Technical skills for weight loss: preliminary data from a randomized trial

BACKGROUND: Optimal behavioral interventions for sustainable weight loss are uncertain. We therefore conducted a study among overweight/obese women comparing conventional dietary counseling of individuals (counseling-based intervention) to a novel, group-based skill-building intervention. METHODS: Eighty subjects were randomly assigned to either the counseling-based or to the skill-building intervention. Outcomes included weight loss, dietitian hours per group and per unit weight loss, and dollars spent per group and per unit weight lost. RESULTS: Weight loss at 6 months (follow-up rate 61.3%) in the counseling-based group was 8.8 lb (P = 0.0001), and in the skill-building group was 3.8 lb (P = 0.01). A total of 160 dietitian hours were required for the counseling-based group, and 131 for the skilled-building group. The counseling-based group cost an average of $21 per pound lost, while the skill-building cost an average of $48 per pound lost (P = 0.16). CONCLUSIONS: At 6 months, individualized office-based counseling produced more weight loss than a skill-building approach and cost less than half as much per pound of weight loss. Longer-term follow-up is required to determine if, as hypothesized, the skill-building intervention produces more sustainable weight loss.     

Prayer marks

BACKGROUND: Prayer marks (PMs) are asymptomatic, chronic skin changes that consist mainly of thickening, lichenification, and hyperpigmentation, and develop over a long period of time as a consequence of repeated, extended pressure on bony prominences during prayer. METHODS: Three hundred and forty-nine Muslims and 24 non-Muslims were examined for the appearance of PMs at different body sites. RESULTS: The prospective study of 349 Muslims (both males and females) with regular praying habits showed the occurrence of PMs on specific locations, such as the forehead, knees, ankles, and dorsa of the feet, leading to dermatologic changes consisting of lichenification and hyperpigmentation. The incidence of PMs was significantly higher in males than in females. Older subjects (over 50 years of age) demonstrated a significantly higher frequency of lichenification and hyperpigmentation, suggesting that repeated pressure and friction for prolonged periods are the causative factors for the development of PMs. Histologic examination of skin biopsies from the affected sites showed compact orthokeratosis, hypergranulosis, dermal papillary fibrosis, and dermal vascularization. PMs were not associated with any risk of secondary complications, such as erythema, bullous formation, and infections. CONCLUSIONS: PMs are commonly occurring dermatologic changes in Muslims who pray for prolonged periods.     

Septic arthritis due to Mycobacterium szulgai in a patient with human immunodeficiency virus: case report

Mycobacterium szulgai is a rare human pathogen that mainly causes pulmonary diseases. We report the first case of M. szulgai causing septic arthritis in a patient with human immunodeficiency virus. A culture from the joint aspiration was needed to isolate and identify this organism. The patient was treated successfully with ciprofloxacin, clarithromycin, and ethambutol.     

High-resolution X-ray computed tomographic scanning of the human stapes footplate

OBJECTIVES: The mechanical behaviour of the footplate and its annular ligament depends critically on their shape and orientation in the oval window, but accurate measurements have been difficult to make owing to their small size. Our aims are to visualize the footplate at high resolution and understand its dynamics. METHODS: The human cadaver stapes footplate was dissected, and very high-resolution x-ray computed tomographic (CT) scans, with voxel sizes from 4 to 8 pm, were performed. Locally developed software was used to reconstruct the images. RESULTS: The data permit us to explore minor details of shape and orientation. The footplate looks like a footprint, and the annular ligament has variable thickness, with a cleft (groove) in its anterior attachment to the oval window. The CT data also permit us to create a three-dimensional finite-element model that can simulate footplate motion. CONCLUSIONS: The results obtained lead to further understanding of the mechanical behaviour of the footplate and the annular ligament.     

Lateral neck radiography versus direct video rhinoscopy in assessing adenoid size

OBJECTIVE: To evaluate the usefulness of adynamic lateral neck radiographs and dynamic video rhinoscopy in assessing adenoid size and the relationship of these methods to associated symptoms and thus the severity of the disease. METHODS: Children with suspected adenoid hypertrophy underwent standard lateral neck soft tissue radiographs: the percentage of airway occlusion, adenoid to nasopharynx (AN) ratio, airway to soft palate ratio, and adenoid thickness were assessed by a radiologist. The percentage of airway closure was assessed by direct fibre-optic rhinoscopy in an ear, nose, and throat clinic. Associated clinical symptoms were assessed by parents using a standardized questionnaire, evaluating the severity of symptoms (snoring, sleep apnea, mouth breathing, and otitis media) to give a total symptom score out of 16. RESULTS: Nonparametric statistical analysis using Spearman's correlation coefficients was performed on 32 patients. There was a weak correlation, which approaches significance, between the percentage of airway occlusion assessed by fibre-optic rhinoscopy and the total symptom score (r = .344, p = .054). However, this correlation becomes significant when the frequency of otitis media is omitted (r = .367, p = .039). There was also a significant correlation between airway occlusion assessed by rhinoscopy and the percentage of airway occlusion as determined by lateral neck radiography (r = .431, p = .014). There was no correlation between any of the measurements taken by lateral soft tissue neck radiography and total symptom score. CONCLUSION: Dynamic video rhinoscopy is more accurate at assessing adenoid hypertrophy, and the percentage of airway occlusion, as estimated by video rhinoscopy, is better correlated to the severity of symptoms than are values obtained by lateral neck radiography.