Characteristics and predictors of social phobia course in a longitudinal study of primary‐care patients

Background: Social Phobia (SP) is a prevalent disorder in primary‐care settings. To date, few researchers have examined the natural course of SP in primary care. We examined the natural course and predictors of recovery in a large sample of primary‐care patients. Methods: Data are obtained from the Primary Care Anxiety Project, a naturalistic, longitudinal study of anxiety disorders in primary‐care patients. This report pertains to 182 patients with SP at intake. We examined intake demographic and clinical variables as predictors of recovery within the 5 years of follow‐up. Results: The probability of recovery from SP during the 5‐year follow‐up period was .40. At intake, a longer duration of SP episode, comorbid Panic Disorder with Agoraphobia, and lower psychosocial functioning predicted lower rates of recovery. Conclusions: These findings highlight the chronicity of SP, as well as factors that may affect its naturalistic course. It is imperative that primary‐care physicians and mental health specialists assess for and treat SP in their practices. Future research is warranted to further examine the effect of medical and psychiatric comorbidity on SP course. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Infusions of albumin increase free fraction of naproxen in healthy volunteers: a randomized crossover study

Background: In vitro and in vivo studies have indicated that stabilizers present in pharmaceutical‐grade albumin influence the albumin‐binding capacity for highly protein‐bound drugs. However, the half‐life of the stabilizers and the quantitative effect have been difficult to determine. Method: A randomized crossover study including six healthy volunteers was performed. The study subjects received 750 mg of oral naproxen 2 h before the study. They were randomized to receive either 100 ml of 20% albumin or 100 ml of Ringer's acetate solution intravenously. Frequent blood samples were obtained. The experiment was repeated 4 weeks later with the alternate solution. The serum samples were analysed to determine the concentrations of albumin, N‐acetyl‐dl ‐tryptophan, caprylate, and naproxen. Results: The free fraction of naproxen increased significantly after the infusion of albumin (P<0.05). The increase was concurrent with the appearance of N‐acetyl‐dl ‐tryptophan and caprylate in serum. The free fraction of naproxen declined rapidly after the albumin infusion was completed. N‐acetyl‐dl ‐tryptophan had a half‐life of approximately 30 min. The half‐life of caprylate was <15 min. Conclusion: A transfusion of albumin results in an increase in the free fraction of naproxen. The transient increase in free‐fraction naproxen decreased together with the detectable levels of the stabilizers N‐acetyl‐dl ‐tryptophan and caprylate. N‐acetyl‐dl ‐tryptophan and caprylate have a short half‐life in serum.     

Cognitive dysfunction and health‐related quality of life after a cardiac arrest and therapeutic hypothermia

Background: Evidence‐based treatment protocols including therapeutic hypothermia have increased hospital survival to over 50% in unconscious out‐of‐hospital cardiac arrest survivors. In this study we estimated the incidence of cognitive dysfunctions in a group of cardiac arrest survivors with a high functional outcome treated with therapeutic hypothermia. Secondarily, we assessed the cardiac arrest group's level of cognitive performance in each tested cognitive domain and investigated the relationship between cognitive function and age, time since cardiac arrest and health‐related quality of life (HRQOL). Methods: We included 26 patients 13–28 months after a cardiac arrest. All patients were scored using the Cerebral Performance Category scale (CPC) and Mini‐Mental State Examination (MMSE). Twenty‐five of the patients were tested for cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). These patients were tested using four cognitive tests: Motor Screening Test, Delayed Matching to Sample, Stockings of Cambridge and Paired Associate Learning from CANTAB. All patients filled in the Short Form‐36 for the assessment of HRQOL. Results: Thirteen of 25 (52%) patients were classified as having a cognitive dysfunction. Compared with the reference population, there was no difference in the performance in motor function and delayed memory but there were significant differences in executive function and episodic memory. We found no associations between cognitive function and age, time since cardiac arrest or HRQOL. Conclusion: Half of the patients had a cognitive dysfunction with reduced performance on executive function and episodic memory, indicating frontal and temporal lobe affection, respectively. Reduced performance did not affect HRQOL.     

Triage and mortality in 2875 consecutive trauma patients

Background: Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage. Methods: We prospectively registered all trauma patients in Eastern Denmark over 12 consecutive months. We analysed the flow of trauma patients through the system, the time spent at different locations, and we assessed the risk factors of mortality. Results: We included 2875 trauma patients, of whom 158 (5.5%) died before arrival at the hospital. Most patients (75.3%) were brought to local hospitals and patients primarily (n=82) or secondarily triaged (n=203) to the level I trauma centre were the most severely injured. Secondarily transferred patients spent a median of 150 min in the local hospital before transfer to the level I trauma centre and 48 min on transportation. Severe injury with an injury severity score >15 was seen in 345 patients, of whom 118 stayed at the local hospital. They had a significantly higher mortality than 116 of those secondarily transferred [45/118, 38.1% vs. 11/116, 9.7% (P<0.0001)]. Mortality within 30 days was 4.3% in admitted patients, and significant risk factors of death were violence [odds ratio (OR)=5.72], unconsciousness (OR=4.87), hypotension (OR=4.96), injury severity score >15 (OR=27.42), and age. Conclusions: Around 50% of all trauma deaths occurred at the scene. Increased survival of severely injured patients may be achieved by early transfer to highly specialised care.     

