Pneumococcusuria: From bench to bedside

The present study highlights six cases of pneumococcusuria during the time period of May 2008 to May 2010. All the patients had a co-existing predisposing factor with the isolation of Streptococcus pneumoniae in urine. Five of the six patients having signs and symptoms of urinary tract infections (UTI) were treated and cured of the same. It becomes essential to consider pneumococcal UTI in the presence of clinical signs and symptoms associated with urinary tract abnormalities like hydronephrosis and renal stones. S. pneumoniae may be regarded as an emerging pathogen in UTI. Precise microbiological diagnosis must correlate with the clinical signs and symptoms for the administration of appropriate antibiotic therapy.     

Attributional style and symptoms of depression in persons with multiple sclerosis

This study was designed to assess hypotheses derived from the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989), specifically that negative attributional style would be associated with depressive symptoms and that negative life events would interact with negative attributional style to explain depressive symptoms in a sample of persons with multiple sclerosis (MS). The research was cross sectional in design. Data was collected via survey from 495 persons with MS. Attributional style was positively associated with depressive symptoms across the whole sample. The proposition that negative life events would interact with negative attributional style to explain depressive symptoms was also supported, although only for global attributional style. Longitudinal studies would assist in determining the causal direction proposed by the hopelessness theory of depression in this population. It is also appropriate that clinicians consider attributional style in persons with MS whom they are treating for depression.     

Fibromyalgia: A time-series analysis of the stressor-physical symptom association

The purpose of this study was to investigate the association among daily stressors, cognitive rumination, and fibromyalgia symptoms using time-series methodology and to determine whether autocorrelation was present in the self-report data. Twelve female fibromyalgia subjects monitored their daily level of stressors, cognitive rumination, and fibromyalgia symptoms for 30–35 days. Time-series regression analyses indicated that there was a positive association between previous-day stressors and fibromyalgia symptoms for one subject and between previous-day cognitive rumination and fibromyalgia symptoms for four subjects. For 7 out of 12 subjects autocorrelation was present, and generalized least-squares methods were used with these subjects. These results indicate that ordinary least-squares methods may often not be appropriate for within-subject designs with self-report data. These results also question the often reported stressor-physical symptom association. This study illustrates a useful methodology and analysis to investigate psychosocial-physical symptom associations.     

Obsessional thoughts and compulsive behaviors in a sample of women with postpartum mood symptoms

Postpartum psychiatric disorders are widely recognized by clinicians and researchers, yet while much attention has been paid to perinatal mood disorders, considerably less has been given to anxiety and obsessive–compulsive symptoms in this population. The present study examined anxiety and obsessive–compulsive symptoms among postpartum women with mood complaints, with the aim of delineating the relationship between these symptoms. Sixty postpartum women seeking treatment in a perinatal mood disorders clinic completed measures of depression, anxiety, and obsessive–compulsive symptoms. Obsession-like thoughts and compulsive-like (“neutralizing”) strategies were present among the majority of the sample, yet the severity of these symptoms ranged widely. Depressive and anxiety symptoms were associated with obsessive and neutralizing compulsive symptoms. It may be helpful to consider anxiety and depressive symptoms as part of a broad spectrum of perinatal psychiatric illness. Clinicians should assess for anxiety and obsessive–compulsive symptoms as routinely as they assess for depressive symptoms in the perinatal period.     

Psychological Treatment and Medication for the Mood and Anxiety Disorders: Moderators, Mediators, and Domains of Outcome

Studies that combine pharmacotherapy with psychological treatment for the mood and anxiety disorders must consider the role of moderators (pretreatment variables that specify the conditions under which treatments are effective) and mediators (change mechanisms in the causal pathways between treatments and outcomes) in explaining the impact of experimental treatments. This article gives examples of the kinds of moderators and mediators—both psychosocial and biological—that are important to examine in combination treatment studies. It conceptualizes outcome as involving multiple domains, including mood and anxiety symptoms, life functioning, and illness costs. Research should also examine the appropriate sequencing of pharmacological and psycho-social interventions and how this sequencing may vary from disorder to disorder.     

颈椎术后轴性症状与影像学评价指标相关性的研究进展

目前,临床上将颈椎术后颈项及肩背部疼痛、僵硬、肌肉紧张酸胀及活动受限等不适感称为轴性症状（AS）。颈椎术后轴性症状的评价及影响因素尚无统一标准,既往众多影响因素中研究较多的是颈椎手术方式,而颈椎影像学参数评价指标与术后轴性症状的相关性是近年来脊柱外科医生研究的热点问题。颈椎手术方式的选择以及大部分颈椎影像学评价指标的改变所引起的术后轴性症状或许均与颈后肌肉、韧带等软组织结构的力学环境和运动模式改变相关。颈后肌肉、韧带等软组织与颈椎影像学评价指标之间存在相互关联,若要进一步分析术后轴性症状的相关因素,则需相互结合,从整体考虑。     

Idiotypes and diseases

Two of the founders of modern immunology, Henry G. Kunkel and Jacques Oudin, died recently. Since they were responsible for the discovery and naming of immunoglobulin idiotypes it was appropriate at a recent meeting to consider our present understanding of the role of idiotypes in the immune system.     

