The association between narcolepsy and REM behavior disorder (RBD)

BACKGROUND AND PURPOSE: Rapid eye movement (REM) sleep Behavior Disorder (RBD) is a movement disorder associated with loss of REM-related muscle atonia and is characterized by complex, vigorous and frequently violent dream-enacting behavior during REM sleep. RBD is usually idiopathic or secondary to neurological problems such as Parkinson's disease. This study looked at the association of RBD with another sleep disorder, narcolepsy. PATIENTS AND METHODS: Seventy-eight questionnaires were sent to known narcoleptics chosen at random from those with contact details available at the center. The questionnaire addressed current narcolepsy symptoms, medication use and symptoms of RBD. Positive questionnaire results were followed up with a telephone interview. Limited polysomnography (PSG) data was also analyzed. RESULTS: Fifty-five patients responded (response rate 71%). Of these, 20 (36%) had symptoms suggestive of RBD. The typical RBD patient is an older male (mean age of onset 60.9 years, 87% male); however, in this study, females were as likely to have RBD as males, and the mean age was 41 years. Sixty-eight percent of patients who regularly experienced cataplexy and the associated symptoms of narcolepsy (sleep paralysis, hypnogogic hallucinations and automatic behavior) had RBD, compared to 14% of those who never or rarely experienced these symptoms. CONCLUSION: This study implies a stronger relationship between these disorders than a previously published figure of 7-12% This is clinically significant as RBD is a potentially distressing but readily treatable disorder. It follows that narcoleptics, especially those with cataplexy and other associated symptoms, should be questioned about symptoms of RBD and treated accordingly. Similarly, anyone presenting with RBD should be assessed for symptoms of narcolepsy, particularly if female or of a younger age group than would otherwise be expected.     

Associations of fibrinogen and C-reactive protein with prevalent and incident coronary heart disease are attenuated by adjustment for confounding factors. British Women's Heart and Health Study

A cross sectional and prospective analysis of 3,745 British women aged 60-79 years at baseline was undertaken. Among these women there were 570 prevalent cases of coronary heart disease (CHD) and 151 new cases among 12,641 person-years of follow up of women who were free of CHD at baseline. Both fibrinogen and CRP were associated with indicators of socioeconomic position in childhood and adulthood and there was a cumulative effect of socioeconomic position from across the life course. The age-adjusted odds ratio (95% confidence interval) of prevalent CHD for a 1 unit (1 g/L) increase in fibrinogen was 1.29 (1.12, 1.49); with full adjustment for all potential confounding factors this attenuated to 1.09 (0.93, 1.28). The hazards ratio for incident CHD among those free of disease at baseline was 1.28 (1.00, 1.64); with full adjustment for all potential confounding factors this attenuated to 1.09 (0.84, 1.44). Similar effects of adjustment for confounding factors were seen for the associations between CRP and both prevalent and incident CHD. By contrast, the strong positive association between smoking (an established causal risk factor for CHD) and CHD was not attenuated by adjustment for life course socioeconomic position or other risk factors. We conclude that fibrinogen and CRP predict CHD but may not be causally related to it.     

A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas

OBJECTIVE: To determine the difference between two laparoscopic methods for the management of endometriomas with regard to recurrence of signs and symptoms and pregnancy rate. DESIGN: Prospective, randomized clinical trial. SETTING: Infertility and gynecologic endoscopy units of two medical university hospitals. PATIENT(S): One hundred patients with endometriomas who had either infertility or pelvic pain. INTERVENTION(S): Patients were randomly divided into two groups; one group underwent cystectomy (group 1), and fenestration and coagulation were performed for the other (group 2). MAIN OUTCOME MEASURE(S): A comparison of recurrence of signs and symptoms of endometriomas and pregnancy rates in two groups. RESULT(S): Fifty-two patients were studied in group 1 and 48 in group 2. The recurrence of symptoms, such as pelvic pain and dysmenorrhea, was 15.8% in group 1 and 56.7% in group 2 after 2 years. The rate of reoperation was 5.8% in group 1 and 22.9% in group 2 and these differences were statistically significant. The cumulative pregnancy rate was significantly higher in group 1 (59.4%) than in group 2 (23.3%) at 1-year follow-up. CONCLUSION(S): Laparoscopic cystectomy of endometriomas is a better choice than fenestration and coagulation because the former technique leads to a lower recurrence of signs and symptoms and a lower rate of reoperation and a higher cumulative pregnancy rate than the latter.     

Women's knowledge about treatment to prevent mother-to-child human immunodeficiency virus transmission

OBJECTIVE: To provide national estimates of knowledge about treatments available to reduce mother-to-infant human immunodeficiency virus (HIV) transmission among U.S. women of childbearing age. METHODS: We used data from 55712 women aged 18 to 44 years who responded to questions on antiretroviral treatment in the 2001 Behavioral Risk Factor Surveillance System. We obtained the percentage of women who correctly answered a question on treatment to prevent mother-to-child transmission of HIV and determined factors independently associated with such knowledge using a multiple logistic regression model. RESULTS: Overall, the percentage of women who correctly stated that treatment existed to help prevent mother-to-child transmission of HIV was 58.6% (95% confidence interval 57.9, 59.3). In the multiple logistic regression model that controlled for sociodemographics, having correct knowledge about treatment to prevent mother-to-child HIV transmission was independently associated with being black, younger age (18-34 years), college level education, and having been tested for HIV. Current pregnancy was not an independent predictor of having knowledge about the availability of treatment to prevent mother-to-child transmission. CONCLUSION: Among US women of childbearing age, just over one half had correct knowledge of effective perinatal HIV prevention strategies. Increasing the awareness of these treatments may lead to greater uptake of HIV testing among pregnant women.