Power Doppler ultrasonography of painful Achilles tendons and entheses in patients with and without spondyloarthropathy—a comparison with clinical examination and contrast-enhanced MRI

The objective of this study was to describe ultrasonography (US) and magnetic resonance imaging (MRI) findings at painful Achilles tendons and entheses in patients with and without spondyloarthropathy (SpA and non-SpA) and healthy control persons (CTRLs). Particularly, we aimed to investigate if any changes differentiate SpA from non-SpA. Finally, we investigated the reliability of US compared to clinical examination of Achilles tendinopathy, using MRI as gold standard reference. Twelve SpA patients and 15 non-SpA patients with pain and tenderness at at least one Achilles tendon and/or enthesis due to sports-related causes and 10 CTRLs were examined at the Achilles tendons and entheses with US, MRI and clinical assessment. Intratendinous changes, entheseal changes, bursitis and peritendonitis were assessed. An US interobserver substudy was performed in nine persons. US findings showed high agreement between observers (median 89 %, κ?=?0.64) and with MRI (median 89 %, κ?=?0.74). All inflammatory intratendinous changes were less frequent in SpA than non-SpA patients (p?<?0.05). Entheseal changes and bursitis were found equally frequent in both patient groups except for enthesophytes, which were most common in the SpA group (p?<?0.01). No findings were exclusively found in SpA. When MRI was considered gold standard, US showed higher sensitivity for intratendinous and entheseal changes than clinical examination (median sensitivity 0.83 versus 0.66). Especially, entheseal changes had higher sensitivity than clinical examination without loss of specificity. In conclusion, US performed by a trained operator can be a useful adjunct to clinical examination for improved assessment of Achilles tendons and entheses.     

Detection of tissue factor in platelets: why is it so troublesome?

Tissue factor (TF) is the most important trigger for the extrinsic coagulation pathway. TF, earlier denoted as thromboplastin, has always been a mystery since its discovery due to its abundant presence in most human tissues but not blood. The latter has been extensively studied in a vast quest for possible sources of blood-borne TF yielding many conflicting findings and confusing conclusions regarding the presence of TF mRNA, protein or functional procoagulant activity in virtually all blood cells. Platelets, in particular, have been heavily scrutinized by investigators eager to demonstrate expression of TF. However, some investigators including our own groups have not found evidence for TF in platelets. This article discusses notable reports and possible reasons for erroneous detection of platelet TF antigen and activity including artificially hyper-stimulated platelets, suboptimal purity of cell preparations, flaws in study design and/or choice of reagents.     

No effect of taurine on platelet aggregation in men with a predisposition to type 2 diabetes mellitus

Abbreviations

ADP–denosine diphosphate; BMI–body mass index; FFA–free fatty acids; FFM–fat-free mass; IGT–impaired glucose tolerance; OGTT–oral glucose tolerance test; PPP–platelet-poor plasma; PRP–platelet-rich plasma; T2DM–type 2 diabetes mellitus; TG–triglyceride.

Contributed equally to this study.

Any diet therapy that potentially could affect platelet function would also influence the initiation of atherosclerotic plaque formation which is an important complication of diabetes mellitus eventually resulting in myocardial infarction and stroke. Blood platelets are rich in taurine, and it has been shown that taurine inhibits platelet aggregation in healthy subjects. The purpose was to examine the effect of taurine supplementation on platelet aggregation in high-risk subjects with a positive family history of T2DM. Twenty healthy men were included in a double-blinded, randomized, crossover study, receiving daily supplementation of 1.5?g taurine or placebo for two 8-week periods. Subjects were overweight and first-degree relatives of T2DM patients. At the end of each treatment, fasting blood samples for assessment of platelet aggregation was drawn. Platelet aggregation was induced by ADP. Plasma taurine concentration was significantly greater after taurine intervention compared to placebo (131.4?±?61.7 vs. 38.9?±?6.7?µmol/l, P?<?0.0001). There was no difference in the threshold level for complete platelet aggregation induced by ADP in vivo between placebo and taurine intervention (placebo 3.86?±?2.21 vs. taurine 3.86?±?3.25?µmol/l). Supplementation with 1.5?g of taurine for 8 weeks had no effect on platelet aggregation in overweight prediabetic men.     

Hydrosonography of the Small Intestine: Comparison with Radiologic Barium Study

Background: Transabdominal ultrasonography of the small intestine is hampered by luminal gas. We have developed a new sonographic method (hydrosonography) that largely eliminates the gas problem and have compared this method with radiologic barium study. Methods: Fifty-six patients admitted for X-ray examination of the small bowel because of abdominal pain, diarrhoea, weight loss and/or known inflammatory bowel disease were examined. To remove luminal gas before performing transabdominal ultrasonography, 2 l of polyethylene glycol solution was inserted through a nasojejunal tube by means of a peristaltic pump. Wall thickness, peristalsis, luminal narrowing, prestenotic dilatation, and extraintestinal complications were recorded. Results: On ultrasonography we were able to visualize the terminal part of the ileum in 98% of the patients. Perfect agreement between hydrosonography and barium studies was seen in 50 of 55 patients. However, 44 patients had normal findings on both examinations. The sensitivity and specificity of hydrosonography were 64% and 100%, respectively. The positive predictive value was 100%. For X-ray examination sensitivity and specificity were 91% and 100%, respectively. Four patients with minor mucosal abnormalities or pathologic findings in the upper part of the small intestine accounted for the relatively low overall sensitivity found for hydrosonography compared with roentgenography. However, important extraintestinal complications were disclosed by ultrasound. Conclusions: Hydrosonography of the small bowel is a new, convenient, and reliable method for examining the lower part of the small intestine. However, it cannot replace barium studies in patients with mucosal abnormalities, especially in the upper part of the small bowel.