Abstract Background The child behavior checklist-Juvenile bipolar disorder phenotype (CBCL-JBD) has been proposed as a distinct profile specific to children and adolescents who have been diagnosed ...with bipolar disorder. The objective of this study was to examine whether bipolar disorder youth with depression exhibit the “CBCL-Juvenile bipolar disorder phenotype.” Methods Thirty-two adolescents, ages 12–18 years, with a depressive episode associated with bipolar I disorder were recruited, and their primary caregivers completed the CBCL. Results Only the internalizing subscale (mean=70.2, SD=9.7) and total score (mean=71.5, SD=8.9) reached clinical significance (>70). Moreover, the CBCL-JBD profile scores of our subjects (204.6, SD=27.5) did not reach clinical significance (>210). Limitations : Our subjects differed demographically from those in studies that have confirmed the CBCL-Juvenile bipolar disorder phenotype with regards to sex, age and ADHD comorbidity, thus limiting the interpretability of our comparisons with other studies. Furthermore, our investigation involved a small sample size and did not include a control group, which should be addressed in future studies. Conclusions The results of our study suggest that the CBCL-JBD profile is not characteristic of depressed youth with bipolar disorder. Better assessment tools for making an accurate and efficient diagnosis of bipolar disorder are needed so that appropriate treatment can be implemented and significant morbidity and mortality are minimized.
Human herpesvirus 6B (HHV-6B) frequently reactivates after cord blood transplantation (CBT). We previously reported an association between HHV-6B reactivation and delirium after hematopoietic cell ...transplantation. In this prospective study, 35 CBT recipients underwent twice-weekly plasma PCR testing for HHV-6 and thrice-weekly delirium assessment until day 84. There was a quantitative association between HHV-6B reactivation and delirium in univariable (odds ratio, 2.88; 95% confidence interval (CI), 0.97-8.59) and bivariable models. In addition, intensified prophylaxis with high-dose valacyclovir mitigated HHV-6B reactivation (adjusted hazard ratio, 0.39; 95% CI, 0.14-1.08). Larger trials are needed to explore the utility of HHV-6B prophylaxis after CBT.
The authors investigated use of the internet-based patient portal, kp.org, among a well-characterized population of adults with diabetes in Northern California. Among 14,102 diverse patients, 5671 ...(40%) requested a password for the patient portal. Of these, 4311 (76%) activated their accounts, and 3922 (69%), logged on to the patient portal one or more times; 2990 (53%) participants viewed laboratory results, 2132 (38%) requested medication refills, 2093 (37%) sent email messages, and 835 (15%) made medical appointments. After adjustment for age, gender, race/ethnicity, immigration status, educational attainment, and employment status, compared to non-Hispanic Caucasians, African-Americans and Latinos had higher odds of never logging on (OR 2.6 (2.3 to 2.9); OR 2.3 (1.9 to 2.6)), as did those without an educational degree (OR compared to college graduates, 2.3 (1.9 to 2.7)). Those most at risk for poor diabetes outcomes may fall further behind as health systems increasingly rely on the internet and limit current modes of access and communication.
Summary
Objective To systematically review articles describing complications of abortion in settings where abortions are thought to be unsafe and to determine the incidence of severe acute maternal ...morbidity (SAMM) attributed to abortion at the population level.
Methods We searched relevant databases using search terms related to abortion and complications. We included population‐representative studies that listed complications of abortion. We extracted data on the definitions and numbers of severe complications and SAMM, and we report abortion complication rates (per 100 000 women of reproductive age) and ratios (per 100 000 live births) for SAMM, severe complications and any complications.
Results We included 15 studies representing eleven countries (six in Africa, four in Asia and one in Latin America). We found a median abortion ratio of SAMM of 237 (range 91–1892) per 100 000 live births and a median abortion ratio of severe complications of 596 (range 435–5298). There was a great degree of heterogeneity between definitions and study populations.
Conclusions The burden of SAMM attributed to abortion is much greater than what is reported for deaths caused by abortion. However, the great heterogeneity in definitions makes it difficult to draw firm conclusions. We call for future work on the burden of unsafe abortion to use strict definitions of SAMM.
Objectif: Analyser systématiquement les articles décrivant les complications de l’avortement dans des contextes où l’avortement est considéréà risque et déterminer l’incidence de la morbidité maternelle sévère aiguë (MMSA) due à l’avortement à l’échelle des populations.
