Chronic pain and depression. IV. DST as a discriminator between chronic pain and depression

In an attempt to clarify the relationship between chronic pain and depression, the authors studied the plasma cortisol response to dexamethasone in a group of 73 consecutive chronic low back pain patients admitted to a pain unit and 34 consecutive patients admitted to an affective disorders unit with the principal diagnosis of primary major depression. Patients with chronic pain were evaluated as to the presence or absence of major depression and patients with primary major depression were evaluated as to the presence or absence of pain complaints as part of their presenting symptomatology. Chronic pain patients with major depression differed significantly from chronic pain patients without major depression (3.4 +/- 3.33 micrograms/dl versus 1.6 +/- 0.9 micrograms/dl, P less than 0.05). Chronic pain patients with major depression also differed from patients with primary major depression with pain complaints (3.4 +/- 3.3 micrograms/dl versus 10.7 +/- 8 micrograms/dl, P less than 0.0005). The values given are post-dexamethasone plasma cortisol levels. Patients having primary major depression with pain complaints do not significantly differ from patients having primary major depression without pain complaints. The dexamethasone suppression test may be a useful method in discriminating those patients with chronic pain versus those with primary major depression, chronic pain patients with major depression versus those with primary major depression and chronic pain patients with major depression versus those with chronic pain and no depression.     

Effects of formal home care on hospitalizations and doctor visits

This study estimates the effects of formal home care, provided by paid professionals, on hospitalizations and doctor visits. We look at different lengths-of-stay (LOS) and types of doctor visits—general practitioners (GP) and specialists—and investigate heterogeneous effects by age groups and informal care availability. Two-part generalized linear models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into 26 cantons. Home care is measured at the canton level and its endogeneity is addressed by using an instrumental variable strategy combined with canton and time fixed-effects. We instrument home care use with the introduction of patient cost sharing for home care in some cantons in 2011. Overall, home care significantly increases the likelihoods of having a hospitalization, any doctor visit, or a GP visit. In addition, home care significantly reduces LOS up to 30 days, but has no effect on the number of doctor visits. These results are driven by the effects on persons 65 years and older. The effects are small, suggesting that the potential of formal home care to limit the growth in inpatient care and doctor visits may be limited.     

A point mutation in the glycerol kinase gene associated with a deletion in the dystrophin gene in a familial X-linked muscular dystrophy: non-contiguous gene syndrome involving Becker muscular dystrophy and glycerol kinase loci

We report a family with an X-linked recessive muscular dystrophy characterised by exercise-induced myalgia, recurrent pigmenturia and mild proximal muscle involvement. Immunocytochemical and immunoblotting analysis in muscle, using the antibody directed against the rod domain of dystrophin, revealed a loss of immunoreactivity, but the immunolabelling using the antibodies directed against the COOH and NH₂ domains of dystrophin were almost normal. The immunoreactions for -sarcoglycan, γ-sarcoglycan and β-dystroglycan were normal. In the five male patients of this family with increased serum creatine kinase levels (from ×8 to ×50), mass spectrometry screening of the urine revealed a large increase in glycerol elimination which was quantified by enzymatic assay (from ×14 to ×39). An in-frame deletion of the dystrophin gene (exons 13–29) was found in the same five males and in three carrier females. All the deleted chromosomes also carried a missense mutation at nucleotide 947 of the Xp glycerol kinase (GK) gene resulting in a Thr to Met substitution at codon 278. These findings indicate that the two mutations cosegregate on the same chromosome in this family. This is the first reported case of two physically independent mutations, within the DMD and GK genes, which are contiguous but several hundred kilobases apart.