Joint Hypermobility Syndrome: Recognizing a Commonly Overlooked Cause of Chronic Pain

Joint hypermobility syndrome, also known as benign hypermobility syndrome, is a connective tissue disease characterized by joint instability, chronic pain, and minor skin changes. It shares many clinical features of Ehlers-Danlos syndrome, Hypermobility Type; enough so that many authorities consider them as one disease process. Approximately 3% of the general population is believed to have joint hypermobility syndrome, but despite this high prevalence, due to lack of awareness, heterogeneity of clinical presentation, and reliance on physical examination for diagnosis, it is largely overlooked by primary care physicians as well as by specialists. This leads to delayed or missed opportunities for diagnosis, and inappropriate interventions that frustrate both providers and patients. We review the literature regarding the pathophysiology, diagnosis, treatment options, and prognosis of joint hypermobility syndrome, and advocate for primary care physicians to consider it in the differential diagnosis of patients with chronic pain.     

Gastric Pepsin Secretion After Prolonged Use of Cimetidine

Eleven patients with proven duodenal ulcer disease but no crater endoscopically were placed on a double-blind, 12-month study of cimetidine vs. placebo b.i.d. There was no evidence of either pepsin or acid rebound hypersecretion at the end of the 12-month study and no obvious differences in this small number of patients between placebo and cimetidine treatment.     

Use of Prolonged Bivalirudin Infusions Following Percutaneous Coronary Intervention

Introduction  

Antithrombotic therapy plays an integral role in percutaneous coronary intervention (PCI). Bivalirudin has been evaluated in elective procedures and across the spectrum of acute coronary syndromes and is associated with decreased bleeding events compared to unfractionated heparin (UFH) in combination with glycoprotein IIb/IIIa inhibitors (GPI) when used for the duration of PCI. The use of bivalirudin beyond the end of PCI is not as well established but is being explored as an option for specific patients.     

Evidence of Altered Cardiac Electrophysiology Following Prolonged Androgenic Anabolic Steroid Use

The non-therapeutic use of androgenic anabolic steroids (AAS) is associated with sudden cardiac death. Despite this, there is no proposed mechanism by which this may occur. Signal-averaged ECG (SAECG) allows the assessment of cardiac electrical stability, reductions of which are a known risk factor for cardiac arrhythmias. The aim of the present study was to examine cardiac electrical stability using SAECG in a group (n = 15) of long-term AAS users (AAS use 21.3 ± 3.1 years) compared with a group (n = 15) of age-matched weight lifters (WL) and age-matched sedentary controls [C (n = 15)]. AS, WL and C underwent SAECG analysis at rest and following an acute bout of exercise to volitional exhaustion. SAECGs were analyzed using a 40 Hz filter and were averaged over 200 beats. Results indicate a non-significant trend for increased incidence of abnormal SAECG measures at rest in AS (P = 0.55). However, AS demonstrated a significantly higher incidence of abnormalities of SAECG following exercise than C or WL (P < 0.05). In conclusion, the higher incidence of abnormal SAECG measurements immediately post-exercise in the AAS group places them at a greater risk of sudden death. The present study provides a strong contraindication to the use of AAS.     

Media and Internet Ownership and Use among Mental Health Outpatients with Serious Mental Illness

Objective: To determine whether people with serious mental illness (SMI) and substance use disorder (SUD) use the Internet to receive health information. Methods: One hundred people with SMI were surveyed in community mental health clinics. Results: Participants with SUD were significantly less likely to use the Internet compared to those who without SUD (.34 [.12–.95] p = .04). Internet users with SUD were significantly more likely to report accessing sites topically related to substance abuse (p = .01). Conclusion: Few participants with SMI and SUD used the Internet. Attention to educating patients about quality health information on the Internet may be warranted.     

Examination of the Inventory of Drug Use Consequences with Individuals with Serious and Persistent Mental Illness and Co-Occurring Substance Use Disorders

Background: The Inventory of Drug Use Consequences (InDUC) () is a 50-item measure that evaluates lifetime and recent consequences of substance use. Objectives: This study examined the psychometric properties of a modified version of the Inventory of Drug Use Consequences (InDUC-M) in individuals with serious and persistent mental illness (SPMI) and co-occurring substance use disorders (SUDs). Methods: We examined self-reported consequences in the sample, evaluated internal consistency, identified items for a brief form of the InDUC-M, and explored relationships with indicators of substance use severity. Results: InDUC-M Lifetime and Recent subscales showed good internal consistency and were related to other measures of substance use and problems. A brief version of the InDUC-M Recent (SIP-M) showed excellent internal consistency and was highly correlated with both Lifetime and Recent subscales. Conclusion: The InDUC-M and the SIP-M performed well in individuals with SPMI and SUDs. Conclusion and Scientific Significance: Overall, these findings are a useful first step in determining the utility of the InDUC-M in people with SPMI and SUDs.     

Limited Effect of Rebamipide in Addition to Proton Pump Inhibitor (PPI) in the Treatment of Post-Endoscopic Submucosal Dissection Gastric Ulcers: A Randomized Controlled Trial Comparing PPI Plus Rebamipide Combination Therapy with PPI Monotherapy

Background/AimsThe ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy.MethodsIn this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses.ResultsThe S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing.ConclusionsCombination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435).     