Méthodes: Nous avons effectué des recherches dans des bases de données pertinentes en utilisant des termes de recherche liés à l’avortement et aux complications. Nous avons inclus des études représentatives de populations qui ont énuméré les complications liées à l’avortement. Nous avons extrait les données sur les définitions et le nombre de complications sévères et la MMSA et nous rapportons un taux de complications liées à l’avortement (pour 100.000 femmes en âge de procréer) et le ratio (pour 100.000 naissances vivantes) pour la MMSA, les complications sévères et toutes formes de complications
Résultats: Nous avons inclus 15 études représentant onze pays (six en Afrique, quatre en Asie et un en Amérique latine). Nous avons trouvé un ratio médian d’avortements à MMSA de 237 (intervalle de 91 à 1892) pour 100.000 naissances vivantes et un ratio médian d’avortement à complications sévères de 596 (intervalle de 435 à 5298). Il y avait une hétérogénéité importante entre les définitions et les populations étudiées.
Conclusion: La charge de MMSA due à l’avortement est beaucoup plus grande que ce qui est rapporté pour les décès dus à l’avortement. Cependant, la grande hétérogénéité dans les définitions rend difficile de tirer des conclusions claires. Nous lançons un appel aux futures études sur la charge de l’avortement à risque, d’utiliser des définitions strictes de la MMSA.
Objetivo: Realizar una revisión sistemática de las publicaciones en las que se describen complicaciones debidas a un aborto en lugares en los que estos se consideran inseguros, y determinar la incidencia de la morbilidad materna aguda y severa (MMAS) por abortos a nivel de la población.
Métodos: Hemos realizado una búsqueda en bases de datos relevantes, utilizando términos de búsqueda relacionados con abortos y complicaciones. Hemos incluido estudios poblacionales representativos en los que se enumeran las complicaciones debidas al aborto. Extrajimos datos sobre las definiciones y números de complicaciones severas y MMAS y reportamos la tasa de complicaciones por aborto (por 100,000 mujeres en edad reproductiva) y la tasa (por 100,000 nacidos vivos) de MMAS, complicaciones severas y cualquier complicación.
Resultados: Hemos incluido 15 estudios que representan a once países (seis en África, cuatro en Asia y uno en América Latina). Encontramos una tasa media de MMAS por aborto de 237 (rango 91 a 1892) por 100,000 nacidos vivos y un tasa media de complicaciones severas por aborto de 596 (rango 435 a 5298). Había un alto grado de heterogeneidad en las definiciones y poblaciones de estudio.
Conclusiones: La carga de MMAS debida al aborto es mucho mayor de lo que se reporta por muertes atribuibles al aborto. Sin embargo, la gran heterogeneidad de las definiciones hace que sea difícil poder sacar conclusiones sólidas. Hacemos un llamamiento para que en trabajos futuros sobre la carga por abortos inseguros se utilicen definiciones estrictas de MMAS.
Identifying various pretreatment factors that predict chemotherapy-induced toxicity in colorectal cancer (CRC) patients undergoing treatment for their disease is crucial to optimising patient care.
...Seventy-three patients received adjuvant 5-fluorouracil (5FU)/leucovorin using either the Mayo Clinic (n=42) or a weekly schedule (n=31) and evaluated for clinical toxicity. Pretreatment blood analysis included measures of plasma uracil and dihydrouracil, peripheral blood mononuclear cell (PBMNC) telomere length (TL), standard biochemistry and cell differential analysis. On the first day of treatment 5FU-pharmacokinetic variables of area under the curve, half life and clearance were also measured. These variables together with age and gender were used in univariate and multivariate analysis as predictors of clinical toxicity.
For the Mayo schedule the primary toxicities were neutropenia (69%), mucositis (58%) and leukopenia (46%), with 70% of patients presenting with haematological toxicity ≥grade 1 (neutropenia and/or leukopenia). Multivariate analysis showed that haematological toxicity was predicted by short TL, high platelet lymphocyte ratio (PLR) and low neutrophil count (R(2)=0.38, P<0.0006), whereas mucositis was predicted by age, TL and PLR (R(2)=0.34, P<0.001). For the weekly schedule diarrhoea predominated (16%), with female gender as the only predictive factor. Although measures of uracil metabolism correlated well with 5FU metabolism (r=0.45-0.49), they did not indicate abnormal pyrimidine metabolism in this cohort and not surprisingly failed to predict for 5FU toxicity.
Short TL of PBMNC and an increased PLR were strong predictors of mucositis and haematological toxicity in CRC patients undergoing 5FU treatment in the adjuvant setting.
Background
Colonic manometry is the current reference standard for assessing colonic neuromuscular function in children with intractable functional constipation (FC). Recently, cine magnetic ...resonance imaging (cine-MRI) has been proposed as a non-invasive alternative. We compared colonic motility patterns on cine-MRI with those obtained by manometry in children, by stimulating high-amplitude propagating contractions (HAPCs) with bisacodyl under manometric control while simultaneously acquiring cine-MRI.
