Evidence of chorda tympani dysfunction in patients with burning mouth syndrome

BACKGROUND: More than two-thirds of patients with burning mouth syndrome (BMS) have altered taste sensation. The authors conducted a study to assess chorda tympani and trigeminal nerve function in these patients. METHODS: The study was composed of 48 patients; 22 were diagnosed as having BMS, 14 had burning symptoms related to other diseases and were diagnosed as having secondary burning mouth syndrome (SBMS), and 12 were healthy volunteers. The authors evaluated the electrical detection thresholds of the infraorbital and mental nerves and the electrical taste and electrical detection/tingling thresholds in the anterior two-thirds of the tongue for all patients. Electrical taste threshold is thought to be dictated by chorda tympani nerve function while electrical detection/tingling thresholds are regulated by trigeminal nerve function. RESULTS: The mean electrical taste/tingling detection thresholds ratio and the taste detection thresholds were significantly higher in patients with BMS than in patients with SBMS and in control subjects, indicating chorda tympani nerve dysfunction. Eighteen (82 percent) of the 22 patients with BMS demonstrated chorda tympani dysfunction (13 unilateral and five bilateral). CONCLUSIONS: Chorda tympani hypofunction may play an important role in BMS pathology. Unilateral hypofunction may be sufficient to produce generalized burning sensation exceeding the affected nerve area. CLINICAL IMPLICATIONS: Elevated taste detection threshold levels determined via electrogustatory testing and an elevated taste/tingling detection thresholds ratio may assist clinicians in the diagnosis of BMS. More studies are needed to validate these findings.     

The Behavioural Assessment of the Dysexecutive Syndrome (BADS) in schizophrenia and its relation to functional outcomes

The purpose of this study was to establish further the validity of the Behavioural Assessment of the Dysexecutive Syndrome (BADS) in a population with schizophrenia. Specific objectives were: to examine the construct validity and sensitivity of the BADS in differentiating between adult inpatients during an acute episode of illness, adult outpatients in the chronic stages of illness, and healthy controls; and to examine the predictive validity of the BADS regarding functional outcomes within the chronic group. Participants were 30 inpatients during an acute episode of their illness; 31 outpatients in the chronic stage; and 93 healthy controls. Instruments included the BADS, the Neurobehavioral Cognitive Status Examination (Cognistat) and the Routine Task Inventory (RTI). Significant differences in BADS scores were found between participants with schizophrenia and healthy controls, and between both groups of patients, showing the chronic group to have more deficits in executive functions. In addition, within the chronic group the BADS was found to be a significant predictor of two of the RTI outcome areas, instrumental activities of daily living (IADL) and communication, beyond that accounted for by basic cognitive skills. These results support the validity of the BADS within the schizophrenic population, and highlight the importance of measuring executive functions for rehabilitation     

Unmet needs and relationship challenges of head and neck cancer patients and their spouses

ABSTRACT

In head and neck cancer (HNC), couple-based interventions may be useful for facilitating treatment completion, patient rehabilitation, and improving both partners' quality of life. With the goal of identifying targets for future interventions, we conducted a qualitative study to understand patient and spouse unmet needs and relationship challenges during curative radiotherapy for HNC. Semistructured interviews were conducted with six HNC patients (83% male) and six spouses (83% female) within 6 months of completing treatment. Interviews were audiotaped and transcribed using grounded theory analysis. Patients and spouses identified several unmet needs including better preparation regarding the severity of physical side effects, a clearer timeline for recovery, and strategies for dealing with their own and each other's emotional reactions. Caregiver's unmet needs included balancing competing roles/responsibilities, making time for self-care, and finding effective strategies for encouraging patient's self-care. Eighty-three percent of spouses and all patients reported increased conflict during treatment. Other relationship challenges included changes in intimacy and social/leisure activities. Findings suggest that couple-based interventions that emphasize the importance of managing physical and psychological symptoms through the regular practice of self-care routines may be beneficial for both patients and spouses. Likewise, programs that teach spouses ways to effectively motivate and encourage patients' self-care may help minimize conflict and help couples navigate HNC treatment and recovery together as a team.     

Can we predict the need for pharmacological treatment according to demographic and clinical characteristics in gestational diabetes?

Objective: To determine the ability to predict the need for pharmacological treatment in gestational diabetes mellitus (GDM).

Method: A retrospective cohort study. Data were collected from medical records of 1324 GDM patients including demographic data, family history of diabetes, obstetrical history, laboratory results, treatment modality and level of glycemic control. Patients who were identified as pre-gestational diabetes were excluded.

Results: Overall, 143 (10.8%) GDM patients required pharmacological therapy. Of women who had GDM in their previous pregnancy; only 11.65% achieved desired glycemic control solely by diet treatment. Moreover, 62.5% of patients requiring pharmacological therapy in their previous pregnancy achieved desired level of glycemic control only by diet. Of patients who achieved desired level of glycemic control on diet until the second antenatal visit, 95% continued to maintain desired level glycemic control throughout pregnancy. Pre-pregnancy BMI?>30, fasting plasma glucose >95?mg/dL and maternal age above 30 were associated with increase need for pharmacological treatment. One abnormal value in the OGTT and GCT result >2?mg/dL did not predict the need for pharmacological therapy. Primigravida and family history of GDM were not found to be predictors for treatment modality.

