Asymptomatic renal failure in a patient with bipolar disease without lithium therapy

A 48-year-old Chinese woman with a history of major depressionand bipolar disease, controlled by bromazepam, clozapine, fluoxepineand lamotrigine for several years, presented with microscopichaematuria (red blood cells: 10–25 per high power fieldon urinalysis) and acute renal failure (serum creatinine: 1.6mg/dL with a baseline value 0.8 mg/dL) upon routine health exam.She was referred to our hospital for further work-up. She deniedany previous ingestion of lithium. Neither analgesics nor anti-inflammatoryagents were used by the patient in the recent past. Her bodyweight (BW) was 71 kg. She showed no signs of dehydration, oedema,     

Incidence and method of suicide mortality in patients with schizophrenia: a Nationwide Cohort Study

Purpose

Suicide is a leading cause of death in patients with schizophrenia. This nationwide cohort study investigated the incidence of each suicide method in patients with schizophrenia compared with the general population.

Methods

In total, records of 174,039 patients with schizophrenia were obtained from the National Health Insurance Research Database in Taiwan from 2001 to 2016. This schizophrenia cohort was linked with the national mortality database, and 26,926 patients died during this follow-up period. Of the deceased, 3033 had died by suicide. Univariate Cox regression was used to estimate the demographic variables associated with suicide. We estimated the difference in the proportion of each suicide method used in patients with schizophrenia compared with the general population. The incidence and standardized mortality ratio (SMR) of each suicide method were calculated and stratified based on sex.

Results

Patients aged 25–34 years exhibited the highest suicide risk. Compared with the general population, patients with schizophrenia were more likely to commit suicide by jumping and drowning and less likely to use charcoal-burning and hanging. Women showed a higher incidence of suicide by drowning and jumping than did men. Comorbidity with substance use disorders (SUDs) was associated with a high suicide SMR (26.9, 95% confidence interval [CI] = 23.4–28.9), particularly for suicide by jumping (61.2, 95% CI = 48.3–76.3).

Conclusions

Patients with schizophrenia had higher suicide rates for all methods than did the general population. Suicide method differed based on sex. Patients with SUDs exhibit a high SMR for each suicide method and warrant intensive clinical attention.

     

No Change of The Lipid Profile Under The Control of ApoE Gene Polymorphism in Schizophrenics Under Paliperidone Treatment

The present study tried to explore the effects of Paliperidone on the lipid profiles of schizophrenia patients. One hundred twenty-nine subjects diagnosed with schizophrenia were enrolled into this study and completed the lipid profile evaluation. Their blood samples were obtained on the morning following a 12-hours fast. Cholesterol and triglyceride (TG) levels in plasma were determined, and lipoproteins were determined by enzymatic methods. All participants provided written informed consent, and underwent additional venous blood withdrawal for DNA extraction for genetic study of the ApoE gene polymorphism. Under T test, TC, TG and HDL levels all declined after Paliperidone treatment although with no statistically significant difference. The ratios of TC/HDL declined after Paliperidone treatment, but without statistically significant difference. After GEE-I analysis, we found that ApoE4 genotype (β = 34.471; p < 0.001) had a positive effect on the total cholesterol (TC) level; female had positive effect on the high-density lipoprotein (HDL) level (β = 15.361; p = 0.003); and age had a positive effect on the TG level (β = 1.317; p = 0.030). Smoking (β = 0.961; p = 0.016) had a positive effect on the ratio of TC/HDL change. Lipid profiles were not increased after Paliperidone treatment under the control of ApoE gene polymorphism.     

Sudden loss of consciousness and right flank pain associated with renal infarction

While at home, a 77-year-old woman with atrial fibrillation(Af), coronary artery disease, hypertension and a 10-year historyof hyperlipidaemia experienced a loss of consciousness combinedwith sudden onset of right flank pain and fell on the ground.She was brought to our hospital where brain computerized tomography(CT) revealed an acute infarction over     

Age Effect on Incidence,Physical, and Psychiatric Comorbidity for Sudden Cardiac Death in Schizophrenia: Effet de l’âge sur l’incidence,la comorbidité physique et psychiatrique de la mort cardiaque subite dans la schizophrénie