Methods
After Institutional Review Board approval, adolescents with FC scheduled to undergo colonic manometry were included. A water-perfused 8-lumen catheter was used for colonic manometry recordings. After an intraluminal bisacodyl infusion, cine-MRI sequences of the descending colon were acquired for about 30 min simultaneously with colonic manometry. Manometry recordings were analysed for HAPCs. MRI images were processed with spatiotemporal motility MRI techniques. The anonymised motility results of both techniques were visually compared for the identification of HAPCs in the descending colon.
Results
Data regarding six patients (three males) were analysed (median age 14 years, range 12–17). After bisacodyl infusion, three patients showed a total of eleven HAPCs with colonic manometry. Corresponding cine-MRI recorded high colonic activity during two of these HAPCs, minimal activity during seven HAPCs, while two HAPCs were not recorded. In two of three patients with absent HAPCs on manometry, colonic activity was recorded with cine-MRI.
Conclusions
Simultaneous acquisition of colonic cine-MRI and manometry in children with FC is feasible. Their motility results did not completely overlap in the identification of HAPCs. Research is needed to unravel the role of cine-MRI in this setting.
Summary
To determine trends in the diagnostic distribution of esophageal motility disorders after implementation of the Chicago Classification Version 3.0 (CC V3.0) for interpretation of ...high-resolution manometry (HRM) studies compared to non-Chicago Classification criteria. Retrospective trends analysis of patients with an HRM study conducted at a single center from January 1, 2013 to September 30, 2015. The implementation of the CC V3.0 for manometry interpretation occurred in September 2014. Patient charts were manually reviewed for data collection including demographics and HRM diagnoses. The prevalence and relative risks (RR) of CC V3.0 diagnostic categories (i.e. normal, indeterminate, achalasia, and EGJ outflow obstruction EJGOO, and major and minor motility disorders) were calculated before and after CC V3.0 implementation. Four hundred sixty-five HRM studies were included in the study including 268 before and 179 after CC V3.0 implementation. The mean ± SD age was 54 ± 15.4 years and 59.8% were female (n = 278). The percentage with indeterminate diagnosis decreased from 35.3% before CC V3.0 implementation to 16.8% after implementation (adjusted RR 0.5, 95%CI 0.30–0.70, p < 0.001). The percentage with a major motility disorders decreased from 13.9% to 7.3% (adjusted RR 0.5, 95%CI 0.2–1.0, p < 0.001). The percentage with EJGOO and minor diagnoses increased from 1.4% to 14.5% and 11.9% to 22.9%, respectively. The percentage with achalasia and normal diagnosis did not change over the study period. Implementation of CCV3.0 was associated with changes in the distribution of esophageal motility diagnoses in clinical practice. The percentage of indeterminate and major diagnosis decreased and EGJOO and minor diagnoses increased. The decrease in the number of indeterminate studies suggests that the CC V3.0 may clarify the criteria for the interpreting physician. The increase in studies with a diagnosis of EGJ outflow obstruction may reflect the heterogeneity of disorders with clinically relevant outflow obstruction.
Painful diabetic peripheral neuropathy (DPN) is a highly prevalent and disabling complication of diabetes that is often misdiagnosed and undertreated. The management of painful DPN involves treating ...its underlying cause via lifestyle modifications and intensive glucose control, targeting its pathogenesis, and providing symptomatic pain relief, thereby improving patient function and health-related quality of life. Four pharmacologic options are currently approved by the US Food and Drug Administration (FDA) to treat painful DPN. These include three oral medications (duloxetine, pregabalin, and tapentadol extended release) and one topical agent (capsaicin 8% topical system). More recently, the FDA approved several spinal cord stimulation (SCS) devices to treat refractory painful DPN. Although not FDA-approved specifically to treat painful DPN, tricyclic antidepressants, serotonin/norepinephrine reuptake inhibitors, gabapentinoids, and sodium channel blockers are common first-line oral options in clinical practice. Other strategies may be used as part of individualized comprehensive pain management plans. This article provides an overview of the most recent US guidelines for managing painful DPN, with a focus on the two most recently approved treatment options (SCS and capsaicin 8% topical system), as well as evidence for using FDA-approved and guideline-supported drugs and devices. Also discussed are unmet needs for this patient population, and evidence for potential future treatments for painful DPN, including drugs with novel mechanisms of action, electrical stimulation devices, and nutraceuticals.
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