Prolonged Use of Surgical Masks and Respirators Affects the Protection and Comfort for Healthcare Workers

This study explored the ideal period for wearing masks to prevent the physiological and psychological problems associated with long-term face mask use during respiratory infections by healthcare workers. Breathing simulators, surgical masks (SM) and medical respirators (PM) were prepared for two to eight hours. Changes in the comfort of masks (facial skin temperature, breathing resistance, and moisture permeability) and protection (filtration efficiency, resistance to blood penetration, and colony count) were assessed. The results demonstrated that the masks offered efficient liquid-particle filtering even after eight hours of use. However, the number of bacterial colonies using PM and SM grew significantly after two and four hours, respectively. Concerning comfort, the inspiratory resistance of masks rose dramatically after two hours, whereas the moisture permeability declined considerably after four hours. In addition, skin temperature had a significant increase within two hours, which may result in facial discomfort. When conditions permitted, the hospital staff was instructed to replace their masks every two hours.     

The Correlates of Serious Alcohol-Related Consequences and Illicit Drug Use Amongst a Cohort of Scottish Teenagers

Further results are reported from the first phase of a follow-up study of drinking habits and alcohol-related consequences amongst 1,036 Scottish teenagers. These data revealed that for both males and females, having serious alcohol-related consequences was significantly positively correlated with tobacco consumption and with the use of illicit drugs. These results lend support to existing evidence indicating that multiple drug use is commonplace amongst young people whose use of alcohol is heavy or, in the case of males, causes problems.     

The Correlates of Serious Alcohol-Related Consequences and Illicit Drug Use Amongst a Cohort of Scottish Teenagers

Further results are reported from the first phase of a follow-up study of drinking habits and alcohol-related consequences amongst 1,036 Scottish teenagers.M These data revealed that for both males and females, having serious alcohol-related consequences was significantly positively correlated with tobacco consumption and with the use of illicit drugs.M These results lend support to existing evidence indicating that multiple drug use is commonplace amongst young people whose use of alcohol is heavy or, in the case of males, causes problems.     

氨基酸在长时间心脏停搏中对心肌的保护作用

目的：探讨谷氨酸盐（Ｇ）和天门冬氨酸盐（Ａ）在长时间心脏缺血的心肌保护作用。方法：离体大鼠工作心模型。心脏在１５°Ｃ缺血１５０分钟。４８只Ｗｉｓｔａｒ大鼠分为３组：１组，即对照组（ｎ＝１６），心脏用多剂量４°ＣＳｔ．Ｔｈｏｍａｓ冷晶体心脏停搏液结合温血停搏液诱导及终末再灌注进行心肌保护；２组（ｎ＝１６）同１组，但温血停搏液含Ｇ和Ａ各１３ｍｍｏｌ／Ｌ；３组（ｎ＝１６）同１组，但Ｓｔ．Ｔｈｏｍａｓ冷晶体心脏停搏液和温血停搏液中均含相同浓度的Ｇ和Ａ。结果：温血停搏液中应用Ｇ和Ａ能增加心肌的收缩性和心输出量，使缺血后心肌耗氧量恢复较好（Ｐ＜０．０５）。Ｓｔ．Ｔｈｏｍａｓ冷晶体心脏停搏液和温血停搏液中应用Ｇ和Ａ均明显增加心肌保护，使心功能和心肌耗氧量几乎完全恢复。缺血后心肌酶漏出少，缺血前后心肌高能磷酸盐含量和含水量无明显变化，超微结构改变也不明显。结论：含Ｇ和Ａ温血停搏液诱导及终末再灌注增加冷晶体心脏停搏液对长时间心脏停搏的心肌保护效果，冷晶体心脏停搏液中也应用Ｇ和Ａ能提高心肌对长时间缺血的耐受性     

Use of Commonly Prescribed Antibiotics Is Not Associated with Prevalence of Helicobacter pylori Infection in Adults

Background: The aim of the study was to investigate the association of the use of commonly prescribed antibiotics with prevalence of Helicobacter pylori infection in a population of adult outpatients. Methods: All patients aged 15–79 years who visited the practice of a general practitioner (GP) between June and September 1996 in a suburban community near Ulm, a city in southern Germany, were asked to participate in the study. Infection status was determined with a ^l3C-urea breath test. In addition, the patients were asked to fill out a self-administered questionnaire. Results: Overall, 475 outpatients were included in the study (response, 94.1%). A total of 266 patients (56.0%) reported a history of antibiotic treatment within the past 5 years, whereas 147 patients (30.9%) did not (62 patients (13.1%) did not know). Prevalence of infection in patients with a history of antibiotic medication during the past 5 years was 23.3%, whereas the prevalence of infection was 20.4% in subjects without antibiotic treatment (P = 0.283 after stratification for age). Control for other potential confounders by multivariable analysis did not materially alter the results. Conclusion: Coincidental antibiotic treatment is not associated with H. pylori prevalence in adults.