When is it appropriate to prescribe postmenopausal hormone therapy?

OBJECTIVE: To develop evidence and consensus-based recommendations for the use of hormone therapy (HT) in postmenopausal women. DESIGN: Using evidence from clinical trials and other publications, a multidisciplinary group of women's health experts developed consensus-based recommendations for HT use in more than 300 clinical scenarios. These panelists utilized the RAND Appropriateness Method and a quantitative scale to rate the appropriateness of treatment options for women with various risk factors and clinical scenarios. RESULTS: The panel judged it appropriate to prescribe all forms of HT to women with intolerable menopause symptoms and usual (age-expected) risks of cardiovascular disease (CVD), venous thromboembolism (VTE), or stroke. Use of HT was judged not appropriate for the clinical scenarios of bone preservation, cosmetic appearance, current memory loss, loss of libido, or CVD protection. For a woman still using HT after 5 or more years, it was considered appropriate to recommend the options of stopping or lowering the dose even if stopping was previously attempted. In treating intolerable symptoms in the presence of some elevated risk for diseases related to HT, route of administration may affect appropriateness but prior stroke or TIA# is a contraindication. CONCLUSIONS: Standard HT is appropriate for women with intolerable menopause symptoms in the absence of HT-related risk factors (eg, CVD, stroke, VTE, breast cancer). Panelists judged it appropriate to repeatedly present the option of stopping or reducing the dose. In most cases, presence of risk factors makes standard-dose oral HT not appropriate; however, some women may be candidates for a different dose or route of administration.     

Oral allergy syndrome (OAS): symptoms of IgE-mediated hypersensitivity to foods

Eighty highly atopic patients were selected for study because they had either atopic eczema (fifty cases) or atopic reactivity to foods, as judged by a positive skin-prick test (thirty cases). In all, sixty-five out of eighty subjects (81%) described symptoms of some kind provoked by foods, but correspondingly positive skin tests were found in only half of these, thirty-three out of eighty (41%). The symptoms experienced by thirty-one of the thirty-three patients with positive skin tests were immediate in onset (within 1 hr) and were at first confined to the upper gastrointestinal tract, the most frequent symptoms being oral irritation and throat tightness. In a proportion of these patients, further symptoms such as urticaria, asthma or anaphylaxis developed following the initial oral symptoms, which suggested the term'oral allergy syndrome'. In the absence of the oral allergy, symptoms such as asthma, urticaria, migraine or eczema starting later than 1 hr after food were seldom associated with positive skin tests. In the oral allergy syndrome, the characteristic symptoms (strong association with positive skin tests and RAST, time of onset and sites at which symptoms are expressed) suggest a causative relationship between exposure to food antigens and specific IgE-induced release of mediators. In cases of food intolerance that lack a characteristic symptom pattern and a positive skin test or radio-allergo-sorbent test, it seems appropriate to consider non-IgE-mediated causes.     

Nasal cavity metastasis of breast cancer: a case report and review of the literature

Objective: The nasal cavity is an uncommon site for metastasis to develop and thus metastases arising from breast cancer are rarely observed. We report a case of a 61-year-old female with two-year history of breast cancer who presented with a nasal cavity that was diagnosed as metastatic breast carcinoma by histopathological analysis of the nasal cavity specimen. Methods: We reviewed the clinical records of the patient and the appropriate world literature.Results: The patient had been diagnosed with breast cancer two years before. Her present complain was oculus dexter visual acuity decreased. CT and MRI scan revealed a palpable mass on the right nasal cavity. PET/CT demonstrated no additional uptake at the level of other organ. ER and PR demonstrated a similar expression pattern in primary breast carcinoma and nasal cavity lesions. As further treatment she received systemic palliative chemotherapy in addition to intravenous treatment with bisphosphonates, and a total dose of 36 Gy of X-ray (3 Gy per day, 12 fractions) was given to the local site of the right nasal cavity. Conclusion: In patient with a previous history of breast cancer who complains even of ophthalmologic symptoms such as visual acuity decreased, it is important to consider nasal cavity metastatic disease. 18FDG-PET/CT is useful to rule out the presence of other organ metastasis. Histopathological analysis may aid the diagnosis. The establishment of treatment strategies based on a comprehensive understanding of both etiology and pathophysiology is needed for rare cases such as this.     

