Primary hyperparathyroidism and pathological fractures: a review

Primary hyperparathyroidism is due most often to a parathyroid adenoma secreting parathyroid hormone. Elevated PTH levels cause bone resorption, the formation of polyostotic lesions and a reduction in bone mineral density, predisposing to pathological fractures. The final stage of this disease is osteitis fibrosa cystica. The authors review the literature about osteitis fibrosa cystica and the treatment options when a pathologic fracture occurs.     

Analysis of the efficacy and safety of sildenafil citrate in the geriatric population

OBJECTIVE: To define the efficacy and tolerability of sildenafil in elderly men, as epidemiological data show an increasing life-expectancy of the population, and age is not only correlated with increasing morbidity but also an increase in the prevalence of erectile dysfunction (ED), for which sildenafil, available for >8 years, is effective and safe across a wide variety of medical comorbidities, severity and causes of ED. PATIENTS AND METHODS: A database was generated from all sildenafil users in one sexual medicine practice, and data were extracted for men aged >60 years. The database included data on patient demographics, comorbidities, International Index of Erectile Function (IIEF) scores and adverse events (AEs). The patients were subdivided into those aged 60-69 (group 1), 70-79 (group 2), and > or = 80 years (group 3). Analysis of variance was used to assess differences among the three groups for several variables of demographics and erectile response. RESULTS: In all, 167 patients were analysed; there were no significant differences in the duration of ED (5 +/- 3 years) or presence of comorbidities among the three groups. With a mean of two risk factors, the overall incidence of comorbidities was hypertension in 37%, dyslipidaemia in 28%, diabetes in 26%, coronary artery disease in 18% and lower urinary tract symptoms in 46%. The efficacy data showed that overall, 54% of men responded to sildenafil, with a mean increase in IIEF EF domain score of 5.7. Within the three groups there was a significant age-related decrease in response rate and IIEF EF domain score with age. However, there was no difference in AE incidence among the three groups, with an overall profile of 18% headache, 8% flushing, 8% dyspepsia, 5% nasal congestion and 2% visual changes. No overt cardiovascular events were reported. CONCLUSIONS: From these data, sildenafil is an effective agent in elderly men, but had a lower efficacy rate with increasing age, especially in men aged >80 years. The incidence of side-effects was similar to that in the general population taking sildenafil, with no difference in AEs among the different age groups.     

Not safe at home: Behavioral treatment of a child''s fear of being at home alone

The behavioral treatment of a child's fear of being alone in her own home is described. Gaining control over frightening images and increasing coping behaviors such as relaxation, distraction, and self-instruction during progressive behavioral rehearsal reduced self-reported fears and increased adaptive responding. The utility of such techniques, particularly control over frightening imagery, is discussed.     

Are Humans Part of the Natural World? U.S. Children's and Adults’ Concept of Nature and its Relationship to Environmental Concern

Understanding factors that promote conservation attitudes is essential given ongoing environmental crises and the need for sustainability. Our research adopted various close- and open-ended tasks to explore: the extent to which U.S. urban adults (Study 1) and children (Study 2) have a basic conception of humans as part of nature, cognitive factors that predict more human-inclusive concepts of nature, and, finally, the relationship of their nature concepts and other individual differences to environmental moral concern and biocentric reasoning. General environmental moral concern and biocentric moral reasoning were a focus because both variables have previously been linked to sustainable attitudes. Across studies, adults and children did not tend to categorize humans as part of nature except when induced or disposed to attribute mind or life to nature. Among adults, a human-inclusive nature concept did not predict environmental moral concern or biocentrism. However, the degree of exposure to nature was positively predictive while a cluster of beliefs about humans as intrinsically unique, superior, and influential (human exceptionalism) was negatively predictive. Among children, a basic human-inclusive concept of nature was related to environmental concern but only among children who also tended to reason in ecological terms. These findings have important implications for sustainability efforts: They suggest that environmental moral concern and biocentric attitudes may be enhanced over-development by nature exposure and interventions that enduringly promote human-inclusive concepts of nature and ecological-systems understanding. Such intervention effects might be achieved by selectively inducing individuals to attribute mind and life to non-human natural phenomena and scaffolding accurate mechanistic understanding of evolution and common ancestry, which may also help to inhibit the development and deleterious effects of human exceptionalism.     

Effect of nintedanib in patients with progressive pulmonary fibrosis associated with rheumatoid arthritis: data from the INBUILD trial

Clinical Rheumatology - Some patients with rheumatoid arthritis develop interstitial lung disease (RA-ILD) that develops into progressive pulmonary fibrosis. We assessed the efficacy and safety of...