Objective:The pathogenesis of sudden cardiac death may differ between younger and older adults in schizophrenia, but evidence remains scant. This study investigated the age effect on the incidence and risk of the physical and psychiatric comorbidity for sudden cardiac death.Methods:Using 2000 to 2016 data from the Taiwan National Health Insurance Research Database and Department of Health Death Certification System, we identified a national cohort of 170,322 patients with schizophrenia, 1,836 of whom had a sudden cardiac death. Standardized mortality ratios (SMRs) were estimated. Hazard ratios and population attributable fractions of distinctive comorbidities for sudden cardiac death were assessed.Results:The SMRs of sudden cardiac death were all >1.00 across each age group for both sexes, with the highest SMR in male patients aged <35 years (30.88, 95% CI: 26.18–36.18). The fractions of sudden cardiac death attributable to hypertension and congestive heart failure noticeably increased with age. By contrast, the fraction attributable to drug-induced mental disorder decreased with age. Additionally, chronic hepatic disease and sleep disorder increased the risk of sudden cardiac death in patients aged <35 years. Dementia and organic mental disorder elevated the risk in patients aged between 35–54 years. Ischemic heart disease raised the risk in patients aged ≥55 years.Conclusions:The risk is increased across the lifespan in schizophrenia, particularly for younger male patients. Furthermore, physical and psychiatric comorbidities have age-dependent risks. The findings suggest that prevention strategies targeted toward sudden cardiac death in patients with schizophrenia must consider the age effect.     

Analysis of the CD161-expressing cell quantities and CD161 expression levels in peripheral blood natural killer and T cells of systemic lupus erythematosus patients

Expressed on the cell surface of most of NK cells and some T cells, CD161 has been shown to deliver inhibitory signal in human NK cells. To determine whether the CD161-expressing cell quantities and the cell surface expression levels of CD161 in NK and T cells were altered in systemic lupus erythematosus (SLE) patients, we analyzed the CD3, CD56 and CD161 expression patterns of peripheral blood lymphocytes by flow cytometric analysis to identify different NK and T cell subpopulations. The cell surface expression levels of CD161 were estimated by the mean florescence intensities (MFIs) of CD161. It was found that SLE patients had lower frequencies of CD161+CD56+CD3? and CD161+CD56+CD3+ cells among the lymphocyte population than normal controls, whereas the frequencies of CD161?CD56+CD3? and CD161+CD56?CD3+ cells were not statistically different between two groups. In addition, SLE patients also had decreased absolute counts of all CD161-expressing NK cells and T cells and had reduced frequencies of CD161+ cells in CD56+CD3?, CD56+CD3+ and CD56?CD3+ cell populations. Moreover, SLE patients had reduced MFIs of CD161 in CD161+CD56+CD3+ and CD161+CD56?CD3+, but not CD161+CD56+CD3?, cell populations. Our results indicated that CD161-expressing cell frequency and the CD161 expression levels were reduced in some NK and T cell subpopulations of SLE patients, suggesting possible important role of CD161 and CD161-expressing immune cells in the SLE pathogenesis.     

Gender and Age Differences in Sleep Problems in Children: Person-Oriented Approach With Multigroup Analysis

Objective/Background: This study aimed to identify subtypes of sleep problems in children and to examine whether these patterns differed between gender and age groups. Participants: There were 3,052 children (951 elementary school boys, 943 elementary school girls, 603 junior high school boys, and 555 junior high school girls) aged 7–16 years from two school-based epidemiological samples. Methods: Sleep problems were measured by the Sleep Habit Questionnaire based on parent reports. Results: Using the latent class modeling, a person-oriented approach, with a multigroup analysis, we identified four classes of sleep problems: moderate to high sleep problems (1.1%–3.1%), sleep-related breathing problems and parasomnias dominant (14.9%–21.1%), insomnias dominant and parasomnias (1.0%–3.1%), and no or low sleep problems (74.7%–81.4%), with varied prevalence rates of sleep problems across gender and age groups. Conclusions: This study identified four classes of sleep problems across gender and age groups but with different prevalence rates of sleep problems, suggesting the complex interaction of gender and age in the subtypes of sleep problems. The gender- and age-specific interventions for sleep problems are suggested. Future studies are warranted to replicate these classes and to identify associated factors with each class.     

Occlusion of the fistula in a dialysis patient--is it always a common reason?

A 67-year-old man with chronic glomerulonephritis and end-stagerenal disease (ESRD), on maintenance haemodialysis for 1 year,had a history for failure of a right radiocephalic fistula,a right radiocephalic graft, a right subclavian permanent catheterand a left radiocephalic fistula due to refratory thrombosis.He presented to our hospital with intermittent gross haematuriafor 9 months and swelling over the right arm and left hand for1 month. On further questioning, he also reported a historyof deep venous thrombosis over bilateral lower legs, 3 monthsearlier. He had