Gout epidemiology: results from the UK General Practice Research Database, 1990-1999

OBJECTIVE: To examine the epidemiology of gout and gout treatment in the United Kingdom using a large national practice based population. METHODS: Data from the UK General Practice Research Database from 1990 to 1999 were examined. Physician diagnoses and drug codes were used, and trends in gout incidence and treatment examined. Additionally, disease prevalence for the year 1999 was assessed. To examine the association of gout with comorbid disease, the prevalence of select health conditions and drug use was compared with the corresponding prevalences seen in osteoarthritis, adjusting for both age and sex. RESULTS: From 1 January 1990 to 31 December 1999 overall gout incidence remained relatively stable, ranging from a low of 11.9 cases (95% confidence interval (CI) 11.5 to 12.3) in 1991 to a high of 18.0 cases (95% CI 17.6 to 18.4) per 10 000 patient-years in 1994. Gout prevalence in 1999 was 1.4% with rates approaching 7% in men over the age of 65. Drugs used for the treatment of gout remained constant in prevalent cases with the exception of a significant decline in non-steroidal anti-inflammatory drug use over the 10 year follow up. Compared with patients with osteoarthritis, patients with gout were significantly more likely to have cardiovascular disease, hypertension, diabetes, and chronic renal failure, and were more likely to have used diuretics or ciclosporin, or both. CONCLUSION: Although gout is common in the UK, particularly among older men, the incidence of the disease seems to have remained stable during the 1990s.     

Telling truth from lie in individual subjects with fast event-related fMRI

Deception is a clinically important behavior with poorly understood neurobiological correlates. Published functional MRI (fMRI) data on the brain activity during deception indicates that, on a multisubject group level, lie is distinguished from truth by increased prefrontal and parietal activity. These findings are theoretically important; however, their applied value will be determined by the accuracy of the discrimination between single deceptive and truthful responses in individual subjects. This study presents the first quantitative estimate of the accuracy of fMRI in conjunction with a formal forced-choice paradigm in detecting deception in individual subjects. We used a paradigm balancing the salience of the target cues to elicit deceptive and truthful responses and determined the accuracy of this model in the classification of single lie and truth events. The relative salience of the task cues affected the net activation associated with lie in the superior medial and inferolateral prefrontal cortices. Lie was discriminated from truth on a single-event level with an accuracy of 78%, while the predictive ability expressed as the area under the curve (AUC) of the receiver operator characteristic curve (ROC) was 85%. Our findings confirm that fMRI, in conjunction with a carefully controlled query procedure, could be used to detect deception in individual subjects. Salience of the task cues is a potential confounding factor in the fMRI pattern attributed to deception in forced choice deception paradigms.     

Colonization with extraintestinal pathogenic Escherichia coli among nursing home residents and its relationship to fluoroquinolone resistance

In a cross-sectional fecal prevalence survey involving 49 residents of a Veterans Affairs nursing home, 59% of subjects were colonized with extraintestinal pathogenic Escherichia coli (ExPEC), 22% were colonized with adhesin-positive E. coli, and 51% were colonized with fluoroquinolone-resistant E. coli. Among 80 unique isolates, adhesins correlated negatively and aerobactin correlated positively with fluoroquinolone resistance.     

Symptom and demographic profiles in first-episode schizophrenia

First-episode schizophrenia (FE-SZP) presents a diagnostic challenge because of symptomatic overlap between the various causes of psychosis. An early and accurate diagnosis is important for the implementation of appropriate treatment, for determining prognosis and for identifying research participants. In an effort to facilitate early diagnosis, we followed a group of first-episode psychosis patients with a presumptive diagnosis of schizophrenia who were subsequently diagnosed at 6-month follow-up with either schizophrenia (n=104) or other psychiatric diagnoses (n=19). The two groups-first-episode schizophrenia and first-episode non-schizophrenia-were compared on measures of demographics, symptoms, quality of life, premorbid adjustment and lateral dominance. Odds ratios were calculated for each variable and all significant variables were entered into a multivariate prediction model. The model showed that higher levels of anhedonia and hallucinations increased the odds of a final diagnosis of schizophrenia. This predictive model was validated in a smaller group of patients.     

Cavernous carotid artery calcification and white matter ischemia

BACKGROUND AND PURPOSE: The relevance of cavernous carotid artery calcification on unenhanced CT scans of the brain has recently been investigated against the backdrop of the widespread implementation of coronary artery calcification scoring. We sought to determine whether the degree of cavernous carotid artery calcification correlated with scores of white matter hyperintensity seen on MR images. In so doing, we sought to establish a relative risk for future stroke on the grade of carotid calcification. METHODS: Neuroradiologic findings in 187 patients who underwent CT and MR imaging examinations within 1 month of each other were retrospectively reviewed. The degree of circumferential calcification and thickness of calcification were graded for the cavernous carotid arteries on the basis of CT findings. Using the scale developed by the Cardiovascular Health Study, the white matter was graded for degree of disease on the basis of MR findings. Correlation tests and regression analyses were performed to determine the impact of age, race, and sex on results. RESULTS: Although the cavernous carotid calcification scores and the MR imaging white matter scores showed good correlation (P <.001), the effect was mediated by age. With age factored in as a covariant, no correlation was shown between CT calcification scores and MR imaging white matter scores. Sex had no effect, but African American study participants had worse MR imaging white matter scores than did white participants. CONCLUSION: After adjusting for age, cavernous carotid calcification grades and MR imaging white matter scores do not show a significant correlation. The relative risk for future stroke cannot be predicted from cavernous carotid calcifications.     

Controlling for severity of illness in assessment of the association between antimicrobial-resistant infection and mortality: impact of calculation of Acute Physiology and Chronic Health Evaluation (APACHE) II scores at different time points.

BACKGROUND: In studies of the association between antibiotic-resistant infection and mortality, the importance of controlling for the underlying severity of illness is well recognized. However, it is unclear when the severity of illness should be assessed. Controlling for severity of illness on the day the culture specimen is obtained may underestimate the true association between resistance and mortality. OBJECTIVE: To assess the impact of calculating the Acute Physiology and Chronic Health Evaluation (APACHE) II score at different time points on the association between antimicrobial resistance and mortality. METHODS: We used an existing data set from a study that investigated the association between fluoroquinolone resistance and mortality. The APACHE II score was calculated at 3 time points: the day the culture specimen was obtained, 1 day before the culture specimen was obtained, and 2 days before the culture specimen was obtained. Separate multivariable models were constructed using the 3 different APACHE II scores. These models were compared qualitatively. RESULTS: Of 91 total subjects, 51 were infected with a fluoroquinolone-resistant strain and 40 with a fluoroquinolone-susceptible strain. The median APACHE II score for all subjects was 13 (95% confidence interval [CI], 11-15) when calculated on the day the culture specimen was obtained, 12 (95% CI, 11-13) when calculated 1 day before, and 11 (95% CI, 10-13) when calculated 2 days before the culture specimen was obtained. Of 91 subjects, 12 (13.2%) died. The 3 multivariable models (each with the APACHE II score calculated on a different day) were not substantively different; the adjusted odds ratio for the association between fluoroquinolone-resistant infection and mortality varied only from 1.38 to 1.65 in the 3 models. CONCLUSIONS: APACHE II scores calculated at different time points relative to obtainment of the culture specimen did not differ substantively. Furthermore, when the adjusted association between fluoroquinolone resistance and mortality was assessed, there were no substantive differences across multivariable models that incorporated APACHE II scores calculated at different time points.     

Association of achalasia and pulmonary Mycobacterium fortuitum infection

A case of achalasia complicated by Mycobacterium fortuitum pulmonary infection and empyema is reported. This association has been documented in the medical literature. Possible mechanisms explaining this association are discussed.