Chronic illness perception in adolescence: Implications for the doctor-patient relationship

To describe the inter-relationship of chronic illness severity as perceived by adolescents with both psychosocial well-being and objective measures of illness severity. Additionally to compare the adolescents' perception of illness severity with how their physicians believe that the adolescents perceive their illness severity.

Methods:

The psychological well-being of 48 adolescents with either cystic fibrosis (CF) or insulin-dependent diabetes mellitus (IDDM) was measured by four standardized questionnaires. The adolescents' perception of severity of illness was measured using an original instrument (PSCI), and this measure was compared to their physicians' estimates of how the adolescents perceived the severity of their illness and clinical illness.

Results:

There were 24 patients in both the CF and IDDM groups. Both groups were found to function well psychosocially; although, there were more patients with low self image compared to normative values. Depression and low self image were associated with a greater adolescent perception of illness severity. For both chronic illness groups, physicians' assessment of assumed adolescent perception of disease severity correlated with clinical indices of disease severity and was higher than the perception of illness severity reported by the adolescents. For adolescents with CF, but not with IDDM, perception of severity of chronic illness correlated with clinical indices.

Conclusions:

For adolescents with chronic illness, their perception of illness severity is an important indicator of psychosocial well-being. Physicians do not accurately infer their patients' perception of illness severity.     

海南野扇花中甾体生物碱的化学研究

从黄杨科野扇花属植物海南野扇花(Sarcococca vagans Stapf)的根中分离得到6个甾体生物碱,经波谱分析及理化常数测定,确定其结构分别为帕其沙明A(pachysamine A,I),矮陀陀碱F(axilarine F,II),海南野扇花碱A～D(sarcovagine A～D,II～VI)。其中,化合物II～VI为新的甾体生物碱。     

AIDS AWARENESS IN PATIENTS ATTENDING THE MEDICAL OUTPATIENT DEPARTMENT OF A PUNE HOSPITAL

A bilingual questionnaire was administered to 400 out-patients to assess their acquired immunodeficiency syndrome (AIDS) awareness. Results were analyzed and three scores, namely educational score (%ES), media score (%MS) and AIDS awareness score (%AAS) were devised to give per cent values to these parameters. Only 49 per cent of the males and 26 per cent of the females had studied beyond Class 10. As many as 103 (25.8%) subjects had never heard of AIDS. The remaining 297 patients knew a fair amount but misconceptions were very common. The %AAS was over 80 per cent in students and in civil servants, around 70 per cent in government servants and business persons and around 60 per cent in house wives. It was higher in those from urban backgrounds and in males. The education and media scores of those ignorant of AIDS were poor compared to those aware of AIDS. Risk factors for ignorance were poor educational levels, low exposure to public media and female gender. A very basic take-off level is therefore required when physicians discuss AIDS related issues with their patients.KEYWORDS: AIDS, HIV, Prevention     

Induction of spermatogenesis in isolated hypogonadotrophic hypogonadism with gonadotrophins and early intervention with intracytoplasmic sperm injection

Idiopathic hypogonadotrophic hypogonadism (IHH) is a potentially correctable cause of male infertility. However hormonal treatment is usually a slow process and artificial reproductive techniques such as intracytoplasmic sperm injection (ICSI) might be resorted to before full testicular response has been achieved. We report here an unusual variant of IHH of post-pubertal onset in which early intervention with ICSI was attempted. Our patient was 37 years old and presented with male infertility due to azoospermia and undetectable serum gonadotrophin concentrations. He had an apparently normal pubertal development, a testicular volume of 8 ml, normal pituitary-thyroid and pituitary-adrenal function, as well as normal computerized tomographic appearance of the sella region. A combination of human chorionic gonadotrophin (HCG) and menopausal gonadotrophins (HMG) was administered. Spermatozoa were first detected in the semen after 3 months and reached a concentration of approximately 2x10(6)/ml after 9 months. ICSI was attempted at this point; the spermatozoa had good fertilizing ability and three embryos were obtained and replaced. Unfortunately no pregnancy resulted. Treatment with 5000 IU HCG and 150 IU HMG three times per week was continued and sperm counts rose rapidly thereafter to reach 28.3x10(6)/ml after 16 months of injections. His wife conceived naturally during this period and the pregnancy is now in the second trimester. This case illustrates the good prognosis of the rare patient with IHH of post-pubertal onset when treated with gonadotrophins, and suggests that ICSI procedures should be delayed until final testicular maturation is attained.      

Isolated central canal rupture of spinal dermoid: Report of two cases

We report two cases of lumbar spinal dermoid cysts with asymptomatic rupture and migration of free fat droplets into the central canal. No fatty droplets were seen within the lumbar subarachnoid space. The presence of fat droplets within the central canal is unusual because the central canal is rudimentary in adults. We suggest that hydromyelia secondary to tumour and specific tumour morphology might facilitate the selective rupture of dermoids into the central canal. We recommend a follow up of these patients to detect any possible intracranial migration of fat droplets and resultant complications.     

Comparison of health‐related quality of life and emotional distress among Chinese cancer survivors

The purpose of this study is to compare health‐related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy—General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems.