Penicillium piceum infection: diagnosis and successful treatment in chronic granulomatous disease.

Infections due to Penicillium species other than P.marneffei are rare. We identified a boy with X-linked chronic granulomatous disease (X-CGD) with a pulmonary nodule and adjacent rib osteomyelitis caused by Penicillium piceum. The only sign of infection was an elevated sedimentation rate. P. piceum was isolated by fine needle aspirate and from excised infected tissues. Surgical removal and one year of voriconazole treatment were very well tolerated and led to complete recovery. Microbiological, microscopic and molecular studies support the fungal diagnosis. P. piceum should be considered as a relevant pathogen in immunocompromised patients.     

Mood change and empathy decline persist during three years of internal medicine training.

PURPOSE: To examine longitudinal changes in mood and empathy over the course of the internal medicine residency. METHOD: The authors conducted a cohort study of 61 residents who completed the Profile of Mood States (POMS) and the Interpersonal Reactivity Index (IRI) at six time points during their internal medicine residency at a university-based program. (POMS was administered five times, and IRI was administered six times.) The main outcomes measured were trends in mood disturbances and multiple domains of empathy over the three-year residency, and comparisons to norms. RESULTS: Response rates varied from Time 1 to Time 6 (98%, 72%, 79%, 79%, 94%, and 95%, respectively). Interns had better scores on four POMS subscales: Depression-Dejection (p = .0031), Anger-Hostility (p < .0001), Fatigue-Inertia (p < .0001), and Vigor-Activity (p < .0001) compared with later administrations, especially midinternship. By the end of residency all POMS scores were returning towards baseline (effects sizes in the .20 s), but only depression was no longer significantly different. IRI scores showed the decline in Empathic Concern remained over residency whereas Personal Distress peaked midinternship year but approached baseline at the end of residency. Compared with the general population, the graduating residents were less tense, depressed, and confused. Personal Distress was significantly lower than the norm group. CONCLUSIONS: Internal medicine residency presents challenges resulting in common mood disturbances. Although graduating residents appear to be better off than the population norms, some domains of their mood disturbances and empathy never fully recover from their internship year.     

Occurrence of the t(2;5)(p23;q35) in non-Hodgkin's lymphoma

Primary CD30(Ki-1)-positive anaplastic large-cell lymphoma (ALCL) is considered by some to be a distinct clinicopathologic entity associated with the t(2;5) (p23;q35). However, the specificity of t(2;5) for ALCL has not been carefully studied. Therefore, we performed a detailed analysis of all cases of ALCL with abnormal cytogenetics results in the Nebraska Lymphoma Study Group registry, as well as all other cases of non-Hodgkin's lymphoma with t(2;5) in the registry. We found the t(2;5) in only five of 10 cases of ALCL, four of whom were young patients. However, we also found the t(2;5) in 11 other cases of nonanaplastic lymphoma, including eight children with typical peripheral T-cell lymphomas of various types. The t(2;5) was also found in three older adults with B-cell lymphomas of various types. Thus, the t(2;5) was not specific for CD30+ ALCL. However, t(2;5) may define a clinicopathologic entity in children and young adults characterized by variable morphologies with a T-cell or indeterminate phenotype, CD30-positivity, nodal disease with frequent extranodal involvement, advanced stage, and an excellent response to therapy, including bone marrow transplantation for relapsed disease. The clinical relevance of the t(2;5) in older patients requires further study.     

Microtubule-associated protein tau is required for axonal neurite elaboration by neuroblastoma cells.

NB2a/d1 neuroblastoma cells constitutively express multiple isoforms of the microtubule-associated protein tau and incorporate this protein into the axonal neurites elaborated during serum deprivation. To examine whether or not tau played an essential role in axonal outgrowth, cells cultured in serum-free medium were treated at 24 h intervals with antisense- and sense-oriented cDNA oligonucleotides (25 or 36 mers that span or are upstream of tau initiation codon) and were simultaneously serum deprived. Oligonucleotide uptake was confirmed by determination of intracellular levels of radiolabeled oligonucleotides. Treatment for 48 h with tau antisense oligonucleotides reversibly inhibited the expression of tau and the number of neurite-bearing cells compared with treatment with sense oligonucleotides. By contrast, tubulin expression was not affected. When cells were treated with antisense oligonucleotide simultaneously with serum deprivation, the initial outgrowth of neurites was unaffected, but continued neurite elongation was prevented. By contrast, neurite outgrowth at 4 h was inhibited when cells were pretreated with tau antisense 24 h before serum deprivation. Furthermore, intracellular delivery of anti-tau antiserum prevented neurite outgrowth and, in cells that had previously been deprived of serum for 24 h, induced retraction of existing neurites. These findings indicate that both the initiation and the continued outgrowth of neurites are dependent on tau and that pre-existing cytoplasmic pools of tau can mediate initial neuritogenesis.     

Hemorrhagic and nonhemorrhagic brain lesions: evaluation with 0.35-T fast MR imaging

Two fast magnetic resonance (MR) imaging techniques, advanced Fourier and partial-flip imaging, were used at 0.35 T to examine 21 patients with suspected intracranial lesions; the results were quantitatively compared with a conventional spin-echo study. Both of the fast MR techniques yielded a fourfold reduction in imaging time per section. The advanced Fourier sequence showed contrast that was identical to the conventional spin-echo study with signal-to-noise ratios of 58% and 57% for the first and second echoes, respectively. The partial-flip sequence showed a contrast of 109% and 57% for lesions versus substantia alba, and 107% and 78% for substantia grisea versus substantia alba relative to the first and second echoes of the conventional spin-echo study. The partial-flip sequence was particularly sensitive to magnetic susceptibility; this produced artifacts that may undermine the usefulness of partial flip for routine screening in certain parts of the brain. However, this susceptibility significantly improved the detection of intracranial hemorrhage when compared with the spin-echo sequence, particularly when combined with phase mapping of the partial-flip study.     

