Sputum Examination in the Screening and Diagnosis of Pulmonary Tuberculosis in the Elderly

Pulmonary tuberculosis is not uncommon in the elderly, particularlythose in institutions, and is notoriously difficult to diagnose.Few bacilli are excreted by individuals with non-cavitatingdisease and positive cultures are usually required to confirmthe diagnosis. Radiography is a poor screening method, and therole of the Mantoux test in this population controversial. Thevalue of sputum culture as a screening procedure in elderlypeople with a productive cough was therefore investigated. Ina prospective surveillance study over 26 months, all permanentresidents in homes for the elderly were entered on the basisof a productive cough for 3 weeks or more irrespective of anyknown or presumed cause. Both smears and cultures were performedon sputum specimens, and Mantoux tests and chest radiographswere performed on those who were sputum positive. The 205 subjects investigated yielded 446 smears, seven of whichwere positive for acid-fast bacilli, and 433 cultures, 32 ofwhich were positive for M. tuberculosis. From this 19 patientswith pulmonary tuberculosis were identified, 18 of whom hadnon-cavitating disease on chest radiography. The numbers ofbacilli in these patients were shown to be low and the excretionpattern haphazard. Smears were not sufficiently sensitive todiagnose non-cavitating tuberculosis in this population, andthe sputum must be cultured in order to exclude the diagnosis.Four negative cultures are required in order to exclude thepresence of pulmonary tuberculosis.     

Epicardial Mapping: Ventricular Epicardial Activation is Unaffected by Heart Position

Epicardial ventricular mapping was performed in five dogs during sinus rhythm with a sock array containing 41 bipolar electrodes. Maps were generated with a computer-assisted mapping system when the heart was in situ and when the heart was lifted by 44 degrees out of the chest. Times of earliest and latest epicardial activation in these two states did not differ. Despite a different frontal plane QRS axis, location of earliest activation was not affected by lifting the heart. In two of the five animals, the site of latest epicardial activation was minimally different from the heart in situ, but the general pattern of epicardial activation was unchanged. Therefore, the change in frontal plane QRS axis with lifting the heart was due to a change in heart position rather than a general change of heart activation.     

认知矫正治疗对慢性精神分裂症患者临床症状和社会功能的影响

目的:观察认知矫正治疗对慢性精神分裂症患者临床症状和社会功能的改善作用。方法:选择2003-01/08在北京回龙观医院住院的慢性精神分裂症患者104例。均符合CCMD-Ⅲ及DSM-Ⅳ关于精神分裂症诊断标准;年龄25～55岁;病程≥2年;病情稳定,处于迁延、残留或部分缓解状态;药物治疗状况稳定,近期无换药打算;纳入对象或家属同意入组并签署知情同意书。应用随机数字表法将患者分认知矫正治疗组和对照组,每组52例。在相近药物治疗的基础上,认知矫正治疗组以Ann Delahunty和Rodney Morice等制定的神经认知矫正手册(汉化)为治疗工具,在治疗师的指导下进行认知作业练习,内容包括认知灵活性、工作记忆、计划执行功能3大功能模块。对照组予以相同时间的工娱治疗,主要包括有治疗师指导的操作性音乐治疗和舞蹈治疗。治疗前后两组患者分别进行PANSS、住院精神患者社会功能缺陷量表和护士观察量表的评定。结果:实验共纳入慢性精神分裂症患者104例,认知矫正治疗组44例,对照组46例进入结果分析,14例脱落。①治疗前后两组患者PANSS量表总分以及阴性症状量表、复合量表、一般精神病理量表、反应缺乏量表4个分量表的评分均有下降,组内比较差异有显著性意义(t=2.12～4.59,P<0.05);减分情况在两组间差异不明显(P>0.05)。②两组患者的社会功能缺陷量表总分在治疗后均有下降,与治疗前比较,差异有显著性意义(t=3.89,2.04,P<0.05);两组间比较,差异无显著性意义(P>0.05)。认知矫正治疗组治疗后护士观察量表的总病情以及总消极、迟滞2个分量表评分下降,与治疗前比较差异有显著性意义(t=1.49,1.19,2.81,P<0.05);其中迟滞项的减分在两组间比较,差异具有显著性意义(F=4.97,P<0.05)。③社会功能量表的改善与词语流畅性的改善呈正相关(R2=0.36,P<0.05),护士观察量表中总病情与积极两项评分的改善也与言语流畅性测验的改善正相关(R2=0.37,0.34,P<0.05)。结论:认知矫正治疗能在一定程度上改善精神分裂症患者的社会功能,并与部分认知功能的改善相关,但对临床症状无明显改善作用。     

