p < 0.0001), suicidal behavior in 18.7%, suspected sexual abuse in 10.05% and substance abuse in 6.8%. The psychomotor agitation episode and psychotic episode showed a prevalence of 2.4% in 2000, while in 2010 it was of 9.5% for the psychomotor agitation episode and of 5.7% for the psychotic episode. Suicidal behavior and suspected sexual abuse were more common in women and the psychomotor agitation episode and substance abuse were more common in men. Hospitalizations for psychosocial causes and, particularly, mental causes in children/adolescents have increased and show a different behavior according to age and gender. Health problems related to violence were the most frequent ones. Sociedad Argentina de Pediatría.

Emerging adults' use of alcohol and social networking sites during a large street festival: A real-time interview study.

PubMed

Whitehill, Jennifer M; Pumper, Megan A; Moreno, Megan A

2015-05-20

Emerging adults have high rates of heavy episodic drinking (binge drinking) and related risks including alcohol-impaired driving. To understand whether social networking sites (SNSs) used on mobile devices represent a viable platform for real-time interventions, this study measured emerging adults' use of two popular SNSs (Facebook and Twitter) during the Mifflin Street Block Party. This annual festival is held in Madison, Wisconsin and is known for high alcohol consumption. Event attendees ages 18-23 years were recruited by young adult research assistants (>21 years). Participants completed a brief in-person interview assessing drinking intensity, use of SNSs, and use of SNSs to plan transportation. Analyses included t-tests, chi-squared tests, and Fisher's exact tests. At the event, nearly all of the 200 participants (97 %) consumed alcohol and 18 % met criteria for heavy episodic drinking. Approximately one-third of participants had used Facebook or Twitter on the day of the event. Facebook use (23 %) was more prevalent than Twitter use (18 %), especially among heavy episodic drinkers. Use of either SNS was 41 % among females and 24 % among males (χ (2)=6.01; df=1; p=0.01). Plans to use a SNS to arrange transportation were relatively uncommon (4 %), but this was more frequent among heavy episodic drinkers (11 %) compared to non-heavy episodic drinkers (2 %) (Fisher's exact p=0.02). These results indicate that SNSs are used during alcohol consumption and warrant exploration as a way to facilitate connections to resources like safe ride services.

Messages about appearance, food, weight and exercise in "tween" television.

PubMed

Simpson, Courtney C; Kwitowski, Melissa; Boutte, Rachel; Gow, Rachel W; Mazzeo, Suzanne E

2016-12-01

Tweens (children ages ~8-14years) are a relatively recently defined age group, increasingly targeted by marketers. Individuals in this age group are particularly vulnerable to opinions and behaviors presented in media messages, given their level of cognitive and social development. However, little research has examined messages about appearance, food, weight, and exercise in television specifically targeting tweens, despite the popularity of this media type among this age group. This study used a content analytic approach to explore these messages in the five most popular television shows for tweens on the Disney Channel (as of 2015). Using a multiple-pass approach, relevant content in episodes from the most recently completed seasons of each show was coded. Appearance related incidents occurred in every episode; these most frequently mentioned attractiveness/beauty. Food related incidents were also present in every episode; typically, these situations were appearance and weight neutral. Exercise related incidents occurred in 53.3% of episodes; the majority expressed resistance to exercise. Weight related incidents occurred in 40.0% of the episodes; the majority praised the muscular ideal. Women were more likely to initiate appearance incidents, and men were more likely to initiate exercise incidents. These results suggest that programs specifically marketed to tweens reinforce appearance ideals, including stereotypes about female attractiveness and male athleticism, two constructs linked to eating pathology and body dissatisfaction. Given the developmental vulnerability of the target group, these findings are concerning, and highlight potential foci for prevention programming, including media literacy, for tweens. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using Low-Frequency Earthquake Families on the San Andreas Fault as Deep Creepmeters

NASA Astrophysics Data System (ADS)

Thomas, A. M.; Beeler, N. M.; Bletery, Q.; Burgmann, R.; Shelly, D. R.

2018-01-01

The central section of the San Andreas Fault hosts tectonic tremor and low-frequency earthquakes (LFEs) similar to subduction zone environments. LFEs are often interpreted as persistent regions that repeatedly fail during the aseismic shear of the surrounding fault allowing them to be used as creepmeters. We test this idea by using the recurrence intervals of individual LFEs within LFE families to estimate the timing, duration, recurrence interval, slip, and slip rate associated with inferred slow slip events. We formalize the definition of a creepmeter and determine whether this definition is consistent with our observations. We find that episodic families reflect surrounding creep over the interevent time, while the continuous families and the short time scale bursts that occur as part of the episodic families do not. However, when these families are evaluated on time scales longer than the interevent time these events can also be used to meter slip. A straightforward interpretation of episodic families is that they define sections of the fault where slip is distinctly episodic in well-defined slow slip events that slip 16 times the long-term rate. In contrast, the frequent short-term bursts of the continuous and short time scale episodic families likely do not represent individual creep events but rather are persistent asperities that are driven to failure by quasi-continuous creep on the surrounding fault. Finally, we find that the moment-duration scaling of our inferred creep events are inconsistent with the proposed linear moment-duration scaling. However, caution must be exercised when attempting to determine scaling with incomplete knowledge of scale.

[Mesenteric-cava shunt's results with autologous jugular vein graft in children with pre-sinusoidal portal hypertension].

PubMed

Leal, N; López Santamaría, M; Gámez, M; Murcia, J; Andolfi, G; Berrocal, T; Frauca, E; Jara, P; Tovar, J

2002-07-01

Presinusoidal portal hypertension (PPH) in children evaluates without functional hepatic damage, and with the time, trends to compensate through the creation of spontaneous portosystemic shunts. Nevertheless, some patients suffer episodes of gastrointestinal bleeding (GIB) that because of its frequency or severity, force to propose the change of surgical treatment. To evaluate the results of the mesocaval shunt (MCS) with autologous jugular vein in children with PPH. Among the 32 children with PPH treated in our Hospital in the last 7 years, 10 had episodes of GIB that forced to perform a surgical shunt. The types of shunt were distal splenorenal in 3 patients and mesocaval in 7. These 7 cases are the material of this study. The origin of the PPH was a cavernomatosis transformation of the portal vein in 6 cases and a congenital hepatic fibrosis in 1. Before the surgery the average number of episodes of GIB was 9 (range 2-15); all the patients needed transfusion of blood products and variceal sclerosis. In 2 cases a tamponade with the Sengtaken balloon was required and 5 patients were treated with somatostatin and propranolol. The Doppler ultrasounds revealed and intense hepatofugal collateral circulation in all the cases. The initial flow through the shunt was adequate in all the patients except one who required a percutaneous balloon dilatation. Only this patient has suffered an episode of GIB. The hyperesplenism signs disappeared or improved in all the seven cases and the collateral circulation was significantly reduced. The pressure in the splenic territory decreased around 50% in the 4 patients that was measured. There were no cases of encephalopasty and only one child with congenital hepatic fibrosis shows signs of mild hepatic disfunction. The medium follow up post-shunt is 32 months (range 8 m-6 years). The MCS prevents the GIB in the PPH not responsive to the conservative treatment; its effectiveness is related with an adequate permeability though the graft and at least in the cases with portal cavernomatosis (the most frequent in children) doesn't produce hepatic dysfunction. Doppler ultrasounds give a very precise information about the post-surgical situation and are an excellent method of follow up.

Spontaneous Pneumothoraces in Patients with Birt–Hogg–Dubé Syndrome

PubMed Central

Kopras, Elizabeth J.; Henske, Elizabeth P.; James, Laura E.; El-Chemaly, Souheil; Veeraraghavan, Srihari; Drake, Matthew G.; McCormack, Francis X.

2017-01-01

Rationale: Spontaneous pneumothorax is a common complication of Birt–Hogg–Dubé syndrome (BHD). Objectives: The optimal approach to treatment and prevention of BHD-associated spontaneous pneumothorax, and to advising patients with BHD regarding risk of pneumothorax associated with air travel, is not well established. Methods: Patients with BHD were recruited from the Rare Lung Diseases Clinic Network and the BHD Foundation and surveyed about disease manifestations and air travel experiences. Results: A total of 104 patients completed the survey. The average age at diagnosis was 47 years, with an average delay from first symptoms of 13 years. Pulmonary cysts were the most frequent phenotypic manifestation of BHD, present in 85% of patients. Spontaneous pneumothorax was the presenting manifestation that led to the diagnosis of BHD in 65% of patients, typically after the second episode (mean, 2.4 episodes). Seventy-nine (76%) of 104 patients had at least one spontaneous pneumothorax during their lifetime, and 82% had multiple pneumothoraces. Among patients with multiple pneumothoraces, 73% had an ipsilateral recurrence, and 48% had a subsequent contralateral spontaneous pneumothorax following a sentinel event. The mean ages at first and second pneumothoraces were 36.5 years (range, 14–63 yr) and 37 years (range, 20–55 yr), respectively. The average number of spontaneous pneumothoraces experienced by patients with a sentinel pneumothorax was 3.6. Pleurodesis was generally performed after the second (mean, 2.4) ipsilateral pneumothorax and reduced the ipsilateral recurrence rate by half. A total of 11 episodes of spontaneous pneumothorax occurred among eight patients either during or within the 24-hour period following air travel, consistent with an air travel–related pneumothorax rate of 8% per patient and 0.12% per flight. Prior pleurodesis reduced the occurrence of a subsequent flight-related pneumothorax. Conclusions: Spontaneous pneumothorax is an important, recurrent manifestation of pulmonary involvement in patients with BHD, and pleurodesis should be considered following the initial pneumothorax to reduce the risk of recurrent episodes. In general, in patients with BHD, pneumothorax occurs in about 1–2 per 1,000 flights, and the risk is lower among patients with a history of prior pleurodesis. PMID:28248571

Adequate dietary fiber supplement and TONE can help avoid surgery in most patients with advanced hemorrhoids.

PubMed

Garg, Pankaj; Singh, Pratiksha

2017-06-01

The root cause of hemorrhoids resides in three deranged defecation habits (DDH), namely increased straining, prolonged defecation-time, and frequent bowel-motions. These DDH are responsible for the development of new hemorrhoids, progression of existing one and hemorrhoidal rupture (bleeding). DDH can be corrected with the help of the "TONE" mnemonic. TONE entails specifying exact treatment goals: T, three minutes at defecation; O, once-a-day defecation frequency; N, no straining during passing motions; E, enough fiber. TONE can be implemented by proper counseling and by prescribing fiber supplement appropriately (5-6 teaspoonfuls of psyllium husk with 600 mL of water daily. Corrected DDH would prevent the progression of hemorrhoids and bleeding episodes. An office procedure may be done to further downgrade the hemorrhoids. Patients with advanced hemorrhoids (grades III and IV) who were referred for surgery were prescribed fiber supplement and were counseled to follow TONE. The outcome parameters evaluated were improvement in prolapse, bleeding episodes, satisfaction levels. A total of 102 patients (75 males and 10 females, mean age 46.0±13.5 years, 17 lost to follow-up) with advanced hemorrhoids (41 with early grade III, 38 with late grade III, and 6 with grade IV) were included in the study. All patients had symptoms of prolapsed hemorrhoids and bleeding episodes were present in 71.8% (61/85) of patients. After the follow-up of 40 (12-96) months, 68.2% (58/85) patients were highly satisfied, 12.9% (11/85) were moderately satisfied and 18.9% (16/85) were not satisfied with treatment. Prolapse improved in 56.5% (48/85), did not progress over time in 25.9 (22/85) and continued to progress in 4.7% (4/85) patients. 12.9% (11/85) underwent operation for hemorrhoids. Bleeding episodes decreased from 71.8% (61/85) to 29.4% (25/85) (P<0.0001). Adequate fiber supplement combined with the TONE method can correct DDH, thus stopping the progression of hemorrhoids and bleeding, and preventing surgery in most patients with advanced hemorrhoids.

The burden of pediatric diarrhea: a cross-sectional study of incurred costs and perceptions of cost among Bolivian families

PubMed Central

2013-01-01

Background Worldwide, acute gastroenteritis represents an enormous public health threat to children under five years of age, causing one billion episodes and 1.9 to 3.2 million deaths per year. In Bolivia, which has one of the lower GDPs in South America, an estimated 15% of under-five deaths are caused by diarrhea. Bolivian caregiver expenses related to diarrhea are believed to be minimal, as citizens benefit from universal health insurance for children under five. The goals of this report were to describe total incurred costs and cost burden associated with caregivers seeking treatment for pediatric gastroenteritis, and to quantify relationships among costs, cost burden, treatment setting, and perceptions of costs. Methods From 2007 to 2009, researchers interviewed caregivers (n=1,107) of pediatric patients (<5 years of age) seeking treatment for diarrhea in sentinel hospitals participating in Bolivia’s diarrheal surveillance program across three main geographic regions. Data collected included demographics, clinical symptoms, direct costs (e.g. medication, consult fees) and indirect costs (e.g. lost wages). Results Patient populations were similar across cities in terms of gender, duration of illness, and age, but familial income varied significantly (p<0.05) when stratified on appointment type. Direct, indirect, and total costs to families were significantly higher for inpatients as compared to outpatients of urban (p<0.001) and rural (p<0.05) residence. Consult fees and indirect costs made up a large proportion of total costs. Forty-five percent of patients’ families paid ≥1% of their annual household income for this single diarrheal episode. The perception that cost was affecting family finances was more frequent among those with higher actual cost burden. Conclusions This study demonstrated that indirect costs due to acute pediatric diarrhea were a large component of total incurred familial costs. Additionally, familial costs associated with a single diarrheal episode affected the actual and perceived financial situation of a large number of caregivers. These data serve as a baseline for societal diarrheal costs before and immediately following the implementation of the rotavirus vaccine and highlight the serious economic importance of a diarrheal episode to Bolivian caregivers. PMID:23915207

Escherichia coli Peritonitis in Peritoneal Dialysis: The Prevalence, Antibiotic Resistance and Clinical Outcomes in a South China Dialysis Center

PubMed Central

Feng, Xiaoran; Yang, Xiao; Yi, Chunyan; Guo, Qunying; Mao, Haiping; Jiang, Zongpei; Li, Zhibin; Chen, Dongmei; Cui, Yingpeng; Yu, Xueqing

2014-01-01

♦ Introduction: Escherichia coli (E. coli) peritonitis is a frequent, serious complication of peritoneal dialysis (PD). The extended-spectrum β-lactamase (ESBL)-producing E. coli peritonitis is associated with poorer prognosis and its incidence has been on continuous increase during the last decades. However, the clinical course and outcomes of E. coli peritonitis remain largely unclear. ♦ Methods: All of the E. coli peritonitis episodes that occurred in our dialysis unit from 2006 to 2011 were reviewed. The polymicrobial episodes were excluded. ♦ Results: In total, ninety episodes of monomicrobial E. coli peritonitis occurred in 68 individuals, corresponding to a rate of 0.027 episodes per patient-year. E. coli was the leading cause (59.2%) of monomicrobial gram-negative peritonitis. ESBL-producing strains accounted for 35.5% of E. coli peritonitis. The complete cure rate and treatment failure rate of E. coli peritonitis were 77.8% and 10.0% respectively. Patients with preceding peritonitis had a higher risk of ESBL production as compared to those without peritonitis history [odds ratio (OR): 5.286; 95% confidence interval (CI): 2.018 - 13.843; p = 0.001]. The risk of treatment failure was significantly increased when the patient had a baseline score of Charlson Comorbidity Index (CCI) above 3 (OR: 6.155; 95% CI: 1.198 - 31.612; p = 0.03), or had diabetes mellitus (OR: 8.457; 95% CI: 1.838 - 38.91; p = 0.006), or hypoalbuminemia (≤ 30g/l) on admission (OR: 13.714; 95% CI: 1.602 - 117.428; p = 0.01). Prolonging the treatment course from 2 to 3 weeks or more reduced the risk of relapse and repeat significantly (p < 0.05). ♦ Conclusions: E. coli peritonitis remains a common complication of PD. The clinical outcomes of E. coli peritonitis are relatively favorable despite the high ESBL rate. A history of peritonitis is associated with increased risk for ESBL development. The severity of baseline comorbidities, the presence of diabetes mellitus and hypoalbuminemia at admission are associated with poor outcomes. PMID:24497589

Self-assessment and characteristics of mixed depression in the French national EPIDEP study.

PubMed

Azorin, Jean-Michel; Kaladjian, Arthur; Adida, Marc; Fakra, Eric; Belzeaux, Raoul; Hantouche, Elie; Lancrenon, Sylvie

2012-12-20

Studies on mixed depression have been conducted so far on the basis of DSM-IV manic symptoms, i.e., a list of 7 symptoms which may provide limited information on the subsyndromal features associated with a full depressive episode. As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 102 (23.8%) were classified as mixed depressives (≥3 hypomanic symptoms), and 146 (34%) as pure depressives (0 hypomanic symptom), after exclusion of bipolar I patients; hypomanic symptoms were assessed with the Multiple Visual Analog Scales of Bipolarity (MVAS-BP, 26 items) of Ahearn-Carroll in a self assessment format. A narrower definition of mixed depression, resting on those MVAS-BP items referring to DSM-IV hypomanic symptoms was also tested, as a sensitivity analysis. Compared to pure depressives, mixed depressive patients had more psychotic symptoms, atypical features and suicide attempts during their index episode; their illness course was characterized by early age at onset, frequent episodes, rapid cycling, and comorbidities. Mixed depressive patients were more frequently bipolar with a family history of bipolar disorder, alcohol abuse, and suicide. A dose-response relationship was found between intradepression hypomania and several clinical features, including temperament measures. The following independent variables were associated with mixed depression: hyperthymic temperament, cyclothymic temperament, irritable temperament, and alcohol abuse. Using the narrower definition of mixed depression missed risk factors such as suicidality and comorbidities. The following are the limitations of this study: retrospective design, recall bias, lack of sample homogeneity, no cross-validation of findings by hetero-evaluation of hypomanic symptoms. EPIDEP data showed the feasibility and face validity of self-assessment of intradepressive hypomania. They replicated previous findings on the severity and high suicidal risk of mixed depression profile. They confirmed, for mixed depression, that mixed states occur when mood episodes are superimposed upon temperaments of opposite polarity. They finally suggested that a definition of mixed depression only based on DSM-IV-TR hypomanic symptoms may not allow to identify the most unstable subforms of the entity. Copyright © 2012 Elsevier B.V. All rights reserved.

Evidence-based classification of low back pain in the general population: one-year data collected with SMS Track.

PubMed

Leboeuf-Yde, Charlotte; Lemeunier, Nadège; Wedderkopp, Niels; Kjaer, Per

2013-01-01

It was previously assumed that low back pain (LBP) is a disorder that can be classified as acute, subacute and chronic. Lately, the opinion seems to have veered towards a concept of it being a more recurrent or cyclic condition. Interestingly, a recent review of the literature indicated that LBP in the general population is a rather stable condition, characterized as either being present or absent. However, only one of the reviewed studies had used frequent data collection, which would be necessary when studying detailed course patterns over time. It was the purpose of this study to see, if it was possible to identify whether LBP, when present, is rather episodic or chronic/persistent. Further, we wanted to see if it was possible to describe any specific course profiles of LBP in the general population. In all, 293 49/50-yr old Danes, who previously participated in a population-based study on LBP were invited to respond to 26 fortnightly text-messages over one year, each time asking them the number of days they had been bothered by LBP in the past two weeks. The course patterns for these individuals were identified through manual analysis, by observing the interplay between non-episodes and episodes of LBP. A non-episode of LBP was defined as a period of at least one month without LBP as proposed by de Vet et al. A fortnight with at least one day of pain was defined as a pain fortnight (FN). At least one pain FN surrounded by a non-episode on each side was defined as an episode of LBP. After some preliminary observations of the spread of data, episodes were further classified as brief (consisting of only one pain FN) or longer (if there were at least 2 pain FNs in a row). An episode of at least 6 pain FNs in a row (i.e. 3 months) was defined as a long-lasting episode. In all, 261 study subjects were included in the analyses, for which 7 distinct LBP subsets could be identified. These could be grouped into three major clusters; those mainly without LBP (35%), those with episodic LBP (30%) and those with persistent LBP (35%). There was a positive association between number of episodes and their duration. In this study population, consisting of 50-yr old persons from the general population, LBP, when present, could be classified as either 'episodic' or 'mainly persistent'. About one third was mainly LBP-free throughout the year of study. More information is needed in relation to their relative proportions in various populations and the clinical relevance of these subgroups.

Dissociation of long-term verbal memory and fronto-executive impairment in first-episode psychosis

PubMed Central

Leeson, V. C.; Robbins, T. W.; Franklin, C.; Harrison, M.; Harrison, I.; Ron, M. A.; Barnes, T. R. E.; Joyce, E. M.

