Mononeuritis multiplex: the yield of evaluations for occult rheumatic diseases

We identified 35 patients who had electrodiagnostic evidence of mononeuritis multiplex and did not have diabetes or multiple nerve compressions. Their charts were reviewed to determine the etiologies of the mononeuritis multiplex and to determine how often the laboratory examination revealed a rheumatic disease in patients whose initial history and physical examination did not suggest that a rheumatic disease was present. In 11/35 (31%; CI = 17-49) a disorder capable of causing mononeuritis multiplex was diagnosed before the symptoms of mononeuritis multiplex began. Ten had a rheumatic disease; 1 had lymphoma. Nine of the other patients were suspected, on the basis of the history and physical examination, of having new onset of a rheumatic disease. Subsequent laboratory evaluation showed that 5/9 (56%; CI = 21-86) had a rheumatic disease, and 4/9 (44%; CI = 14-79) were unknowns. In 15/35 (43%; CI = 26-61) patients with mononeuritis multiplex, no rheumatic disease was suspected on the basis of the initial history and physical examination. The subsequent laboratory examination revealed an underlying rheumatic disease in 0/15 (0%; CI = 0-18). Mean clinical follow-up of 16 +/- 16 months in the patients with mononeuritis multiplex of unknown cause also failed to identify a rheumatic disease. Overall 19/35 (54%; CI = 37-71) did not have a rheumatic disease or any other known cause. Of the 14 patients with mononeuritis multiplex associated with a rheumatic disease, 5/14 (36%; CI = 13-15) had systemic lupus erythematosus; an additional patient had both lupus and the CREST syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)     

Association of coping responses with fibromyalgia tender points in patients with systemic lupus erythematosus

OBJECTIVE: To determine the association between fibromyalgia (FM) tender points (TP) and psychological constructs in patients with systemic lupus erythematosus (SLE). METHODS: One hundred seventy-three patients with SLE were examined for FM TP, and asked to complete 2 questionnaires at the same visit, the Health-Related Hardiness Scale (HRHS), and the Mishel Uncertainty in Illness Scale (MUIS). RESULTS: The examination of FM TP showed that 38.2% had no TP, 44.5% had 1-10 TP, and 17.3% had > or = 11 TP. The mean +/- SD score of the HRHS was 155.6 +/- 19.7 (range 105.0-198.0; higher scores indicate greater hardiness), and the MUIS was 85.3 +/- 18.7 (range 41.0-132.0; higher scores indicate uncertainty). There were significant associations between FM TP and HRHS (no TP 161.2 +/- 20.2, 1-10 TP 152.5 +/- 19.7, > or = 11 TP 151.0 +/- 15.8; p = 0.0108) and between FM TP and MUIS (no TP 78.2 +/- 20.2, 1-10 TP 86.9 +/- 17.6, > or = 11 TP 95.8 +/- 14.7; p = 0.0001). CONCLUSION: This study shows a strong association between FM TP and uncertainty or lack of "hardiness." We conclude that SLE patients with FM TP are less likely to be good "copers." Prospective studies to determine if "poor coping" predicts FM in SLE are recommended. If the association between coping and FM is causal, it will justify interventions to improve coping and similar constructs, such as self-efficacy.     

Real-time perfusion adenosine stress echocardiography in the coronary care unit: a feasible bedside tool for predicting coronary artery stenosis in patients with acute coronary syndrome.

Myocardial contrast echocardiography using power modulation real-time perfusion (RTP) is an appealing method for bedside risk stratification of patients with acute coronary syndrome. In this study, we aimed to evaluate the accuracy in predicting significant coronary stenosis of a bedside RTP adenosine stress protocol in patients with acute coronary syndrome. METHODS: Prior to coronary angiography, 36 consecutive in-patients with acute coronary syndrome underwent a bedside adenosine stress echocardiography with RTP in the coronary care unit. Visual assessment of both perfusion and wall motion was made, comparing rest and hyperaemia images. Each segment was attributed to one of the three main coronary vessel areas. RESULTS: The sensitivity of predicting significant stenosis was 87, 83 and 81% for left anterior descending, circumflex and right posterior descending areas, respectively. Specificity was 69, 67 and 60%, respectively. The positive predictive values were 83, 79 and 74%, respectively. CONCLUSIONS: RTP using adenosine is a feasible bedside tool in predicting the area of significant coronary stenosis and could be helpful as a bedside decision-making tool in the clinical setting. More studies are required to assess the clinical value of RTP adenosine stress echocardiography.     

Increased lipolysis by secretory phospholipase A(2) group V of lipoproteins in diabetic dyslipidaemia

