Malignant Thyroid Teratoma: Report of an Aggressive Tumor in a 64-Year-Old Man

Malignant teratoma of the thyroid is a rare and aggressive tumor, frequent in children than in adults. Histologically, thyroid teratomas usually show a predominance of a neuroectodermal component. Mature cartilage and bone may be present. We present the case of primary malignant teratoma of the thyroid in a 64-year-old man. Histologically, the tumor displayed a predominant neuroectodermal component. The diagnosis was confirmed by immunohistochemistry. The patient underwent a radical thyroidectomy with central neck dissection as primary treatment and radioiodine treatment afterwards. The patient had local and distant recurrence. A second surgery was performed with poor results and the patient died 3 months afterwards.     

A discussion paper on self-care and its implications for pharmacists

Self-care is what people do to themselves to establish and maintain health, prevent and deal with illness. It includes nutrition, lifestyle, self-medication, hygiene, socio-economic and environmental factors. Self-care has been with us for thousands of years, but today there is an opportunity for pharmacists to assist patients with self-care. Society is better educated than ever before and now has access to accurate, understandable and objective, up-to-date information about drug therapies. Moreover, there is a general trend to take back control from physicians and other care-givers, and for patients to make decisions about their own care. Additional drugs are becoming available OTC and some information may require professional interpretation. On a parallel plane, the pharmacist is being recognized as a trustworthy source of information and advice. When these trends interact, there becomes a golden opportunity for pharmacists to demonstrate their worth to their patients. This report provides the perspectives from numerous sources as to the future role of the pharmacist in self-care.     

Inequalities in the Utilization of Psychiatric and Psychological Services in Catalonia: A Multilevel Approach

The aim of this study was to analyze individual and contextual inequalities in psychiatrist and psychologist visits in Catalonia. This is a multilevel cross-sectional study using data from the 2006 Catalan Health Interview Survey (n = 15,554). 5.3 % of men and 9.0 % of women visited a psychologist and/or psychiatrist in the last 12 months. People aged 65 years or over were less likely to have visited these professionals and those with a supplemental private health insurance had a higher proportion of having visited. Moreover, people living in lower density regions were less likely to have visited, independently of their level of need. There is a need to develop policies for reducing inequalities in access by people with public health insurance and living in lower density areas.     

Perception of environmental problems and common mental disorders (CMD)

Background

In the past few years, there has been increasing interest in studying the association between problems in the neighbourhood environment and health indicators. The objective of this study is to examine the relationship between the perception of environmental problems by individuals and the prevalence of common mental disorders (CMD) in Spain.

Methods

A cross-sectional study using data from a large scale national representative survey of households (the 2006 Spanish National Health Survey). Participants included in the study were aged between 16 and 64?years (n?=?23,760). The dependent variable was common mental disorders assessed with the General Health Questionnaire (GHQ-12). The independent variable was the individual’s perception of environmental problems. Raw and adjusted Odds Ratios and their confidence intervals (95%) were calculated by fitting logistic regression models adjusting for age, marital status, work situation, social class, rural or urban area, country of origin, restrictions in carrying out activities of daily life due to a health problem and social support.

Results

The individuals who reported environmental problems had a higher prevalence of CMD. There was a clear increasing gradient in CMD prevalence with the increase in the number of environmental problems mentioned. Among the subjects who reported to have 1 or no environmental problem the prevalence of CMD was 11.8% (men) and 18.7% (women), and among those who mentioned 6 or more problems, the prevalence increased to 20.8% (men) and 35.4% (women). After adjusting for all the co-variables, there is an association between environmental problems and CMD (men OR 1.44, 95% CI 1.08–1.66; women OR 1.46, 95% CI 1.27–1.67). The environmental problems most strongly associated with the prevalence of CMD are noise, bad smell, air pollution, and lack of green areas.

Conclusions

Our findings show that individuals who perceive environmental problems in their neighbourhood have a higher prevalence of CMD, even after adjusting for all co-variables. In addition, there is a clear increasing gradient in the prevalence of CMD with the increase in the number of environmental problems. Efforts to reduce the prevalence of CMD must be directed to improve individual and contextual risks.     