2009-01-01

Background Verbal memory is frequently and severely affected in schizophrenia and has been implicated as a mediator of poor clinical outcome. Whereas encoding deficits are well demonstrated, it is unclear whether retention is impaired. This distinction is important because accelerated forgetting implies impaired consolidation attributable to medial temporal lobe (MTL) dysfunction whereas impaired encoding and retrieval implicates involvement of prefrontal cortex. Method We assessed a group of healthy volunteers (n=97) and pre-morbid IQ- and sex-matched first-episode psychosis patients (n=97), the majority of whom developed schizophrenia. We compared performance of verbal learning and recall with measures of visuospatial working memory, planning and attentional set-shifting, and also current IQ. Results All measures of performance, including verbal memory retention, a memory savings score that accounted for learning impairments, were significantly impaired in the schizophrenia group. The difference between groups for delayed recall remained even after the influence of learning and recall was accounted for. Factor analyses showed that, in patients, all variables except verbal memory retention loaded on a single factor, whereas in controls verbal memory and fronto-executive measures were separable. Conclusions The results suggest that IQ, executive function and verbal learning deficits in schizophrenia may reflect a common abnormality of information processing in prefrontal cortex rather than specific impairments in different cognitive domains. Verbal memory retention impairments, however, may have a different aetiology. PMID:19419594

Impact of REM sleep on distortions of self-concept, mood and memory in depressed/anxious participants

PubMed Central

McNamara, Patrick; Auerbach, Sanford; Johnson, Patricia; Harris, Erica; Doros, Gheorghe

2009-01-01

Introduction: We tested the hypothesis that REM sleep contributes to core features of cognitive dysfunction of anxious depression including negative self-appraisals, biased memory processing and unpleasant dream content. Methods: After a habituation night in a sleep lab, a convenience sample of 35 healthy college students and 20 depressed/anxious students were awakened 10 minutes into a REM sleep episode and then 10 minutes into a NREM sleep episode. Awakenings were counterbalanced to control circadian effects. After each awakening participants reported a dream and then completed memory recall, mood and self-appraisal tasks. Results: Self-appraisals of depressed/anxious participants were significantly less positive and significantly more negative after awakenings from REM sleep vs NREM sleep. Appraisal of the REM sleep dream self was negative for depressed/anxious subjects only. Recall of negative memories was significantly more frequent after REM vs NREM sleep awakenings for both depress/anxious and healthy participants. REM sleep dreams were associated with greater frequencies of negative emotion, greater aggression and victimization rates than dreams in NREM sleep for depressed/anxious participants. Limitations: Depressed/anxious participants were classified as such on the basis of mood scales rather than clinical interview. All participants were drawn from a volunteer college student population and thus our results may not be applicable to some elderly clinical populations. Conclusions: REM appears to facilitate cognitive distortions of anxious depression. PMID:19631989

Maxillofacial injuries associated with intimate partner violence in women

PubMed Central

2010-01-01

Background The facial region has been the most common site of injury following violent episodes. The purpose of this study was to determine the prevalence and pattern of maxillofacial injuries associated with intimate partner violence (IPV) in women treated at a single facility in Malaysia. Methods A retrospective review of 242 hospital records of female IPV victims who were seen at the One-Stop Crisis Centre (OSCC) in Hospital Raja Perempuan Zainab II, Kelantan over a two-year period (January 1, 2005 to December 31, 2006) was performed. A structured form was used for data collection. Information regarding the anatomical sites of injuries, types of injuries, and mechanisms of assault were obtained. Results Most victims were married (85.1%), were injured by the husband (83.5%), and had at least one previous IPV episode (85.5%). Injury to the maxillofacial region was the most common (50.4%), followed by injury to the limbs (47.9%). In 122 cases of maxillofacial injuries, the middle of the face was most frequently affected (60.6%), either alone or in combination with the upper or lower third of the face. Injury to soft tissues (contusions, abrasions and lacerations) was the most common (87.7%). Conclusions This study indicates there is a high prevalence of maxillofacial injuries associated with IPV among women treated at the OSCC in Kelantan, Malaysia. PMID:20492720

Symptomatological Features of Patients with and without Ecstasy Use during Their First Psychotic Episode

PubMed Central

Rugani, Fabio; Bacciardi, Silvia; Rovai, Luca; Pacini, Matteo; Maremmani, Angelo Giovanni Icro; Deltito, Joseph; Dell’Osso, Liliana; Maremmani, Icro

2012-01-01

Background: Ecstasy use is generally chosen by adolescents and young adults for its entactogenic properties (the production of feelings of empathy, love, and emotional closeness to others.) Despite this desired and frequently realized outcome, Ecstasy use has often resulted in the genesis of psychotic symptoms and aggressive behaviors, particularly after chronic and/or intensive use. Methods: To explore the negative consequences of Ecstasy use and to examine the aggressive nature oftentimes seen in many Ecstasy users we employed a case-control study model. We compared, by means of validated psychometric tests, the psychopathological symptoms (BPRS), the aggressiveness (OAS) and the social adjustment (DSM-GAF) of psychotic patients with (n = 23) and without (n = 46) recent user of Ecstasy, during their first psychotic episode and hospitalization. All 23 Ecstasy users were Ecstasy users only. Results: Almost all of the psychotic symptoms were of similar severity in both groups. Blunted affect was milder in users than in non-users, whereas hostility and aggressive behavior was significantly more severe in users than in non-users. Conclusions: psychosis with a high level of aggressiveness and violence constitutes an important ‘side-effect’ that surely runs counter to the expected entactogenic action of Ecstasy. At a patient psycho-educational level, this study suggests that the use of Ecstasy may be counterproductive with respect to user expectations. PMID:22851941

Headache (chronic tension-type)

PubMed Central

2009-01-01

Introduction Chronic tension-type headache (CTTH) is a disorder that evolves from episodic tension-type headache, with daily or very frequent episodes of headache lasting minutes to days. It affects 4.1% of the general population in the USA, and is more prevalent in women (up to 65% of cases). Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for chronic tension-type headache? What are the effects of non-drug treatments for chronic tension-type headache? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 50 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture; amitriptyline; analgesics; anticonvulsant drugs; benzodiazepines; botulinum toxin; chiropractic and osteopathic manipulations; cognitive behavioural therapy (CBT); Indian head massage; mirtazapine; relaxation and electromyographic biofeedback; selective serotonin reuptake inhibitor antidepressants (SSRIs); and tricyclic antidepressants (other than amitriptyline). PMID:21696647

Determinants of occurrence and recovery from hallucinations in daily life.

PubMed

Delespaul, Philippe; deVries, Marten; van Os, Jim

2002-03-01

Data related to the dynamics of hallucinatory experiences of patients suffering from schizophrenia are scarce. Detecting antecedent conditions and coping strategies may aid development of targeted psychological interventions. We studied hallucinating and non-hallucinating patients suffering from schizophrenia spectrum disorder (n = 57), and non-schizophrenic severe mentally ill patients with depression (n = 37). Data were collected using the Experience Sampling Method (ESM) over a period of 1 week. Contingent on a randomly signalling beep, subjects filled in reports of ongoing hallucinations as well as thought, mood, current activity, social circumstances and places frequented. More subjects suffering from schizophrenia reported hallucinations, but for all hallucinating subjects the qualities of hallucination episodes were quite similar. More subjects reported visual hallucinations at least once. In contrast, the intensity of auditory hallucinations was higher. Anxiety was the most prominent emotion during hallucinations and reports of anxiety intensity exceeded baseline levels before the first report of auditory hallucinations. Context modified hallucination intensity over the course of an episode. Social withdrawal resulted in a decrease of hallucinatory intensity (AH > VH), while social engagement slightly raised intensity levels (VH > AH). Doing nothing (VH > AH) and work activities (AH > VH) led to decreases in intensity levels over time, while passive leisure activities (watching TV) resulted in increases in intensity levels of hallucinations (AH > VH). The results suggest that hallucinating experiences are subject to a host of contextual influences. Understanding variation offers useful insights for therapy.

Role of Acid and Weakly Acidic Reflux in Gastroesophageal Reflux Disease Off Proton Pump Inhibitor Therapy

PubMed Central

Sung, Hea Jung; Moon, Sung Jin; Kim, Jin Su; Lim, Chul Hyun; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Myung-Gye

2012-01-01

Background/Aims Available data about reflux patterns and symptom determinants in the gastroesophageal reflux disease (GERD) subtypes off proton pump inhibitor (PPI) therapy are lacking. We aimed to evaluate reflux patterns and determinants of symptom perception in patients with GERD off PPI therapy by impedance-pH monitoring. Methods We retrospectively reviewed the impedance-pH data in patients diagnosed as GERD based on results of impedance-pH monitoring, endoscopy and/or typical symptoms. The characteristics of acid and weakly acidic reflux were evaluated. Symptomatic and asymptomatic reflux were compared according to GERD subtypes and individual symptoms. Results Forty-two patients (22 males, mean age 46 years) were diagnosed as GERD (17 erosive reflux disease, 9 pH(+) non-erosive reflux disease [NERD], 9 hypersensitive esophagus and 7 symptomatic NERD). A total of 1,725 reflux episodes were detected (855 acid [50%], 857 weakly acidic [50%] and 13 weakly alkaline reflux [< 1%]). Acid reflux was more frequently symptomatic and bolus clearance was longer compared with weakly acidic reflux. In terms of globus, weakly acidic reflux was more symptomatic. Symptomatic reflux was more frequently acid and mixed reflux; these associations were more pronounced in erosive reflux disease and symptomatic NERD. The perception of regurgitation was related to acid reflux, while that of globus was more related to weakly acidic reflux. Conclusions In patients not taking PPI, acid reflux was more frequently symptomatic and had longer bolus clearance. Symptomatic reflux was more frequently acid and mixed type; however, weakly acidic reflux was associated more with globus. These data suggest a role for impedance-pH data in the evaluation of globus. PMID:22837877

Age-related susceptibility to infection with diarrheagenic E. coli in infants from peri-urban areas of Lima, Peru

PubMed Central

Ochoa, Theresa J.; Ecker, Lucie; Barletta, Francesca; Mispireta, Mónica L.; Gil, Ana I.; Contreras, Carmen; Molina, Margarita; Amemiya, Isabel; Verastegui, Hector; Hall, Eric R.; Cleary, Thomas G.; Lanata, Claudio F.

2009-01-01

Background Diarrheagenic E. coli are being recognized as important pediatric enteropathogens worldwide. However, it is unclear whether there are differences in age-related susceptibility to specific agents, especially among infants. Methods We conducted a passive surveillance diarrhea cohort study of 1034 children from 2 to 12 months of age in Lima, Perú. Control stool samples were collected from randomly selected children without diarrhea. All samples were analyzed for common enteric pathogens and for the diarrheagenic E. coli by a multiplex real-time PCR. Results The most commonly isolated pathogens from 1065 diarrheal episodes were the diarrheagenic E. coli (31%), including enteroaggregative (15.1%) and enteropathogenic E. coli (EPEC) (7.6%). Diarrheagenic E. coli, Campylobacter and rotavirus were more frequently isolated from infants ≥ 6m. Diffusely adherent E. coli and enterotoxigenic E. coli (ETEC) were more frequently isolated in diarrheal samples than in controls in older infants (p<0.05). Children ≥ 6m infected with ETEC had a 4.56-fold increased risk for diarrhea (95% CI, 1.20 to 17.28). Persistent diarrhea was more frequent in infants < 6m (13.5% vs. 3.6%, p<0.001). Among diarrheagenic E. coli positive samples, co-infections with other pathogens were more common in diarrhea than in controls (40.1% vs. 15.6%, p<0.001). Conclusions Diarrheagenic E. coli were more frequently isolated in older infants. In this setting with high frequency of pathogen exposure and high frequency of breastfeeding, we hypothesize that the major age-related differences result from decreased exposure to milk protective factors and with increased exposure to contaminated food and water. PMID:19857163

Episodic Memories in Anxiety Disorders: Clinical Implications

PubMed Central

Zlomuzica, Armin; Dere, Dorothea; Machulska, Alla; Adolph, Dirk; Dere, Ekrem; Margraf, Jürgen

2014-01-01

The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD). The available literature on explicit, autobiographical, and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret, and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms. PMID:24795583

Religion and the presence and severity of depression in older adults

PubMed Central

Hayward, R. David; Owen, Amy D.; Koenig, Harold G.; Steffens, David C.; Payne, Martha E.

2011-01-01

Objectives To examine the associations of dimensions of religiousness with the presence and severity of depression in older adults. Design Cross-sectional analysis of clinical and interview data. Setting Private university-affiliated medical center in the Southeastern US. Participants Four hundred seventy-six psychiatric patients with a current episode of unipolar major depression, and 167 nondepressed comparison subjects, ages 58 years and older (mean = 70, SD = 7). Measurements Diagnostic Interview Schedule, Montgomery-Åsberg Depression Rating Scale, Duke Depression Evaluation Schedule. Results Presence of depression was related to less frequent worship attendance, more frequent private religious practice, and moderate subjective religiosity. Among the depressed group, less severe depression was related to more frequent worship attendance, less religiousness, and having had a born-again experience. These results were only partially explained by effects of social support and stress buffering. Conclusions Religion is related to depression diagnosis and severity via multiple pathways. PMID:22273738

Religion and the presence and severity of depression in older adults.

PubMed

Hayward, R David; Owen, Amy D; Koenig, Harold G; Steffens, David C; Payne, Martha E

2012-02-01

: To examine the associations of dimensions of religiousness with the presence and severity of depression in older adults. : Cross-sectional analysis of clinical and interview data. : Private university-affiliated medical center in the Southeastern United States. : Four hundred seventy-six psychiatric patients with a current episode of unipolar major depression, and 167 nondepressed comparison subjects, ages 58 years or older (mean = 70 years, SD = 7). : Diagnostic Interview Schedule, Montgomery-Åsberg Depression Rating Scale, and Duke Depression Evaluation Schedule were used in the study. : Presence of depression was related to less frequent worship attendance, more frequent private religious practice, and moderate subjective religiosity. Among the depressed group, less severe depression was related to more frequent worship attendance, less religiousness, and having had a born-again experience. These results were only partially explained by effects of social support and stress buffering. : Religion is related to depression diagnosis and severity via multiple pathways.

Database of episode-integrated solar energetic proton fluences

NASA Astrophysics Data System (ADS)

Robinson, Zachary D.; Adams, James H.; Xapsos, Michael A.; Stauffer, Craig A.

2018-04-01

A new database of proton episode-integrated fluences is described. This database contains data from two different instruments on multiple satellites. The data are from instruments on the Interplanetary Monitoring Platform-8 (IMP8) and the Geostationary Operational Environmental Satellites (GOES) series. A method to normalize one set of data to one another is presented to create a seamless database spanning 1973 to 2016. A discussion of some of the characteristics that episodes exhibit is presented, including episode duration and number of peaks. As an example of what can be understood about episodes, the July 4, 2012 episode is examined in detail. The coronal mass ejections and solar flares that caused many of the fluctuations of the proton flux seen at Earth are associated with peaks in the proton flux during this episode. The reasoning for each choice is laid out to provide a reference for how CME and solar flares associations are made.

A Philosophical Perspective on Construct Validation: Application of Inductive Logic to the Analysis of Experimental Episode Construct Validity.

ERIC Educational Resources Information Center

Rossi, Robert Joseph

Methods drawn from four logical theories associated with studies of inductive processes are applied to the assessment and evaluation of experimental episode construct validity. It is shown that this application provides for estimates of episode informativeness with respect to the person examined in terms of the construct and to the construct…

Do frequent exposures to threats and violence at work affect later workforce participation?

PubMed

Biering, Karin; Andersen, Lars Peter Sønderbo; Hogh, Annie; Andersen, Johan Hviid

2018-05-01

Threats and violence at work are common problems in the human service sector. It can result in physical and psychological health symptoms. The aim of this study was to examine the association between exposure to threats and violence and workforce participation in four human service sectors. 5170 employees answered questionnaires about threats and violence in 2010 and were followed in a register for public transfer incomes for 3.5 years to identify episodes of sick leave, general workforce participation, and permanent health-related benefits. We found associations between exposures to threats and violence at work and workforce participation, though only a few specific types of threats and violence were associated on their own. Self-rated severity of both threatening and violent episodes was associated with overall low workforce participation, new sick leave episodes, and permanent health-related benefits. However, the latter was not statistically significant. The same pattern seems to be present in the relation between the total amount of exposure to threats and violence (threats score and violence score), respectively, and overall low workforce participation and new sick leave episodes. The threats score was also related to permanent health-related benefits. Exposure to threats and violence is associated with temporary and permanent health-related benefits as well as with low workforce participation in general, although some of the associations were not statistically significant.

A microstructural analysis of schedule-induced polydipsia reveals incentive-induced hyperactivity in an animal model of ADHD.

PubMed

Íbias, Javier; Pellón, Ricardo; Sanabria, Federico

2015-02-01

Recent research has suggested that frequent short bursts of activity characterize hyperactivity associated with attention deficit hyperactivity disorder (ADHD). This study determined whether such pattern is also visible in schedule-induced polydipsia (SIP) in the spontaneously hypertensive rat (SHR), an animal model of ADHD. Male SHR, Wistar Kyoto (WKY) and Wistar rats were exposed to 40 sessions of SIP using a multiple fixed-time (FT) schedule of food delivery with FT 30-s and FT 90-s components. Stable performance was analyzed to determine the extent to which SIP-associated drinking is organized in bouts. The Bi-Exponential Refractory Model (BERM) of free-operant performance was applied to schedule-induced licks. A model comparison analysis supported BERM as a description of SIP episodes: licks were not produced at a constant rate but organized into bouts within drinking episodes. FT 30-s induced similar overall licking rates, latencies to first licks and episode durations across strains; FT 90-s induced longer episode durations in SHRs and reduced licking rate in WKY and Wistar rats to nearly baseline levels. Across schedules, SHRs made more and shorter bouts when compared to the other strains. These results suggest an incentive-induced hyperactivity in SHR that has been observed in operant behaviour and in children with ADHD. Copyright © 2014 Elsevier B.V. All rights reserved.

Incidence and outcome of retained Port-A-Cath fragments during removal.

PubMed

Aworanti, Olugbenga Michael; Linnane, Niall; Tareen, Farhan; Mortell, Alan

2017-07-01

Port-A-Cath devices are frequently used for long-term venous access. We postulate that long-term use predisposes them to getting stuck and retained in a central vein at the time of removal. We aim to report the incidence and outcome of this complication. Between January 2006 and July 2016, a retrospective review of all Port-A-Cath removals that were performed at our centre was conducted. At the time of removal, catheters that could not be removed from the vein were considered retained. During the study period, 107 children had 174 episodes of silicone Sitimplant (Vygon, Ecouen, France) Port-A-Cath insertions. These children required 135 removal episodes and there were 3 (2.2%) instances whereby the catheter fragment was retained. These episodes of retained catheters only occurred in children with factor VIII deficiency (4.1% incidence in this cohort). For each episode of catheter insertion and removal, the catheters had been left in situ for a mean duration of 43 months in children with factor deficiency and no retained fragments, and the mean duration was 91 months in children with factor deficiency and retained catheter fragments (p = 0.0011). Port-A-Caths that are retained after attempted removal is a complication encountered predominantly in catheters that have been in use for a prolonged duration. Furthermore, factor replacement therapy in haemophiliacs may be a risk factor for this complication.

[Pain management nursing in hospitalized patients with non-oncological diseases].

PubMed

Sepúlveda-Sánchez, Juana María; Canca-Sánchez, José Carlos; Rivas-Ruiz, Francisco; Martín-García, Mónica; Pérez-González, María Josefa; Timonet-Andreu, Eva María

2016-01-01

To assess pain management in patients hospitalized with a non-oncological disease and evaluate factors involved in pain assessment. A descriptive, cross-sectional study. We reviewed pain episodes documented in the medical records of 105 patients aged>18 years admitted to the medical units of a regional hospital between September and December 2014. Reports of pain episodes were evaluated by assessing 22 variables related to pain management quality criteria. A total of 184 reports were reviewed. Pain was measured using the visual analogue scale (VAS) in 70.1% of patients (n=129); pain was reassessed in 44.3% (n=54) of patients. Pain reassessment was significantly more frequent in patients aged<70 years, as compared to older patients (53.1 vs. 26.8%, respectively; p=0.01). Pain was more frequently considered to be unrelated to the cause of admission in women as compared to men (50 vs. 25.7% p=0.027). Pain was identified in the patient care plan as a collaborative problem by the nurse for 21.1% of the patients. Some aspects of pain management should be improved, especially those regarding pain description and reassessment. The age and sex of patients significantly influence the approach of pain. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Vertical structure of foggy haze over the Beijing-Tianjin-Hebei area in January 2013

NASA Astrophysics Data System (ADS)

Han, Feng; Xu, Jun; He, Youjiang; Dang, Hongyan; Yang, Xuezhen; Meng, Fan

2016-08-01

In January 2013, frequent episodes of intense air pollution occurred in the Beijing-Tianjin-Hebei area (BTH), China. Besides the occurrence of region-wide dry haze pollution, foggy haze conditions also developed across the region on numerous days, lasting into the afternoon. Synergistic analysis, using multisatellite datasets, air sounding and surface meteorological observations, indicated that there was a vertical overlap of fog and aerosol layers during the foggy haze episodes in the region. Fog appeared at a low level of the atmosphere. The altitude of the upper boundary of the fog differed across the region, but it was always below 1 km. The aerosol layer that closely contacted with the top of the underlying fog was rather dense, having a high concentration comparable to that during severe pollution on the ground. Above the dense aerosol layer, aerosol with a concentration equivalent to that of moderate pollution stretched up to an altitude of 2 km. Beyond that, a tenuous aerosol layer extended 5 km into the atmosphere. This overlapping of fog and haze layers frequently occurred across the region in January 2013. The occurrence of a foggy haze over BTH could worsen the regional air quality, and its appearance across this region would have notable effects on the radiation balance.

Computer animated relaxation therapy in children between 7 and 13 years with tension-type headache: a pilot study.

PubMed

Tornoe, Birte; Skov, Liselotte

2012-03-01

This pilot study evaluated the effect of computer animated relaxation therapy in children between 7 and 13 years with tension-type headache and the children's experiences with the therapy. The therapy consisted of an uncontrolled nine-session course in modified progressive relaxation therapy assisted by computer animated surface EMG provided from the trapezius muscles and with the physiotherapist as a participant observer. Outcome measures were (a) headache frequency and intensity, (b) pericranial tenderness, (c) tension patterns, and (d) evaluations assessed at baseline and at 3 months follow up. Nine children, mean age 10.9 (SD 1.7) years, diagnosed with frequent episodic or chronic tension-type headache completed the course. The results showed a mean improvement of 45% for headache frequency at 3 months follow up versus baseline and a significant reduction in headache frequency for all participants and in Total Tenderness Score for children with frequent episodic tension-type headache. The children expressed a growing understanding of body reactions and an acquired ability to deactivate and regulate these reactions. Computer animated SEMG seems an applicable learning strategy for young headache sufferers. This study suggests that children below the age of 13 need both the dialog and guidance from a participant observer in order to achieve body awareness.

Screening for confabulations with the confabulation screen.

PubMed

Dalla Barba, Gianfranco; Brazzarola, Marta; Marangoni, Sara; La Corte, Valentina

2018-04-24

The objective of this work is to devise and validate a sensitive and specific test for confabulatory impairment. We conceived a screening test for confabulation, the Confabulation Screen (CS), a brief test using 10 questions of episodic memory (EM), where confabulators most frequently confabulate. It was postulated that the CS would predict confabulations not only in EM, but also in the other subordinate structures of personal temporality, namely the present and the future. Thirty confabulating amnesic patients of various aetiologies and 97 normal controls entered the study. Participants were administered the CS and the Confabulation Battery (Dalla Barba, G., & Decaix, C. (2009). "Do you remeber what you did on March 13 1985?" A case study of confabulatory hypermnesia. Cortex, 45(5), 566-574). Confabulations in the CS positively and significantly correlated with confabulations in personal temporality domains of the CB, namely EM, orientation in time and place and episodic plans. Conversely, as expected, they did not correlate with confabulations in impersonal temporality domains of the CB. Consistent with results of previous studies, the most frequently observed type of confabulation in the CS was Habits Confabulation. The CS had high construct validity and good discriminative validity in terms of sensitivity and specificity. Cut-off scores for clinical and research purposes are proposed. The CS provides efficient and valid screening for confabulatory impairment.

Mixed, melancholic, and anxious features in depression: a cross-sectional study of sociodemographic and clinical correlates.

PubMed

Zaninotto, Leonardo; Souery, Daniel; Calati, Raffaella; Scudellari, Paolo; Janiri, Luigi; Montgomery, Stuart; Kasper, Siegfried; Zohar, Joseph; Mendlewicz, Julien; Serretti, Alessandro

2014-11-01

Major depression (MD) is currently viewed as a heterogeneous condition, characterized by different psychopathological dimensions. Our sample was composed of 1,289 nonpsychotic bipolar/unipolar depressed patients. Participants were divided into mixed (MXD), melancholic (MEL), and anxious (ANX) depressed, according to a hierarchical functional model. Sociodemographic and clinical variables were compared across depressive subtypes by χ2 test and analysis of variance. The Young Mania Rating Scale (YMRS) and 2 subscales (melancholic [MEL-S] and psychic-somatic anxiety [PSOM-ANX]) from the Hamilton Depression Rating Scale also served as continuous outcome measures. MXD patients more frequently had bipolar I disorder (BD I), younger age of onset, and a higher familial load for mood disorders. MEL and ANX patients were more frequently diagnosed with major depressive disorder and reported a higher suicide risk. YMRS scores in depression was associated with BD I diagnosis (P < .0001) and manic polarity of the last episode (P < .0001), while a depressive polarity of the last episode (P < .0001) was associated with higher MEL-S score. No specific predictor was associated with PSOM-ANX score. Overall, our findings suggest that mixed depressive features are associated with significant hallmarks of bipolarity, and melancholic features may be influenced by previous depressive polarity. The symptom domain of anxiety appears to have no specific predictor.

