Psychiatric disorders among victims of a courthouse shooting spree: a three-year follow-up study

This study examined the longitudinal course of psychiatric sequelae of a mass shooting incident at a courthouse. A sample of 80 individuals was examined 6–8 weeks after the incident and 77 of these were reassessed one and three years later using the Diagnostic Interview Schedule/Disaster Supplement. Only 5% of the study sample met criteria for PTSD after this incident. Universal distress, however, was evident as 96% of the respondents reported PTSD symptoms and 75% described the incident as very upsetting. The need for intervention among symptomatic individuals not meeting diagnostic criteria should not be discounted as subdiagnostic distress may warrant specific intervention.     

Clinical and molecular features of adPEO due to mutations in the Twinkle gene

We have analyzed Twinkle, the causative gene for autosomal dominant progressive external ophthalmoplegia (adPEO) on chromosome 10, in 11 Australian autosomal dominant progressive external ophthalmoplegia families of Caucasian origin, and investigated whether there are distinct molecular and clinical features associated with mutations in this gene. We found two new mutations in Twinkle, in 3 of the 11 pedigrees examined. One resides in the linker region of this gene while the other is in the primase domain. Both regions are highly conserved between species. Multiple deletions in the mtDNA from muscle are not always prominent and there are significant variations in the clinical presentation within and between families with mutations in the Twinkle gene. Therefore, genotype/phenotype predictions are difficult. No mutations were found in adenine nucleotide translocator 1 (ANT1), another known adPEO causative gene, in four of the seven remaining families investigated. Thus, Twinkle appears to be the most common gene associated with adPEO in Australian families.     

Obsessive-compulsive disorder

TOPIC: Identification and management of obsessive-compulsive disorder (OCD). PURPOSE: To increase advanced practice clinicians' awareness of the prevalence, screening tools, diagnostic criteria, differential diagnosis, and therapeutic management of OCD. SOURCES: Published literature. CONCLUSIONS: Nurses have a pivotal role in teaching self-management techniques to people with OCD.     

Randomized,controlled trial of intravenous immunoglobulin in myasthenia gravis

We initiated a randomized, double-blinded, placebo-controlled trial of intravenous immunoglobulin (IVIG) treatment in myasthenia gravis (MG). Patients received IVIG 2 gm/kg at induction and 1 gm/kg after 3 weeks vs. 5% albumin placebo. The primary efficacy measurement was the change in the quantitative MG Score (QMG) at day 42. Fifteen patients were enrolled (6 to IVIG; 9 to placebo) before the study was terminated because of insufficient IVIG inventories. At day 42, there was no significant difference in primary or secondary outcome measurements between the two groups. In a subsequent 6-week open-label study of IVIG, positive trends were observed.     

Mechanism of CAR syndrome: anti-recoverin antibodies are the inducers of retinal cell apoptotic death via the caspase 9- and caspase 3-dependent pathway

Anti-recoverin autoantibodies have been associated with cancer-associated retinopathy (CAR), a paraneoplastic blinding disease. Those antibodies have been shown to induce apoptotic death of photoreceptor cells. The objective was to ascertain the mechanisms of retinal death induced by anti-recoverin antibody in vitro by examining the apoptotic pathway involved in retinal cell death. Internalization of anti-recoverin antibody or its Fab fragments by retinal cells mediated by endocytosis lead to cytotoxicity. Antibody cellular translocation induced the increase of bcl-x(s) and bax and the decrease in the bcl-x(L) protein. We detected the release of cytochrome c and down-regulation of the apaf-1 protein. This correlated with the sequential activation of caspase 9 and caspase 3, as well as the degradation of the caspase substrate PARP and the fragmentation of DNA. Our data show that anti-recoverin antibodies are inducers of apoptosis through the mitochondrial pathway involving caspases 9 and 3. We propose that a similar mechanism may be in place in patients with CAR syndrome where high levels of circulating antibodies have been associated with retinal degeneration.     

