Psychiatric illness presenting with a sexual complaint and management by psychotropic medications: a case report

IntroductionSexual medicine healthcare professionals, who do not normally examine men and women with psychiatric disorders, need to be aware that those with psychiatric disorders can and do present with sexual medicine problems. In particular, psychiatric individuals may present with a variety of delusions including those that have sexual content or sexual implications. The rare disorder of reverse delusional misidentification syndrome may be encountered in schizophrenic patients and may be best managed by the combined team effort of a sexual medicine specialist and psychiatrist.AimTo report a case study that reiterates the assessment and sexual medicine management of a female with sexual dysfunction who believed she was transforming into a male.MethodsCase report of a woman who attended an outpatient clinic in an academic medical center.ResultsA 60-year-old woman with a history of paranoid schizophrenia presented to a gynecologist for ovarian cancer screening. Evaluation revealed complaints that the patient’s ovaries were testes that produced sperm and her clitoris was a penis capable of erection and ejaculation. Gynecological examination revealed only atrophic vaginitis. The patient was treated with local minimally absorbed vaginal estrogens and referred for psychological assessment and counseling. Psychotropic medication compliance was encouraged, weekly psychotherapy was continued, and delusional symptoms were minimized.ConclusionSexual medicine healthcare providers should be prepared to manage sex health concerns of men and women with psychiatric disorders, including delusional misidentification syndrome, in conjunction with a psychiatrist. Krychman M, and Amsterdam A. Psychiatric illness presenting with a sexual complaint and management by psychotropic medications: A case report.     

Efficient purification of the biosurfactant viscosin from Pseudomonas libanensis strain M9-3 and its physicochemical and biological properties

Viscosin (1), an effective surface-active cyclic lipopeptide, was efficiently recovered from Pseudomonas libanensis M9-3 with a simple purification protocol. A major pigment also obtained during this process was identified as phenazine-1-carboxylic acid. The critical micelle concentration (cmc) of viscosin was determined to be 54 mg L (-1), and the minimum surface tension between air and water at the cmc was 28 mN m (-1). Viscosin forms stable emulsions even at low concentrations (7.5 mg L (-1)), and the conditional stability constant for a cadmium-viscosin complex was determined to be 5.87. The physicochemical properties measured for viscosin are similar to other well-studied biosurfactants such as rhamnolipid and surfactin. Viscosin inhibited migration of the metastatic prostate cancer cell line, PC-3M, without visible toxicity. These properties suggest the potential of viscosin in environmental and biomedical applications.     

Neonatal and 5-year outcomes after birth at 30-34 weeks of gestation

OBJECTIVE: To evaluate the rates of in-hospital death, neonatal complications, and 5-year outcomes of infants born at 30-34 weeks of gestation. METHODS: In nine regions of France, all 2,020 stillbirths and live births at 30, 31, and 32 weeks in 1997 and all 457 births at 33 and 34 weeks in April and October 1997 were recorded. Survivors were evaluated at 5 years of age. RESULTS: Increasing gestational age from 30 to 34 weeks was associated with progressive decreases in in-hospital mortality (from 8.1% to 0.4%) and neonatal complications (respiratory distress syndrome, 43.8% to 2.6%; maternofetal infections, 7.2% to 2.6%; and severe white matter injury, 5.5% to 1.3%). Although infants at 33 and 34 weeks of gestation rarely experienced necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infections, they still required endotracheal ventilation, antibiotics, or parenteral nutrition. At 5 years of age, older gestational age was associated with significant decreases in rates of cerebral palsy (6.3% at 30 weeks and 0.7% at 34 weeks) and mild to severe cognitive impairments (35.3% at 30 weeks and 23.9% at 34 weeks). In singletons, preterm rupture of membranes or preterm labor carried an increased risk of cerebral palsy but not of cognitive impairment. CONCLUSION: Neonates born at 30-34 weeks experienced substantial morbidity and often required admission to neonatal intensive care units. These outcomes suggest that prolonging pregnancies beyond 34 weeks may be desirable whenever possible. Infants born at 30-34 weeks should be carefully monitored to ensure prompt detection and management of neurodevelopmental impairment.     

Childhood obesity: the infancy connection

The prevalence of overweight has risen to 19% in children aged 6 to 11 years and 17% in adolescents aged 12 to 19 years. This paper examines gestational and infancy factors that influence the risk of overweight in childhood. Important factors to eliminate the infancy connection to childhood obesity include the following: (a) maternal lifestyle patterns, (b) infant feeding transitions, and (c) environmental factors. Prevention efforts need to focus on practice, research, and public policy.     

Amniotic fluid embolism

Amniotic fluid embolism is a catastrophic syndrome occurring during labor and delivery or immediately postpartum. Although presenting symptoms may vary, common clinical features include shortness of breath, altered mental status followed by sudden cardiovascular collapse, disseminated intravascular coagulation, and maternal death. It was first recognized as a syndrome in 1941, when two investigators described fetal mucin and squamous cells during postmortem examination of the pulmonary vasculature in women who had unexplained obstetric deaths. Since then, many studies, case reports, and series have been published in an attempt to elucidate the etiology, risk factors, and pathogenesis of this mysterious obstetric complication.