Antipsychotic medication for early episode schizophrenia

PubMed Central

Bola, John; Kao, Dennis; Soydan, Haluk; Adams, Clive E

2014-01-01

Background Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment. Objectives To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders. Search methods We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data. Selection criteria Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment. Data collection and analysis Working independently, we critically appraised records from 681 studies, of which five studies met inclusion criteria. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. Main results Five studies (combined total n=998) met inclusion criteria. Four studies (n=724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs n=353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT n=240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT n=236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT n=94, RR 0.96 CI 0.3 to 3.6). Two studies contributed data to assessment of adverse effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications compared to placebo. One trial suggested a higher rehospitalisation rate for those receiving chlorpromazine compared to placebo (n=80, RR 2.29 CI 1.3 to 4.0, NNH 2.9). However, a higher attrition in the placebo group is likely to have introduced a survivor bias into this comparison, as this difference becomes non-significant in a sensitivity analysis on intent-to-treat participants (n=127, RR 1.69 CI 0.9 to 3.0). One study contributes data to a comparison of trifluoperazine to psychotherapy on long-term health in favour of the trifluoperazine group (n=92, MD 5.8 CI 1.6 to 0.0); however, data from this study are also likely to contain biases due to selection and attrition. One other study contributes data to a comparison of typical antipsychotic medication to psychosocial treatment on six-week outcome measures of global psychopathology (n=89, MD 0.01 CI −0.6 to 0.6) and global improvement (n=89, MD −0.03 CI −0.5 to 0.4), indicating no between-group differences. On the whole, there is very little useable data in the few studies meeting inclusion criteria. Authors’ conclusions With only a few studies meeting inclusion criteria, and with limited useable data in these studies, it is not possible to arrive at definitive conclusions. The preliminary pattern of evidence suggests that people with early episode schizophrenia treated with typical antipsychotic medications are less likely to leave the study early, but more likely to experience medication-related side effects. Data are too sparse to assess the effects of antipsychotic medication on outcomes in early episode schizophrenia. PMID:21678355

Bullying at work and onset of a major depressive episode among Danish female eldercare workers.

PubMed

Rugulies, Reiner; Madsen, Ida E H; Hjarsbech, Pernille U; Hogh, Annie; Borg, Vilhelm; Carneiro, Isabella G; Aust, Birgit

2012-05-01

The aim of this study was to analyze whether exposure to workplace bullying among 5701 female employees in the Danish eldercare sector increases the risk of onset of a major depressive episode (MDE). Participants received questionnaires in 2004-2005 and again in 2006-2007. MDE was assessed with the Major Depression Inventory. We examined baseline bullying as a predictor of onset of MDE at follow-up using multiple logistic regression. We further conducted a cross-sectional analysis at the time of follow-up among participants who at baseline were free of bullying, MDE, and signs of reduced psychological health. Finally, we analyzed reciprocal effects, by using baseline bullying and baseline MDE as predictors for bullying and MDE at follow-up. Onset rates of MDE in the groups of no, occasional, and frequent bullying were 1.5%, 3.4%, and 11.3%, respectively. Odds ratios (OR) for onset of MDE were 2.22 [95% confidence interval (95% CI) 1.31-3.76] for occasional bullying and OR 8.45 (95% CI 4.04-17.70) for frequent bullying, after adjustment for covariates. In the cross-sectional analysis, OR were 6.29 (95% CI 2.52-15.68) for occasional bullying and 20.96 (95% CI 5.80-75.80) for frequent bullying. In the analyses on reciprocal effects, both baseline bullying [occasional: OR 2.12 (95% CI 1.29-3.48) and frequent: OR 6.39 (95% CI 3.10-13.17)] and baseline MDE [OR 7.18 (95% CI 3.60-14.30] predicted MDE at follow-up. However, only baseline bullying [occasional: OR 7.44 (95% CI 5.94-9.31) and frequent: OR 11.91 (95% CI 7.56-18.77)] but not baseline MDE [OR 0.93 (95% CI 0.47-1.84)] predicted bullying at follow-up. Workplace bullying increased the risk of MDE among female eldercare workers. MDE did not predict risk of bullying. Eliminating bullying at work may be an important contribution to the prevention of MDE.

Characteristics of menstrual vs nonmenstrual migraine: a post hoc, within-woman analysis of the usual-care phase of a nonrandomized menstrual migraine clinical trial.

PubMed

MacGregor, E Anne; Victor, Timothy W; Hu, Xiaojun; Xiang, Qinfang; Puenpatom, Rajitkanok A; Chen, Wei; Campbell, John C

2010-04-01

To compare, using a within-woman analysis, the severity, duration, and relapse of menstrual vs nonmenstrual episodes of migraine during treatment with usual migraine therapy. Studies comparing the clinical characteristics of menstrual and nonmenstrual migraine attacks have yielded conflicting results, contributing to disagreement regarding whether menstrual migraine attacks are clinically more problematic than nonmenstrual migraine attacks. Post hoc within-woman analysis of the usual-care phase (month 1) of a 2-month, multicenter, prospective, open-label study at 21 US medical practices (predominantly primary care). Participants were women > or =18 years of age with regular predictable menstrual cycles (28 +/- 4 days) who self-reported a > or =1-year history of migraine attacks occurring between days -2 and +3 (menses onset = day +1) and > or =8 such attacks within the previous 12 cycles. Migraine treatment episodes were categorized as menstrual (occurring on days -2 to +3 of menses) or nonmenstrual (occurring on days +4 to -3 of menses). Pain severity, functional impairment, duration, relapse in 24 hours, and use of rescue medication were compared. Sources of variability (within- or between-patient) were determined using mathematical modeling. The http://www.clinicaltrial.gov code for trial is NCT00904098. Women (n = 153; intent to treat) reported 212 menstrual (59.2%) and 146 nonmenstrual (40.8%) migraine treatment episodes. Compared with nonmenstrual treatment episodes, menstrual episodes were more likely to cause impairment (unadjusted odds ratio, 1.65, 95% CI, 1.05-2.60; P = .03), were longer (unadjusted hazard ratio 1.68; 95% CI, 1.31-2.16; P < .001), and were more likely to relapse within 24 hours (unadjusted odds ratio, 2.66; 95% CI, 1.25-5.68; P = .01). Within-patient effects accounted for only 18-33% of the total variance in these outcomes. Post hoc, within-woman analysis of migraine treatment episodes categorized based on International Headache Society criteria showed that menstrual treatment episodes were more impairing, longer lasting, and more likely to relapse than nonmenstrual treatment episodes in this selected population of women with frequent menstrual migraine. The current analysis indicates that most of the variability in these outcomes is due to differences between headache types and not within-patient differences for a given type of headache, suggesting that menstrual episodes are potentially treatable. These findings underscore the differences between menstrual and nonmenstrual episodes of migraine and the need to offer effective migraine treatment to women.

EEG Functional Connectivity Prior to Sleepwalking: Evidence of Interplay Between Sleep and Wakefulness

PubMed Central

Desjardins, Marie-Ève; Carrier, Julie; Lina, Jean-Marc; Fortin, Maxime; Gosselin, Nadia; Montplaisir, Jacques

2017-01-01

Abstract Study Objectives: Although sleepwalking (somnambulism) affects up to 4% of adults, its pathophysiology remains poorly understood. Sleepwalking can be preceded by fluctuations in slow-wave sleep EEG signals, but the significance of these pre-episode changes remains unknown and methods based on EEG functional connectivity have yet to be used to better comprehend the disorder. Methods: We investigated the sleep EEG of 27 adult sleepwalkers (mean age: 29 ± 7.6 years) who experienced a somnambulistic episode during slow-wave sleep. The 20-second segment of sleep EEG immediately preceding each patient’s episode was compared with the 20-second segment occurring 2 minutes prior to episode onset. Results: Results from spectral analyses revealed increased delta and theta spectral power in the 20 seconds preceding the episodes’ onset as compared to the 20 seconds occurring 2 minutes before the episodes. The imaginary part of the coherence immediately prior to episode onset revealed (1) decreased delta EEG functional connectivity in parietal and occipital regions, (2) increased alpha connectivity over a fronto-parietal network, and (3) increased beta connectivity involving symmetric inter-hemispheric networks implicating frontotemporal, parietal and occipital areas. Conclusions: Taken together, these modifications in EEG functional connectivity suggest that somnambulistic episodes are preceded by brain processes characterized by the co-existence of arousal and deep sleep. PMID:28204773

[Role of rifaximin in the treatment of hepatic encephalopathy].

PubMed

Sanchez-Delgado, Jordi; Miquel, Mireia

2016-04-01

Hepatic encephalopathy (HE) is a frequent and serious complication of liver cirrhosis. In addition to correction of the precipitating factors, the most commonly used treatments are non-absorbable disaccharides and rifaximin. Many of the recommendations are based on current clinical practice and there are few randomized controlled trials. Currently, rifaximin should be initiated during an episode of EH if, after 24-48 hours of non-absorbable disaccharide therapy, there is no clinical improvement. In recurrent EH, it is advisable to add rifaximin in patients under non-absorbable disaccharide therapy who develop a new episode. Currently, standard treatment with rifaximin for minimal EH is not recommended. Rifaximin is effective in the acute treatment of overt encephalopathy and in preventing recurrence. Copyright © 2015 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

Dual diagnosis in Depression: treatment recommendations.

PubMed

Tirado Muñoz, Judit; Farré, Adriana; Mestre-Pintó, Joan; Szerman, Nestor; Torrens, Marta

2018-01-01

Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separately.

Hepatic Encephalopathy: From the Pathogenesis to the New Treatments

PubMed Central

Cordoba, Juan

2014-01-01

Hepatic encephalopathy is a frequent and serious complication of liver cirrhosis; the pathophysiology of this complication is not fully understood although great efforts have been made during the last years. There are few prospective studies on the epidemiology of this complication; however, it is known that it confers with high short-term mortality. Hepatic encephalopathy has been classified into different groups depending on the degree of hepatic dysfunction, the presence of portal-systemic shunts, and the number of episodes. Due to the large clinical spectra of overt EH and the complexity of cirrhotic patients, it is very difficult to perform quality clinical trials for assessing the efficacy of the treatments proposed. The physiopathology, clinical manifestation, and the treatment of HE is a challenge because of the multiple factors that converge and coexist in an episode of overt HE. PMID:27335836

Ischemia episode detection in ECG using kernel density estimation, support vector machine and feature selection

PubMed Central

2012-01-01

Background Myocardial ischemia can be developed into more serious diseases. Early Detection of the ischemic syndrome in electrocardiogram (ECG) more accurately and automatically can prevent it from developing into a catastrophic disease. To this end, we propose a new method, which employs wavelets and simple feature selection. Methods For training and testing, the European ST-T database is used, which is comprised of 367 ischemic ST episodes in 90 records. We first remove baseline wandering, and detect time positions of QRS complexes by a method based on the discrete wavelet transform. Next, for each heart beat, we extract three features which can be used for differentiating ST episodes from normal: 1) the area between QRS offset and T-peak points, 2) the normalized and signed sum from QRS offset to effective zero voltage point, and 3) the slope from QRS onset to offset point. We average the feature values for successive five beats to reduce effects of outliers. Finally we apply classifiers to those features. Results We evaluated the algorithm by kernel density estimation (KDE) and support vector machine (SVM) methods. Sensitivity and specificity for KDE were 0.939 and 0.912, respectively. The KDE classifier detects 349 ischemic ST episodes out of total 367 ST episodes. Sensitivity and specificity of SVM were 0.941 and 0.923, respectively. The SVM classifier detects 355 ischemic ST episodes. Conclusions We proposed a new method for detecting ischemia in ECG. It contains signal processing techniques of removing baseline wandering and detecting time positions of QRS complexes by discrete wavelet transform, and feature extraction from morphology of ECG waveforms explicitly. It was shown that the number of selected features were sufficient to discriminate ischemic ST episodes from the normal ones. We also showed how the proposed KDE classifier can automatically select kernel bandwidths, meaning that the algorithm does not require any numerical values of the parameters to be supplied in advance. In the case of the SVM classifier, one has to select a single parameter. PMID:22703641

Psychotherapy with Women Who Have Worked in the “Sex Industry”

PubMed Central

Anklesaria, Ariz

2012-01-01

Psychotherapy is effective for a myriad of mental health symptoms, with the clinical situation dictating the most applicable method. For episodes of severe stress including acute depression and anxiety, supportive mechanisms (crisis interventions and shoring up existing coping skills and strategies) may be the best fit. During periods of relatively milder symptomatology a psychodynamic approach may be utilized with the same patient (focusing on self-reflection and a more in-depth exploration). This article focuses on the use of psychotherapy with women working in the sex industry, whether indoor (such as strip clubs and cabarets) or outdoor (such as prostitution and escort services). These women frequently experience violence in various forms, and most report multiple traumatic experiences, both during their developmental years and while working in the industry. A composite case is included that illustrates some of the supportive and psychodynamic psychotherapy techniques that can be applied when treating these individuals. PMID:23198274

Use of intrathecal urokinase in repeated shunt and external ventricular drain blockage from high CSF protein due to an optic pathway glioma.

PubMed

Shooman, David; Vajramani, Girish V; Davidson, Jennifer; Sparrow, Owen C

2010-05-01

High cerebrospinal fluid (CSF) protein is a recognised association of optic pathway gliomas. This can occlude ventriculoperitoneal (VP) shunt catheters or external ventricular drains (EVD). We describe an 8-year-old boy with an optic pathway glioma, who had frequent episodes of a blocked VP shunt and EVD due to high CSF protein level. This responded favourably to repeated urokinase instillation into the catheter lumen. We present the course of treatment and the method of administration and review the literature behind thrombolytic therapy for occluded catheter devices. Intrathecal urokinase was effective in unblocking the EVD and lysing the protein clots within the ventricle. We found no previously published cases of intrathecal urokinase for this problem. This novel intervention seemed promising as a safe and effective means of maintaining EVD patency in cases complicated by excessive protein loads in CSF and hydrocephalus.

Filtering Data Based on Human-Inspired Forgetting.

PubMed

Freedman, S T; Adams, J A

2011-12-01

Robots are frequently presented with vast arrays of diverse data. Unfortunately, perfect memory and recall provides a mixed blessing. While flawless recollection of episodic data allows increased reasoning, photographic memory can hinder a robot's ability to operate in real-time dynamic environments. Human-inspired forgetting methods may enable robotic systems to rid themselves of out-dated, irrelevant, and erroneous data. This paper presents the use of human-inspired forgetting to act as a filter, removing unnecessary, erroneous, and out-of-date information. The novel ActSimple forgetting algorithm has been developed specifically to provide effective forgetting capabilities to robotic systems. This paper presents the ActSimple algorithm and how it was optimized and tested in a WiFi signal strength estimation task. The results generated by real-world testing suggest that human-inspired forgetting is an effective means of improving the ability of mobile robots to move and operate within complex and dynamic environments.

Quantitative Measurements of Autobiographical Memory Content

PubMed Central

Mainetti, Matteo; Ascoli, Giorgio A.

2012-01-01

Autobiographical memory (AM), subjective recollection of past experiences, is fundamental in everyday life. Nevertheless, characterization of the spontaneous occurrence of AM, as well as of the number and types of recollected details, remains limited. The CRAM (Cue-Recalled Autobiographical Memory) test (http://cramtest.info) adapts and combines the cue-word method with an assessment that collects counts of details recalled from different life periods. The SPAM (Spontaneous Probability of Autobiographical Memories) protocol samples introspection during everyday activity, recording memory duration and frequency. These measures provide detailed, naturalistic accounts of AM content and frequency, quantifying essential dimensions of recollection. AM content (∼20 details/recollection) decreased with the age of the episode, but less drastically than the probability of reporting remote compared to recent memories. AM retrieval was frequent (∼20/hour), each memory lasting ∼30 seconds. Testable hypotheses of the specific content retrieved in a fixed time from given life periods are presented. PMID:23028629

Anomalous diffusion in neutral evolution of model proteins.

PubMed

Nelson, Erik D; Grishin, Nick V

2015-06-01

Protein evolution is frequently explored using minimalist polymer models, however, little attention has been given to the problem of structural drift, or diffusion. Here, we study neutral evolution of small protein motifs using an off-lattice heteropolymer model in which individual monomers interact as low-resolution amino acids. In contrast to most earlier models, both the length and folded structure of the polymers are permitted to change. To describe structural change, we compute the mean-square distance (MSD) between monomers in homologous folds separated by n neutral mutations. We find that structural change is episodic, and, averaged over lineages (for example, those extending from a single sequence), exhibits a power-law dependence on n. We show that this exponent depends on the alignment method used, and we analyze the distribution of waiting times between neutral mutations. The latter are more disperse than for models required to maintain a specific fold, but exhibit a similar power-law tail.

Anomalous diffusion in neutral evolution of model proteins

NASA Astrophysics Data System (ADS)

Nelson, Erik D.; Grishin, Nick V.

2015-06-01

Protein evolution is frequently explored using minimalist polymer models, however, little attention has been given to the problem of structural drift, or diffusion. Here, we study neutral evolution of small protein motifs using an off-lattice heteropolymer model in which individual monomers interact as low-resolution amino acids. In contrast to most earlier models, both the length and folded structure of the polymers are permitted to change. To describe structural change, we compute the mean-square distance (MSD) between monomers in homologous folds separated by n neutral mutations. We find that structural change is episodic, and, averaged over lineages (for example, those extending from a single sequence), exhibits a power-law dependence on n . We show that this exponent depends on the alignment method used, and we analyze the distribution of waiting times between neutral mutations. The latter are more disperse than for models required to maintain a specific fold, but exhibit a similar power-law tail.

Critical analysis of dual-chamber implantable cardioverter-defibrillator arrhythmia detection : results and technical considerations.

PubMed

Wilkoff, B L; Kühlkamp, V; Volosin, K; Ellenbogen, K; Waldecker, B; Kacet, S; Gillberg, J M; DeSouza, C M

2001-01-23

One of the perceived benefits of dual-chamber implantable cardioverter-defibrillators (ICDs) is the reduction in inappropriate therapy due to new detection algorithms. It was the purpose of the present investigation to propose methods to minimize bias during such comparisons and to report the arrhythmia detection clinical results of the PR Logic dual-chamber detection algorithm in the GEM DR ICD in the context of these methods. Between November 1997 and October 1998, 933 patients received the GEM DR ICD in this prospective multicenter study. A total of 4856 sustained arrhythmia episodes (n=311) with stored electrogram and marker channel were classified by the investigators; 3488 episodes (n=232) were ventricular tachycardia (VT)/ventricular fibrillation (VF), and 1368 episodes (n=149) were supraventricular tachycardia (SVT). The overall detection results were corrected for multiple episodes within a patient with the generalized estimating equations (GEE) method with an exchangeable correlation structure between episodes. The relative sensitivity for detection of sustained VT and/or VF was 100.0% (3488 of 3488, n=232; 95% CI 98.3% to 100%), the VT/VF positive predictivity was 88.4% uncorrected (3488 of 3945, n=278) and 78.1% corrected (95% CI 73.3% to 82.3%) with the GEE method, and the SVT positive predictivity was 100.0% (911 of 911, n=101; 95% CI 96% to 100%). A structured approach to analysis limits the bias inherent in the evaluation of tachycardia discrimination algorithms through the use of relative VT/VF sensitivity, VT/VF positive predictivity, and SVT positive predictivity along with corrections for multiple tachycardia episodes in a single patient.

Anaphylaxis in children: clinical and allergologic features.

PubMed

Novembre, E; Cianferoni, A; Bernardini, R; Mugnaini, L; Caffarelli, C; Cavagni, G; Giovane, A; Vierucci, A

1998-04-01

Despite the importance of anaphylaxis, little information is available on its clinical features. To evaluate the clinical and allergologic features of anaphylaxis in children referred to the allergology and immunology unit of A. Meyer Children's Hospital (Florence, Italy) from 1994 to 1996. Ninety-five episodes of anaphylaxis occurred in 76 children (50 boys and 26 girls). Sixty-six children (87%) had only one episode of anaphylaxis, while 10 (13%) had two or more episodes. Sixty-two (82%) of the 76 patients had a personal history of atopic symptoms, although 14 (18%) did not. Sixty (79%) of the 76 children studied had at least one positive skin prick test to one or more of the common inhalant and/or food allergens. Children with venom-induced anaphylaxis usually had negative skin tests to the allergens tested. A younger age and eczema were more frequent among children with food-dependent anaphylaxis, whereas an older age together with urticaria-angioedema were common among those with exercise-induced anaphylaxis. The mean latent period (+/-SD) of the anaphylaxis episodes was 15.4 +/- 27.5 minutes. Skin and respiratory manifestations had an earlier onset and were more common than the gastrointestinal and cardiovascular ones. The most frequent clinical manifestation in children with food anaphylaxis was gastrointestinal symptoms, whereas cardiovascular symptoms were rare. The most probable causative agents in the 95 episodes described were foods (57%), drugs (11%), hymenoptera venom (12%), exercise (9%), additives (1%), specific immunotherapy (1%), latex (1%), and vaccines (2%), but in 6 cases (6%) the agent was never determined. Among the foods, seafood and milk were the most frequently involved. As for location, 57% of the anaphylactic events occurred in the home (54/95), 12% outdoors (11/95); 5% in restaurants (5/95); 3% in the doctor's office (3/95); 3% in hospitals (3/95); 3% on football fields (3/95); 2% on the beach (2/95); 1% in the gym (1/95); 1% at school (1/95); and 1% in the operating room (1/95). In the remaining 12% of cases (11/95) the site remained unknown. Sixty-two percent of the patients (59/95) were treated in an emergency room or hospital, while 32% (30/95) were not (this information is lacking in 6% of the cases [6/95]). Patients were treated with corticosteroids in 72% of the cases (68/95), with antihistamines in 20% (19/95), with epinephrine in 18% (17/95), with beta2-agonists in 5% (5/95), and with oxygen in 4% (4/95). In our area, foods, particularly seafood and milk, seem to be the most important etiologic factors triggering anaphylaxis. Food-induced anaphylaxis often occurs in younger children with a severe food allergy, whereas exercise-induced anaphylaxis occurs more often in older children with a history of urticaria-angioedema. The venom-induced variant usually presents itself in nonatopic subjects. Given the fact that most of the children had only one anaphylactic reaction, prevention is almost impossible. Epinephrine, although it is the first-choice treatment of anaphylaxis, often goes unused, even in hospitals and doctors' offices.

Onset of frequent dust storms in northern China at ~AD 1100.

PubMed

He, Yuxin; Zhao, Cheng; Song, Mu; Liu, Weiguo; Chen, Fahu; Zhang, Dian; Liu, Zhonghui

2015-11-26

Dust storms in northern China strongly affect the living and health of people there and the dusts could travel a full circle of the globe in a short time. Historically, more frequent dust storms occurred during cool periods, particularly the Little Ice Age (LIA), generally attributed to the strengthened Siberian High. However, limited by chronological uncertainties in proxy records, this mechanism may not fully reveal the causes of dust storm frequency changes. Here we present a late Holocene dust record from the Qaidam Basin, where hydrological changes were previously reconstructed, and examine dust records from northern China, including the ones from historical documents. The records, being broadly consistent, indicate the onset of frequent dust storms at ~AD 1100. Further, peaked dust storm events occurred at episodes of high total solar irradiance or warm-dry conditions in source regions, superimposed on the high background of frequent dust storms within the cool LIA period. We thus suggest that besides strong wind activities, the centennial-scale dust storm events over the last 1000 years appear to be linked to the increased availability of dust source. With the anticipated global warming and deteriorating vegetation coverage, frequent occurrence of dust storms in northern China would be expected to persist.

