Socio-cognitive skills as a determinant of life satisfaction in aged persons.

The purpose of this study was to explore the viability of a revised model of elderly life satisfaction, specifically evaluating the contribution of socio-cognitive skills. The role of such skills in relation to life satisfaction among aged persons has not been explored in research to date. Pilot data gathered from 60 community-living aged individuals indicated that numerous variables (e.g., subjective/objective health, education, financial satisfaction, role participation, subjective integration) significantly correlated with life satisfaction. However, the combined effects of two variables, persons' feelings of loneliness and isolation from their families and a measure of socio-cognitive skill, accounted for 49 percent of the variability in elderly life satisfaction. The effects of each on life satisfaction were unique however. Implications of these data and possible interventions for increasing elderly persons' life satisfaction are discussed.     

Haemophilus ducreyi Associated with Skin Ulcers among Children,Solomon Islands

During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization’s yaws eradication program.     

A new prognostic model identifies patients aged 80 years and older with diffuse large B‐cell lymphoma who may benefit from curative treatment: A multicenter,retrospective analysis by the Spanish GELTAMO group

The means of optimally managing very elderly patients with diffuse large B‐cell lymphoma (DLBCL) has not been established. We retrospectively analyzed 252 patients aged 80‐100 years, diagnosed with DLBCL or grade 3B follicular lymphoma, treated in 19 hospitals from the GELTAMO group. Primary objective was to analyze the influence of the type of treatment and comorbidity scales on progression‐free survival (PFS) and overall survival (OS). One hundred sixty‐three patients (63%) were treated with chemotherapy that included anthracyclines and/or rituximab, whereas 15% received no chemotherapeutic treatment. With a median follow‐up of 44 months, median PFS and OS were 9.5 and 12.5 months, respectively. In an analysis restricted to the 205 patients treated with any kind of chemotherapy, comorbidity scales did not influence the choice of treatment type significantly. Independent factors associated with better PFS and OS were: age < 86 years, cumulative illness rating scale (CIRS) score < 6, intermediate risk (1‐2) R‐IPI, and treatment with R‐CHOP at full or reduced doses. We developed a prognostic model based on the multivariate analysis of the 108 patients treated with R‐CHOP‐like: median OS was 45 vs. 12 months (P = .001), respectively, for patients with 0‐1 vs. 2‐3 risk factors (age > 85 years, R‐IPI 3‐5 or CIRS > 5). In conclusion, treatment with R‐CHOP‐like is associated with good survival in a significant proportion of patients. We have developed a simple prognostic model that may aid the selection patients who could benefit from a curative treatment, although it needs to be validated in larger series.     

Idiopathic eosinophilic myositis associated with vasculitis and symmetrical polyneuropathy

We present a 79-yr-old white woman admitted to the hospital with diffuse myalgias and muscle weakness associated with eosinophilia. Examination of a muscle biopsy section revealed eosinophilic myositis with vasculitis. This association is infrequent and we describe the first case report with symmetrical polyneuropathy. The treatment with prednisone (60 mg/day) led to a complete clinical-pathological recovery of the disease. We review the differential diagnosis and the aetiopathogenic mechanism.      

Gruesomeness,emotional attachment,and personal threat: Dimensions of the anticipated stress of body recovery

Previous research has shown that exposure to grotesque death has been associated with posttraumatic stress disorder and higher levels of stress have been associated with mortuary workers who anticipated handling remains than those who did not. Additional research is presented here to further clarify the nature of the anticipated stress of handling the dead. Anticipated stress of handling human remains was rated for 13 different situations by 479 persons (384 men and 95 women) without such experience, but whose job was likely to require it. Factor analysis of their ratings revealed three psychological dimensions: the gruesomeness of the remains, an emotional link between the viewer and the remains, and personal threats to the remains handler. Suggestions for preventive measures, training, and interventions for those who may handle remains are made.The views of the authors do not purport to reflect the position of the Department of the Army or the Department of Defense (para 4-3, AR360-5).     

Non tumoral hyperserotoninaemia responsive to octreotide due to dual polymorphism in UGT1A1 and UGT1A6

Gilbert's syndrome is a common inherited metabolic disorder, caused by genetic aberration in the enzyme UDP-glucuronosyl-transferase 1A1 that leads to reduced glucuronidation of bilirubin. Recent advances in molecular genetics have frequently reported the concurrence of dual genetic polymorphisms in UDP glucuronosyl-transferases 1A6 and 1A1 in patients with Gilbert's syndrome, leading to defective glucuronidation of bilirubin, as well as several other endogenous and exogenous substrates, such as serotonin. We present a case of Gilbert's syndrome with severe persistent hyperserotoninaemia, mimicking carcinoid syndrome, due to dual polymorphisms in UDP-glucuronosyl-transferases 1A1 and 1A6. The patient was treated with a long-acting somatostatin analogue (octreotide) for 8 months, resulting in a significant reduction in serum serotonin levels and immediate relief of the symptomatology, followed by a long-term remission. The frequent occurrence of hyperserotoninaemia in Gilbert's syndrome may contribute, at least partly, to the nonspecific symptomatology commonly seen in these patients and should be promptly evaluated.     