Conclusion: Using clinical and demographical data can predict the need for pharmacological treatment for GDM.     

Assessments of the Importance of Provider Characteristics for Abortion Care: Data From Women in Rajasthan,India

While client satisfaction is a widely recognized component of effective reproductive health care services, little is known about women's perspectives toward abortion care and providers. We use data from a large, community-based abortion knowledge, attitudes, and practices survey in Rajasthan, India, to describe women's assessments of the importance of eight attributes of potential abortion providers and to investigate the sociodemographic differentials in these assessments. Women prioritized technical aspects of abortion care, including provider skill and an equipped facility, and they deemphasized distance and postabortion contraceptive requirements. Although assessments were stable across many sociodemographic factors, the priorities of urban and rural women varied significantly. Women's prioritization of provider attributes should be incorporated into abortion services.     

The challenge of drug-rechallenge: Facts and controversies

The accurate identification of the culprit drug inducing a patient's cutaneous adverse drug reaction is important to avoid future adverse reactions and to provide safe alternative drugs. The assessment has to rely on the clinical signs, the time course, and response to treatment. Sometimes, additional diagnostic procedures are also needed. If diagnostic procedures such as in vivo skin testing and in vitro laboratory tests do not lead to conclusive results, confirmation of a presumptive diagnosis by a rechallenge test is often the only reliable way to establish a diagnosis. This procedure should be undertaken only with great caution and a compelling need, because a rechallenge test might cause severe or even fatal reactions. Contraindications and ethical considerations should be taken into account and an individual risk-benefit calculation must be performed in every case.     

Neutrophilic dermatosis of the hands after influenza vaccination

An otherwise healthy 72-year-old man presented with a painful eruption composed of grouped hemorrhagic purulent blisters on erythematous plaques, on both palms of his hands, which appeared 12 h after he had been vaccinated against influenza.
Based on the patient's history, physical examination, histopathological and laboratory findings, the diagnosis of neutrophilic dermatosis of the hands (NDH) was made.
NDH is currently considered a distributional variant of Sweet's syndrome (SS). It is identical to atypical pyoderma gangrenosum (PG) and pustular vasculitis of the hands.
There are only seven reported cases of SS after vaccination, none of them with lesions confined solely to the palms or soles. Our current case is the third one of SS following influenza vaccination.     

Side effects of mifepristone-misoprostol abortion versus surgical abortion. Data from a trial in China, Cuba, and India.

Although serious adverse events of early abortion have been studied, little attention has been paid to the more common side effects experienced by early medical or surgical abortion clients. Using data from a multicenter comparative trial of women < or = 56 days' gestation in China, Cuba, and India (n = 1373), side effects experienced by mifepristone-misoprostol medical abortion and surgical abortion clients were analyzed at the different stages of their abortions. Data on side effects came from women's reports at each clinic visit, providers' observations during the clinic visits, and symptom diaries maintained during the study period. Medical abortion clients at all sites experienced more side effects than their surgical counterparts. The disparity between the two groups was particularly pronounced for bleeding and pain. Despite more reports of side effects among medical abortion clients, however, assessments of well-being and reports of satisfaction at the exit interview were similar in both treatment groups.     

Assessments of the importance of provider characteristics for abortion care: data from women in Rajasthan, India

While client satisfaction is a widely recognized component of effective reproductive health care services, little is known about women's perspectives toward abortion care and providers. We use data from a large, community-based abortion knowledge, attitudes, and practices survey in Rajasthan, India, to describe women's assessments of the importance of eight attributes of potential abortion providers and to investigate the sociodemographic differentials in these assessments. Women prioritized technical aspects of abortion care, including provider skill and an equipped facility, and they deemphasized distance and postabortion contraceptive requirements. Although assessments were stable across many sociodemographic factors, the priorities of urban and rural women varied significantly. Women's prioritization of provider attributes should be incorporated into abortion services.     

Intertriginous lymphomatoid drug eruption

A 76-year-old man developed a maculopapular purpuric eruption confined to the intertriginous areas (i.e. the inguinal, gluteal, and axillary folds). Two days before the eruption appeared, he had received a second course of chemotherapy consisting of cisplatinum 40 mg and gemcitabine (Gemzar) 1700 mg for the treatment of squamous cell carcinoma of the lung stage III B. The histologic picture was of either lymphomatoid drug eruption or lymphomatoid papulosis. The antineoplastic therapy was changed to once-weekly intravenous vinorelbine (Navelbine) 50 mg, a Vinca alkaloid, and the eruption resolved completely within two weeks without any further therapy. These circumstantial evidences support the diagnosis of intertriginous drug eruption. Our case is interesting and unusual in that it demonstrated a rare clinical presentation of drug eruption, namely, intertriginous drug eruption or baboon syndrome, with a histologic picture of a lymphomatoid drug eruption that can mimic lymphoma. We are unaware of any earlier reported case of baboon syndrome with a histologic picture of lymphomatoid drug eruption. The pathomechanisms of both types of drug eruption, i.e. baboon syndrome and lymphomatoid drug eruption, are not fully understood.