Myocardial Injury from Tranylcypromine-Induced Hypertensive Crisis Secondary to Excessive Tyramine Intake

Monoamine oxidase inhibitors (MAOIs) are known to cause hypertensive crisis when combined with intake of tyramine, classically found in cheese. We present a case of MAOI-induced hypertensive crisis leading to significant troponin release after soft cheese intake. A 51-year-old lady presented with left-sided chest pain, palpitations and headache in the context of significant hypertension after eating soft cheese. She had a similar episode 2 month prior to this presentation, which resulted in a diagnosis of non-ST elevation myocardial infarction after a troponin of 2768 ng/L (Ref?<?17 ng/L) with normal cardiac investigations and CT pulmonary angiogram. She was known to be on tranylcypromine for bipolar depression. Subsequent cardiac investigations were normal, as were those for phaeochromocytoma and Conn’s disease. Tranylcypromine is a non-selective irreversible MAOI used in refractory depression and bipolar disorder. MAOIs are known to cause hypertensive crisis when combined with soft cheese due to unopposed release of catecholamines from reduced tyramine metabolisation, leading to injury and possible myonecrosis. Three previous case reports have demonstrated either creatinine kinase or troponin rise with myocardial infarction due to this hypertensive crisis and our case is the fourth with significant hypertension and cardiac biomarker rise related to MAOI, specifically tranylcypromine.     

Predictors of cancer screening among low-income primary care patients

Although population-based studies report lower rates of cancer screening among racial/ethnic minorities than among Whites in the U.S., few studies have examined predictors of screening among low-income Hispanic, Black, and Chinese primary care patients. We examined utilization of mammography, Pap smear, digital rectal examination, fecal occult blood testing, sigmoidoscopy/colonoscopy, and prostate-specific antigen testing in 833 patients from 2 community health centers in New York City, ascertaining relationships between use of screening and race/ethnicity, income, education, years in the U.S., insurance, cancer risk perception, family disease history, and physician recommendation. Despite similar access to primary care, Hispanics and Blacks reported higher utilization rates of all screening tests than Chinese (p<.01). Physician recommendation and more years in the U.S. were associated with greater use of all screening services (p<.001), with physician recommendation most strongly associated with screening. Interventions to enhance screening by at-risk groups should emphasize both physician recommendation and culturally-sensitive patient education.     

Polymorphisms in glucocorticoid receptor gene and the outcome of childhood acute lymphoblastic leukemia (ALL)

Childhood acute lymphoblastic leukemia patients (n = 310) were analyzed for four SNPs in the NR3C1 gene. Polymorphisms ?627A/G, intron 2 +646C/G and 9bT/C were all associated with reduced event-free survival. Haplotypes composed of AGT alleles at these loci and tagged by the intron 2 +646G variant also associated with lower event-free survival (p = 0.03). The progressive impact of this haplotype on outcome was seen with two copies associated with reduced overall survival (p = 0.05). Quantitative mRNA analysis in lymphoblastoid cell lines showed that carriers of the AGT haplotype had a higher ratio of GR γ/α isoforms (p = 0.04), which possibly explains its association with reduced event-free survival and overall survival.     

Parental and Child Psychopathology: Moderated Mediation by Gender and Parent–Child Relationship Quality

Previous literature has not examined the processes underlying the relations among parent–child relationship quality, parental psychopathology, and child psychopathology in the context of gender. Further, research examining these variables in emerging adulthood is lacking. The current study examined whether parent–child relationship quality would mediate the relation between parental and child psychopathology, and whether gender moderated these associations. Participants were emerging adults (N?=?665) who reported on perceptions of their parents’ and their own psychological problems as well as their parent–child relationship quality. Results indicated that the relation between parental internalizing problems and parent–child relationship quality was positive for males, and that mother–child relationship quality was related positively to psychological problems in males. This suggests that sons may grow closer to their parents (particularly their mother) who are exhibiting internalizing problems; in turn, this enmeshed relationship may facilitate transmission of psychopathology. Mediational paths were conditional upon gender, suggesting moderated mediation. Overall, the current study emphasizes that the complexities of parenting must be understood in the context of gender. Further, the mother–son dyad may particularly warrant further attention.     

Tetraplegia after elective abdominal aortic aneurysm repair

Spinal cord ischemia after elective infrarenal aortic aneurysm repair is extremely rare, and documented cases that are described are of paraplegia. This case of tetraplegia occurred in a 64-year-old man with disabling claudication after an aortobifemoral graft repair for occlusive disease associated with a 5-cm infrarenal aneurysm. Magnetic resonance imaging supported lower cervical spinal cord ischemia, an unusual area for ischemia during aortic clamping since this area is usually most resistant. Because the lower thoracic and upper lumbar region, typically T8, is more susceptible to ischemia due to the variable collateral spinal cord circulation, the level of clamping was unlikely to be responsible. Other causes are considered. It was likely to be multifactorial and illustrates the need for great attention to detail in perioperative management and patient consent.     

Intensive dialectical behavior therapy for outpatients with borderline personality disorder who are in crisis

OBJECTIVE: This study examined the effectiveness of an intensive version of dialectical behavior therapy for patients in an outpatient setting who met criteria for borderline personality disorder and who were in crisis. METHODS: Over the two-year study period, 127 patients (103 women) between the ages of 18 and 52 years were referred to the program; 87 were admitted, and because of a limited number of places, 40 were referred elsewhere. Patients were admitted after recent suicidal or parasuicidal behavior, and the most suicidal patients were given priority. The treatment was a three-week intensive version of dialectical behavior therapy consisting of individual therapy sessions; an emphasis on skills training provided in groups, including mindfulness skills; and team consultation. A diagnostic interview was administered, and patients were screened with the International Personality Disorder Examination Screening Questionnaire, the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), and the Social Adaptation Self-Evaluation Scale. RESULTS: The only significant difference at intake between patients admitted to the program and those referred elsewhere was a slighter higher incidence of antisocial traits in the latter group. Of the 87 patients admitted, 71 (82 percent) completed the program and 16 (18 percent) dropped out. Pre-post analysis showed significant improvement in scores on the BDI and BHS. CONCLUSIONS: The three-week, intensive version of dialectical behavior therapy was found to be an effective treatment. Treatment completion was high, and patients showed statistically significant improvements in depression and hopelessness measures. This approach allowed therapists to treat a large number of patients in a short time.     

Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences

Objective. To investigate alcohol consumption among mid‐adolescents from different ethnic groups and explore overall and gender variations in drinking behaviours.

Methods. A survey of alcohol use by 609 14–16 year olds recruited from three schools in an ethnically diverse area of London. Approximately 70% of the sample was of White English, White Irish, Black Caribbean or Black African ethnic origin. Self‐report information was collected via a researcher‐administered structured interview.

Results. There was a significantly lower prevalence of lifetime alcohol use among Black African respondents than among the other three ethnic groups. Black African males and males and females from the two White ethnic groups reported drinking above levels recommended by the English Department of Health. Among the recent drinkers, over half of the White Irish and White English groups and over a quarter of Black Caribbean and Black African groups had been intoxicated in the 90 days before interview. Approximately three quarters of the White English and White Irish recent drinkers, but only a half of Black Caribbean and Black African recent drinkers had experienced a negative drinking‐related consequence during the last year.

Conclusions. The survey findings suggest that while young people of White English or White Irish ethnic origin from the populations studied are more likely to drink excessively and experience negative consequences from their drinking than Black African and Black Caribbean youth, a substantial minority of Black African and Black Caribbean youth also experience alcohol‐related problems.