Insight, symptomatic dimensions, and cognition in patients with acute-phase psychosis

AimsThis study was designed to evaluate the relationship between insight and the severity of psychotic symptomatology in a sample of patients in an acute phase of psychosis, as well as to analyze the relationship between insight and the symptomatic profile of the patient. In addition, the role of general cognitive abilities in this relationship was explored.MethodCross-sectional observational study of 96 acute psychotic adults. To evaluate psychopathology we used the Positive and Negative Syndrome Scale; for insight, the Scale of Unawareness of Mental Disorder; and for general cognitive abilities, the Screen for Cognitive Impairment in Psychiatry.ResultsInsight showed significant and moderate positive correlations with positive and general symptoms but not with negative symptoms. In the subgroup with positive symptomatic profile, awareness of the disorder and of the effects of medication were positively associated with severity of positive and general psychotic symptoms. Awareness of social consequences of the disease was positively associated with positive symptoms. In the subgroup with a negative symptomatic profile, awareness of the disorder and of the effects of medication were positively associated with severity of positive and general psychotic symptoms. In this subgroup, these relationships were significantly affected by general cognitive abilities.ConclusionsInsight was not related with the severity of negative psychotic symptoms. The symptomatic profile of subjects played an important role in determining the relationship between insight and its dimensions and the severity of psychotic symptoms. Cognitive function moderated these relationships only in the negative symptomatic profile.     

A versatile strategy for preimplantation genetic diagnosis of haemophilia A based on F8-gene sequencing

Preimplantation genetic diagnosis (PGD) of hemophilia A (HA) and other X-linked diseases through sex selection implies that male embryos will be systematically discarded, even though 50% are unaffected. The objective of the present work was to develop a PGD protocol for direct mutation identification that could be applied to first polar bodies (1PBs) in several HA clinical cases. Single buccal cells from controls and patients, and 1PBs were subjected to primer extension preamplification (PEP) PCR followed by amplification of F8 gene coding and intronic flanking regions, and direct sequencing. Moreover, multiplex fluorescent amplification of four short tandem repeats was adapted to a single cell preamplification in order to rule out contamination and allele drop-out, and for confirmatory indirect diagnosis. A couple at risk of HA transmission, with a familial mutation characterized as a 41-bp duplication in exon 14 of the F8 gene, was selected for the first clinical study. After optimizing the protocol, the complete F8 gene coding sequence was obtained from single cells to demonstrate the sensitivity of our methodology although in any clinical case only the relevant region, not the whole gene, must be amplified. The woman enrolled in the first clinical case has completed the first in-vitro fertilization cycle, and seven oocytes were analyzed with concordant results by both linkage analysis and direct sequencing method. Only one oocyte, among those diagnosed as mutation free, developed to embryo at day 3. It was transferred but pregnancy was not achieved. This PGD procedure enables non-affected and noncarrier embryo selection in families with any point or small-range mutation in the F8 gene, without the need for further custom-made modifications.     

Analysis of nine chromosome probes in first polar bodies and metaphase II oocytes for the detection of aneuploidies

We used fluorescent in situ hybridisation (FISH) to detect nine chromosomes (1, 13, 15, 16, 17, 18, 21, 22 and X) in 89 first Polar Bodies (1PBs), from in vitro matured oocytes discarded from IVF cycles. In 54 1PBs, we also analysed the corresponding oocyte in metaphase II (MII) to confirm the results; the other 35 1PBs were analysed alone as when preimplantation genetic diagnosis using 1PB (PGD-1PB) is performed. The frequency of aneuploid oocytes found was 47.5%; if the risk of aneuploidy for 23 chromosomes is estimated, the percentage rises to 57.2%. Missing chromosomes or chromatids found in 1PBs of 1PB/MII doublets were confirmed by MII results in 74.2%, indicating that only 25.8% of them were artefactual. Abnormalities observed in 1PBs were 55.8% whole-chromosome alterations and 44.2% chromatid anomalies. We observed a balanced predivision of chromatids for all chromosomes analysed. Differences between balanced predivision in 1PB and MII were statistically significant (P&<0.0001, chi(2) test); the 1PB was most affected. The mean abnormal segregation frequency for each chromosome was 0.89% (range 0.52-1.70%); so, each of the 23 chromosomes of an oocyte has a risk of 0.89% to be involved in aneuploidy. No significant differences were observed regarding age, type of abnormality (chromosome or chromatid alterations) or frequency of aneuploidy. Nine of the 35 patients (25.7%) whose 1PB and MII were studied presented abnormalities (extra chromosomes) that probably originated in early oogenesis. Analysis of 1PBs to select euploid oocytes could help patients of advanced age undergoing in vitro fertilization (IVF) treatment.