Concurrent medical and psychiatric disorders among schizophrenic and neurotic outpatients

The records of two groups of patients (358 schizophrenics and 69 neurotics), attending the community mental health center of the Johns Hopkins Hospital, were reviewed to assess the extent and severity of reported medical problems. Results indicate that 38% of the schizophrenics and 53% of the neurotics report medical problems, but schizophrenics present with serious medical problems more often than do the neurotics. The authors draw attention to the need for properly assessing the severity of these medial problems and for adequately coordinating psychiatric and medical care. Strategies to overcome these difficulties are suggested.     

Selective and differential medium for recovery of Pseudomonas cepacia from the respiratory tracts of patients with cystic fibrosis.

A selective and differential medium, OFPBL (oxidation-fermentation base supplemented with agar, lactose, and two antimicrobial agents), for the isolation of Pseudomonas cepacia from respiratory specimens of patients with cystic fibrosis was developed and tested. Among 725 specimens submitted from seven centers over a 4- to 6-month period, 58 (8%) yielded P. cepacia on OFPBL; only 19 of these were recovered on MacConkey or sheep blood agar (P less than 0.001). No isolate was recovered on MacConkey or sheep blood agar alone. Ranges of recovery rates among centers were 0 to 15% on OFPBL and 0 to 10% on MacConkey or sheep blood agar. Ninety percent of P. cepacia isolates were detected on OFPBL in less than or equal to 3 days. Other nonfermenters and yeasts isolated on OFPBL were distinguished from P. cepacia by failure to acidify the medium. The new medium was clearly superior to MacConkey and sheep blood agars for the isolation of P. cepacia from the respiratory secretions of patients with cystic fibrosis.     

16例应激性溃疡的临床诊治体会

目的 报告应激性溃疡的临床诊治体会。方法 全组16例,男12例,女4例。术前均无溃疡病史,血红蛋白检查均正常。术后早期应用糖皮质激素9例,出血前发生肺不张、严重呼吸道感染、呼吸功能不全6例,低血容量休克5例,急性重症出血坏死性胰腺炎4例,食管癌、贲门癌术后6例,严重烧伤(80％(?)Ⅱ°)1例。14例保守治疗,2例保守治疗无效而手术治疗。结果14例经治疗后(2例手术治疗)痊愈出院,2例死亡。结论 应激性溃疡大出血患者多病情危重,难以忍受二次手术,死亡率约为50％,因此应采取有效的保守治疗,对于保守治疗无效、大出血休克或胃肠穿孔者应及时手术治疗。     

Antibiotics sensitivity pattern of N. gonorrhoeae with special emphasis on norfloxacin and ciprofloxacin

The current study is carried out to find the in-vitro susceptibility of N. gonorrhoeae to Ciprofloxacin, Norfloxacin, Gentamycin etc. in 110 isolates obtained from acute gonococcal urethritis confirmed by smear examination. The isolates obtained are from the patients attending the Skin and STD Clinic of a teaching hospital, clinically diagnosed as suffering from acute gonococcal urethritis. Antibiotic susceptibility test was done by Kirby Bauer disc diffusion technique. Four to five similar well isolated colonies of the gonococcal strains were picked up with a wire loop and transferred to 5 cc of sterile trypticase soya broth (TSB). Tubes were incubated at 36 degrees C. GC agar base plates were inoculated with suspensions using a sterile cotton swab. Antibiotic discs were placed on these plates. The plates were incubated at 35 degrees C for 18-24 hours in a candle jar with 5-10% CO2. The plates were then observed to note the zones of inhibition around the discs. 87.27% of isolated strains were inhibited by norfloxacin at an MIC of 0.06 mu gm/ml; 89.08% of the strains were inhibited by ciprofloxacin at an MIC of 0.025 mu gm/ml. All the strains (110) were inhibited by ciprofloxacin at a concentration of 0.2 mu gm/ml. Gentamycin sensitivity was 86.36%. Out of 110 patients, 85 were treated with norfloxacin of which 81 (95.29%) were cured. Twenty five were treated with ciprofloxacin of which 24 (96%) were cured. This study shows high sensitivity of N. gonorrhoeae to norfloxacin and ciprofloxacin.     