Depressive symptoms and help-seeking intentions in young people

Whether the help-negation effect as demonstrated for suicidal thoughts was also evident for depressive symptoms was investigated in three studies of young people from diverse urban areas. The studies involved a large sample of younger high school students (years 7 – 10), a sample of older high school students (years 8 – 12), and first year university students. A self-report questionnaire that measured help-seeking intentions, prior help-seeking experiences, and depression was administered. It was found that the strongest inverse association between level of depressive symptoms was with intentions to seek help from parents across all three samples. There was a consistent trend for students to report being more likely to seek help from no one as depressive symptoms increased. Evidence of the help-negation effect being present for depressive symptoms is discussed in terms of ways to encourage appropriate and effective help-seeking in young people.     

The relevance of analogue studies for understanding obsessions and compulsions

Analogue samples are often used to study obsessive–compulsive (OC) symptoms and related phenomena. This approach is based on the hypothesis that results derived from such samples are relevant to understanding OC symptoms in individuals with a diagnosis of obsessive–compulsive disorder (OCD). Two decades ago, Gibbs (1996) reviewed the available literature and found initial support for this hypothesis. Since then there have been many important advances addressing this issue. The purpose of the present review was to synthesize various lines of research examining the assumptions of using analogue samples to draw inferences about people with OCD. We reviewed research on the prevalence of OC symptoms in non-clinical populations, the dimensional (vs. categorical) nature of these symptoms, phenomenology, etiology, and studies on developmental and maintenance factors in clinical and analogue samples. We also considered the relevance of analogue samples in OCD treatment research. The available evidence suggests research with analogue samples is highly relevant for understanding OC symptoms. Guidelines for the appropriate use of analogue designs and samples are suggested.     

Airway disease: similarities and differences between asthma, COPD and bronchiectasis

Airway diseases are highly prevalent worldwide; however, the prevalence of these diseases is underestimated. Although these diseases present several common characteristics, they have different clinical outcomes. The differentiation between asthma, chronic obstructive pulmonary disease and bronchiectasis in the early stage of disease is extremely important for the adoption of appropriate therapeutic measures. However, because of the high prevalence of these diseases and the common pathophysiological pathways, some patients with different diseases may present with similar symptoms. The objective of this review is to highlight the similarities and differences between these diseases in terms of the risk factors, pathophysiology, symptoms, diagnosis and treatment.     

Glycogen Storage Disease Type III diagnosis and management guidelines

PurposeGlycogen storage disease type III is a rare disease of variable clinical severity affecting primarily the liver, heart, and skeletal muscle. It is caused by deficient activity of glycogen debranching enzyme, which is a key enzyme in glycogen degradation. Glycogen storage disease type III manifests a wide clinical spectrum. Individuals with glycogen storage disease type III present with hepatomegaly, hypoglycemia, hyperlipidemia, and growth retardation. Those with type IIIa have symptoms related to liver disease and progressive muscle (cardiac and skeletal) involvement that varies in age of onset, rate of disease progression, and severity. Those with type IIIb primarily have symptoms related to liver disease. This guideline for the management of glycogen storage disease type III was developed as an educational resource for health care providers to facilitate prompt and accurate diagnosis and appropriate management of patients.MethodsAn international group of experts in various aspects of glycogen storage disease type III met to review the evidence base from the scientific literature and provided their expert opinions. Consensus was developed in each area of diagnosis, treatment, and management.ResultsThis management guideline specifically addresses evaluation and diagnosis across multiple organ systems (cardiovascular, gastrointestinal/nutrition, hepatic, musculoskeletal, and neuromuscular) involved in glycogen storage disease type III. Conditions to consider in a differential diagnosis stemming from presenting features and diagnostic algorithms are discussed. Aspects of diagnostic evaluation and nutritional and medical management, including care coordination, genetic counseling, hepatic transplantation, and prenatal diagnosis, are addressed.ConclusionsA guideline that will facilitate the accurate diagnosis and appropriate management of individuals with glycogen storage disease type III was developed. This guideline will help health care providers recognize patients with all forms of glycogen storage disease type III, expedite diagnosis, and minimize stress and negative sequelae from delayed diagnosis and inappropriate management. It will also help identify gaps in scientific knowledge that exist today and suggest future studies.     

