Insidious Illness Research Articles

Significant Improvement of Somatic Symptom Disorder With Brief Psychoeducational Intervention by PMHNP in Primary Care.

Patients with somatic symptom disorders (SSD) are prevalent in primary care, urgent care, and emergency rooms and present with reduced quality of life, increased disability, and suicidality . Criteria for SSD include (1) somatic symptoms that cause distress and disrupt life; (2) concurrent physical illness with thoughts and feelings that are disproportionate to the seriousness of the illness; and (3) distress which is persistent and causes suffering. The frequency of SSD in the general population is 5% to 7%; however, in primary care, it is 5% to 35% . Because patients present with anxiety, depression, and/or pain, providers are flummoxed when diagnostic findings do not match symptom intensity. The purpose of this project was to provide an intervention for patients with SSD and measure its effectiveness on their somatic symptoms. This study provided a single-session, 30-minute psychoeducational intervention for patients to explain brain pathways for pain and the body's response to stress, including scientific benefits of exercise and healthy diet. Patients were asked questions using the motivational interviewing technique OARS (open-ended question, affirmation, reflection, summary) and were encouraged to talk about their concerns. The study used a pre- and post-intervention visual analogue scale and a self-reported Patient Health Questionnaire-15 both before and 3 weeks post-intervention. Measurements showed significant symptom improvement immediately after the intervention with sustained improvement 3 weeks post-intervention. This intervention demonstrates an effective treatment for this insidious illness, which plagues up to 35% of patients in primary care.

Serum C-reactive protein and Pro-Calcitonin as an Indicator in Post-Operative Infection after Hepatobiliary Surgery

Background: Major hepato-biliary surgeries carry a high risk for post-operative sepsis. Recent therapeutic advances both medical and surgical have improved early post-operative outcome. Considering the difficulties in diagnosis of infection in critically ill patients an early sensitive and specific marker for sepsis would be of interest. Studies have shown that C - reactive protein (CRP) and pro calcitonin (PCT) are acute phase reactants and good independent early markers of post-operative sepsis, severe or septic shock. This aspect has not been evaluated in the hepatobiliary surgeries. More over there is no data available from the Indian sub-continent in this aspect. This study aims to evaluate the efficacy of serum CRP and PCT levels after hepatobiliary surgery for diagnosis of postoperative complication. Subjects and Methods: This is a cross-sectional diagnostic study has conducted in 42 patients who all are satisfying the inclusion criteria. Study duration was From August 2017 to July 2019, conducted on patients between 18-80yrs of age undergoing hepato-biliary surgery, in surgical wards of PK Das Institute of Medical Sciences. Study variables include age, sex, pre-operative serum albumin level, pre and post-operative S.CRP AND S.PCT levels. On post-operative day 4 and day 7 S.CRP and S.PCT are monitored and its predictability also measured. . Descriptive statistical analysis will be carried out using SPSS (IBM). The p-value of less than 0.05 will be taken as significant. Results: out of 42 patients studied, 30 patients developed post-operative complications. Pre-operative serum C - reactive protein and serum procalcitonin measured compared with pre-operative serum albumin was significant identifying post-operative complications (P-value 0.02). On post-operative day 4 and 7value was significant in post-operative patients with P-value of 0.04 vs. 0.046 respectively. Similarly serum procalcitonin values also were significant on postoperative day (POD) 4 and 7 with P-value of 0.02 and 0.03. Sensitivity and specificity of S.PCT was more compared to S.CRP (92 vs 90% in sensitivity and 100% vs 80% in specificity respectively. This study shows those who were clinically septic post operatively have statistically elevated levels of serum CRP and Procalcitonin. Conclusion: S.PCT is more sensitive and specific as a marker of post operative infection following hepato biliary surgery. Early identification of patients with insidious septic illness allows early therapeutic intervention which may favorably influence outcome.

An empirical study of five sets of diagnostic criteria for delusional disorder

BackgroundThe diagnosis of paranoia/delusional disorder has been significantly modified and redefined from DSM-III to DSM-5, which in turn also meaningfully differ from the ICD-10 criteria. In this study we examined the degree to which these diagnostic systems differ on external variables. MethodTwo-hundred and eighty-six subjects diagnosed of paranoia/delusional disorder according to DSM-III, DSM-III-R, DSM-IV, DSM-5 or ICD-10 criteria were examined for a number of validators including risk factors, premorbid features, illness-related variables and psychosocial functioning. The prevalence rates of the diagnostic criteria and their concordance level were examined, such as the degree to which the criteria sets and their main diagnostic features were differentially related to the validators. ResultsDiagnostic criteria showed poor to fair concordance. The most inclusive system was the DSM-5 (n = 274) and the most restrictive the DSM-III (n = 187). Compared with subjects fulfilling other diagnostic criteria, those with a DSM-III diagnosis showed more and stronger associations with the validators: presence of cluster A personality disorders, insidious illness onset, poor response to treatment, chronic illness course and poor psychosocial functioning. This association pattern was mainly due to the 6-month duration criterion. Stability of delusions, type of delusions and the ICD-10 3-month duration criterion were poorly related to the validators. ConclusionsDiagnostic criteria for delusional disorder are not interchangeable. DSM-III criteria for paranoia may identify a more severe disorder mainly because the 6-month duration criterion. Type of delusions had a small impact on the validators across diagnostic systems. These findings have implications for future classifications of delusional disorder.