[Home Parenteral Nutrition (HPN) registry in Spain for the years 2007, 2008 and 2009 (NADYA-SENPE Group)].

PubMed

Puiggrós, C; Gómez-Candela, C; Chicharro, L; Cuerda, C; Virgili, N; Martínez, C; Moreno, J M; Pérez de la Cruz, A; Alvarez, J; Luengo, L M; Ordóñez, J; Wanden-Berghe, C; Cardona, D; Laborda, L; Garde, C; Pedrón, C; Gómez, L; Penacho, M A; Martínez-Olmos, M A; Apezetxea, A; Sánchez-Vilar, O; Cánovas, B; García, Y; Forga, M T; Gil, C

2011-01-01

To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2007, 2008 and 2009. We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st 2007 to December 31st 2009. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. 2007: 133 patients with HPN were registered (61 males and 72 females), belonging to 21 hospitals. Average age for the 119 patients older than 13 years old was 53.7 ± 14.9 years, and 3.6 ± 3.6 y. for the 14 patients under 14 years old. Most frequent pathology was neoplasm (24%), followed by intestinal motility disorders and actinic enteritis (14% both). The reason for HPN provision was short bowel syndrome (43%), malabsorption (27%), and intestinal obstruction (23%). Tunnelled catheters were mostly used (69%), followed by implanted port-catheters (27%). Catheter related infections were the most frequent complications, with a rate of 0.92 episodes/103 HPN days. HPN was provided for more than two years in 50% of the cases. By the end of 2007, 71.4% of the patients remained active; exitus was the most frequent reason to end HPN (57.5%). 26% of the patients were eligible for intestinal transplant. 2008: 143 patients with HPN were registered (62 males and 81 females), belonging to 24 hospitals. Average age for the 133 patients older than 13 years old was 54.7 ± 13.9 years, and 3.7 ± 0.6 y. for the 10 patients under 14 years old. Most frequent pathology was neoplasm (20%), followed by actinic enteritis (14%) and intestinal motility disorders (13% ). The reason for HPN provision was short bowel syndrome (44%), malabsorption (28%), and intestinal obstruction (20%). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (29%). Catheter related infections were the most frequent complications, with a rate of 0.50 episodes/10³ HPN days. HPN was provided for more than two years in 67% of the cases. By the end of 2008, 71.6% of the patients remained active; exitus was the most frequent reason to end HPN (52.4%). 29% of the patients were eligible for intestinal transplant. 2009: 158 patients with HPN were registered (62 males and 96 females), belonging to 24 hospitals. Average age for the 149 patients older than 13 years old was 55.2 ± 13.0 years. Most frequent pathology was neoplasm (25%), followed by actinic enteritis (12%) and intestinal motility disorders (11%). The reason for HPN provision was short bowel syndrome (42%), malabsorption, and intestinal obstruction (23% both). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (36%). Catheter related infections were the most frequent complications, with a rate of 0.67 episodes/10³ HPN days. HPN was provided for more than two years in 58% of the cases. By the end of 2009, 79.2% of the patients remained active; full oral nutrition was the most frequent reason to end HPN (48%). 23% of the patients were eligible for intestinal transplant. We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections in the last two years, being the 2008 rate the smallest since the register's beginning.

The Infant Born to a Woman with Gestational Diabetes.

PubMed

Povinelli, Theresa; Lim, Caitlin; Raines, Deborah A

2017-07-01

Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset during pregnancy. During pregnancy, women with GDM develop insulin resistance, which results in altered glucose tolerance. As a result, there are frequent episodes of hyperglycemia and high levels of circulating amino acids, increasing the transfer of nutrients to the fetus. This article discusses the role of the mother-baby nursing in the care of neonates born to women with gestational diabetes.

Clinical Features of Candidiasis in Patients With Inherited Interleukin 12 Receptor β1 Deficiency

PubMed Central

Ouederni, Monia; Sanal, Ozden; Ikincioğullari, Aydan; Tezcan, Ilhan; Dogu, Figen; Sologuren, Ithaisa; Pedraza-Sánchez, Sigifredo; Keser, Melike; Tanir, Gonul; Nieuwhof, Chris; Colino, Elena; Kumararatne, Dinakantha; Levy, Jacov; Kutukculer, Necil; Aytekin, Caner; Herrera-Ramos, Estefanía; Bhatti, Micah; Karaca, Neslihan; Barbouche, Ridha; Broides, Arnon; Goudouris, Ekaterini; Franco, José Luis; Parvaneh, Nima; Reisli, Ismail; Strickler, Alexis; Shcherbina, Anna; Somer, Ayper; Segal, Anthony; Angel-Moreno, Alfonso; Lezana-Fernandez, José Luis; Bejaoui, Mohamed; Bobadilla-Del Valle, Miriam; Kachboura, Salem; Sentongo, Timothy; Ben-Mustapha, Imen; Bustamante, Jacinta; Picard, Capucine; Puel, Anne; Boisson-Dupuis, Stéphanie; Abel, Laurent; Casanova, Jean-Laurent; Rodríguez-Gallego, Carlos

2014-01-01

Background. Interleukin 12Rβ1 (IL-12Rβ1)–deficient patients are prone to clinical disease caused by mycobacteria, Salmonella, and other intramacrophagic pathogens, probably because of impaired interleukin 12–dependent interferon γ production. About 25% of patients also display mucocutaneous candidiasis, probably owing to impaired interleukin 23–dependent interleukin 17 immunity. The clinical features and outcome of candidiasis in these patients have not been described before, to our knowledge. We report here the clinical signs of candidiasis in 35 patients with IL-12Rβ1 deficiency. Results. Most (n = 71) of the 76 episodes of candidiasis were mucocutaneous. Isolated oropharyngeal candidiasis (OPC) was the most common presentation (59 episodes, 34 patients) and was recurrent or persistent in 26 patients. Esophageal candidiasis (n = 7) was associated with proven OPC in 2 episodes, and cutaneous candidiasis (n = 2) with OPC in 1 patient, whereas isolated vulvovaginal candidiasis (VVC; n = 3) was not. Five episodes of proven invasive candidiasis were documented in 4 patients; 1 of these episodes was community acquired in the absence of any other comorbid condition. The first episode of candidiasis occurred earlier in life (median age±standard deviation, 1.5 ± 7.87 years) than infections with environmental mycobacteria (4.29 ± 11.9 years), Mycobacterium tuberculosis (4 ± 3.12 years), or Salmonella species (4.58 ± 4.17 years) or other rare infections (3 ± 11.67 years). Candidiasis was the first documented infection in 19 of the 35 patients, despite the vaccination of 10 of these 19 patients with live bacille Calmette-Guérin. Conclusions. Patients who are deficient in IL-12Rβ1 may have candidiasis, usually mucocutaneous, which is frequently recurrent or persistent. Candidiasis may be the first clinical manifestation in these patients. PMID:24186907

Can local adaptation explain varying patterns of herbivory tolerance in a recently introduced woody plant in North America?

PubMed

Long, Randall W; Bush, Susan E; Grady, Kevin C; Smith, David S; Potts, Daniel L; D'Antonio, Carla M; Dudley, Tom L; Fehlberg, Shannon D; Gaskin, John F; Glenn, Edward P; Hultine, Kevin R

2017-01-01

Patterns of woody-plant mortality have been linked to global-scale environmental changes, such as extreme drought, heat stress, more frequent and intense fires, and episodic outbreaks of insects and pathogens. Although many studies have focussed on survival and mortality in response to specific physiological stresses, little attention has been paid to the role of genetic heritability of traits and local adaptation in influencing patterns of plant mortality, especially in non-native species. Tamarix spp. is a dominant, non-native riparian tree in western North America that is experiencing dieback in some areas of its range due to episodic herbivory by the recently introduced northern tamarisk leaf beetle ( Diorhabda carinulata ). We propose that genotype × environment interactions largely underpin current and future patterns of Tamarix mortality. We anticipate that (i) despite its recent introduction, and the potential for significant gene flow, Tamarix in western North America is generally adapted to local environmental conditions across its current range in part due to hybridization of two species; (ii) local adaptation to specific climate, soil and resource availability will yield predictable responses to episodic herbivory; and (iii) the ability to cope with a combination of episodic herbivory and increased aridity associated with climate change will be largely based on functional tradeoffs in resource allocation. This review focusses on the potential heritability of plant carbon allocation patterns in Tamarix , focussing on the relative contribution of acquired carbon to non-structural carbohydrate (NSC) pools versus other sinks as the basis for surviving episodic disturbance. Where high aridity and/or poor edaphic position lead to chronic stress, NSC pools may fall below a minimum threshold because of an imbalance between the supply of carbon and its demand by various sinks. Identifying patterns of local adaptation of traits related to resource allocation will improve forecasting of Tamarix population susceptibility to episodic herbivory.

Can local adaptation explain varying patterns of herbivory tolerance in a recently introduced woody plant in North America?

PubMed Central

Bush, Susan E.; Grady, Kevin C.; Smith, David S.; Potts, Daniel L.; D'Antonio, Carla M.; Dudley, Tom L.; Fehlberg, Shannon D.; Gaskin, John F.; Glenn, Edward P.; Hultine, Kevin R.

2017-01-01

Abstract Patterns of woody-plant mortality have been linked to global-scale environmental changes, such as extreme drought, heat stress, more frequent and intense fires, and episodic outbreaks of insects and pathogens. Although many studies have focussed on survival and mortality in response to specific physiological stresses, little attention has been paid to the role of genetic heritability of traits and local adaptation in influencing patterns of plant mortality, especially in non-native species. Tamarix spp. is a dominant, non-native riparian tree in western North America that is experiencing dieback in some areas of its range due to episodic herbivory by the recently introduced northern tamarisk leaf beetle (Diorhabda carinulata). We propose that genotype × environment interactions largely underpin current and future patterns of Tamarix mortality. We anticipate that (i) despite its recent introduction, and the potential for significant gene flow, Tamarix in western North America is generally adapted to local environmental conditions across its current range in part due to hybridization of two species; (ii) local adaptation to specific climate, soil and resource availability will yield predictable responses to episodic herbivory; and (iii) the ability to cope with a combination of episodic herbivory and increased aridity associated with climate change will be largely based on functional tradeoffs in resource allocation. This review focusses on the potential heritability of plant carbon allocation patterns in Tamarix, focussing on the relative contribution of acquired carbon to non-structural carbohydrate (NSC) pools versus other sinks as the basis for surviving episodic disturbance. Where high aridity and/or poor edaphic position lead to chronic stress, NSC pools may fall below a minimum threshold because of an imbalance between the supply of carbon and its demand by various sinks. Identifying patterns of local adaptation of traits related to resource allocation will improve forecasting of Tamarix population susceptibility to episodic herbivory. PMID:28852513

Evidence-based treatment of frequent heartburn: the benefits and limitations of over-the-counter medications.

PubMed

McRorie, Johnson W; Gibb, Roger D; Miner, Philip B

2014-06-01

This review summarizes the pharmacological effects of over-the-counter (OTC) heartburn drugs, and the implications for treating frequent heartburn. PubMed and SCOPUS were searched across all years to identify well-controlled, randomized clinical studies that assessed mechanism of action and efficacy. Antacids can transiently neutralize acid in the esophagus, but do not significantly affect gastric pH or prevent subsequent heartburn episodes. Histamine-2 receptor antagonists (H2 RAs) rapidly develop tolerance with repeat dosing, and exhibit an analgesic effect that may provide heartburn relief while leaving the esophagus exposed to acid. Proton pump inhibitors (PPIs) provide a sustained inhibition of gastric acid production, and are superior to antacids and H2 RAs for control of gastric acid and treatment of frequent heartburn. When recommending therapies for frequent heartburn, it is of particular importance to understand the strengths and weaknesses of available OTC medications. Antacids and H2 RAs are not recommended for treatment of frequent heartburn, while OTC PPIs are both indicated for, and effective for, treatment of frequent heartburn. A PPI dose of 20 mg is optimal for empiric treatment of frequent heartburn, and consistent with the 2013 treatment guidelines established by the American College of Gastroenterology (ACG) for treatment with a minimum effective dose. ©2014 The Author(s) ©2014 American Association of Nurse Practitioners.

Transcranial direct current stimulation (tDCS) and its influence on analgesics effectiveness in patients suffering from migraine headache.

PubMed

Przeklasa-Muszyńska, Anna; Kocot-Kępska, Magdalena; Dobrogowski, Jan; Wiatr, Maciej; Mika, Joanna

2017-08-01

Headache is one of the most common conditions troubling nearly 45% of the world's population. Migraine headache itself, being more common among women, affects 7-18% of people. As much as 20-30% of the population report accompanying aura and neurological symptoms. In many cases, migraine headache can be effectively treated with suitably selected pharmacotherapies which include drugs used in symptomatic treatment. Frequent occurrence of the condition is treated with prophylaxis, which often fails. Neuromodulating methods are part of the multidirectional treatment and they may be valuable complement to pharmacotherapy. Our study evaluates the impact of the transcranial direct current stimulation (tDCS) on the consumption of drugs and on pain conditions (frequency, duration, intensity). We recruited 50 patients with migraine headache (30 with aura, 20 without aura) refractory to pharmacological therapy. In 30 patients (18 with aura, 12 without aura) previous unsatisfactory treatment was supplemented with tDCS performed tenfold. 20 patients (12 with aura, 8 without aura) from a control group were treated with pharmacological methods The observation continued for 30 days after the stimulation. After tDCS, a reduction in the consumption of analgesics and triptans was reported. Additionally, we monitored pain intensity decrease during pain episodes, duration of episodes and the number of pain days. The subjective assessment of pain reduction in migraine patients encompassed 36-40% after tDCS much more effective in comparison to group with only pharmacotherapy (10-12.5%). The study suggests that tDCS may be safe and useful clinical tool in migraine prophylaxis and treatment. Copyright © 2017 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Exploring Alcohol-Use Behaviors Among Heterosexual and Sexual Minority Adolescents: Intersections With Sex, Age, and Race/Ethnicity

PubMed Central

Hughes, Tonda L.; Aranda, Frances; Birkett, Michelle; Marshal, Michael P.

2014-01-01

Objectives. We examined sexual orientation status differences in alcohol use among youths aged 13 to 18 years or older, and whether differences were moderated by sex, age, or race/ethnicity. Methods. We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys and conducted weighted analyses, adjusting for complex design effects. We operationalized sexual orientation status with items assessing sexual orientation identity, sexual behavior, sexual attraction, or combinations of these. Results. Compared with exclusively heterosexual youths, sexual-minority youths were more likely to report each of the primary study outcomes (i.e., lifetime and past-month alcohol use, past-month heavy episodic drinking, earlier onset of drinking, and more frequent past-month drinking). Alcohol-use disparities were larger and more robust for (1) bisexual youths than lesbian or gay youths, (2) girls than boys, and (3) younger than older youths. Few differences in outcomes were moderated by race/ethnicity. Conclusions. Bisexual youths, sexual-minority girls, and younger sexual-minority youths showed the largest alcohol-use disparities. Research is needed that focuses on identifying explanatory or mediating mechanisms, psychiatric or mental health comorbidities, and long-term consequences of early onset alcohol use, particularly frequent or heavy use, among sexual-minority youths. PMID:24328614

Molecular Epidemiology of Rhinovirus Detections in Young Children

PubMed Central

Howard, Leigh M.; Johnson, Monika; Gil, Ana I.; Griffin, Marie R.; Edwards, Kathryn M.; Lanata, Claudio F.; Williams, John V.; Grijalva, Carlos G.

2016-01-01

Background. Human rhinoviruses (HRVs) are frequently detected in children with acute respiratory illnesses (ARIs) but also in asymptomatic children. We compared features of ARI with HRV species (A, B, C) and determined genotypes associated with repeated HRV detections within individuals. Methods. We used clinical data and respiratory samples obtained from children <3 years old during weekly active household-based surveillance. A random subset of samples in which HRV was detected from individuals during both ARI and an asymptomatic period within 120 days of the ARI were genotyped. Features of ARI were compared among HRV species. Concordance of genotype among repeated HRV detections within individuals was assessed. Results. Among 207 ARI samples sequenced, HRV-A, HRV-B, and HRV-C were detected in 104 (50%), 20 (10%), and 83 (40%), respectively. Presence of fever, decreased appetite, and malaise were significantly higher in children with HRV-B. When codetections with other viruses were excluded (n = 155), these trends persisted, but some did not reach statistical significance. When 58 paired sequential HRV detections during asymptomatic and ARI episodes were sequenced, only 9 (16%) were identical genotypes of HRV. Conclusions. Clinical features may differ among HRV species. Repeated HRV detections in young children frequently represented acquisition of new HRV strains. PMID:26900577

Treatment of gonorrhoea in Auckland, New Zealand: marked variation in prescriber adherence to treatment guidelines.

PubMed

Forster, Rose; Ng, Diana; Upton, Arlo; Franklin, Rick; Thomas, Mark

2017-06-01

The relentless emergence and spread of strains of Neisseria gonorrhoeae that are resistant to many antimicrobial agents has led to frequent changes in treatment guidelines, with a consequent risk that prescribers may not be aware of current guidelines. To determine the proportion of patients with gonorrhoea who were treated with a regimen consistent with the New Zealand Sexual Health Society (NZSHS) guidelines. We audited the treatment given to adult patients with laboratory-proven gonorrhoea in Auckland, New Zealand, during the first 6 months of 2015. Treatment compliant with the current NZSHS guidelines was administered in only 65% (458/706) episodes overall. Guideline-compliant treatment was much more likely to be prescribed for patients who presented to a sexual health clinic (89%) than for patients who presented to either a general practice or other community clinic (52%) or to a hospital (56%) (P < 0.0001). Overall, 52 of 706 (7%) episodes were not treated with any antimicrobial regimen by the service that diagnosed the patients' gonorrhoea, 13 of 62 (21%) episodes in patients who presented to a hospital, 34 of 403 (8%) episodes in patients who presented to a general practice or other community clinic and 5 of 241 (2%) episodes in patients who presented to a sexual health clinic (P < 0.0001). Low levels of compliance with treatment guidelines increase the risk that antibiotic-resistant strains of N. gonorrhoeae will spread within the Auckland region. Improved compliance with treatment guidelines, particularly in patients who present either to general practice or to hospitals, is necessary to maintain the efficacy of current treatment regimens. © 2017 Royal Australasian College of Physicians.

Survey of spatial disorientation in military pilots and navigators.

PubMed

Holmes, Sharon R; Bunting, Alex; Brown, David Lex; Hiatt, Keith L; Braithwaite, Malcolm G; Harrigan, Michael J

2003-09-01

The direction of future spatial disorientation (SD) research and training is shaped primarily by the outcome of formal investigation of aircraft accidents and incidents. However, another source of vital information is aircrews' experience of SD that does not result in reported incidents. A short postal SD survey was distributed to 5 Naval Air Squadrons, 22 Joint Helicopter Command Units, and 7 Royal Air Force stations in the United Kingdom. There were 752 questionnaires, including responses from 562 pilots and 149 navigators, that were returned. Analysis was conducted primarily on the pilot data. The most frequently experienced SD episodes were "the leans" (by 92% of respondents), loss of horizon due to atmospheric conditions (82%), misleading altitude cues (79%), sloping horizon (75%), and SD arising from distraction (66%). In general, the frequency of SD episodes and ratings of severity of the worst ever SD episode were positively related to flying experience (p < 0.05). Overall, pilots who had received in-flight SD training reported more episodes of SD than those who had not participated in this training (p < 0.05). Differences in types of SD experienced were found between aircraft categories, e.g., more episodes of SD during night vision goggle use were reported by rotary-wing pilots compared with fast-jet aviators (p < 0.05). This preliminary survey has shown that SD is still a significant hazard of military flying. Overall, this study shows that the postal questionnaire is a useful tool for assessing how SD training and experience may benefit the recognition of situations that may cause SD. However, it is difficult to access those situations where aircrew were truly disorientated.

Do you remember? How caregivers question their spouses who have Alzheimer's disease and the impact on communication.

PubMed

Small, Jeff A; Perry, JoAnn

2005-02-01

This study examined the types of questions caregivers use and their outcomes when conversing with their spouse with Alzheimer's disease (AD). Of particular interest was caregivers' use of yes-no and open-ended questions and the demands they make on the memory of the person with AD. It was hypothesized that communication between caregivers and their spouses would be more successful when caregivers used yes-no rather than open-ended questions; however, it was also predicted that a more positive communication outcome would occur when caregivers used open-ended questions that requested information from semantic rather than episodic memory. Eighteen caregivers and their spouses diagnosed with AD were audiotaped while they conversed for approximately 10 min on a topic of their choosing. The conversations were transcribed and coded according to the occurrence of questions, the type of question (yes-no, choice, or open-ended), the type of memory required to respond to a question (semantic or episodic), and the outcome of a response to a question (communication breakdown). The results indicated that caregivers used yes-no and open-ended questions to a similar extent, whereas episodic questions were used almost twice as frequently as semantic questions. Communication was more successful when caregivers used yes-no compared with open-ended questions and when questions placed demands on semantic rather than episodic memory. The findings from this study suggest that caregivers can reduce communication problems by avoiding the use of questions that depend on episodic memory. In addition, while yes-no questions were associated with more favorable outcomes than open-ended questions, the latter do not need to be avoided if they refer to information that draws only on semantic memory.

Indoor human exposure to size-fractionated aerosols during the 2015 Southeast Asian smoke haze and assessment of exposure mitigation strategies

NASA Astrophysics Data System (ADS)

Sharma, Ruchi; Balasubramanian, Rajasekhar

2017-11-01

The 2015 smoke haze episode was one of the most severe and prolonged transboundary air pollution events ever seen in Southeast Asia (SEA), affecting the air quality of several countries within the region including Indonesia, Malaysia and Singapore. The 24 h mean outdoor PM2.5 (particulate matter (PM) with aerodynamic diameter ≤ 2.5 μm) concentrations ranged from 72-157 μg m-3 in Singapore during this episode, exceeding the WHO 24 h mean PM2.5 guidelines (25 μg m-3) several times over. The smoke haze episode not only affected ambient air quality, but also indoor air quality due to the migration of PM of different sizes from the outdoor to the indoor environment. Despite the frequent occurrence of smoke haze episodes over the years, their potential health impacts on indoor building occupants remain largely unknown in SEA due to the lack of systematic investigations and observational data. The current work was carried out in Singapore to assess human exposure to size-resolved PM during the 2015 smoke haze episode, and to evaluate the effectiveness of exposure mitigation measures in smoke-haze-impacted naturally ventilated indoor environments. The potential health risks associated with exposure to PM2.5 were assessed based on the concentrations of redox active particulate-bound trace elements, which are known to be harmful to human health, with and without exposure mitigation. Overall, it was observed that human health exposure to PM2.5 and its carcinogenic chemical components was reduced substantially by 62% (p < 0.05) while using an air cleaner. However, extremely small hazardous particles were only partially removed by the air cleaner and remain a matter of concern for public health.

EffenDys-Fentanyl Buccal Tablet for the Relief of Episodic Breathlessness in Patients With Advanced Cancer: A Multicenter, Open-Label, Randomized, Morphine-Controlled, Crossover, Phase II Trial.