Seasonality of symptom onset in first-episode schizophrenia

BACKGROUND: There have been numerous reports of seasonal trends in psychotic illnesses. In schizophrenia, seasonal trends in incidence have been shown to be especially apparent in first-episode cases. Most previous research has used date of admission as a proxy for date of incidence of disorder; we present results of an investigation into seasonal trends in dates of onset of symptoms in a group of 295 first-episode cases of schizophrenia and schizophreniform disorder. METHOD: Data were analysed using statistical methods appropriate for detecting seasonal trends in pooled data over 6 years. RESULTS: Only male cases of schizophrenia and schizophreniform disorder showed a significant seasonal distribution to dates of onset of symptoms, with a peak in August (winter). CONCLUSION: True seasonal patterns are present in schizophrenia incidence, but their consistency with other published studies and wider significance, is difficult to ascertain because of different methods used in dating incidence of disorder.     

EMAS recommendations for conditions in the workplace for menopausal women

Women form a large part of many workforces throughout Europe. Many will be working throughout their menopausal years. Whilst the menopause may cause no significant problems for some, for others it is known to present considerable difficulties in both their personal and working lives. During the menopausal transition women report that fatigue and difficulties with memory and concentration can have a negative impact on their working lives. Furthermore, hot flushes can be a source of embarrassment and distress. Some consider that these symptoms can impact on their performance. Greater awareness among employers, together with sensitive and flexible management can be helpful for women at this time. Particular strategies might include: fostering a culture whereby employees feel comfortable disclosing health problems, allowing flexible working, reducing sources of work-related stress, providing easy access to cold drinking water and toilets, and reviewing workplace temperature and ventilation.     

Treating schizophrenia at the time of menopause

The purpose of this review is to optimize treatment for women with schizophrenia during the menopause. Recommendations are based on a relatively sparse literature derived from searching PubMed, PsychINFO, SOCINDEX with appropriate search terms for all years subsequent to 2000. Attention needs to be paid to menopausal symptoms in women with schizophrenia and to the possibility that psychotic symptoms may worsen at this time and that general health may deteriorate. Antipsychotic treatment may need to be modified and cardiac and metabolic health indices closely monitored.     

Diagnostic issues for adolescents and adults with ADHD

Attention deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric syndrome once thought to disappear with maturation. Current data indicate that ADHD remains "hidden" in many of the grown-ups who had it as children. Adult prevalence rates range from 1% to 6% of the population. Research suggests the core childhood symptoms of hyperactivity, inattention, and impulsivity shift with development, perhaps transforming into more overt difficulties in executive functions and affect regulation. ADHD is also usually nestled with other comorbid psychiatric conditions, especially in adolescents and adults, further complicating diagnosis and treatment. This article discusses how to recognize and diagnose ADHD in older patients. Key points include core symptoms present during childhood, appropriate family history in this strongly genetic condition, management of comorbidity, and the evolving role of diagnostic testing. Other medical causes for similar symptoms are considered.     

Diagnosis of organic anxiety disorders

The author reviews the differential diagnosis of organic conditions that can present with prominent symptoms of anxiety. The unique characteristics of various cardiopulmonary, endocrine, neurologic, and other disorders are emphasized, and essential diagnostic studies are discussed. With full awareness of these disorders, the clinician can ensure that patients with anxiety receive appropriate medical evaluations.     

Polychlorinated dibenzofurans (PCDFs) in the subcutaneous adipose tissue of yusho patients and normal controls

Polychlorinated dibenzofurans (PCDFs) are well known to be the toxic chemicals in both animal experiments and human studies. It is, therefore, important to determine the level of PCDFs still retained in patients for understanding relationship between the concentration of PCDFs and present symptoms of the disease. In this study, the abdominal subcutaneous adipose tissue of 18 yusho patients and those of 11 normal controls who were all of volunteers were collected, and their levels were determined by high resolution gas chromatography/high resolution mass spectrometry. Results obtained were as follows: The principal compounds detected in the adipose tissue of yusho patients were 2,3,4,7,8-pentachlorodibenzofuran (PenCDF), 1,2,3,4,7,8- and 1,2,3,6,7,8-hexachlorodibenzofuran (HCDF). The concentration of the compounds in 7 patients, wearing typical symptoms, from 160 to 3,000 ppt for 2,3,4,7,8-PenCDF, from 51 to 1,000 ppt for 1,2,3,4,7,8-HCDF, and from 16 to 220 ppt for 1,2,3,6,7,8-HCDF. In normal controls, 2,3,4,7,8-PenCDF was detected only in five samples at the low level of from 16 to 38 ppt. On an average, PCDF levels in in the typical 7 yusho patients and 11 normal controls were 1,900 ppt and 16 ppt, respectively. On the basis of the results, the concentrations of PCDF congeners in the adipose tissues of the typical 7 patients was 100 times higher than that of the normal controls. Hence, we consider that the present levels of PCDFs in the patients probably play an important role for the symptoms of the yusho.