Synthesis and Biological Evaluation of Hybrid 1,5- and 2,5-Disubstituted Indoles as Potentially New Antitubercular Agents.

Tuberculosis (TB) is the second leading cause of mortality worldwide being a highly contagious and insidious illness caused by Mycobacterium tuberculosis, Mtb. Additionally, the emergence of multidrug-resistant and extensively drug-resistant strains of Mtb, together with significant levels of co-infection with HIV and TB (HIV/TB) make the search for new antitubercular drugs urgent and challenging. This work was based on the hypothesis that an active compound could be obtained if substituents present in some other active compounds were attached on a core of an important structure, in this case the indole scaffold, thus generating a hybrid compound. A QSAR-oriented design based on classification and regression models along with the estimation of physicochemical and biological properties have also been used to assist in the selection of compounds. Chosen compounds were synthesized using various synthetic procedures and evaluated against M. tuberculosis H37Rv strain. Selected compounds possess substituents at positions C5, C2 and N1 of the indole ring. The substituents involve p-halophenyl, pyridyl, benzyloxy and benzylamine groups. Four compounds were synthesised using suitable synthetic procedures to attain the desired substitution at the indole core. From these, three compounds are new and have been fully characterized, and tested in vitro against the H37Rv ATCC27294T Mtb strain, using isoniazid as a control. One of them, compound 2, with the pyridyl group at N1, has an experimental log (1/MIC) very close to 5 and can be considered as being (weakly) active. In fact, it is more active than 64% of all indole molecules in our data sets of experimental results from literature. The most active indole in this data sets has log (1/MIC)=5.93 with only 6 compounds with log (1/MIC) above 5.5. Despite the lower activity found for the tested compounds, when compared to other reported indole-derivatives, these structures, which rely on a hybrid design concept, may constitute interesting scaffolds to prepare a new family of TB inhibitors with improved activity.

Insidious illness in active seniors: decoding atypical presentations.

Older athletes and active seniors may have serious medical problems without commonly recognized signs and symptoms. The cases of an older tennis player, a golfer, and a deep-sea sport fisherman illustrate unusual presentations of coronary artery disease, bacterial pneumonia, and peptic ulcer disease in senior patients. Alertness for the effects of coexisting illnesses, chronic use of medicines, reduced physiologic and immunologic reserves, altered pain perception, and symptom denial can facilitate prompt treatment of active senior patients.

Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

OBJECTIVES:Septic pulmonary embolism caused by a Klebsiella (K.) pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment.METHOD:We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years.RESULTS:The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%), nodules with or without cavities (79%), pleural effusions (71%), peripheral wedge-shaped opacities (64%), patchy ground-glass opacities (50%), air bronchograms within a nodule (36%), consolidations (21%), halo signs (14%), and lung abscesses (14%). Nine (64%) of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14%) patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis.CONCLUSION:The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis.

Functional outcome in major psychiatric disorders and associated clinical and psychosocial variables: A potential cross-diagnostic phenotype for further genetic investigations?

Objectives. Functional outcome has recently become of interest for cross-diagnostic subphenotype approaches in psychiatric genetics. Therefore, it is crucial to know about clinical, demographic and psychosocial variables that correlate with long-term functioning. Unfortunately, there is a lack of studies that directly compare the importance of correlates for functional outcome between different disorders. Methods. Applying regression models to samples of patients with schizophrenia (SZ, n = 238), bipolar disorder (BD, n = 533) and major depressive disorder (MDD, n = 398), we compared the magnitude of association of potential correlates with functional outcome, measured by the Global Assessment of Functioning (GAF) score. Results. Shared correlates for worse functional outcome were poor premorbid functioning, insidious illness onset and poor premorbid work or social adjustment in all three disorders, and negative symptomatology in SZ and BD. Disorder-specific correlates for SZ were longer duration of illness, lower functioning during episodes and being life-time single, for BD substance abuse and suicidality, and for MDD premorbid unemployment and having a premorbid personality disorder. Conclusions. We found different patterns of correlates for long-term functioning in SZ, BD and MDD. Knowledge of these patterns may improve the quality of genetic investigations focussing on functional outcome.

Septic Shock Due to Tuberculosis in Down Syndrome

Both Immune dysfunction and deficiency, are known in Down syndrome. Tuberculosis commonly presents as insidious illness and septicemic shock is its rare presentation, mostly in immunocompromized patients. We report a 16 year old boy with Down syndrome presenting with septicemic shock due to tuberculosis.