PubMed

Simon, Steffen T; Kloke, Marianne; Alt-Epping, Bernd; Gärtner, Jan; Hellmich, Martin; Hein, Rebecca; Piel, Maren; Cornely, Oliver A; Nauck, Friedemann; Voltz, Raymond

2016-11-01

Episodic breathlessness is a frequent and burdensome symptom in cancer patients but pharmacological treatment is limited. To determine time to onset, efficacy, feasibility, and safety of transmucosal fentanyl in comparison to immediate-release morphine for the relief of episodic breathlessness. Phase II, investigator-initiated, multicenter, open-label, randomized, morphine-controlled, crossover trial with open-label titration of fentanyl buccal tablet (FBT) in inpatients with incurable cancer. The primary outcome was time to onset of meaningful breathlessness relief. Secondary outcomes were efficacy (breathlessness intensity difference at 10 and 30 minutes; sum of breathlessness intensity difference at 15 and 60 minutes), feasibility, and safety. Study was approved by local ethics committees. Twenty-five of 1341 patients were eligible, 10 patients agreed to participate (four female, mean age 58 ± 11, mean Karnofsky score 67 ± 11). Two patients died before final visits and two patients dropped-out because of disease progression leaving six patients for analysis with 61 episodes of breathlessness. Mean time to onset was for FBT 12.7 ± 10.0 and for immediate-release morphine 23.6 ± 15.1 minutes with a mean difference of -10.9 minutes (95% CI = -24.5 to 2.7, P = 0.094). Efficacy measures were predominately in favor for FBT. Both interventions were safe. Feasibility failed because of too much study demands for a very ill patient group. The description of a faster and greater relief of episodic breathlessness by transmucosal fentanyl versus morphine justifies further evaluation by a full-powered trial. Copyright © 2016. Published by Elsevier Inc.

Economic burden of gouty arthritis attacks for employees with frequent and infrequent attacks.

PubMed

Lynch, Wendy; Chan, Wing; Kleinman, Nathan; Andrews, L M; Yadao, Anthony M

2013-04-01

The objective of this study was to compare episode-related and annual costs and work absence days for employees with <3 versus ≥ 3 annual gout attacks. Human Capital Management Services data (2009-2010) from adult employees with gout (International Classification of Diseases, Ninth Revision code 274.x) and ≥ 12 months of medical and pharmacy benefits were studied. Outcomes of interest included medical and drug costs, number of emergency department and urgent care visits, number of inpatient days, short- and long-term disability, sick leave, workers' compensation costs, and work absence days. An algorithm based on diagnosis code and antigout medication use identified acute gout treatment episodes. Multivariate analysis compared annual and pre-episode vs. during-episode outcomes for employees with ≥ 3 vs. <3 gout annual attacks. Of 3361 employees with gout, 76 had ≥ 3 attacks; these employees had higher short-term disability costs ($1663 vs. $643, P=0.06) and days (11.68 versus 4.61, P<0.05), more emergency room visits (0.55 vs. 0.23, P<0.0001), and urgent care visits (0.07 vs. 0.04, P<0.01), and lower pharmacy costs ($1677 vs. $1108, P<0.0001) than those with <3 attacks. Medical costs both before ($203 higher) and during attacks ($136 higher) were significantly higher for those with ≥ 3 attacks than for those with <3 attacks. Additionally, a quadratic increasing relationship was found between number of attacks and cost. Frequency of acute gout attacks (≥ 3 episodes per year) among employees with gout was associated with greater short-term disability cost, absence days, and emergency department and urgent care visits, and trends toward higher overall costs.

The real world cost and health resource utilization associated to manic episodes: The MANACOR study.

PubMed

Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnín, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduard

2015-01-01

Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables. Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations. One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost. Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

A Long-Term Retention Advantage for Spatial Information Learned Naturally and in the Laboratory

DTIC Science & Technology

1989-06-09

study. Memory & Cognition, 10, 324-332. Tulving, E. (1972). Episodic and semantic memory . In E. Tulving & W. Donaldson (Eds.), Organization of memory ...the cognitive research literature. Some of the better known divisions include the distinction between semantic , episodic and procedural knowledge...the probe method by being more structured and more focused on specific memory episodes . In general, questionnaire studies simply involve formulating

Hypoglycaemic haemiparesis

PubMed Central

Kirresh, Othman; Kamara, Achmed; Samadian, Samad

2013-01-01

Hypoglycaemic haemiparesis (HH) is an uncommon but important presentation to the emergency department, and it often mimics stroke and is therefore frequently misdiagnosed by clinicians. The mechanism of haemiparesis is not fully understood. This case outlines a diabetic elderly woman, who had been having frequent hypoglycaemic episodes and presented to paramedics with hypoglycaemia associated with a right-sided haemiparesis. She was immediately transferred to the local stroke centre after presenting to the emergency department. CT and MRI did not fit in with her presenting neurology. Her weakness resolved, after normoglycaemia was achieved with dextrose infusion; however, she was reported to be more sleepy and drowsy than usual. After extensive and costly investigations during her prolonged inpatient stay, her unifying diagnosis was an HH which triggered of a hypoactive delirium. PMID:24130203

Introduction to section 2. Climax-stage magmatism: Growth history Of Kilauea Volcano and its instability

NASA Astrophysics Data System (ADS)

Lipman, Peter W.

On the south flank of Hawai'i Island, frequent eruptions, abundant earthquakes, and rapid ground deformation mark the current locus of volcanism along the Hawaiian Ridge. Kïlauea and Mauna Loa volcanoes are in a tholeiitic shield-building stage, erupting mainly on land. South of Kïlauea, Lö'ihi Seamount has erupted alkalic and transitional basalts that mark the growth of Hawai`i's youngest volcano. Kïlauea is the most active volcano on Earth, and its summit caldera and two rift zones characterize the typical shield stage of Hawaiian volcanoes. Kïlauea's south flank, between the rift zones, is subject to sustained and episodic seaward displacements associated with frequent earthquakes and expressed on land by the Hilina fault system.

Medication regimens of frail older adults after discharge from home health care

PubMed Central

Lancaster, Rachelle; Marek, Karen Dorman; Bub, Linda Denison; Stetzer, Frank

2015-01-01

The purpose of this study was to examine the number and types of discrepancy errors present after discharge from home health care in older adults at risk for medication management problems following an episode of home healthcare. More than half of the 414 participants had at least one medication discrepancy error (53.2%, n=219) with the participant’s omission of a prescribed medication (n=118, 30.17%) occurring most frequently. The results of this study support the need for home health clinicians to perform frequent assessments of medication regimens to ensure that the older adults are aware of the regimen they are prescribed, and have systems in place to support them in managing their medications. PMID:25268528

Differential Response of Coral Assemblages to Thermal Stress Underscores the Complexity in Predicting Bleaching Susceptibility.

PubMed

Chou, Loke Ming; Toh, Tai Chong; Toh, Kok Ben; Ng, Chin Soon Lionel; Cabaitan, Patrick; Tun, Karenne; Goh, Eugene; Afiq-Rosli, Lutfi; Taira, Daisuke; Du, Rosa Celia Poquita; Loke, Hai Xin; Khalis, Aizat; Li, Jinghan; Song, Tiancheng

2016-01-01

Coral bleaching events have been predicted to occur more frequently in the coming decades with global warming. The susceptibility of corals to bleaching during thermal stress episodes is dependent on many factors and an understanding of these underlying drivers is crucial for conservation management. In 2013, a mild bleaching episode ensued in response to elevated sea temperature on the sediment-burdened reefs in Singapore. Surveys of seven sites highlighted variable bleaching susceptibility among coral genera-Pachyseris and Podabacia were the most impacted (31% of colonies of both genera bleached). The most susceptible genera such as Acropora and Pocillopora, which were expected to bleach, did not. Susceptibility varied between less than 6% and more than 11% of the corals bleached, at four and three sites respectively. Analysis of four of the most bleached genera revealed that a statistical model that included a combination of the factors (genus, colony size and site) provided a better explanation of the observed bleaching patterns than any single factor alone. This underscored the complexity in predicting the coral susceptibility to future thermal stress events and the importance of monitoring coral bleaching episodes to facilitate more effective management of coral reefs under climate change.

Differential Response of Coral Assemblages to Thermal Stress Underscores the Complexity in Predicting Bleaching Susceptibility

PubMed Central

Toh, Kok Ben; Ng, Chin Soon Lionel; Cabaitan, Patrick; Tun, Karenne; Goh, Eugene; Afiq-Rosli, Lutfi; Taira, Daisuke; Du, Rosa Celia Poquita; Loke, Hai Xin; Khalis, Aizat; Li, Jinghan; Song, Tiancheng

2016-01-01

Coral bleaching events have been predicted to occur more frequently in the coming decades with global warming. The susceptibility of corals to bleaching during thermal stress episodes is dependent on many factors and an understanding of these underlying drivers is crucial for conservation management. In 2013, a mild bleaching episode ensued in response to elevated sea temperature on the sediment-burdened reefs in Singapore. Surveys of seven sites highlighted variable bleaching susceptibility among coral genera–Pachyseris and Podabacia were the most impacted (31% of colonies of both genera bleached). The most susceptible genera such as Acropora and Pocillopora, which were expected to bleach, did not. Susceptibility varied between less than 6% and more than 11% of the corals bleached, at four and three sites respectively. Analysis of four of the most bleached genera revealed that a statistical model that included a combination of the factors (genus, colony size and site) provided a better explanation of the observed bleaching patterns than any single factor alone. This underscored the complexity in predicting the coral susceptibility to future thermal stress events and the importance of monitoring coral bleaching episodes to facilitate more effective management of coral reefs under climate change. PMID:27438593

[Higher Brain Dysfunction in Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis and Stroke-Like Episodes (MELAS)].

PubMed

Ichikawa, Hiroo

2016-02-01

Stroke-like episodes are one of the cardinal features of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), and occur in 84-99% of the patients. The affected areas detected on neuroimaging do not have classical vascular distribution, and involve predominantly the temporal, parietal and occipital lobes. Thus, the neurological symptoms including higher brain dysfunction correlate with this topographical distribution. In association with the occipital lobe involvement, the most frequent symptom is cortical blindness. Other symptoms have been occasionally reported in case reports: visual agnosia, prosopagnosia, cortical deafness, auditory agnosia, topographical disorientation, various types of aphasia, hemispatial neglect, and so on. On the other hand, cognitive decline associated with more diffuse brain impairment rather than with focal stroke-like lesions has been postulated. This condition is also known as mitochondrial dementia. Domains of cognitive dysfunction include abstract reasoning, verbal memory, visual memory, language (naming and fluency), executive or constructive functions, attention, and visuospatial function. Cognitive functions and intellectual abilities may decline from initially minimal cognitive impairment to dementia. To date, the neuropsychological and neurologic impairment has been reported to be associated with cerebral lactic acidosis as estimated by ventricular spectroscopic lactate levels.

Analysis of Solar Spectral Irradiance Measurements from the SBUV/2-Series and the SSBUV Instruments

NASA Technical Reports Server (NTRS)

Cebula, Richard P.; DeLand, Matthew T.; Hilsenrath, Ernest

1997-01-01

The NOAA-9 SBEV/2 instrument has made the first regular measurements ot solar UV activity over a complete solar cycle, beginning in March 1985 and continuing as of this writing. The NOAA-9 solar irradiance data set includes the minimum between Cycles 21-22 and the current minimum at the end of Cycle 22. Although overall solar activity is low during these periods, 27-day rotational modulation is frequently present. The episode of 13-day periodicity observed during September 1994 - March 1995 shows that phenomena previously associated with high levels of solar activity can occur at any point in the solar cycle. The 205 nm irradiance and Mg II index measured by NOAA-9 showed very similar behavior during the Cycle 21-22 minimum in 1985-1986, when 27-day periodicity dominated short-term solar variations, but behaved differently in 1994-1995 during the episode of 13-day periodicity. We plan further investigations into the physical causes of this result, since it affects the extent to which the Mg II index is an accurate proxy for 205 nm irradiance variations during such episodes. The NOAA-9 Mg II data are available.

The chemotherapeutic agent paclitaxel selectively impairs reversal learning while sparing prior learning, new learning and episodic memory.

PubMed

Panoz-Brown, Danielle; Carey, Lawrence M; Smith, Alexandra E; Gentry, Meredith; Sluka, Christina M; Corbin, Hannah E; Wu, Jie-En; Hohmann, Andrea G; Crystal, Jonathon D

2017-10-01

Chemotherapy is widely used to treat patients with systemic cancer. The efficacy of cancer therapies is frequently undermined by adverse side effects that have a negative impact on the quality of life of cancer survivors. Cancer patients who receive chemotherapy often experience chemotherapy-induced cognitive impairment across a variety of domains including memory, learning, and attention. In the current study, the impact of paclitaxel, a taxane derived chemotherapeutic agent, on episodic memory, prior learning, new learning, and reversal learning were evaluated in rats. Neurogenesis was quantified post-treatment in the dentate gyrus of the same rats using immunostaining for 5-Bromo-2'-deoxyuridine (BrdU) and Ki67. Paclitaxel treatment selectively impaired reversal learning while sparing episodic memory, prior learning, and new learning. Furthermore, paclitaxel-treated rats showed decreases in markers of hippocampal cell proliferation, as measured by markers of cell proliferation assessed using immunostaining for Ki67 and BrdU. This work highlights the importance of using multiple measures of learning and memory to identify the pattern of impaired and spared aspects of chemotherapy-induced cognitive impairment. Copyright © 2017 Elsevier Inc. All rights reserved.

Suicide attempts and clinical features of bipolar patients.

PubMed

Berkol, Tonguç D; İslam, Serkan; Kırlı, Ebru; Pınarbaşı, Rasim; Özyıldırım, İlker

2016-06-01

To identify clinical predictors of suicide attempts in patients with bipolar disorder. This study included bipolar patients who were treated in the Psychiatry Department, Haseki Training and Research Hospital, Istanbul, Turkey, between 2013 and 2014; an informed consent was obtained from the participants. Two  hundred and eighteen bipolar patients were assessed by using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis-I (SCID-I) in order to detect all possible psychiatric comorbid diagnoses. Clinical predictors of suicide attempts were examined in attempters and non-attempters. The study design was retrospective. The lifetime suicide attempt rate for the entire sample was 19.2%. Suicide attempters with bipolar disorder had more lifetime comorbidity of eating disorder. Female gender and family history of mood disorder were significant predictors for suicide attempts. There was no difference between groups in terms of bipolar disorder subtype, onset age of bipolar disorder, total number of episodes, first and predominant episode type, suicide history in first degree relatives, severity of episodes, and hospitalization and being psychotic. Our study revealed that female gender, family history of mood disorder, and eating disorder are more frequent in bipolar patients with at least one suicide attempt.

Frequency and Correlates of Diary-Measured Hangover-Like Experiences in a College Sample

PubMed Central

Piasecki, Thomas M.; Slutske, Wendy S.; Wood, Phillip K.; Hunt-Carter, Erin E.

2010-01-01

A sample of college students, oversampled for smoking (N = 127, 43% smokers), monitored daily experiences using electronic diaries over 14 days. We examined the frequency and correlates of liberally-defined hangover-like experiences (HLEs) using data from 1,595 person-days (1,325 following abstention from drinking, 270 following drinking, including 125 HLEs). More than 40% of the sample reported at least one HLE and nearly half of all drinking episodes were followed by HLE. Endorsement of HLE was more likely as the number of drinks increased and was associated with modest elevations of hangover symptoms. Gender did not predict rates of overall HLE endorsement, but males were less likely to report HLE after a drinking episode and showed a weaker relation between number of drinks and HLE. Smokers were more likely to report HLE, but there was no evidence that smoking status was associated with increased HLE susceptibility. Self-reported parental alcohol problems were associated with more frequent HLE and incrementally predicted HLE endorsement when number of drinks was covaried. The findings suggest HLE is a common outcome of college drinking and attest to the feasibility of using electronic diaries to assess its episode- and person-level correlates. PMID:20307125

Increased severity of Escherichia coli peritonitis in peritoneal dialysis patients independent of changes in in vitro antimicrobial susceptibility testing.

PubMed

Valdés-Sotomayor, Jorge; Cirugeda, Antonio; Bajo, María-Auxiliadora; del Peso, Gloria; Escudero, Elena; Sánchez-Tomero, José A; Selgas, Rafael

2003-01-01

Despite improvements in peritoneal dialysis (PD) technique, peritonitis continues to be one of the most frequent complications of PD. Nonresolving peritonitis remains a risk for severe anatomical peritoneal changes that may limit the viability of the membrane for dialysis purposes. We have observed remarkably poor outcome of peritonitis caused by Escherichia coli in the past 6 years. With its very low response rate to broad-spectrum antibiotics, the increased severity of E. coli peritonitis deteriorates peritoneal function and affects patient outcome. Retrospective study. Two large PD units in two university hospitals. The total number of patients reviewed was 456. The records of 49 E. coli peritonitis episodes were studied.The observation period started in 1980 and ended in March 2001. Sixteen males and 19 females were included. Severity was defined in terms of days of peritoneal inflammation, lack of response to a potentially useful antibiotic, requirement for catheter removal, and/or laparotomy. Study cases (study group) were those episodes appearing after 1996 (when the first severe cases appeared) and historic controls were episodes occurring before 1996. In the study group, 18 peritonitis episodes developed in 15 patients. In the control group, 31 peritonitis episodes developed in 20 patients. There were no significant differences in clinical presentation; however, the outcome was significantly poorer for the later period. A severe outcome occurred in 50% of study versus 10% of control patients. In fact, 68% of the episodes registered before 1996 were cured in 3 days or less. Concurring with this trend, the numbers of surgical interventions and catheter removals were also higher in the study group. Strikingly, E. coli did not show changes in in vitro susceptibility testing to antibiotics, although the in vivo response was much worse. We describe a change in the virulence of E. coli peritonitis episodes over the past 5 years leading to a high percentage of treatment failure, which does not depend on antibiotic sensitivity and seems to be dependent on changes in host response mechanisms.

Secondary inorganic aerosols formation during haze episodes at an urban site in Beijing, China

NASA Astrophysics Data System (ADS)

Zhang, Rui; Sun, Xuesong; Shi, Aijun; Huang, Yuhu; Yan, Jing; Nie, Teng; Yan, Xiao; Li, Xuan

2018-03-01

Severe PM2.5 pollution was observed frequently in Beijing. We conducted highly time-resolved measurements of inorganic ions associated with PM2.5 at an urban site in Beijing from 10 February to 19 March, 2015. The average PM2.5 mass concentrations during the six haze episodes ranged from 113.0 μg/m3 to 182.6 μg/m3, which were more than 8 times higher than those observed in clean periods. The secondary inorganic species (NH4+, SO42- and NO3-) in PM2.5 sharply increased during the haze episodes, indicating more extensive formation of SO42- and NO3-. The sulfur oxidation ratios (SOR) and the nitrogen oxidation ratios (NOR) in haze episodes were higher than those in clean periods, which indicated that secondary transformation in haze episodes was more significant than those in clean periods. No correlations between SOR and the oxidants (O3 and HONO) and the temperature were found, whereas a high correlation between SOR and relative humidity (RH) was found in haze episodes, which implied that sulfate was mainly produced by the aqueous-phase oxidation of SO2 rather than the gas-phase conversion of SO2 to sulfate. The conversion of SO2 to SO42- was observed to be sensitive to changes in RH. Furthermore, the SOR sharply increased at RH > 60% with the highest value of 0.88 at RH around 80% during complicated pollution. NO2 played an important role in the rapid sulfate formation with high RH and NH3 neutralization conditions in haze episodes in Beijing. The impact of RH was less apparent for nitrate than for sulfate. Nitrate was found to be produced mainly by photochemical and heterogeneous reactions, while heterogeneous reactions had a greater influence on NOR at nighttime. The NO3-/SO42- ratio indicated that mobile sources contributed more to the formation of PM2.5 than stationary sources. The result suggested the need for control of vehicle emissions to reduce the high levels of NOx and nitrate and the severe PM2.5 pollution in Beijing.

Continuous Measurement of Methane Ebullition Flux from a Northern Peatland using a Fast Methane Analyzer

NASA Astrophysics Data System (ADS)

Zhongjie, Y.; Schafer, K. V.; Slater, L. D.; Varner, R. K.; Amante, J.; Comas, X.; Reeve, A. S.; Alcivar, W.; Gonzalez, D.

2012-12-01

Northern peatlands are an important source of methane (CH4) release to the atmosphere, estimated at between 20 and 50 Tg/yr. Recent work on CH4 emissions from peatlands has demonstrated that ebullition can be a more important emission pathway than previously assumed. However, accurate quantification of the atmospheric CH4 burden due to ebullition is still very limited because ebullition exhibits high spatiotemporal variability such that sudden episodic events are difficult to capture and quantify with existing experimental methods. We have initiated a novel measurement program to better quantify the spatiotemporal variability in CH4 flux in peatlands, and to examine potential effects of vegetation and environmental factors, e.g. atmospheric pressure, water table, etc on these releases. A flow-through system was designed, consisting of a closed static chamber and a fast methane analyzer (FMA) (LI-COR model 7700) that has been employed at both the field and laboratory scale. The CH4 concentration in the air flowing through the chamber is continuously measured by the analyzer and used to reconstruct continuous CH4 emission fluxes. The high sampling rate of the FMA makes it sensitive to both ebullition and diffusion of gaseous CH4, capturing short duration, episodic ebullition fluxes. Non-steady static chamber measurements were also conducted to cross-validate the continuous measurements. Results acquired during summer 2011 show that episodic ebullition occurred more frequently at the pool site where previous studies indicate extensive wood layers at depth and the vegetation was a mix of Sphagnum and wooded heath. During a 3 day period of continuous measurements captured the passage of a tropical storm Irene, where short term episodic releases of CH4, ranging from 113 mg CH4/m2/d to 202 mg CH4/m2/d, were observed at the time of lowest atmospheric pressure, providing new evidence that atmospheric pressure is an important factor to controlling CH4 ebullition from peatlands. While traditional techniques, e.g. static chamber measurement can only occasionally detect the occurrence of ebullition, the continuous measurement by using a flow-through system is able to resolve spatiotemporal complexity of episodic CH4 ebullition events. These continuous CH4 measurements provide new insights into the timing of CH4 ebullition from peatlands to the atmosphere as climate changes and the role of environmental variables in regulating these CH4 releases.

The Etiology and Clinical Course of Chronic Pancreatitis in Children With Early Onset of the Disease.

PubMed

Wejnarska, Karolina; Kolodziejczyk, Elwira; Wertheim-Tysarowska, Katarzyna; Dadalski, Maciej; Sobczynska-Tomaszewska, Agnieszka; Kierkus, Jarosław; Bal, Jerzy; Rygiel, Agnieszka Magdalena; Oracz, Grzegorz

2016-12-01

The etiological factors of chronic pancreatitis (CP) in children differ from those in adults. To date, no study has assessed the clinical course of CP in young children. The aim of our study was to evaluate the etiology and the clinical presentation of the disease in children with disease onset before 5 years of age in comparison to later-onset of CP. A total of 276 children with CP, hospitalized from 1988 to 2015, were enrolled in the study. Data on presentation, diagnostic findings, and treatment were reviewed. Two hundred sixty patients were screened for the most frequent mutations in major pancreatitis-associated genes, such as cationic trypsinogen/serine protease gene (PRSS1), serine protease inhibitor, Kazal type 1 gene (SPINK1), and cystic fibrosis transmembrane conductance regulator gene (CFTR). The disease onset before the age of 5 years occurred in 51 patients (group 1), the later onset in 225 patients (group 2). We found no significant discrepancies in distribution of the etiological factors between groups. The youngest patients (group 1) had more pancreatitis episodes (median 5.0 vs 3.00; P < 0.05) and underwent surgeries more frequently (25.5% vs 8.9%; P < 0.05). It could be associated with significantly longer follow-up in early onset group (median 6 vs 4 years; P < 0.05). There were no differences in nutritional status or exocrine and endocrine pancreatic function. Early- and later-onset pancreatitis have similar etiological factors with predominance of gene mutations. The most frequent mutation found was p.Asn34Ser (N34S) in SPINK1 gene. The clinical presentation differed in number of pancreatitis episodes and frequency of surgeries.

Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis.

PubMed

Isidro, María L; Jorge, Segundo

2013-04-01

To evaluate the association between recreational drug use and diabetic ketosis (DK) and diabetic ketoacidosis (DKA) in our area. Retrospective examination of records from a 1,450 bed urban teaching hospital in Spain. All adult admissions for DK or DKA from January 1, 2005, to December 31, 2009 in our hospital were included. Demographic, exploratory (blood pressure, heart rate, respiratory rate), and analytical data (glucose, urea, creatinine, corrected Na(+), K(+), pH, HCO3(-) and HbA1c) at admittance were recorded. In 152 patients, 253 episodes of DK or DKA occurred. Screening for drug use was performed in 40.3% of the events; 20.6% of the episodes (n = 52) were shown to be substance abuse. Cocaine, followed by cannabis and alcohol, was the most frequently involved drug. Poly-substance abuse occurred in 67.3% of them. Comorbidities were present in 11.5 and 39.8% of the cases shown and not shown to be related to drug use (P = 0.00). Seventy percent of the patients who were at least once shown to have consumed drugs, and 15.9% of those who were never shown to have done so, were admitted more than once (P = 0.00). The frequency of recent drug misuse in patients presenting with DK or DKA was high. Substance abuse screening was frequently neglected. Adverse profile, most significantly in readmission to hospital, was found in the patients with positive drug findings. History taking in this context should routinely include questions on substance abuse, and toxicology screening may be worthwhile, particularly in those with the history of frequent readmissions.

Intense dust episodes in the Mediterranean and possible effects on atmospheric lapse rates

NASA Astrophysics Data System (ADS)

Hatzianastassiou, Nikos; Gkikas, Antonis; Papadimas, Christos D.; Gavrouzou, Maria

2016-04-01

Dust aerosols are major contributor to the atmospheric particulate matter, having significant effects on climate and weather patterns as well as on human health, not to mention others like agriculture or ocean chlorophyll. Moreover, these effects are maximized under conditions of massive dust concentration in the atmosphere, namely dust episodes or events. Such events are caused by uplifting and transport of dust from arid and semi-arid areas under favorable synoptic conditions. The Mediterranean basin, nearby to the greatest world deserts of North Africa and Middle East, frequently undergoes dust episodes. During such Mediterranean episodes, the number and mass concentration of dust is high, due to the proximity of its source areas. The dust episodes, through the direct interaction of dust primarily withthe shortwave but also with longwave radiation can lead to strong local warming in the atmosphere, possibly causing temperature inversion during daytime. The existence of such temperature inversions, associated with intense dust episodes in the Mediterranean, is the focus in this study. The methodology followed to achieve the scientific goal of the study consists in the use of a synergy of different data. This synergy enables: (i) the determination of intense dust episodes over the Mediterranean, (ii) the investigation and specification of temperature lapse rates and inversions during the days of dust episodes and (iii) the identification of vertical distribution of aerosols in the atmosphere over specific locations during the days of the episodes. These objectives are achieved through the use of data from: (i) the AERosol Robotic NETwork (AERONET) network, (ii) the Upper Air Observations (radiosondes) database of the University of Wyoming (UoW) and (iii) the European Aerosol Research Lidar Network (EARLINET) database. The study period spans the years from 2000 to 2013, constrained by the data availability of the databases. A key element of the methodology is the simultaneous availability of data from all these three databases for a specific Mediterranean location and day. Here, results are presented for two stations, Lecce (Italy) and Thessaloniki (Greece). For each station, using long-term AERONET daily aerosol retrievals, including optical depth (AOD), and applying a specific methodology aiming to find out days in which aerosol burden is unusually high, dust episodes are determined for specific days. Subsequently, for these days, a search is made for simultaneously available UoW radiosonde and EARLINET aerosol profiles (vertically distributed aerosol backscatter and extinction coefficients). This procedure led in a number of study case dust episodes, which were further confirmed by back-trajectories of air masses obtained with the Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) Model. Our study reveals that during the investigated episodes, in the daytime, high dust atmospheric loadings induce temperature inversions in heights ranging from the surface to the top of boundary, but also through to the lower free tropospheric layer.

Risk factors for repetition of a deliberate self-harm episode within seven days in adolescents and young adults: A population-level record linkage study in Western Australia.

PubMed

Hu, Nan; Glauert, Rebecca A; Li, Jianghong; Taylor, Catherine L

2016-02-01

The risk of repetition of deliberate self-harm peaks in the first 7 days after a deliberate self-harm episode. However, thus far no studies have examined the risk factors for repeating deliberate self-harm during this short-term period. We aimed to investigate the effects of socio-demographic factors, self-harm method and mental health factors in adolescents (10-19 years old) and young adults (20-29 years old). We used data linkage of population-wide administrative records from hospital inpatients and emergency departments to identify all the deliberate self-harm-related episodes that occurred in adolescents and young adults in Western Australia from 2000 to 2011. Logistic regression with generalised estimating equations was used for the analyses. The incidence of repeating deliberate self-harm within the first 7 days after an index episode was 6% (403/6,768) in adolescents and 8% (842/10,198) in young adults. Socio-demographic risk factors included female gender and socioeconomic disadvantage. Compared with non-poisoning, self-poisoning predicted increased risk of having a repeated deliberate self-harm episode in males, but not in females. Borderline personality, impulse-control and substance use disorders diagnosed within one week before and one week after an index deliberate self-harm episode conferred the highest risk, followed by depressive and anxiety disorders. Having a preceding deliberate self-harm episode up to 7 days before an index episode was a strong predictor for the future repetition of a deliberate self-harm episode. Having a repeated deliberate self-harm episode within the first 7 days was related to a wide range of factors present at an index deliberate self-harm episode including socio-demographic characteristics, deliberate self-harm method and co-existing psychiatric conditions. These factors can inform risk assessments tailored to adolescents and young adults respectively to reduce the repetition of deliberate self-harm within a short but critical period, potentially contributing to reduce the repetition of deliberate self-harm in the long term. © The Royal Australian and New Zealand College of Psychiatrists 2016.

The Association between Nutritional Status and Malaria in Children from a Rural Community in the Amazonian Region: A Longitudinal Study

PubMed Central

Alexandre, Márcia Almeida Araújo; Benzecry, Silvana Gomes; Siqueira, Andre Machado; Vitor-Silva, Sheila; Melo, Gisely Cardoso; Monteiro, Wuelton Marcelo; Leite, Heitor Pons; Lacerda, Marcus Vinícius Guimarães; Alecrim, Maria das Graças Costa

2015-01-01

Background The relationship between malaria and undernutrition is controversial and complex. Synergistic associations between malnutrition and malaria morbidity and mortality have been suggested, as well as undernutrition being protective against infection, while other studies found no association. We sought to evaluate the relationship between the number of malaria episodes and nutritional statuses in a cohort of children below 15 years of age living in a rural community in the Brazilian Amazon. Methodology/Principal Findings Following a baseline survey of clinical, malaria and nutritional assessment including anthropometry measurements and hemoglobin concentration, 202 children ranging from 1 month to 14 years of age were followed for one year through passive case detection for malaria episodes. After follow-up, all children were assessed again in order to detect changes in nutritional indicators associated with malaria infection. We also examined the risk of presenting malaria episodes during follow-up according to presence of stunting at baseline. Children who suffered malaria episodes during follow-up presented worse anthropometric parameters values during this period. The main change was a reduction of the linear growth velocity, associated with both the number of episodes and how close the last or only malaria episode and the second anthropometric assessment were. Changes were also observed for indices associated with chronic changes, such as weight-for-age and BMI-for-age, which conversely, were more frequently observed in children with the last or only episode occurring between 6 and 12 months preceding the second nutritional assessment survey. Children with inadequate height-for-age at baseline (Z-score < -2) presented lower risk of suffering malaria episodes during follow-up as assessed by both the log-rank test (p =0.057) and the multivariable Cox-proportional hazards regression (Hazard Ratio = 0.31, 95%CI [0.10; 0.99] p=0.049). Conclusions Malaria was associated with impaired nutritional status amongst children in an endemic area of the Western Brazilian Amazon where P. vivax predominates. Our data all supports that the association presents differential effects for each age group, suggesting distinct pathophysiology pathways. We were also able to demonstrate that undernourishment at baseline was protective to malaria during follow-up. These findings support an intriguing interaction between these conditions in the rural Amazon and the need for a more integrative approach by health systems in endemic areas. PMID:25928774

Usual Dietary Intakes: SAS Macros for the NCI Method

Cancer.gov

SAS macros are currently available to facilitate modeling of a single dietary component, whether consumed daily or episodically; ratios of two dietary components that are consumed nearly every day; multiple dietary components, whether consumed daily or episodically.

RAGG - R EPISODIC AGGREGATION PACKAGE

EPA Science Inventory

The RAGG package is an R implementation of the CMAQ episodic model aggregation method developed by Constella Group and the Environmental Protection Agency. RAGG is a tool to provide climatological seasonal and annual deposition of sulphur and nitrogen for multimedia management. ...

Positive and negative social exchanges and cognitive aging in young-old adults: differential associations across family, friend, and spouse domains.

PubMed

Windsor, Tim D; Gerstorf, Denis; Pearson, Elissa; Ryan, Lindsay H; Anstey, Kaarin J

2014-03-01

We examined how positive and negative social exchanges with friends, family, and spouses were related to cognitive aging in episodic and working memory, and perceptual speed. To do so, we used a large sample of cognitively intact young-old participants from the PATH Through Life Study (PATH; aged 60 to 64 years at baseline, n = 1,618) who were assessed on 3 occasions over 8 years. Additional replication analyses were conducted using the Health and Retirement Study (HRS), which provided data on episodic memory. The main analysis of PATH Through Life showed that positive exchanges with friends and family were associated with less decline in perceptual speed, with these associations attenuated by adjustment for physical functioning and depressive symptoms. Negative exchanges with spouses were associated with poorer working memory performance. Positive exchanges with friends were associated with better initial episodic memory in both PATH and HRS. More frequent negative exchanges with friends and family were associated with better episodic memory in the PATH sample. However, these findings were not replicated in HRS. Our findings provide indirect support for the role of social exchange quality in contributing to cognitive enrichment. However, the inconsistent pattern of results across cognitive and social exchange domains points to possibilities of reverse causality, and may also indicate that social exchange quality plays a less important role for cognitive enrichment than other psychosocial characteristics. (c) 2014 APA, all rights reserved.

Mixed features in bipolar disorder.

PubMed

Solé, Eva; Garriga, Marina; Valentí, Marc; Vieta, Eduard

2017-04-01

Mixed affective states, defined as the coexistence of depressive and manic symptoms, are complex presentations of manic-depressive illness that represent a challenge for clinicians at the levels of diagnosis, classification, and pharmacological treatment. The evidence shows that patients with bipolar disorder who have manic/hypomanic or depressive episodes with mixed features tend to have a more severe form of bipolar disorder along with a worse course of illness and higher rates of comorbid conditions than those with non-mixed presentations. In the updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), the definition of "mixed episode" has been removed, and subthreshold nonoverlapping symptoms of the opposite pole are captured using a "with mixed features" specifier applied to manic, hypomanic, and major depressive episodes. However, the list of symptoms proposed in the DSM-5 specifier has been widely criticized, because it includes typical manic symptoms (such as elevated mood and grandiosity) that are rare among patients with mixed depression, while excluding symptoms (such as irritability, psychomotor agitation, and distractibility) that are frequently reported in these patients. With the new classification, mixed depressive episodes are three times more common in bipolar II compared with unipolar depression, which partly contributes to the increased risk of suicide observed in bipolar depression compared to unipolar depression. Therefore, a specific diagnostic category would imply an increased diagnostic sensitivity, would help to foster early identification of symptoms and ensure specific treatment, as well as play a role in suicide prevention in this population.

Influence of intraoperative hypotension on leaks after sleeve gastrectomy.

PubMed

Nienhuijs, Simon W; Kaymak, Uzay; Korsten, Erik; Buise, Marc P

2016-01-01

Leak after a sleeve gastrectomy (SG) is a severe complication. Risk factors, such as regional ischemia, increased intraluminal pressure, technical failure of the stapling device, and surgeon error, have been reported. It was hypothesized that intraoperative hypotension is another risk factor for leak, similar to that reported for colorectal surgery. Tertiary teaching hospital in The Netherlands. Results of a 7-year cohort of primary SGs were reviewed in relation to multiple intraoperative blood pressure measurements. The thresholds for the mean pressure were 40 to 70 mm Hg and for the systolic pressure 70 to 100 mm Hg. Only continuous episodes of 15 and 20 minutes were included. Twenty-four leaks were identified in a cohort of 1041 primary SGs. Episodes of systolic blood pressure<100 mm Hg for 15 min (P = .027) and 20 minutes (P = .008) were significantly related to a staple line leak. An episode of mean blood pressure<70 mm Hg for 20 min was significantly related to leak (P = .014). Episodes with lower thresholds of pressure occurred less frequently and revealed no significant differences. Other identified risk factors were smoking (P = .019), fast-track recovery program (P = .006), use of a tri-stapler (P = .004), and duration of surgery (P = .000). In a multivariate analysis, only intraoperative systolic pressure<100 mm Hg for 20 minutes remained significant (odds ratio, 2.45; P = .012). Intraoperative hypotension may contribute independently to a leak after SG. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Response of first-line antibiotic therapy in patients with febrile neutropenia during treatment of hematological disorders.

PubMed

Taj, M; Qureshi, R N; Farzana, T; Shamsi, T S; Ahmed, S S

2015-06-01

Patients with hematological disorders develop febrile neutropenia (FN); most of these events remain undetermined in origin. We performed a prospective study to determine the microbiological characteristics of infections and their response to the first-line antibiotic therapy in FN. The study was conducted at National Institute of Blood Disease and Bone Marrow Transplant. Two-hundred episodes of FN were assessed for the bacterial growth, antimicrobial susceptibility pattern and response to the first-line treatment of FN. All patients were given Ceftazidime and Amikacin Bosch Pharmaceutical (Pvt. Ltd), as first-line antibiotic in FN. Out of 200 episodes we had 108 clinically and microbiologically documented infections. The isolated frequencies for gram negative and gram positive organisms were n = 52 and 49 (48 and 45 %) respectively. Among gram negative micro-organisms, Escherichia coli (E. coli) was isolated in 15 (28.8 %), Klebsiella pneumonae in 4 (7.6 %) and Pseudomonas aeruginosa in 10 (19.2 %) were in highest frequencies. Methicillin sensitive staphylococci emerged as the frequently isolated gram-positive bacteria. Eight-one episodes (45.3 %) responded to the first-line treatment and death reported in 20 cases (10 %). Our study showed almost equal trend of gram positive and gram negative bacteria isolated from patients suffering from neutropenic fever. Empirical use of Ceftazidime and Amikacin as first-line antibiotics was able to cover the infection only in 45.3 % of episodes suffering from FN.

Mitochondrial disorder caused Charles Darwin's cyclic vomiting syndrome.

PubMed

Finsterer, Josef; Hayman, John

2014-01-08

Charles Darwin (CD), "father of modern biology," suffered from multisystem illness from early adulthood. The most disabling manifestation was cyclic vomiting syndrome (CVS). This study aims at finding the possible cause of CVS in CD. A literature search using the PubMed database was carried out, and CD's complaints, as reported in his personal writings and those of his relatives, friends, colleagues, biographers, were compared with various manifestations of mitochondrial disorders (MIDs), known to cause CVS, described in the literature. Organ tissues involved in CD's disease were brain, nerves, muscles, vestibular apparatus, heart, gut, and skin. Cerebral manifestations included episodic headache, visual disturbance, episodic memory loss, periodic paralysis, hysterical crying, panic attacks, and episodes of depression. Manifestations of polyneuropathy included numbness, paresthesias, increased sweating, temperature sensitivity, and arterial hypotension. Muscular manifestations included periods of exhaustion, easy fatigability, myalgia, and muscle twitching. Cardiac manifestations included episodes of palpitations and chest pain. Gastrointestinal manifestations were CVS, dental problems, abnormal seasickness, eructation, belching, and flatulence. Dermatological manifestations included painful lips, dermatitis, eczema, and facial edema. Treatments with beneficial effects to his complaints were rest, relaxation, heat, and hydrotherapy. CVS in CD was most likely due to a multisystem, nonsyndromic MID. This diagnosis is based upon the multisystem nature of his disease, the fact that CVS is most frequently the manifestation of a MID, the family history, the variable phenotypic expression between affected family members, the fact that symptoms were triggered by stress, and that only few symptoms could not be explained by a MID.

Biological extinction in earth history

NASA Technical Reports Server (NTRS)

Raup, D. M.

1986-01-01

Virtually all plant and animal species that have ever lived on the earth are extinct. For this reason alone, extinction must play an important role in the evolution of life. The five largest mass extinctions of the past 600 million years are of greatest interest, but there is also a spectrum of smaller events, many of which indicate biological systems in profound stress. Extinction may be episodic at all scales, with relatively long periods of stability alternating with short-lived extinction events. Most extinction episodes are biologically selective, and further analysis of the victims and survivors offers the greatest chance of deducing the proximal causes of extinction. A drop in sea level and climatic change are most frequently invoked to explain mass extinctions, but new theories of collisions with extraterrestrial bodies are gaining favor. Extinction may be constructive in a Darwinian sense or it may only perturb the system by eliminating those organisms that happen to be susceptible to geologically rare stresses.

Mitochondria: role of citrulline and arginine supplementation in MELAS syndrome.

PubMed

El-Hattab, Ayman W; Emrick, Lisa T; Chanprasert, Sirisak; Craigen, William J; Scaglia, Fernando

2014-03-01

Mitochondria are found in all nucleated human cells and generate most of the cellular energy. Mitochondrial disorders result from dysfunctional mitochondria that are unable to generate sufficient ATP to meet the energy needs of various organs. Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a frequent maternally inherited mitochondrial disorder. There is growing evidence that nitric oxide (NO) deficiency occurs in MELAS syndrome and results in impaired blood perfusion that contributes significantly to several complications including stroke-like episodes, myopathy, and lactic acidosis. Both arginine and citrulline act as NO precursors and their administration results in increased NO production and hence can potentially have therapeutic utility in MELAS syndrome. Citrulline raises NO production to a greater extent than arginine, therefore, citrulline may have a better therapeutic effect. Controlled studies assessing the effects of arginine or citrulline supplementation on different clinical aspects of MELAS syndrome are needed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Acute auditory agnosia as the presenting hearing disorder in MELAS.

PubMed

Miceli, Gabriele; Conti, Guido; Cianfoni, Alessandro; Di Giacopo, Raffaella; Zampetti, Patrizia; Servidei, Serenella

2008-12-01

MELAS is commonly associated with peripheral hearing loss. Auditory agnosia is a rare cortical auditory impairment, usually due to bilateral temporal damage. We document, for the first time, auditory agnosia as the presenting hearing disorder in MELAS. A young woman with MELAS (A3243G mtDNA mutation) suffered from acute cortical hearing damage following a single stroke-like episode, in the absence of previous hearing deficits. Audiometric testing showed marked central hearing impairment and very mild sensorineural hearing loss. MRI documented bilateral, acute lesions to superior temporal regions. Neuropsychological tests demonstrated auditory agnosia without aphasia. Our data and a review of published reports show that cortical auditory disorders are relatively frequent in MELAS, probably due to the strikingly high incidence of bilateral and symmetric damage following stroke-like episodes. Acute auditory agnosia can be the presenting hearing deficit in MELAS and, conversely, MELAS should be suspected in young adults with sudden hearing loss.

The risks of nocturnal hypoglycaemia in insulin-treated diabetes.

PubMed

Graveling, Alex J; Frier, Brian M

2017-11-01

Over half of all episodes of severe hypoglycaemia (requiring external help) occur during sleep, but nocturnal hypoglycaemia is often asymptomatic and unrecognised. The precise incidence of nocturnal hypoglycaemia is difficult to determine with no agreed definition, but continuous glucose monitoring has shown that it occurs frequently in people taking insulin. Attenuation of the counter-regulatory responses to hypoglycaemia during sleep may explain why some episodes are undetected and more prolonged, and modifies cardiovascular responses. The morbidity and mortality associated with nocturnal hypoglycaemia is probably much greater than realised, causing seizures, coma and cardiovascular events and affecting quality of life, mood and work performance the following day. It may induce impaired awareness of hypoglycaemia. Cardiac arrhythmias that occur during nocturnal hypoglycaemia include bradycardia and ectopics that may provoke dangerous arrhythmias. Treatment strategies are discussed that may help to minimise the frequency of nocturnal hypoglycaemia. Copyright © 2017 Elsevier B.V. All rights reserved.

Asymptomatic bacteriuria: review and discussion of the IDSA guidelines.

PubMed

Nicolle, Lindsay E

2006-08-01

Asymptomatic bacteriuria is a common finding, but is usually benign. Screening and treatment of asymptomatic bacteriuria is only recommended for pregnant women, or for patients prior to selected invasive genitourinary procedures. Healthy women identified with asymptomatic bacteriuria on population screening subsequently experience more frequent episodes of symptomatic infection, but antimicrobial treatment of asymptomatic bacteriuria does not decrease the occurrence of these episodes. Clinical trials in spinal-cord injury patients, diabetic women, patients with indwelling urethral catheters, and elderly nursing home residents have consistently found no benefits with treatment of asymptomatic bacteriuria. Negative outcomes with antimicrobial treatment do occur, including adverse drug effects and re-infection with organisms of increasing resistance. Optimal management of asymptomatic bacteriuria requires appropriate implementation of screening strategies to promote timely identification of the selected patients for whom treatment is beneficial, and avoidance of antimicrobial therapy where no benefit has been shown.

Music to the inner ears: exploring individual differences in musical imagery.

PubMed

Beaty, Roger E; Burgin, Chris J; Nusbaum, Emily C; Kwapil, Thomas R; Hodges, Donald A; Silvia, Paul J

2013-12-01

In two studies, we explored the frequency and phenomenology of musical imagery. Study 1 used retrospective reports of musical imagery to assess the contribution of individual differences to imagery characteristics. Study 2 used an experience sampling design to assess the phenomenology of musical imagery over the course of one week in a sample of musicians and non-musicians. Both studies found episodes of musical imagery to be common and positive: people rarely wanted such experiences to end and often heard music that was personally meaningful. Several variables predicted musical imagery, including personality, musical preferences, and positive mood. Musicians tended to hear musical imagery more often, but they reported less frequent episodes of deliberately-generated imagery. Taken together, the present research provides new insights into individual differences in musical imagery, and it supports the emerging view that such experiences are common, positive, and more voluntary than previously recognized. Copyright © 2013 Elsevier Inc. All rights reserved.