Autosomal genome-wide scan for coronary artery calcification loci in sibships at high risk for hypertension

Coronary artery disease (CAD) is the leading cause of mortality in the developed world. Although several CAD risk factors, including measures of lipid metabolism, obesity, and blood pressure, have a genetic basis, many genes for CAD susceptibility have yet to be identified. Coronary atherosclerosis is the major cause of CAD, but many with coronary atherosclerosis lack symptoms. Thus, a major limitation of using symptomatic CAD endpoints (eg, sudden coronary death, myocardial infarction) as a study outcome is substantial disease misclassification. Coronary artery calcification (CAC) is part of the atherosclerotic process and is an independent predictor of CAD endpoints. In the present study, CAC was noninvasively quantified by electron beam computed tomography. We performed genome-wide multipoint mode-of-inheritance-free linkage analysis on affected sib pairs, defined as being > or = the 70th sex- and age-specific percentile for CAC quantity, in a sample of 29 families enriched for hypertension. Almost 95% of participants were asymptomatic for CAD. Our LOD score (log10 odds in favor of linkage) results provide evidence that chromosomal regions 6p21.3 (maximum LOD score=2.22, P=0.00070) and 10q21.3 (maximum LOD score=3.24, P=0.000057) may harbor genes associated with subclinical coronary atherosclerosis.     

Evaluation of the overall system precision of the Welch-Allyn transtelephonic home blood pressure monitor in adults with Parkinson's disease

BACKGROUND: Non-invasive blood pressure (BP) devices should be independently evaluated before being used in special populations. The objective of this study was to assess the accuracy of the Welch-Allyn transtelephonic home blood pressure monitor in adults with Parkinson's disease to evaluate the device for use in a large clinical trial involving the safety and efficacy of a monoamine oxidase inhibitor. METHODS: BP measurements taken with the device were compared with the results obtained by two experienced observers using a mercury sphygmomanometer in patients with Parkinson's disease. The limits of agreement were then calculated for the device and compared with the results of the two observers. RESULTS: The agreement parameters between the two observers were -0.5 +/- 2.6 mmHg for systolic BP and 0.1 +/- 2.2 mmHg for diastolic BP. The agreement between the Welch-Allyn transtelephonic device and the observers was -2.6 +/- 4.5 mmHg and -1.9 +/- 3.2 mmHg for systolic and diastolic BP respectively. Nearly 90% of the readings were within 10 mmHg of the observers for both systolic and diastolic BP. Mild tremor had a moderate effect on the validity of the device. CONCLUSIONS: The Welch-Allyn transtelephonic device demonstrated acceptable precision in this cohort of patients with Parkinson's disease and is considered valid for use in a clinical trial involving these patients.     

Randomized trial evaluating a new 0.5% fluorouracil formulation demonstrates efficacy after 1-, 2-, or 4-week treatment in patients with actinic keratosis

The efficacy and safety of a new 0.5% fluorouracil topical cream were compared with vehicle control for the treatment of actinic keratosis (AK). Active treatment applied once daily for 1, 2, or 4 weeks was more effective than vehicle control in achieving reduction from baseline in lesion counts and lesion clearance. Active treatment also resulted in significantly better global assessments of overall improvement. Treatment was effective regardless of the number of baseline lesions. Although longer treatment duration correlated with greater efficacy, treatment for 1, 2, or 4 weeks was effective. This new microsphere-based fluorouracil formulation was generally well tolerated; adverse events were primarily limited to facial irritation that resolved quickly after treatment. This new treatment provides a safe alternative to the topical fluorouracil formulations currently available for the 1-, 2-, or 4-week treatment of AK.     

Microflora changes with the use of a vaginal microbicide

BACKGROUND: The rate of HIV transmission is increasing more in women than in any other group. There is an urgent need for the development of microbicides with activity against this virus that women can use during intercourse. These products must be convenient, effective, and safe, and ideally they will cause minimal disruption in the normal vaginal ecosystem. GOAL: The objective of this study was to evaluate changes in vaginal microflora, specifically Lactobacillus species, with the use of BufferGel. STUDY DESIGN: A prospective cohort study was performed to evaluate the change in vaginal flora before and after BufferGel use. BufferGel was applied vaginally once or twice daily for 14 days by low-risk abstinent and monogamous women. RESULTS: There was no change in frequency of Lactobacillus species after BufferGel use. However, there was a decrease in H2O2-producing lactobacilli (from 4.9 x 107 to 1.1 x 107 cfu; P = 0.001). The proportion of facultative gram-negative rods present increased from 27% to 65% after BufferGel use, whereas obligately anaerobic microbes decreased from 62% to 38%. CONCLUSION: Use of BufferGel once or twice daily for 14 days resulted in no clinically significant change in Lactobacillus colonization.