Are GRIK3 (T928G) gene variants in schizophrenia patients different from those intheir first-degree relatives?

We examined whether the GRIK3 (T928G) polymorphic variants in patients with schizophrenia are different from those of their first-degree relatives and healthy controls. The study population was composed of 256 patients with schizophrenia, 305 first-degree relatives of schizophrenia patients and 242 healthy control subjects. The GRIK3 (T928G) polymorphism was determined by restriction fragment length polymorphism. The frequency of the TT genotype was predominant, whereas the GG genotype was rare among all groups. The frequencies of GRIK3 (T928G) genotype distributions in the patients with schizophrenia were similar to those of their relatives. The frequency of the GG genotype was significantly higher in patients than in healthy controls. Similarly, GG genotype distribution in relatives was elevated compared with that in controls, but this value did not reach statistical significance. On the other hand, the subgroups of schizophrenia patients did not show a significant association with the GRIK3 (T928G) gene. It appears that the patients share the same (GRIK3) T928G gene variants with their relatives. One interpretation of our findings is that the relatives are at risk for the development of schizophrenia in the future.     

Magnetic resonance imaging at first episode in pediatric multiple sclerosis retrospective evaluation according to KIDMUS and lesion dissemination in space criteria

Background: Several diagnostic imaging criteria are being described and examined in pediatric multiple sclerosis (MS). Compared to adults, children are more likely to experience acute or relapsing demyelinating episodes of various etiologies which show similar clinical and magnetic resonance imaging (MRI) findings. Aim: To investigate the fulfillment of MRI diagnostic criteria at initial episode in pediatric MS. Methods: We reviewed our series of children and adolescents with the final diagnosis of clinically definite MS and applied the McDonald dissemination in space (DIS) and KIDMUS criteria to their initial MRI scans. Results: Thirty patients (17 girls, 13 boys), most with brainstem dysfunction and polysymptomatic presentation, were included in the study. Twenty-five (83.3%) patients fulfilled both McDonald and KIDMUS criteria. Patients who did not meet any McDonald DIS criteria did not meet KIDMUS criteria either. Only one patient met the McDonald criteria but not the KIDMUS criteria because of the absence of lesions perpendicular to corpus callosum. Conclusions: Our results show 5/30 (16.6%) of MS patients may not present the diagnostic MRI features initially. The variable sensitivity observed for the current MRI criteria in different series can be due to referral biases, differences between populations and length of follow-up, and the definition of MS patients by two attacks only.     

Abdominal sacrohysteropexy in young women with uterovaginal prolapse: results of 20 cases

OBJECTIVE: To report the results of abdominal sacrohysteropexy with polypropylene mesh in young women who wish to retain their uteri following uterovaginal prolapse. STUDY DESIGN: Twenty young women underwent abdominal sacrohysteropexy and concomitant reconstructive surgery. The preoperative and postoperative protocols included a urogynecologic history, physical examination, voiding diary, 1-hour pad test, cough stress test, multichannel urodynamic studies and administration of a validated, prolapse-specific symptom inventory and quality of life instrument. RESULTS: Of the 20 patients with marked uterovaginal prolapse, 13 had urodynamic stress incontinence. Anterior and posterior vaginal wall prolapse and urodynamic stress incontinence recurred in 1 of 20 patients (5%) at a mean follow-up of 25 months. Nineteen patients stated that their sex life had improved, although 3 of them had dyspareunia. One patient was dissatisfied owing to persistent dyspareunia. The postoperative values on the symptom inventory and quality of life scores were significantly lower than the preoperative values. The low scores suggest satisfaction and no symptoms of prolapse. CONCLUSION: Abdominal sacrohysteropexy is effective and safe in the treatment of uterovaginal prolapse in women who wish to retain their uteri. It maintains a durable anatomic restoration, normal vaginal axis and sexual function. The success rate is excellent for correcting prolapse, and the complications are minimal.     

Evaluation of three methods for detection of methicillin-resistant Staphylococcus aureus