Biological Extinction in Earth History

NASA Astrophysics Data System (ADS)

Raup, David M.

1986-03-01

Virtually all plant and animal species that have ever lived on the earth are extinct. For this reason alone, extinction must play an important role in the evolution of life. The five largest mass extinctions of the past 600 million years are of greatest interest, but there is also a spectrum of smaller events, many of which indicate biological systems in profound stress. Extinction may be episodic at all scales, with relatively long periods of stability alternating with short-lived extinction events. Most extinction episodes are biologically selective, and further analysis of the victims and survivors offers the greatest chance of deducing the proximal causes of extinction. A drop in sea level and climatic change are most frequently invoked to explain mass extinctions, but new theories of collisions with extraterrestrial bodies are gaining favor. Extinction may be constructive in a Darwinian sense or it may only perturb the system by eliminating those organisms that happen to be susceptible to geologically rare stresses.

The enuretic episode--a complete micturition from a bladder with normal capacity? A critical reappraisal of the definition.

PubMed

Rasmussen, P V; Kirk, J; Rittig, S; Djurhuus, J C

1997-01-01

Fifty-five normal children, aged between 7 and 12 years, were hospitalised for four consecutive nights. On three of these nights, the subjects received 25 ml/kg body weight of fluid prior to bedtime. Such fluid-loading provoked 28 enuresis-like episodes in 17 children, most of which occurred during the first few hours of sleep. The incidence of these enuretic events decreased with increasing age, more boys than girls were affected, there was a statistically significant correlation between total enuresis volume and nocturia volume, and the micturition was frequently incomplete, leaving large volumes of residual urine in the bladder. It was concluded that if nocturnal urine production exceeds bladder capacity, enuresis may be provoked, even in children who do not normally wet the bed. Furthermore, the definition of nocturnal enuresis as a complete emptying of the bladder during sleep may need revision.

Bevacizumab for Refractory Gastrointestinal Bleeding in Rendu-Osler-Weber Disease

PubMed Central

Bernardes, Carlos; Santos, Sara; Loureiro, Rafaela; Borges, Verónica; Ramos, Gonçalo

2018-01-01

Rendu-Osler-Weber disease, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant disorder which is often characterized by recurrent epistaxis, mucocutaneous and gastrointestinal telangiectasias, and visceral arteriovenous malformations. Patients with gastrointestinal involvement can present with a wide spectrum of severity, which may vary from uncomplicated iron deficiency anemia to continuous and refractory bleeding. We present the case of a 62-year-old female, who was admitted with anemia following several episodes of melena, and whose endoscopic examination revealed multiple angiodysplasias in the stomach and small bowel. Despite endoscopic and medical treatment attempts with hormonal agents and octreotide, she developed persistent hemorrhage and severe anemia, requiring frequent red blood cell transfusions. Immediately after initiating bevacizumab (7.5 mg/kg, every 3 weeks), complete cessation of bleeding episodes was observed. Currently, after 1 year of follow-up, she maintained sustained remission without the occurrence of adverse events. PMID:29662934

Simultaneous determination of the potential carcinogen 1,4-dioxane and malodorous alkyl-1,3-dioxanes and alkyl-1,3-dioxolanes in environmental waters by solid-phase extraction and gas chromatography tandem mass spectrometry.

PubMed

Carrera, Guillem; Vegué, Lídia; Boleda, Mª Rosa; Ventura, Francesc

2017-03-03

1,4-dioxane is a synthetic industrial solvent used in various industrial processes, and it is a probable human carcinogen whose presence in the aquatic environment is frequently reported. Alkyl-1,3-dioxanes and alkyl-1,3-dioxolanes are compounds that have been identified as causing several odor episodes in waters over the last years, with the result of downtime of drinking water treatment plants. According to published studies, some of these episodes may be caused either by resins synthesis processes, or by industrial residues added to dehydrated sludge in wastewater treatment plants (WWTPs) in order to increase biogas production efficiency. Analytical methods based on closed loop stripping analysis (CLSA) are routinely used when taste and odor events appear, but this technique has demonstrated to be unsuitable to determine 1,4-dioxane at trace levels. In this context, drinking water companies tend to focus on determining odorous compounds, but not on those compounds that are potentially harmful. The suitability of a SPE method and further analysis by GC/MS-MS to simultaneously determine 1,4-dioxane and alkyl-1,3-dioxanes and dioxolanes has been demonstrated. Recoveries in surface waters spiked at 25ng/L ranged from 76% to 105%, whereas method quantification limits (MQLs) varied from 0.7 to 26ng/L for dioxanes, and dioxolanes and 50ng/L for 1,4-dioxane. Uncertainties were evaluated at two different concentrations, 0.02μg/L and 0.4μg/L, with values of 25% for 1,4-dioxane, and of 16-28% for alkyl-1,3-dioxanes and alkyl-1,3-dioxolanes for the later. The methodology has been successfully applied to samples from the aquifer of the Llobregat River (NE. Spain). Copyright © 2017 Elsevier B.V. All rights reserved.

Chronic asymptomatic pyuria precedes overt urinary tract infection and deterioration of renal function in autosomal dominant polycystic kidney disease

PubMed Central

2013-01-01

Background Urinary tract infection (UTI) occurs in 30%-50% of individuals with autosomal dominant polycystic kidney disease (ADPKD). However, the clinical relevance of asymptomatic pyuria in ADPKD patients remains unknown. Methods We retrospectively reviewed medical records of 256 ADPKD patients who registered to the ADPKD clinic at Seoul National University Hospital from Aug 1999 to Aug 2010. We defined the asymptomatic pyuria as more than 5-9 white blood cells in high-power field with no related symptoms or signs of overt UTI. Patients were categorized into 2 groups depending on its duration and frequency: Group A included non-pyuria and transient pyuria patients; Group B included recurrent and persistent pyuria patients. The association between asymptomatic pyuria and both the development of overt UTI and the deterioration of renal function were examined. Results With a mean follow-up duration of 65.3 months, 176 (68.8%) out of 256 patients experienced 681 episodes of asymptomatic pyuria and 50 episodes of UTI. The annual incidence of asymptomatic pyuria was 0.492 episodes/patient/year. The patients in group B showed female predominance (58.5% vs. 42.0%, P=0.01) and experienced an upper UTI more frequently (hazard ratio: 4.612, 95% confidence interval: 1.735-12.258; P=0.002, adjusted for gender and hypertension). The annual change in estimated glomerular filtration rate (ΔeGFR) was significantly larger in magnitude in group B than in group A (-2.7±4.56 vs. -1.17±5.8, respectively; P=0.01). Age and Group B found to be the independent variables for ΔeGFR and developing end-stage renal disease (16.0% vs. 4.3%, respectively; P=0.001). Conclusions Chronic asymptomatic pyuria may increase the risk of developing overt UTI and may contribute to declining renal function in ADPKD. PMID:23295127

Cost analysis of a growth guidance system compared with traditional and magnetically controlled growing rods for early-onset scoliosis: a US-based integrated health care delivery system perspective

PubMed Central

Luhmann, Scott J; McAughey, Eoin M; Ackerman, Stacey J; Bumpass, David B; McCarthy, Richard E

2018-01-01

Purpose Treating early-onset scoliosis (EOS) with traditional growing rods (TGR) is effective but requires periodic surgical lengthening, risking complications. Alternatives include magnetically controlled growing rods (MCGR) that lengthen noninvasively and the growth guidance system (GGS), which obviate the need for active, distractive lengthenings. Previous studies have reported promising clinical effectiveness for GGS; however the direct medical costs of GGS compared to TGR and MCGR have not yet been explored. Methods To estimate the cost of GGS compared with MCGR and TGR for EOS an economic model was developed from the perspective of a US integrated health care delivery system. Using dual-rod constructs, the model estimated the cumulative costs associated with initial implantation, rod lengthenings (TGR, MCGR), revisions due to device failure, surgical-site infections, device exchange, and final spinal fusion over a 6-year episode of care. Model parameters were from peer-reviewed, published literature. Medicare payments were used as a proxy for provider costs. Costs (2016 US$) were discounted 3% annually. Results Over a 6-year episode of care, GGS was associated with fewer invasive surgeries per patient than TGR (GGS: 3.4; TGR: 14.4) and lower cumulative costs than MCGR and TGR, saving $25,226 vs TGR. Sensitivity analyses showed that results were sensitive to changes in construct costs, rod breakage rates, months between lengthenings, and TGR lengthening setting of care. Conclusion Within the model, GGS resulted in fewer invasive surgeries and deep surgical site infections than TGR, and lower cumulative costs per patient than both MCGR and TGR, over a 6-year episode of care. The analysis did not account for family disruption, pain, psychological distress, or compromised health-related quality of life associated with invasive TGR lengthenings, nor for potential patient anxiety surrounding the frequent MCGR lengthenings. Further analyses focusing strictly on current generation technologies should be considered for future research. PMID:29588607

Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy.

PubMed

Vargo, John J; Zuccaro, Gregory; Dumot, John A; Conwell, Darwin L; Morrow, J Brad; Shay, Steven S

2002-06-01

Recommendations from the American Society of Anesthesiologists suggest that monitoring for apnea using the detection of exhaled carbon dioxide (capnography) is a useful adjunct in the assessment of ventilatory status of patients undergoing sedation and analgesia. There are no data on the utility of capnography in GI endoscopy, nor is the frequency of abnormal ventilatory activity during endoscopy known. The aims of this study were to determine the following: (1) the frequency of abnormal ventilatory activity during therapeutic upper endoscopy, (2) the sensitivity of observation and pulse oximetry in the detection of apnea or disordered respiration, and (3) whether capnography provides an improvement over accepted monitoring techniques. Forty-nine patients undergoing therapeutic upper endoscopy were monitored with standard methods including pulse oximetry, automated blood pressure measurement, and visual assessment. In addition, graphic assessment of respiratory activity with sidestream capnography was performed in all patients. Endoscopy personnel were blinded to capnography data. Episodes of apnea or disordered respiration detected by capnography were documented and compared with the occurrence of hypoxemia, hypercapnea, hypotension, and the recognition of abnormal respiratory activity by endoscopy personnel. Comparison of simultaneous respiratory rate measurements obtained by capnography and by auscultation with a pretracheal stethoscope verified that capnography was an excellent indicator of respiratory rate when compared with the reference standard (auscultation) (r = 0.967, p < 0.001). Fifty-four episodes of apnea or disordered respiration occurred in 28 patients (mean duration 70.8 seconds). Only 50% of apnea or disordered respiration episodes were eventually detected by pulse oximetry. None were detected by visual assessment (p < 0.0010). Apnea/disordered respiration occurs commonly during therapeutic upper endoscopy and frequently precedes the development of hypoxemia. Potentially important abnormalities in respiratory activity are undetected with pulse oximetry and visual assessment.

Web-Based Study of Risk Factors for Pain Exacerbation in Osteoarthritis of the Knee (SPARK-Web): Design and Rationale

PubMed Central

Metcalf, Ben; Zhang, Yuqing; Bennell, Kim; March, Lyn; Hunter, David J

2015-01-01

Background Knee osteoarthritis (OA) is the most frequent cause of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Many persons with symptomatic knee OA experience recurrent pain exacerbations. Knowledge and clarification of risk factors for pain exacerbation may allow those affected to minimize reoccurrence of these episodes. Objective The aim of this study is to use a Web-based case-crossover design to identify risk factors for knee pain exacerbations in persons with symptomatic knee OA. Methods Web-based case-crossover design is used to study persons with symptomatic knee OA. Participants with knee pain and radiographic knee OA will be recruited and followed for 90 days. Participants will complete an online questionnaire at the baseline and every 10 days thereafter (totaling up to 10 control-period questionnaires); participants will also be asked to report online when they experience an episode of increased knee pain. Pain exacerbation will be defined as an increase in knee pain severity of two points from baseline on a numeric rating scale (NRS 0-10). Physical activity, footwear, knee injury, medication use, climate, psychological factors, and their possible interactions will be assessed as potential triggers for pain exacerbation using conditional logistic regression models. Results This project has been funded by the National Health and Medical Research Council (NHMRC). The enrollment for the study has started. So far, 343 participants have been enrolled. The study is expected to be finished in October 2015. Conclusions This study will identify risk factors for pain exacerbations in knee OA. The identification and possible modification/elimination of such risk factors will help to prevent the reoccurrence of pain exacerbation episodes and therefore improve knee OA management. PMID:26156210

Dynamics of Cough Frequency in Adults Undergoing Treatment for Pulmonary Tuberculosis

PubMed Central

Bravard, Marjory A.; López, José W.; Lee, Gwenyth O.; Bui, David; Datta, Sumona; Comina, Germán; Zimic, Mirko; Coronel, Jorge; Caviedes, Luz; Cabrera, José L.; Salas, Antonio; Ticona, Eduardo; Vu, Nancy M.; Kirwan, Daniela E.; Loader, Maria-Cristina I.; Friedland, Jon S.; Moore, David A. J.; Evans, Carlton A.; Tracey, Brian H.; Gilman, Robert H.

2017-01-01

Abstract Background. Cough is the major determinant of tuberculosis transmission. Despite this, there is a paucity of information regarding characteristics of cough frequency throughout the day and in response to tuberculosis therapy. Here we evaluate the circadian cycle of cough, cough frequency risk factors, and the impact of appropriate treatment on cough and bacillary load. Methods. We prospectively evaluated human immunodeficiency virus–negative adults (n = 64) with a new diagnosis of culture-proven, drug-susceptible pulmonary tuberculosis immediately prior to treatment and repeatedly until treatment day 62. At each time point, participant cough was recorded (n = 670) and analyzed using the Cayetano Cough Monitor. Consecutive coughs at least 2 seconds apart were counted as separate cough episodes. Sputum samples (n = 426) were tested with microscopic-observation drug susceptibility broth culture, and in culture-positive samples (n = 252), the time to culture positivity was used to estimate bacillary load. Results. The highest cough frequency occurred from 1 pm to 2 pm, and the lowest from 1 am to 2 am (2.4 vs 1.1 cough episodes/hour, respectively). Cough frequency was higher among participants who had higher sputum bacillary load (P < .01). Pretreatment median cough episodes/hour was 2.3 (interquartile range [IQR], 1.2–4.1), which at 14 treatment days decreased to 0.48 (IQR, 0.0–1.4) and at the end of the study decreased to 0.18 (IQR, 0.0–0.59) (both reductions P < .001). By 14 treatment days, the probability of culture conversion was 29% (95% confidence interval, 19%–41%). Conclusions. Coughs were most frequent during daytime. Two weeks of appropriate treatment significantly reduced cough frequency and resulted in one-third of participants achieving culture conversion. Thus, treatment by 2 weeks considerably diminishes, but does not eliminate, the potential for airborne tuberculosis transmission. PMID:28329268

Epidemiological aspects of suicide attempts among Moroccan children.

PubMed

Mekaoui, Nour; Karboubi, Lamiae; Ouadghiri, Fatima Zahra; Dakhama, Badr Sououd Benjelloun

2016-01-01

Suicidal behavior among children has significantly increased in Morocco. We conducted a study on the epidemiological aspect to propose a treatment strategy. Descriptive retrospective study over a period of 3 years (April 2012-April 2015) involving children who visited pediatric medical emergencies of the Children Hospital of Rabat after an autolysis attempt. We observed epidemiological parameters, history, social and family context, the means used, the presumed cause, clinical manifestation, and the management. 66 patients were identified. A female predominance was found (sex =15). The average age was 13 years old. This was a first episode in 97% of cases. Psychiatric history was found in 6 patients. The causes of suicide attempt were unidentified in 65%. The most frequent cause was family conflict (35%). The most frequent method was pharmaceutical drug ingestion (54.4%). Children were asymptomatic (57.6%). Neurological manifestations (30%) were most frequent. Digestive symptoms (12%) and hemodynamic (3%) were also discovered. Patients were hospitalized in a general pediatric service 92.4% of the times, admitted to intensive care 4.5% of the times, and two patients refused to be hospitalized. The treatment consisted of gastric lavage (18%) supplemented by symptomatic measures. The outcome was favorable in 95.4% of cases. We recorded 2 deaths by rat poison poisoning. All patients were advised in writing after leaving to follow up with a psychological treatment. Suicide attempts are the result of an ill being, mostly among children living in a family with conflict. Upstream treatment is essential to identify children at risk. Additionally, a psychiatric care in hospital is essential to avoid recurrences.

Examining Duration of Binge Eating Episodes in Binge Eating Disorder

PubMed Central

Schreiber-Gregory, Deanna N.; Lavender, Jason M.; Engel, Scott G.; Wonderlich, Steve A.; Crosby, Ross D.; Peterson, Carol B.; Simonich, Heather; Crow, Scott; Durkin, Nora; Mitchell, James E.

2013-01-01

Objective The primary goal of this paper is to examine and clarify characteristics of binge eating in individuals with binge eating disorder (BED), particularly the duration of binge eating episodes, as well as potential differences between individuals with shorter compared to longer binge eating episodes. Method Two studies exploring binge eating characteristics in BED were conducted. Study 1 examined differences in clinical variables among individuals (N = 139) with BED who reported a short (< 2 hours) versus long (≥ 2 hours) average binge duration. Study 2 utilized an ecological momentary assessment (EMA) design to examine the duration and temporal pattern of binge eating episodes in the natural environment in a separate sample of nine women with BED. Results Participants in Study 1 who were classified as having long duration binge eating episodes displayed greater symptoms of depression and lower self-esteem, but did not differ on other measures of eating disorder symptoms, compared to those with short duration binge eating episodes. In Study 2, the average binge episode duration was approximately 42 minutes, and binge eating episodes were most common during the early afternoon and evening hours, as well as more common on weekdays versus weekends. Discussion Past research on binge episode characteristics, particularly duration, has been limited to studies of binge eating episodes in BN. This study contributes to the existing literature on characteristics of binge eating in BED. PMID:23881639

Socioeconomic status and alcohol-related behaviors in mid- to late adolescence in the Avon Longitudinal Study of Parents and Children.

PubMed

Kendler, Kenneth S; Gardner, Charles O; Hickman, Matt; Heron, Jon; Macleod, John; Lewis, Glyn; Dick, Danielle M

2014-07-01

Prior studies of the relationship between socioeconomic status (SES) and alcohol consumption and problems in adolescence have been inconclusive. Few studies have examined all three major SES indicators and a broad range of alcohol-related outcomes at different ages. In the Avon Longitudinal Study of Parents and Children cohort, we examined (by logistic regression, with differential weighting to control for attrition) the relationship between family income and parental education and occupational status, and five alcohol outcomes assessed at ages 16 and 18 years. At age 16, high SES-as indexed by income and education-significantly predicted frequent alcohol consumption. Low SES-as measured by education and occupational status-predicted alcohol-related problems. At age 18, high SES-particularly income and education-significantly predicted frequent alcohol consumption and heavy episodic drinking and, more weakly, symptoms of alcohol dependence. All three measures of SES were inversely related to high-quantity consumption and alcohol behavioral problems. In adolescents in the United Kingdom, the relationship between SES and alcohol-related behaviors is complex and varies as a function of age, SES measure, and specific outcome. High SES tends to predict increased consumption and, in later adolescence, heavy episodic drinking and perhaps symptoms of alcohol dependence. Low SES predicts alcohol-related behavioral problems and, in later adolescence, high-quantity alcohol consumption.

Mood Changes After Indoor Tanning Among College Women: Associations with Psychiatric/Addictive Symptoms

PubMed Central

Heckman, Carolyn; Darlow, Susan; Cohen-Filipic, Jessye; Kloss, Jacqueline

2016-01-01

Indoor tanning (IT) has been linked with psychiatric and addictive symptoms, and frequent tanning may indicate tanning dependence (addiction). The current study evaluated the effects of an IT episode on mood states and the association of these effects with psychiatric and addictive symptoms among young adult female indoor tanners. One-hundred thirty-nine female university students aged 18-25 years who had indoor tanned completed an online survey including the Positive and Negative Affects Scales and a standardized psychiatric interview (the MINI International Neuropsychiatric Interview) via telephone. Psychiatric and addictive symptoms were relatively common among these young adult female indoor tanners. Overall, participants reported significant decreases in both negative (upset, scared, irritable, nervous, jittery, afraid) and positive (feeling interested) mood states after their most recent tanning episode. Multivariable linear regression analyses showed that more frequent indoor tanning in the past month and symptoms of illicit drug use disorders were associated with decreases in negative mood, and symptoms of generalized anxiety disorder were associated with a decrease in feeling interested. In summary, indoor tanners report relatively high rates of psychiatric and substance use symptoms, including symptoms of tanning dependence, and indoor tanning appears to alter mood. Women with certain substance use and psychiatric characteristics may be more vulnerable to such mood changes after tanning indoors. Further research is needed to clarify the relationships among these variables. PMID:27403462

Mood Changes After Indoor Tanning Among College Women: Associations with Psychiatric/Addictive Symptoms.

PubMed

Heckman, Carolyn; Darlow, Susan; Cohen-Filipic, Jessye; Kloss, Jacqueline

2016-06-23

Indoor tanning (IT) has been linked with psychiatric and addictive symptoms, and frequent tanning may indicate tanning dependence (addiction). The current study evaluated the effects of an IT episode on mood states and the association of these effects with psychiatric and addictive symptoms among young adult female indoor tanners. One-hundred thirty-nine female university students aged 18-25 years who had indoor tanned completed an online survey including the Positive and Negative Affects Scales and a standardized psychiatric interview (the MINI International Neuropsychiatric Interview) via telephone. Psychiatric and addictive symptoms were relatively common among these young adult female indoor tanners. Overall, participants reported significant decreases in both negative (upset, scared, irritable, nervous, jittery, afraid) and positive (feeling interested) mood states after their most recent tanning episode. Multivariable linear regression analyses showed that more frequent indoor tanning in the past month and symptoms of illicit drug use disorders were associated with decreases in negative mood, and symptoms of generalized anxiety disorder were associated with a decrease in feeling interested. In summary, indoor tanners report relatively high rates of psychiatric and substance use symptoms, including symptoms of tanning dependence, and indoor tanning appears to alter mood. Women with certain substance use and psychiatric characteristics may be more vulnerable to such mood changes after tanning indoors. Further research is needed to clarify the relationships among these variables.

Peritoneal dialysis peritonitis by anaerobic pathogens: a retrospective case series

PubMed Central

2013-01-01

Background Bacterial infections account for most peritoneal dialysis (PD)-associated peritonitis episodes. However, anaerobic PD peritonitis is extremely rare and intuitively associated with intra-abdominal lesions. In this study, we examined the clinical characteristics of PD patients who developed anaerobic peritonitis. Methods We retrospectively identified all anaerobic PD peritonitis episodes from a prospectively collected PD registry at a single center between 1990 and 2010. Only patients receiving more than 3 months of PD were enrolled. We analyzed clinical features as well as outcomes of anaerobic PD peritonitis patients. Results Among 6 patients, 10 episodes of PD-associated peritonitis were caused by anaerobic pathogens (1.59% of all peritonitis episodes during study the period), in which the cultures from 5 episodes had mixed growth. Bacteroides fragilis was the most common species identified (4 isolates). Only 3 episodes were associated with gastrointestinal lesions, and 4 episodes were related to a break in sterility during exchange procedures. All anaerobic pathogens were susceptible to clindamycin and metronidazole, but penicillin resistance was noted in 4 isolates. Ampicillin/sulbactam resistance was found in 2 isolates. In 5 episodes, a primary response was achieved using the first-generation cephalosporin and ceftazidime or aminoglycoside. In 3 episodes, the first-generation cephalosporin was replaced with aminoglycosides. Tenckhoff catheter removal was necessary in 2 episodes. Only one episode ended with mortality (due to a perforated bowel). Conclusion Anaerobic PD-associated peritonitis might be predominantly caused by contamination, rather than intra-abdominal events. Half of anaerobic PD-associated peritonitis episodes had polymicrobial growth. The overall outcome of anaerobic peritonitis is fair, with a high catheter survival rate. PMID:23705895

Individualized prediction of illness course at the first psychotic episode: a support vector machine MRI study

PubMed Central

Mourao-Miranda, J.; Reinders, A. A. T. S.; Rocha-Rego, V.; Lappin, J.; Rondina, J.; Morgan, C.; Morgan, K. D.; Fearon, P.; Jones, P. B.; Doody, G. A.; Murray, R. M.; Kapur, S.; Dazzan, P.