Background. Lipolysis of lipoproteins by secretory phospholipase A₂ group V (sPLA₂‐V) promotes inflammation, lipoprotein aggregation and foam cell formation – all considered as atherogenic mechanisms. Objective. In this study, we compared the susceptibility to sPLA₂‐V lipolysis of VLDL and LDL from individuals with type 2 diabetes and the metabolic syndrome (T2D‐MetS) and from healthy controls. Design. VLDL and LDL were isolated from 38 T2D‐MetS subjects and 38 controls, treated pair‐wise. Extent of sPLA₂‐V lipolysis was measured as release of nonesterified free fatty acids (NEFA). In a subset of the subjects, lipoprotein composition was determined as a relationship between lipid and apolipoprotein components. Results. Mean paired increase in sPLA₂‐V lipolysis after 1 h for T2D‐MetS versus control was 2.0 μmol NEFA l^?1 for VLDL (P = 0.004) and 0.75 μmol NEFA l^?1 for LDL (P = 0.001). There were also substantial differences in lipoprotein composition between the groups. T2D‐MetS VLDL had higher triglyceride and cholesterol contents than control VLDL. T2D‐MetS LDL was smaller and contained more triglycerides and less cholesterol than control LDL. Both VLDL and LDL from T2D‐MetS subjects also contained more apolipoprotein CIII per particle. Conclusion. VLDL and LDL from T2D‐MetS individuals were more susceptible to sPLA₂‐V lipolysis than those from control individuals. This may result in elevated levels of NEFA and lysophosphatidylcholine, both in circulation and in LDL, possibly contributing to the elevated inflammatory state and increased risk of cardiovascular diseases seen in these individuals.     

Circulating ghrelin levels in the newborn are positively associated with gestational age

OBJECTIVE: Ghrelin exerts potent GH-releasing activity and stimulates food intake. Circulating ghrelin levels are increased in anorexia and cachexia, reduced in obesity and restored by weight recovery. Newborns are characterized by GH hypersecretion associated with low IGF-I levels reflecting peripheral GH resistance. STUDY DESIGN: The aim of our study was to measure cord ghrelin levels in 117 newborns appropriate for gestational age, born either at term or preterm. RESULTS: Ghrelin levels in cord blood (median; 25th-75th centile: 327.6; 206.0-413.0 pg/ml) were higher (P < 0.0001) than those in maternal blood at delivery (133.0; 89.0-173.7 pg/ml), without gender differences. A positive correlation between ghrelin levels in mothers and newborns (r = 0.26, P < 0.01) was observed. Ghrelin levels in newborns born at term (399.0; 229.0-438.0 pg/ml) were remarkably higher (P < 0.0001) than those in born preterm (208.0; 144.5-278.9 pg/ml). A clear positive association was present between ghrelin levels and gestational age. No association between ghrelin and GH, IGF-I, insulin, glucose and leptin levels were found. CONCLUSIONS: Cord ghrelin levels show clear gestational age-related dependency. The lack of any direct relationship between ghrelin and anthropometric or biochemical parameters in adequate for gestational age newborns does not support the hypothesis that ghrelin has major role in foetal GH secretion and growth.     

Molecular Characterization of Enterotoxigenic Escherichia coli Isolates Recovered from Children with Diarrhea during a 4-Year Period (2007 to 2010) in Bolivia

Enterotoxigenic Escherichia coli (ETEC) is an important cause of childhood diarrhea. This study aimed to characterize ETEC strains isolated from Bolivian children aged <5 years according to enterotoxin profile, colonization factors (CFs), suggested virulence genes, and severity of disease. A total of 299 ETEC isolates recovered from children with diarrhea and 55 ETEC isolates from children without diarrhea (controls) were isolated over a period of 4 years. Strains expressing heat-labile toxin (LT) or heat-stable toxin (ST) alone were about equally common and twice as common as ETEC producing both toxins (20%). ETEC strains expressing human ST (STh) were more common in children aged <2 years, while ETEC strains expressing LT plus STh (LT/STh) were more frequent in 2- to 5-year-old children. Severity of disease was not related to the toxin profile of the strains. CF-positive isolates were more frequently identified in diarrheal samples than in control samples (P = 0.02). The most common CFs were CFA/I and CS14. CFA/I ETEC strains were more frequent in children aged <2 years than CS1+CS3 isolates and CS14 isolates, which were more prevalent in 2- to 5-year-old children. The presence of suggested ETEC virulence genes (clyA, eatA, tia, tibC, leoA, and east-1) was not associated with disease. However, east-1 was associated with LT/STh strains (P < 0.001), eatA with STh strains (P < 0.001), and tia with LT/STh strains (P < 0.001). A minor seasonal peak of ETEC infections was identified in May during the cold-dry season and coincided with the peak of rotavirus infections; this pattern is unusual for ETEC and may be important for vaccination strategies in Bolivia.     

Comparison of Disfluent and Ungrammatical Speech of Preadolescents with and without ASD

Journal of Autism and Developmental Disorders - This paper analyses disfluencies and ungrammatical expressions in the speech of 11–13-year-old Finnish-speaking boys with ASD...     

The simultaneous occurrence of human norovirus and hepatitis E virus in a Norway rat (Rattus norvegicus)

Wild rats can be reservoirs and vectors for several human pathogens. An initial RT-PCR screening of the intestinal contents of Norway rats trapped in the sewer system of Copenhagen, Denmark, for caliciviruses revealed the presence of a human norovirus in one of 11 rodents. Subsequent phylogenetic analysis of the ~4.0-kb 3′-terminus of the norovirus genome resulted in the identification of a recombinant GI.b/GI.6 strain. The simultaneous detection of hepatitis E virus-like particles in the feces of this rat by transmission electron microscopy was confirmed by RT-PCR and sequence determination, resulting in the identification of a novel rat hepatitis E virus.     

Clinical performance of the H. PYLORI QUIK CHEK™ and H. PYLORI CHEK™ assays,novel stool antigen tests for diagnosis of Helicobacter pylori

European Journal of Clinical Microbiology & Infectious Diseases - Infection with Helicobacter pylori is a global health issue, and rapid and accurate testing is a key to diagnosis. We aimed to...