Mapping the Epidemiology of Yaws in the Solomon Islands: A Cluster Randomized Survey

Yaws, a non-venereal treponemal disease, is targeted for eradication by 2020 but accurate epidemiological data to guide control programs remain sparse. The Solomon Islands reports the second highest number of cases of yaws worldwide. We conducted a cluster randomized survey of yaws in two provinces of the Solomon Islands. One thousand four hundred and ninety-seven (1,497) children 5–14 years of age were examined. Clinical signs of active yaws were found in 79 children (5.5%), whereas 140 children (9.4%) had evidence of healed yaws lesions. Four hundred and seventy (470) (31.4%) children had a positive Treponema pallidum particle agglutination assay (TPPA). Two hundred and eighty-five (285) children (19%) had a positive TPPA and rapid plasma regain assay. Risk of yaws increased with age and was more common in males. The prevalence of yaws at village level was the major risk factor for infection. Our findings suggest the village, not the household, should be the unit of treatment in the World Health Organization (WHO) yaws eradication strategy.     

Preoperative corticosteroid injections are associated with worse long-term outcome of surgical carpal tunnel release: A retrospective study of 174 hands with a mean follow-up of 5.5 years

Background and purpose

Failed closed treatment of carpal tunnel syndrome (CTS) is often followed by surgery. We investigated whether preoperative steroid injections could have a negative effect on the long-term outcome of the operation.

Patients and methods

174 hands (164 patients) were operated on by a single surgeon at Tartu University Hospital in 2005. The patients were interviewed by telephone 5–6 years after the operation. Self-reported data were gathered retrospectively concerning the number of steroid injections received before the surgery and the perceived regression of symptoms (on a 100-point numeric rating scale) at the time of interview. The patients were also asked about the presence of specific symptoms of CTS if regression of their symptoms had not been complete.

Results

93 of the 174 hands had complete regression of symptoms. Each additional injection was associated with an increased risk of occurrence of pain (RR = 1.1, 95% CI: 1.02–1-2), paresthesiae (RR = 1.1, CI: 1.1–1.2), and nocturnal awakenings (RR = 1.2, CI: 1.1–1.3). There was a weak association between the number of injections and the score given to regression of symptoms.

Interpretation

This is the first study to indicate that patients who received a greater number of local steroid injections preoperatively were more likely to have postoperative complaints associated with CTS.The prevalence of CTS in the general population has been estimated to be 1–5% (Atroshi et al. 1999, Stephens et al. 2008, Shiri et al. 2009). Non-steroidal anti-inflammatory drugs, diuretics, vitamin B6 injections, ultrasound therapy, laser therapy, acupuncture, magnetic therapy, bracing and local steroid injections have been used for closed treatment (Armstrong et al. 2004, Huisstede et al. 2010a). Effective results in the short-term treatment of CTS have been demonstrated clearly only for bracing and local steroid injections (Carlson et al. 2010, Huisstede et al. 2010a). For surgery, both open and endoscopic methods are used, although no benefit in long-term results has been demonstrated with endoscopic operation (Huisstede et al. 2010b). Since there is no consensus on the superiority of conservative treatment or immediate surgical treatment, therapy that first relies on steroid injections has been recommended (Verdugo et al. 2008, Shi et al. 2011). Although some patients may achieve long-lasting relief of symptoms after injection(s), many often fail to respond to subsequent injections and are operated on (Armstrong et al. 2004, Verdugo et al. 2008). Assessments of the outcome of surgical treatment in the literature have mostly concentrated on the differences between endoscopic and open methods, and less attention has been paid to the effects of pre- and postoperative treatment.We have not found any studies that investigated the effect of preoperatively performed local steroid injections on the long-term outcome of surgical carpal tunnel release. Although not directly comparable, a recent systematic review of the treatment of tendinopathy with corticosteroids highlighted their harmful medium and long-term effects in lateral epicondylitis (Coombes et al. 2010). Thus, based on clinical suspicion and on inconsistencies in the published results on the long-term effectiveness of local steroid injections, we hypothesized that preoperative steroid injections might worsen long-term postoperative outcome in patients with CTS.