Mycobacterial Infections After Renal Transplantation

Mycobacterial infections occurred in 11 of 633 (1.7 per cent)recipients of successful renal transplants. There were no casesof tuberculosis in patients receiving chemoprophylaxis, butamongst those who did not receive prophylaxis disease occurredin six of the 27 (22 per cent) high-risk patients. The majorcause of morbidity during treatment was renal allograft rejection,largely due to reduction in immunosuppressive drug therapy.     

Retreatment of hepatitis C patients with pegylated interferon combined with ribavirin in non-responders to interferon plus ribavirin. Is it different in real life?

Background  

More than 50% of hepatitis C viruses (HCV)-infected patients do not respond to the classical Interferon (IFN)/Ribavirin (RBV) combination therapy. The aim of this study was to evaluate the efficacy of retreatment with Peg-Interferon alpha-2b (PEG-IFN alpha-2b) plus RBV, in patients with HCV, genotypes 1 or 3, who were non-responders to the previous standard treatment with IFN/RBV.     

Efficacy and complications of adalimumab treatment for medically-refractory Crohn's disease: analysis of nationwide experience in Scotland (2004–2008)

Background  Adalimumab is a second generation humanized anti-tumour necrosis factor (TNF) monoclonal antibody with established efficacy in Crohn's disease (CD).
Aims  To evaluate the efficacy and safety of adalimumab on a nationwide clinical setting.
Methods  We used the Scottish Society of Gastroenterology network to identify and follow up the clinical outcomes of patients with CD treated with adalimumab over a 4-year period (2004–2008).
Results  A total of 98 patients received adalimumab - 100.5 patient follow-up years were recorded (64.3% females; median age at diagnosis of 20.7 years; 88.8% treated with 80/40 mg induction regimen. Eighty eight (89.8%) had previous infliximab with 29 (32.9%) primary nonresponders; 32 (32.6%) were corticosteroid-dependent; 47 (47.9%) were intolerant/resistant to most immunosuppressive therapies (two or more). In all, 60% of patients were in clinical remission at 1-year follow-up, with 30% and 55% requiring dose escalation to weekly therapy at 1-and 2-year follow-up respectively. Overall, 29 (29.6%) patients developed complications with eight nonfatal serious (8.2%) adverse events and 2 (2.0%) case fatalities (sepsis following perforation and disseminated colorectal cancer, respectively).
Conclusions  Adalimumab is efficacious in severe and refractory CD in the clinical setting, although there remain significant therapy- and disease-related risks of serious complications.     

Psychological disorders among Spanish Nursing students three months after COVID-19 lockdown: A cross-sectional study

The COVID-19 pandemic had a notable impact on the psychological well-being of a large part of the population, putting them at risk of developing depressive symptoms, different levels of anxiety disorders, and posttraumatic stress disorder (PTSD). One group considered to be at high risk are Nursing students; they were affected as learning strategies changed and clinical practices were cancelled. This study attempts to assess the psychological impact COVID-19 pandemic had on Nursing students and to explore the sociodemographic differences that can be risk factors for mental health disturbance. The psychological impact was evaluated using the Impact of Event Scale-Revised (IES-R) and Hospital Anxiety and Depression Scale (HADS). The study took place 4 months after the state of alarm was declared over in Spain. From a total sample of 304 Nursing students, 26.7%, 39.8%, and 15.5% showed PTSD, anxiety, and depression symptoms, respectively. Severe levels of psychological impact have been associated with being a female, a smoker, and feeling fear and stress. Having a relative test positive has been linked to lower anxiety levels while being afraid or stressed to higher anxiety levels. Being a female, co-habit with friends and feeling stress have been associated with higher depression levels.     

Emmetropic eye growth in East Asians and non-East Asians

Purpose

To compare axial length (AL) growth curves in East Asian (EA) and non-EA emmetropes.

Methods

A meta-regression of 28 studies with emmetrope-specific AL data (measured with optical biometry) was performed. Emmetropia was defined as spherical equivalent refraction (SER) between −0.50 and +1.25 D, determined under cycloplegia if the mean age was ≤20 years. The AL growth curve (mean AL vs. mean age) was first fitted to the full dataset using a weighted nonlinear mixed-effects model, before refitting the model with ethnicity as a two-level grouping variable (EA vs. non-EA). Ethnic differences in growth curve parameters were tested using the Wald test.

Results

A total of 3331 EA and 1071 non-EA emmetropes (mean age: 6.5–23.1 years) were included. There was no evidence of an ethnic difference in either final AL (difference: 0.15 mm, 95% CI: −0.04 to 0.35 mm, p = 0.15) or initial AL, as represented by the amount that the final AL needed to be offset to obtain the y-intercept (difference: −2.77 mm, 95% CI: −10.97 to 5.44, p = 0.51). Likewise, AL growth rate (curve steepness) did not differ between ethnic groups (difference: 0.09, 95% CI: −0.13 to 0.31, p = 0.43). Collectively, AL growth rate decreased from 0.24 mm/year at 6 years of age to around 0.05 mm/year at 11 years of age, after which it dipped below the repeatability of optical biometry (±0.04 mm) and practically plateaued around 16 years of age (final AL: 23.60 mm).

Conclusions

EA and non-EA emmetropes have comparable AL growth curves.     

Coronary heart disease and depression in the elderly--a population- based study

BACKGROUND: Growing interest is nowadays focused on the quality of life of elderly people who survive with chronic diseases. Coronary heart disease (CHD) is one of the most common diseases among the elderly and may have an unfavourable impact on the patient's emotional well-being. OBJECTIVES: We aimed to describe the prevalence of depression and the occurrence of depressive symptoms among elderly CHD patients, with a special emphasis on the relations between depression and the severity of CHD, and to find out the possible association between CHD and depression. METHODS: The study was carried out at the health centre of the municipality of Lieto, in south-west Finland. The study population consisted of 488 community-dwelling men and 708 women, over 64 years old, from among whom the participants with CHD (89 men and 73 women) were selected, and for whom 178 male and 146 female sex- and age- matched controls (free of CHD) were drawn from the population. CHD patients were selected on the basis of the presence of angina pectoris or a past myocardial infarction. Depressive symptoms were measured with the Zung Self-rating Depression Scale. Depression was described in relation to the severity of dyspnoea and chest pain among patients. The associations between depression and age, health, health behaviour, drugs, functional ability and social, psychosocial and environmental factors were analysed by logistic regression analyses. RESULTS: The prevalence of depression was 29% among male patients and 20% among female patients. Depression was significantly more common among male CHD patients than among male controls (P = 0.011). Among women, depression was not associated with CHD. Earlier, depression had gone undiagnosed among many CHD patients and controls, especially male patients. Among male CHD patients, depression was associated with more severe dyspnoea, but no similar association was found among female CHD patients. Among men the occurrence of CHD, physical disability, widowhood or divorce, and among women previous clinical depression, physical disability and the use of angiotensin-converting enzyme (ACE) inhibitors, were associated with depression. CONCLUSION: Depression is common among patients with CHD. It seems that CHD is not an independent factor in the aetiology of depression among the elderly. The association of CHD with depression among men is explained by the acute or chronic psychic stress caused by CHD. It may be that the more complicated the patient's CHD, the more probable is the presence of depression.