2012-01-01

Background To date, magnetic resonance imaging (MRI) has made little impact on the diagnosis and monitoring of psychoses in individual patients. In this study, we used a support vector machine (SVM) whole-brain classification approach to predict future illness course at the individual level from MRI data obtained at the first psychotic episode. Method One hundred patients at their first psychotic episode and 91 healthy controls had an MRI scan. Patients were re-evaluated 6.2 years (s.d.=2.3) later, and were classified as having a continuous, episodic or intermediate illness course. Twenty-eight subjects with a continuous course were compared with 28 patients with an episodic course and with 28 healthy controls. We trained each SVM classifier independently for the following contrasts: continuous versus episodic, continuous versus healthy controls, and episodic versus healthy controls. Results At baseline, patients with a continuous course were already distinguishable, with significance above chance level, from both patients with an episodic course (p=0.004, sensitivity=71, specificity=68) and healthy individuals (p=0.01, sensitivity=71, specificity=61). Patients with an episodic course could not be distinguished from healthy individuals. When patients with an intermediate outcome were classified according to the discriminating pattern episodic versus continuous, 74% of those who did not develop other episodes were classified as episodic, and 65% of those who did develop further episodes were classified as continuous (p=0.035). Conclusions We provide preliminary evidence of MRI application in the individualized prediction of future illness course, using a simple and automated SVM pipeline. When replicated and validated in larger groups, this could enable targeted clinical decisions based on imaging data. PMID:22059690

Validation of the Argentine version of the Memory Binding Test (MBT) for Early Detection of Mild Cognitive Impairment

PubMed Central

Roman, Fabian; Iturry, Mónica; Rojas, Galeno; Barceló, Ernesto; Buschke, Herman; Allegri, Ricardo F.

2016-01-01

ABSTRACT Background: "Forgetfulness" is frequent in normal aging and characteristic of the early stages of dementia syndromes. The episodic memory test is central for detecting amnestic mild cognitive impairment (MCI). The Memory Binding Test (MBT) is a simple, easy and brief memory test to detect the early stage of episodic memory impairment. Objective: To validate the Argentine version of the MBT in a Latin American population and to estimate the diagnostic accuracy as a tool for early detection of MCI. Methods: 88 subjects (46 healthy controls and 42 patients with amnestic MCI) matched for age and educational level were evaluated by an extensive neuropsychological battery and the memory binding test. Results: A significantly better performance was detected in the control group; all MBT scales were predictive of MCI diagnosis (p<.01). The MBT showed high sensitivity (69%) and high specificity (88%), with a PPV of 93% and a NPV of 55% for associative paired recall. A statistically significant difference (c2=14,164, p<.001) was obtained when comparing the area under the curve (AUC) of the MBT (0.88) and the MMSE (0.70). Conclusion: The Argentine version of the MBT correlated significantly with the MMSE and the memory battery and is a useful tool in the detection of MCI. The operating characteristics of the MBT are well suited, surpassing other tests commonly used for detecting MCI. PMID:29213458

Breakthrough candidemia after the introduction of broad spectrum antifungal agents: A 5-year retrospective study.

PubMed

Breda, Giovanni L; Tuon, Felipe F; Meis, Jacques F; Herkert, Patricia F; Hagen, Ferry; de Oliveira, Letícia Z; Dias, Viviane de Carvalho; da Cunha, Clóvis Arns; Queiroz-Telles, Flávio

2018-06-01

Candidemia is the main invasive fungal disease among hospitalized patients. Several breakthrough candidemia (BrC) cases have been reported, but few studies evaluate the epidemiology, risk factors, molecular characterization, antifungal susceptibility profile and outcome of those patients, especially in developing countries and including patients using broad spectrum antifungals. We conducted a retrospective study from 2011 to 2016, including patients aged 12 years or older with candidemia. Epidemiological characteristics and risk factors for candidemia were evaluated and compared with patients with BrC using univariate and multivariate analysis. Sequential Candida isolates from BrC were identified by internal transcribed spacer sequencing, genotyped with amplified fragment length polymorphism fingerprinting (AFLP), and tested for antifungal susceptibility. From 148 candidemia episodes, 27 breakthrough episodes (18%) were identified, with neutropenia and mucositis being independent risk factors for BrC. Candida non-albicans was more frequent in the BrC group (P < .001). AFLP showed high correlation with conventional methods of identification among breakthrough isolates and a high genetic similarity among isolates from the same patient was observed. C. albicans was the most susceptible species with low MIC values for all antifungal agents tested. In contrast, we found isolates of C. glabrata, C. parapsilosis and C. tropicalis resistant to triazoles and echinocandins. In conclusion, BrC occurred mainly in severely immunosuppressed patients, with neutropenia and mucositis. Mortality did not differ between the groups. Candida non-albicans species were more recovered from BrC, with C. albicans being the most susceptible to antifungals.

Recurrent urinary tract infections in women.

PubMed

Aydin, Abdullatif; Ahmed, Kamran; Zaman, Iftikhar; Khan, Muhammad Shamim; Dasgupta, Prokar

2015-06-01

Recurrent urinary tract infections (UTIs) are more common in women and are frequently defined as ≥2 episodes in the last 6 months or ≥3 episodes in the last 12 months. In a primary care setting, 53 % of women above the age of 55 years and 36 % of younger women report a recurrence within 1 year. Thus, management and prevention of recurrent UTI is of utmost significance. This review aims to highlight the latest research in prevention strategies and suggest a management pathway. A search was conducted on MEDLINE, Embase and the Cochrane Database of Systematic Reviews databases for the latest systematic reviews and high-quality randomized controlled trials. Special emphasis was placed on the remit "recurrent" and strongly adhered to. Furthermore, a Google search was conducted for current guidelines on the management of UTIs. Current prevention strategies include eliminating risk factors that increase the risk of acquiring recurrent UTI and continuous, post-coital and self-initiated antimicrobial prophylaxis. Other prospective preventative strategies, currently under trial, include use of vaccinations, D-mannose and lactobacillus (probiotics). Although risk factors should be identified and addressed accordingly, individualized antibiotic prophylaxis remains the most effective method of management. Non-antibiotic prevention strategies such as cranberry, vitamin C and methenamine salts lack strong evidence to be introduced as routine management options and as alternatives to antibiotics. Based on current evidence and guidelines, a management pathway is recommended. Emerging therapies require further evaluation before they can be recommended.

Challenges and successes in the treatment of hemophilia: the story of a patient with severe hemophilia A and high-titer inhibitors

PubMed Central

Saba, Hussain I; Tran, Duc Quang

2012-01-01

In the past, patients with severe hemophilia have suffered a substantially reduced quality of life with frequent bleeding episodes, disabling arthropathy, and shorter life expectancy. In addition, methods of treatment and management have been costly and time-consuming, and have placed a considerable burden on patients’ physical and psychological well-being. With the advent of the on-demand therapy and prophylactic treatment paradigm, patients have been able to receive care with less interruption of daily activities. Treatments may be more challenging for hemophiliacs with inhibitors to replacement factor; however, recent advances in the use of bypassing agents and immune tolerance therapy have enabled them to aggressively manage their disease while maintaining their independence. This review focuses on the challenges of treating such a severe hemophiliac through examination of the lifetime experience of a young adult male with a severe form of congenital hemophilia A. At this stage of his life, the patient has minimal disabilities and is inhibitor-free through optimal care and strong family support. His aspiration to pursue a productive life has led him to a career in medicine. After receiving his medical degree, he pursued a specialty in the treatment of hemophilia. By assisting other hemophilia patients, he exemplifies both the rewards of persevering through episodes of bleeding and other complications and the fact that disabilities can be minimized when managed meticulously and in a timely fashion to enable a productive and dignified life. PMID:22715320

Frequent detection of ‘azole’ resistant Candida species among late presenting AIDS patients in northwest Ethiopia

PubMed Central

2013-01-01

Background The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia. Methods Two hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method. Results The colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent. Conclusion HIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs. PMID:23398783

[Environmental tobacco smoke exposure in children and its relationship with the severity of asthma].

PubMed

Suárez López de Vergara, R G; Galván Fernández, C; Oliva Hernández, C; Aguirre-Jaime, A; Aquirre-Jaime, A; Vázquez Moncholí, C

2013-01-01

Environmental tobacco smoke (ETS) exposure produces serious respiratory problems in childhood. The aim of the study was to evaluate if environmental tobacco smoke affects the severity of asthma in asthmatic children. A prospective, multicentre study was conducted on asthmatic children and their parents in 2007-2008, using an exposure questionnaire, pulmonary function, level of cotinine in urine, and evaluation of the severity of asthma according to GEMA guide. The characteristics of the sample are summarised using the appropriate statistical tools, and the comparisons were made using the Pearson chi2 test, Mann-Whitney U test or Studentĭs t, according to the variable and number of groups compared. Four hundred and eighty four households in 7 Autonomous Communities were included. The population included, 61% male children with asthma, 56% with a smoking caregiver in their home, 34% fathers, 31% mothers and 17% both. Home exposure was 37%, with 11% daily and 94% passive smokers since birth. There was 20% with exposure during whole period of pregnancy of 5±1 cigarettes/day. Children exposed to 6±1 cigarettes/day, 27%, up to 10 cigarettes/day, and 10% to more than 10. Severity of asthma during the survey was worse among those exposed (episodic-occasional 47%, episodic-frequent 35% and persistent-moderate 18% versus 59%, 25% and 16%, respectively, P=.040). Severity of asthma in the last year was worse in those exposed (episodic - occasional 22%, episodic - frequent 37% and persistent - moderate 50% versus 38%, 28% and 25% respectively, P=.037). The spirometry was abnormal in 64% of the exposed against to 36% in the non-exposed for FEV(1) (P=.003, 63% vs 38% for FVC (P=.038), and 54% vs 46% for the PEF (P=.050). The cotinine was higher in exposed: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (P=.032). A relationship was observed between cotinine and level of exposure: 120 (0-590) ng/ml for >10 cigarettes/day as opposed to 44 (0-103) ng/ml ≤10 cigarettes/day (P=.035), which corroborates the consistency of the data collected. The exposure of children with asthma to environmental tobacco smoke has a highly negative effect on the severity of their asthma. Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier España. All rights reserved.

The impact of brief depressive episodes on the outcome of bipolar disorder and major depressive disorder: a 1-year prospective study.

PubMed

Altamura, A Carlo; Buoli, Massimiliano; Dell'osso, Bernardo; Albano, Alessandra; Serati, Marta; Colombo, Francesca; Pozzoli, Sara; Angst, Jules

2011-11-01

Brief depressive episodes (BDEs) cause psychosocial impairment and increased risk of suicide, worsening the outcome and long-term course of affective disorders. The aim of this naturalistic observational study was to assess the frequency of BDEs and very brief depressive episodes (VBDEs) and their impact on clinical outcome in a sample of patients with major depressive disorder (MDD) and bipolar disorder (BD). Seventy patients with a diagnosis of MDD or BD were followed up and monthly visited for a period of 12 months, assessing the eventual occurrence of BDEs and/or VBDEs. Clinical and demographic variables of the total sample and of the groups divided according to the presence of BDEs or VBDEs were collected and compared by one-way ANOVAs. Hamilton Depression Rating Scale 21 items (HDRS), Young Mania Rating Scale (YMRS), Clinical Global Impression (severity of illness) (CGIs) and the Short Form Health Survey (SF-36-item 1) were administered at baseline and logistic regression was performed to evaluate whether baseline scores were predictive of the onset of BDEs or VBDEs. BDEs (88.6% of the total sample), VBDEs (44.3% of the total sample) and BDEs+VBDEs (40.0% of the total sample) were found to occur frequently across the sample. BDE patients showed more death thoughts during major depressive episodes (χ(2) = 4.14, df = 1, p = 0.04, Phi = 0.24) compared to patients without BDEs. Indeed VBDE patients showed a higher rate of hospitalization (χ(2) = 5.71, df = 1, p = 0.031, phi = 0.29), a more frequent prescription of a combined treatment (χ(2) = 13.07, df = 7, p = 0.03, phi = 0.43) and higher scores at SF-36 item 1 (F = 6.65, p = 0.01) compared to patients without VBDEs. Finally, higher SF-36 item 1 scores were found to be predictive of VBDEs (odds ratio = 2.81, p = 0.03). Major depressives, either unipolar or bipolar, with BDEs or VBDEs showed a worse outcome, represented by a more severe psychopathology and higher rates of hospitalization. VBDEs were predicted by a negative subjective general health perception. Studies with larger samples and longer follow-up are warranted to confirm the results of the present study. Copyright © 2011 Elsevier B.V. All rights reserved.

Modeling HIV-1 Drug Resistance as Episodic Directional Selection

PubMed Central

Murrell, Ben; de Oliveira, Tulio; Seebregts, Chris; Kosakovsky Pond, Sergei L.; Scheffler, Konrad

2012-01-01

The evolution of substitutions conferring drug resistance to HIV-1 is both episodic, occurring when patients are on antiretroviral therapy, and strongly directional, with site-specific resistant residues increasing in frequency over time. While methods exist to detect episodic diversifying selection and continuous directional selection, no evolutionary model combining these two properties has been proposed. We present two models of episodic directional selection (MEDS and EDEPS) which allow the a priori specification of lineages expected to have undergone directional selection. The models infer the sites and target residues that were likely subject to directional selection, using either codon or protein sequences. Compared to its null model of episodic diversifying selection, MEDS provides a superior fit to most sites known to be involved in drug resistance, and neither one test for episodic diversifying selection nor another for constant directional selection are able to detect as many true positives as MEDS and EDEPS while maintaining acceptable levels of false positives. This suggests that episodic directional selection is a better description of the process driving the evolution of drug resistance. PMID:22589711

Modeling HIV-1 drug resistance as episodic directional selection.

PubMed

Murrell, Ben; de Oliveira, Tulio; Seebregts, Chris; Kosakovsky Pond, Sergei L; Scheffler, Konrad

2012-01-01

The evolution of substitutions conferring drug resistance to HIV-1 is both episodic, occurring when patients are on antiretroviral therapy, and strongly directional, with site-specific resistant residues increasing in frequency over time. While methods exist to detect episodic diversifying selection and continuous directional selection, no evolutionary model combining these two properties has been proposed. We present two models of episodic directional selection (MEDS and EDEPS) which allow the a priori specification of lineages expected to have undergone directional selection. The models infer the sites and target residues that were likely subject to directional selection, using either codon or protein sequences. Compared to its null model of episodic diversifying selection, MEDS provides a superior fit to most sites known to be involved in drug resistance, and neither one test for episodic diversifying selection nor another for constant directional selection are able to detect as many true positives as MEDS and EDEPS while maintaining acceptable levels of false positives. This suggests that episodic directional selection is a better description of the process driving the evolution of drug resistance.

Improvement in out-of-hours outcomes following the implementation of Hospital at Night.

PubMed

Beckett, D J; Gordon, C F; Paterson, R; Chalkley, S; Stewart, C; Jones, M C; Young, M; Bell, D

2009-08-01

Hospital at Night (H@N) is a Department of Health (England) driven programme being widely implemented across UK. It aims to redefine how medical cover is provided in hospitals during the out-of-hours period. To investigate whether the implementation of H@N is associated with significant change in system or clinical outcomes. An observational study for 14 consecutive nights before, and 14 consecutive nights after the implementation of H@N. Data were collected from the Combined surgical and medical Assessment Unit (CAU), the 18 medical/surgical wards (The Ward Arc) and the four High Dependency Units (The Critical Care corridor) within the Royal Infirmary of Edinburgh. Following an overnight episode of clinical concern, data were gathered on response time, seniority of reviewing staff, patient outcome and the use of Standardized Early Warning Score (SEWS). Two hundred and nine episodes of clinical concern were recorded before the implementation of H@N and 216 episodes afterwards. There was no significant change in response time in the CAU, Ward Arc or Critical Care corridor. However, significant inter-speciality differences in response time were eradicated, particularly in the Critical Care corridor. Following the implementation of H@N, patients were reviewed more frequently by senior medical staff in CAU (28% vs. 4%, P < 0.05) and the Critical Care corridor (50% vs. 22%, P < 0.001). Finally there was a reduction in adverse outcome (defined as unplanned transfer to critical care/cardiac arrest) in the Ward Arc and CAU from 17% to 6% of patients reviewed overnight (P < 0.01). SEWS was more frequently and accurately recorded in CAU. This is the first study that we are aware of directly comparing out-of-hours performance before and after the implementation of H@N. Significant improvements in both patient and system outcomes were observed, with no adverse effects noted.

Frequency and characteristics of individuals with seasonal pattern among depressive patients attending primary care in France.

PubMed

Azorin, Jean-Michel; Adida, Marc; Belzeaux, Raoul

2015-01-01

High rates of bipolar disorder (BD) have been found among major depressives with seasonal pattern (SP) consulting in psychiatric departments, as well as among patients seeking primary care. As SP was reported to be common in the latter, the current study was designed to assess (a) the frequency and characteristics of SP among major depressives attending primary care and (b) the prevalence and aspects of BD in this population. Among 400 patients who consulted French general practitioners (GPs) for major depression between February and December 2010, 390 could be included in the study: 167 (42.8%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for seasonal pattern [SP(+)], whereas 223 (57.2%) did not meet these criteria [SP(-)]. The two groups were compared on demographic, clinical, family history and temperamental characteristics. Compared to SP(-), SP(+) patients were more frequently female, married and with a later age at first depressive episode, and showed more atypical vegetative symptoms, comorbid bulimia and stimulant abuse. They also exhibited more lifetime depressive episodes, were more often diagnosed as having BD II and met more often bipolarity specifier criteria, with higher rates of bipolar temperaments and a higher BD family loading. Among SP(+) patients, 68.9% met the bipolarity specifier criteria, whereas 31.1% did not. Seasonality was not influenced by climatic conditions. The following independent variables were associated with SP: BD according to bipolarity specifier, female gender, comorbid bulimia nervosa, hypersomnia, number of depressive episodes and family history of substance abuse. Seasonal pattern is frequent among depressive patients attending primary care in France and may be indicative of hidden bipolarity. Given the risks associated with both SP and bipolarity, GPs are likely to have a major role in regard to prevention. Copyright © 2015 Elsevier Inc. All rights reserved.

Southern Hemisphere Extratropical Cyclones and their Relationship with ENSO in springtime

NASA Astrophysics Data System (ADS)

Reboita, M. S.; Ambrizzi, T.; Da Rocha, R.

2013-05-01

Extratropical cyclones occurrence is associated with the teleconnection mechanisms that produce climate variability. Among these mechanisms we have El Niño-Southern Oscillation (ENSO). Some works have indicated that during the ENSO positive phase there are more cyclogenetic conditions in some parts of the globe as the southwest of South Atlantic Ocean. Therefore, the purpose of this study is to verify if the extratropical cyclones number and location are altered in the different ENSO phases in the austral spring over the Southern Hemisphere (SH). The Melbourne University automatic tracking scheme was used to determine the cyclone climatology from 1980 to 2012. All cyclones that appear with lifetime higher or equal to 24 hours in the sea level pressure data from National Centers for Environment Prediction reanalysis I were included in the climatology. El Niño (EN), La Niña (LN) and Neutral (N) years were identified through the Oceanic Niño Index (ONI) from Climate Prediction Center/NOAA. The average number of cyclones in the spring over the SH is similar in the EN (200), N (184) and LN (197) episodes. By latitude bands, during EN episodes the cyclones occurrence reduces in 16% between 70-60 degrees and increases in ~15% between 80-70 and 50-40 degrees. On the other hand, during the LN episodes, the cyclones are 17% more frequent in 50-60 degrees and 22% less frequent in 30-20 degrees. One more detailed analysis of the cyclones trajectory density (that is a statistic product of the tracking algorithm) shows that in the South Atlantic Ocean, near the southeast of South America, the number of cyclones in EN years is higher than in the neutral period and lower than in the LN years. In the Indian Ocean, the EN year is characterized by a cyclones reduction in the west and east sector, near the continents. In the Pacific Ocean, the region southward the New Zealand presents more cyclones occurrence in EN years.

Medullary Sponge Kidney and Urinary Calculi Aeromedical Concerns

NASA Technical Reports Server (NTRS)

Jones, Jeffrey A.; Cherian, Sebastian F.; Barr, Yael R.; Stocco, Amber

2008-01-01

Medullary Sponge Kidney (MSK) is a benign disorder associated with renal stones in 60% of patients. Patients frequently have episodic painless hematuria but are otherwise asymptomatic unless renal calculi or infections complicate the disease. Nephrolithiasis is a relative, but frequently enforced, contraindication to space or other high performance flight. Two case reports of asymptomatic NASA flight crew with MSK and three cases of military aviators diagnosed with MSK are reviewed, all cases resulted in waiver and return to flight status after treatment and a vigorous follow up and prophylaxis protocol. MSK in aviation and space flight necessitates a highly case-by-case dependent evaluation and treatment process to rule out other potential confounding factors that might also contribute to stone formation and in order to re-qualify the aviator for flight duties.

The prevalence and nature of stalking in the Australian community.

PubMed

Purcell, Rosemary; Pathé, Michele; Mullen, Paul E

2002-02-01

This study examines the extent and nature of stalking victimisation in a random community sample. A postal survey was distributed to 3700 adult men and women selected from the electoral roll in the State of Victoria. Outcome measures included the lifetime and annual cumulative incidence of stalking, the duration and methods of harassment, rates of associated violence and responses to victimisation. Almost one in four respondents (23.4%;432) had been stalked, the unwanted behaviour they were subjected to being both repeated and fear-provoking. One in 10 (197) had experienced a protracted course of stalking involving multiple intrusions spanning a period of at least one month. Women were twice as likely as men to report having been stalked at some time in their lives, though the rates of victimisation in the 12 months prior to the study did not differ significantly according to gender. Younger people were significantly more likely than older respondents to report having been stalked. Victims were pursued by strangers in 42% of cases. The most common methods of harassment involved unwanted telephone calls, intrusive approaches and following. Associated threats (29%) and physical assaults (18%) frequently arose out of the stalking. Significant social and economic disruption was created by the stalking for 63% of victims. Most sought assistance to manage their predicament (69%). The experience of being stalked is common and appears to be increasing. Ten percent of people have been subjected at some time to an episode of protracted harassment. Assaults by stalkers are disturbingly frequent. Most victims report significant disruption to their daily functioning irrespective of exposure to associated violence.