Familial dysphagia and eosinophilia

BACKGROUND: Recent reports suggest a familial predisposition to eosinophilic esophagitis (EE) and a link between Schatzki's rings and EE. OBJECTIVE: Our objective is to present our experience with 7 families with dysphagia and eosinophilia. DESIGN: Case series. SETTING: One-thousand-bed community-based teaching hospital. PATIENTS: Seventeen patients from 7 families with dysphagia and eosinophilia. METHODS: Direct clinical and endoscopic examination with review of radiologic and pathologic data. RESULTS: Twelve patients had EE alone, one had eosinophilic gastroenteritis (EG) alone, one had EE and EG, and 3 geriatric patients had Schatzki's rings (one with EG and peripheral eosinophilia [PE] and one with PE). EE spanned 2 generations in 4 families and involved 2 brothers in one family. LIMITATIONS: This was a case series. CONCLUSION: We propose a familial dysphagia syndrome characterized by eosinophilia in the form of EE, EG, or PE and Schatzki's rings in older generations.     

Long-term prognostic value of triiodothyronine concentration in elderly patients with heart failure

In this study the authors sought to determine the prevalence and long-term prognostic value of low triiodothyronine levels in elderly patients with heart failure and no thyroid disease. Lower levels of triiodothyronine are more prevalent in patients with advanced heart failure without thyroid disease, and this may have prognostic implications. However, this hormonal milieu has not been investigated in elderly patients. The authors prospectively followed a consecutive sample of 69 elderly patients aged 76.5±5.9 years with heart failure and 44 age-matched controls without heart failure between March 1997 and September 2000 at the Geriatric Cardiology Outpatient Clinic of the Heart Institute of São Paulo, Brazil. Events analyzed included death, hospitalization, and the combined end point of death or hospitalization. The study revealed that levels of triiodothyronine were lower in heart failure patients than in controls (89±23 vs. 101 ±16 ng/dL , p= 0.001). During the follow-up period of 14.3±8.1 months there were 19 deaths and 33 hospitalizations in the heart failure group. The combined end point of death or hospitalization occurred in 38 patients. Triiodothyronine levels were lower in heart failure patients who had a cardiovascular event than in event-free patients (82.7±24.8 vs. 96.7±19.2 ng/dL , p= 0.012). The odds ratio for events was 9.8 (95% confidence interval, 2.2–43 , p= 0.004) for patients in the lowest tertile of triiodothyronine, that is, lower than 80 ng/dL, compared with patients with levels above 80 ng/dL. The authors conclude that among elderly patients with heart failure, lower triiodothyronine concentrations are more prevalent and are associated with a worse prognosis.     

Pesticide Residues in some Commodities: Dietary Risk for Children

The objective of this study was to identify pesticides found in infants’ and children’s diets. Fruits and vegetables were collected from 2004 to 2007 and analyzed using a multiresidue method. The most frequently detected residues were procymidone, captan, chlorpyrifos and chlorothalonil. Twenty-eight percent of the samples contained pesticide residues. Strawberry, pear, apple, peach and tomato contained pesticide levels of concern. Twenty-one pesticides were found with the estimated total mean daily intake greater than the acceptable daily intake for four of the pesticides. Residues of carbaryl, diazinon and methidathion exceeded regulatory levels in (apple, strawberry, and orange).     

Sporadic inclusion body myositis: Pathogenic considerations

Sporadic inclusion body myositis is the commonest acquired disease of skeletal muscles after 50 years of age, and as such it has commanded a great deal of attention of investigators over the past 25 years. As a result, a large amount of information has accumulated concerning its clinical profile, myopathology, and immunopathology. In the myopathology and immunopathology, there is general agreement that the characteristic features could be divided into a degenerative and an inflammatory group. However, there has been controversy about the possible role of these changes in the pathogenesis of muscle fiber damage. In particular, there is no agreement whether a cause‐and‐effect relationship exists between these two groups of changes, and if so, which is the primary one. In this brief overview, we examine the validity of the various controversial observations and critically review the justification for the two major hypotheses for the primary role of inflammation versus degeneration. Ann Neurol 2009;65:7–11     

An examination of the relationship between low vision and Charles Bonnet syndrome

Objective: In recent years, the Low Vision Clinic (LVC) appeared to have a large percentage of patients admitting to phantom vision (Charles Bonnet syndrome [CBS]). The objective of this study was to learn more about CBS from an ophthalmological perspective, as research has been conducted primarily by other specialists.Design: Large-scale prospective study using a cohort of low-vision and normal-vision subjects.Participants: Two hundred fifty-eight low-vision and 251 control subjects (with little or no vision loss) were enrolled.Methods: A comparison of visual acuity, ophthalmic conditions, eye treatments, medications, mental state, general health, socialization, etc., was undertaken, and other factors influencing the hallucinations were recorded.Results: CBS was present in 34% of LVC subjects and in <2% of the general population with little or no vision loss. Many subjects had unformed hallucinations; bright lights or spot-like images should not be overlooked because they could be determined to be hallucinations upon further questioning of the patient. CBS occurred in subjects with visual acuity from 20/40 to 20/1600; subjects were twice as likely to have CBS if their visual acuity was between 20/301 and 20/800.The prevalence of CBS did not differ significantly by cause of visual problem. Thirty-four percent of people were distressed about their initial hallucination; many did not consult a doctor for an explanation, and if they did, many did not receive an adequate explanation.Conclusions: This large-scale study shows that CBS is connected with a low vision level; thus, patients should be told about the common possibility of hallucinations.     

MDS research criteria for prodromal Parkinson's disease

This article describes research criteria and probability methodology for the diagnosis of prodromal PD. Prodromal disease refers to the stage wherein early symptoms or signs of PD neurodegeneration are present, but classic clinical diagnosis based on fully evolved motor parkinsonism is not yet possible. Given the lack of clear neuroprotective/disease‐modifying therapy for prodromal PD, these criteria were developed for research purposes only. The criteria are based upon the likelihood of prodromal disease being present with probable prodromal PD defined as ≥80% certainty. Certainty estimates rely upon calculation of an individual's risk of having prodromal PD, using a Bayesian naïve classifier. In this methodology, a previous probability of prodromal disease is delineated based upon age. Then, the probability of prodromal PD is calculated by adding diagnostic information, expressed as likelihood ratios. This diagnostic information combines estimates of background risk (from environmental risk factors and genetic findings) and results of diagnostic marker testing. In order to be included, diagnostic markers had to have prospective evidence documenting ability to predict clinical PD. They include motor and nonmotor clinical symptoms, clinical signs, and ancillary diagnostic tests. These criteria represent a first step in the formal delineation of early stages of PD and will require constant updating as more information becomes available. © 2015 International Parkinson and Movement Disorder Society