Associations of serum TRAIL concentrations, anthropometric variables, and serum lipid parameters in healthy adults

To investigate the relationships of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), anthropometric variables, and lipid parameters, we measured serum TRAIL concentrations, body mass index (BMI), total body fat (TBF), and serum lipid profiles in 207 healthy adults. There were no significant differences in serum TRAIL concentrations between men and women, nor between elderly persons and middle-aged subjects. However, men with TBF 16.4 kg (75th per centile) exhibited significantly higher serum TRAIL concentrations than those with TBF 11.2 kg (25th per centile) (69.7 +/- 15.1 pg/ml vs 50.2 +/- 14.3 pg/ml, p < 0.05). Serum TRAIL concentration averaged 76.2 +/- 16.1 pg/ml in women with low-density lipoprotein cholesterol (LDL-C) 165 mg/dl (75th per centile), which was significantly above the values (53.1 +/- 12.9 pg/ml, p < 0.05) in those with LDL-C 117 mg/dl (25th per centile), although no differences were observed on the basis of TBF (75th percentile vs 25th percentile). Serum TRAIL concentrations correlated significantlywithTBF (r = 0.31, p < 0.05) and lean body mass (r = -0.26, p <0.05) in men and LDL-C (r = 0.32, p < 0.05) and total cholesterol (r = 0.21, p < 0.05) in women. In conclusion, serum TRAIL concentrations are associated with serum lipid levels and body adiposity in healthy adults, but are unrelated to a subject's age or gender.     

Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features

BACKGROUND: This study evaluated the clinical and sociodemographic features associated with various degrees of concurrent comorbidity in adult outpatients with nonpsychotic major depressive disorder (MDD). METHODS: Outpatients enrolled in the STAR*D trial completed the Psychiatric Diagnostic Screening Questionnaire (PDSQ). An a priori 90% specificity threshold was set for PDSQ responses to ascertain the presence of 11 different concurrent DSM-IV Axis I disorders. RESULTS: Of 1376 outpatients, 38.2% had no concurrent comorbidities, while 25.6% suffered one, 16.1% suffered two, and 20.2% suffered three or more comorbid conditions. Altogether, 29.3% met threshold for social anxiety disorder, 20.8% for generalized anxiety disorder, 18.8% for posttraumatic stress disorder, 12.4% for bulimia, 11.9% for alcohol abuse/dependence, 13.4% for obsessive-compulsive disorder, 11.1% for panic disorder, 9.4% for agoraphobia, 7.3% for drug abuse/dependence, 3.7% for hypochondriasis, and 2.2% for somatoform disorder. Those with more concurrent Axis I conditions had earlier ages at first onset of MDD, longer histories of MDD, greater depressive symptom severity, more general medical comorbidity (even though they were younger than those with fewer comorbid conditions), poorer physical and mental function, health perceptions, and life satisfaction; and were more likely to be seen in primary care settings. LIMITATIONS: Participants had to meet entry criteria for STAR*D. Ascertainment of comorbid conditions was not based on a structured interview. CONCLUSIONS: Concurrent Axis I conditions (most often anxiety disorders) are very common with MDD. Greater numbers of concurrent comorbid conditions were associated with increased severity, morbidity, and chronicity of their MDD.     

Prevalence of hepatitis C virus antibody among Korean adults.

To estimate the prevalence of hepatitis C virus (HCV) infection among Korean adults and to present the putative route of HCV transmission among them, serum samples from 4917 adults older than 20 years of age were tested for antibody to HCV (anti-HCV), and histories of blood transfusion and other pertinent information were obtained by self-administered questionnaires. The overall prevalence of anti-HCV was 1.7%; prevalence was 1.4% in subjects with normal levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), 3.3% in those with slightly elevated and 5.9% in those with markedly elevated levels of the enzymes. The prevalence of anti-HCV increased with increasing age (P < 0.01), but was not associated with blood transfusion. The present study suggests that the prevalence of HCV infection was 1.4% and that the major routes of HCV transmission may be other than blood transfusion in healthy Korean adults.