The reproducibility of data from a Food Frequency Questionnaire among low-income Latina mothers and their children.

We examined the 3-month and 1-year reproducibility of mothers' and children's dietary intakes of calories and 11 nutrients derived from oral administrations of a food frequency questionnaire to 166 Latina women. One-year correlations generally ranged from 0.40 to 0.55 for both mothers and children. For most nutrients, roughly half the children in the highest (lowest) quartile of intake at baseline were also in the highest (lowest) quartile 1 year later. The food frequency questionnaire has great potential for measuring typical nutrient intakes in these populations.     

Poverty and health in West Germany

Summary The relationship between poverty and several health-related characteristics in West Germany was investigated. Data were derived from the National and Regional Health Surveys conducted in West Germany from 1984 to 1992. 25544 males and 25719 females with German nationality aged 25–69 years were examined. Poverty was defined as a household income of 50% less than the mean for West Germany. Multiple logistic regression analysis was used to analyze the relationship between poverty and four health variables: individual health behavior, subjective assessment of health status, cardiovascular disease risk factors, and self-reported prevalence of lifetime chronic diseases. 10.2% of males and 12.8% of females were classified as being below the poverty line. For most but not all health parameters, less favourable results were found for the segment of the population with a household income below the poverty line. The most striking poverty-related differences were observed for lack of regular sport activities, subjective health satisfaction, obesity and myocardial infarction/stroke. Significantly lower prevalence rates for study subjects below the poverty line were observed for hypercholesterolemia in females only. Allergic disorders were the only chronic diseases reported significantly less often in males and females below the poverty line. Poverty has strong effects on individual health status and the prevalence of chronic diseases. Due to the rising unemployment rates in Germany in the last years it is very likely that the strong negative consequences of poverty for health are increasing.

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Zusammenfassung Es wird untersucht, welche Zusammenhänge zwischen Armut und verschiedenen gesundheitsbezogenen Merkmalen bestehen. Datenbasis sind die nationalen und regionalen Gesundheitssurveys, die in den Jahren 1984 bis 1992 in Westdeutschland durchgeführt wurden. 25544 Männer und 25719 Frauen mit deutscher Nationalität im Alter von 25 bis 69 Jahren wurden einbezogen. Armut wurde definiert als ein Haushaltseinkommen, das um 50% niedriger ist als das mittlere Einkommen in Westdeutschland. Die statistische Auswertung erfolgte mittels multipler logischer Regressionsanalyse, 10,2% der Männer und 12,8% der Frauen hatten ein Haushaltseinkommen unterhalb der Armutsgrenze. Die ausgeprägtesten armutsbezogenen Unterschiede wurden beobachtet für den Mangel an körperlicher Bewegung, die subjektive Gesundheitszufriedenheit, das starke. Übergewicht und die kardiovaskulären Krankheiten. Signifikant niedrigere Prävalenzen für Personen mit Einkommen unterhalb der Armutsgrenze ergaben sich bei den Frauen für den Risikofaktor Hypercholesterinämie. Allergien waren die einzige chronische Krankheit, die bei beiden Geschlechtern signifikant seltener in der von Armut betroffenen Bevölkerungsgruppe berichtet wurde. Vor dem Hintergrund der in den letzten Jahren stark angestiegenen Arbeitslosigkeit in Deutschland ist zu befürchten, dass die negativen Konsequenzen der Armut für die gesundheitliche Lage deutlich zugenommen haben.

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Résumé Les rapports entre pauvreté et differents indices sanitaires ont été examinés. Les donnees proviennent des surveys de santé nationales et régionales, réalisées en Allemagne de l'Ouest durant les années 1984 à 1992. 25719 femmes et 25544 hommes de nationalité allemande entre 25 et 69 ans ont paticipé. Le seuil de pauvreté a été fixé à un revenu égal a 50% du revenu moyen en Allemagne de l'Ouest. On a analysé les indices sanitaires suivants: le comportement sanitaire individuell, l'auto-estimation de sa santé, les facteurs de risque cardio-vasculaires et la prévalence des maladies chroniques. L'analyse statistique a été réalisée par regression logique multiple. 12,8% des femmes et 10,2% des hommes avaient un revenu inferieur au seuil de pauvreté. Pour la majorité des indices sanitaires on a trouvé des résultats défavorables pour la groupe ayant un revenu au dessous du seuil de pauvreté. Le manque de mouvement, l'auto-estimation de sa santé, l'excés de poids et les maladies cardio-vasculaires sont les indices quid diffèrent, relatif à la pauvreté, le plus. Les femmes ayant un revenu au-dessous du seuil de pauvreté ont des pourcentages de prévalence inférieurs significatifs pour le facteur de risque hypercholestérolémie. Les allergies sont les seules maladies qui existent significativement moins souvent chez les deux sexes de la groupe des pauvres. En résumé, la pauvreté présente un désavantage pour la santé individuelle et la prévalence des maladies chroniques. Sachant que le taux de chômage s'est aggravé pendant les dernières années, il est à craindre que les effets négatifs de la pauvreté sur la situation sanitaire ont nettement augmenté.