AIM: To evaluate GenoType methicillin-resistant Staphylococcus aureus (MRSA) Direct assay and cultivation for the identification of MRSA by using mecA polymerase chain reaction (PCR) as the “gold standard” assay. METHODS: In total of 61 nasal specimens from patients at the intensive care unit were studied by GenoType MRSA Direct test, conventional culture method and automated bacterial identification system. The results of GenoType MRSA Direct assay were compared to conventional culture method the identification of MRSA and mecA gene PCR as the “gold standard” method. The sensitivity, specificity, positive predictive value and negative predictive value were calculated. RESULTS: In total, 61 specimens were studied. Fifty-four specimens (88.5%) were negative by all three methods. Six swabs (9.8%) were found positive by GenoType MRSA Direct test, conventional culture method and automated bacterial identification system. The presence of mecA in these strains was confirmed by PCR. One swab sample was negative for culture methods but MRSA and mecA gene were detected by GenoType MRSA Direct test and mecA PCR respectively. GenoType MRSA Direct test had a sensitivity of 100% (6/6) and a specificity of 100% (55/55), with a positive predictive value of 100% and a negative predictive value of 98%. Culture method of MRSA had a sensitivity of 83.3% (5/6) and a specificity of 98.2% (55/56). CONCLUSION: It was found that the GenoType MRSA Direct assay, which is a rapid and accurate test, is of the same sensitivity and specificity with mecA PCR. The GenoType MRSA Direct assay can be a better tool for rapid and accurate detection of MRSA in diagnostic laboratories.     

CD26/dipeptidyl-peptidase IV and adenosine deaminase serum levels in psoriatic patients treated with cyclosporine, etanercept, and psoralen plus ultraviolet A phototherapy

Objective The aim of this study is to determine serum levels of soluble forms of CD26/dipeptidyl‐peptidase IV (DPP‐IV) and adenosine deaminase (ADA), thought to be markers of T‐cell activation, and changes in their levels in response to cyclosporine, etanercept, and psoralen plus ultraviolet A (PUVA) treatments with respect to disease activity. Methods This study is designed as a prospective clinical study with a control group and three months of follow‐up. The study included 41 patients with psoriasis and 41 healthy controls that were older than 18 years of age. There were three different treatment groups: PUVA (n = 15), cyclosporine (n = 15), and etanercept (n = 11). To determine disease severity of patients with psoriasis, psoriasis area and severity index (PASI) scores were calculated. Results Only mean serum ADA levels were different between patients with psoriasis [mean ± standard deviation (SD) = 13.9 ± 3.3 U/ml] and control group (mean ± SD = 12 ± 3.5 U/ml). Mean serum ADA levels were significantly higher before treatment than after treatment (mean ± SD = 12.4 ± 3.4 U/ml). Contrarily, following three months of therapy, mean serum CD26 levels increased significantly from 777.7 ± 214.6 to 835.3 ± 203 ng/ml (P < 0.05) and mean serum DPP‐IV activity increased significantly from 12.1 ± 4 to 15.9 ± 4.2 nmol/min (P < 0.05). There was no correlation between ADA and CD 26/DPP‐IV with PASI values. Conclusions The results show that ADA might be a useful marker indicating disease activity and T‐cell activation. As significant changes were observed in serum CD26/DPP‐IV before and after treatment, we think CD26/DPP‐IV might play a role in psoriasis pathogenesis, which should be clarified by further studies.     

Radiological,clinical and audiological evaluation of jugular bulb–vestibular aqueduct dehiscence

Objective: The aim of this study is to determine the prevalence of jugular bulb–vestibular aqueduct dehiscence (JBVAD) in patients undergoing temporal bone multidetector computed tomography (MDCT) and assess the relationship between JBVAD and hearing loss with the findings of audiometry.

Methods: About 1503 temporal bone MDCT scans were evaluated for the prevalence of JBVAD. Correlation of the imaging findings and audiometric data was performed. Patients were divided into two groups, those with and those without hearing loss, and were statistically compared.

Results: Jugular bulb–vestibular aqueduct dehiscence was detected in 124 of the 1503 patients with a prevalence of 8.2%. MDCT images of 56 of the 124 patients were normal except for JBVAD (n?=?38) and close proximity of the jugular bulb (JB) and vestibular aqueduct (VA) (n?=?18). A total of 23 of 38 patients with JBVAD and 7 of 18 patients with close proximity of the JB and VA had hearing loss detected by audiometric evaluation.

Conclusions: The most common hearing loss was detected as sensorineural hearing loss in patients with JBVAD. Also, median air and bone conduction and air bone gap values were found statistically higher in patients with hearing loss versus those without hearing loss.     

The impact of case mix on timely access to appointments in a primary care group practice

At the heart of the practice of primary care is the concept of a physician panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. A physician’s appointment burden is determined by the size and composition of the panel. Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. In this paper, we quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide adequate access to its empanelled patients. We use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. We formulate problem of minimizing the maximum overflow for a multi-physician practice as a non-linear integer programming problem and establish structural insights that enable us to create simple yet near optimal heuristic strategies to change panels. This optimization framework helps a practice: (1) quantify the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and (2) determine how panels can be altered in the least disruptive way to improve access. We illustrate our methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. An important advantage of our approach is that it can be implemented in an Excel Spreadsheet and used for aggregate level planning and panel management decisions.