Long-term course of treatment strategies in panic disorder: an update narrative review 1999-2010

Panic disorder (PD) represents an insidious, often chronic, recurrent and relapsing illness. Although studying PD is a topical subject because it affects both treatment costs and patients' quality of life, the literature demonstrates that long-term studies are rare and not very systematic. Even if many short-term studies (within 6 months) show that the present treatment strategies have very good results, the outcome data in the long- term suggest that a significant rate of patients with PD, in remission at the end of a treatment, relapses during the follow-up, so that there is the need to find treatment strategies to maintain the remission achieved in the short-term as long as possible. This study offers an overview of 35 studies on the long-term outcomes of PD, reviewing the recent follow-up studies with at least 6 months of follow-up and that investigate the role of comorbidity in the follow-up of PD, the outcome predictors and the present treatment strategies.

A Groundhog, a Novel Bartonella Sequence, and My Father's Death

During the summer of 2007, migratory joint pain developed in my (E.B.B.) 86-year-old father, previously an ironworker, farmer, and World War II veteran. Because of occasional tick attachments, a Borrelia burgdorferi ELISA was performed; antibodies were not detected, and no treatment was instituted. In the fall, subtle memory loss developed, and he fell twice a few weeks apart. Dad jokingly blamed the falls and the memory loss on “old timer’s disease.” Subsequently, episodes of subtle confusion and more frequent memory loss generated family concern as to what the future might hold. On December 15, he broke his left femur during a fall while climbing 2 stairs to enter our home. Despite having successfully climbed those stairs thousands of times in the past, he would never climb those or any other stairs again. Retrospectively obvious, a pattern of insidious illness characterized by joint pain, memory loss, and incoordination, not recognizable by my father or other family members, had begun before that summer. Medically stable historical problems included coronary artery disease, atherosclerosis, carotid artery occlusion, hypertension, and atrial fibrillation. During the previous year, a normocytic, normochromic, nonregenerative anemia persisted. Despite normal serum iron, total iron binding capacity, ferritin, and vitamin B12 values, anemia was attributed to intestinal blood loss. When examined in May 2007, before anesthesia for endoscopy, mood and affect were appropriate, recent and remote memory were intact, insight and judgment were good. A hiatal hernia, mild antral gastritis, and duodenitis were visualized.

The biochemical investigation of Cushing syndrome

Cushing syndrome is an insidious illness that warrants an early diagnosis to avoid the effects of prolonged hypercortisolism. The variability in the clinical features of the disease and the occasional inconsistencies between different biochemical tests performed to identify it render the diagnosis challenging. In this paper the author discusses the various biochemical tests that are useful for the diagnoses of Cushing syndrome and Cushing disease, with an emphasis on the respective sensitivities and specificities of these tests. The measurement of evening salivary cortisol and the combined low-dose dexamethasone-corticotropin-releasing hormone stimulation test have improved overall sensitivity and specificity in the evaluation of Cushing syndrome and Cushing disease.

Insidious Illness in Active Seniors

Older athletes and active seniors may have serious medical problems without commonly recognized signs and symptoms. The cases of an older tennis player, a golfer, and a deep-sea sport fisherman illustrate unusual presentations of coronary artery disease, bacterial pneumonia, and peptic ulcer disease in senior patients. Alertness for the effects of coexisting illnesses, chronic use of medicines, reduced physiologic and immunologic reserves, altered pain perception, and symptom denial can facilitate prompt treatment of active senior patients.

Active Native Valve Endocarditis: Determinants of Operative Death and Late Mortality

Background. In this report, we reviewed 247 patients who underwent operation by our team for active native valve endocarditis between January 1979 and December 1993.Methods. There were 201 male and 46 female patients (mean age, 45.4 ± 6 years). The aortic valve was involved in 163 cases, the mitral valve in 36 cases, both mitral and aortic valves in 44 cases, and the tricuspid valve alone in 4 cases. The most common microorganisms were streptococci. Univariate Pearson (χ2 test) and multivariate (stepwise logistic regression [BMDPLR]) analyses were used to identify significant predictors of operative mortality, reoperation, and recurrent endocarditis. Cox proportional hazards regression model was used to study late survival.Results. Operative mortality was 7.6% (n = 19). Increased age, cardiogenic shock at the time of operation, insidious illness, and greater thoracic ratio (>0.5) were the predominant risk factors; the length of antibiotic therapy appeared to have no influence. Two hundred thirteen patients were followed up. Median follow-up time was 6 years (range, 2 to 19 years). Overall survival rate (operative mortality excluded) was 71.3% ± 3.8% at 9 years. Increased age, preoperative neurologic complications, cardiogenic shock at the time of operation, shorter duration of the illness, insidious illness before the operation, and mitral valve endocarditis were the predominant risk factors for late mortality. The probability of freedom from reoperation (operative mortality included) was 73.3% ± 4.2% at 8 years; risk factors were younger age and aortic valve endocarditis. The rate of prosthetic valve endocarditis was 7%. No significant risk factor was found.Conclusions. Increased age, insidious illness, and hemodynamic failure are the main risk factors for operative mortality. Long-term survival is good except for patients with preoperative neurologic complications and mitral valve endocarditis.(Ann Thorac Surg 1997;63:1737–41)

Electro-encephalographic investigations in myalgic encephalomyelitis.

The main EEG features are described of thirty-six young adults who were examined at the Royal Free Hospital between 1960 and 1964 and twelve children seen at the Hospital for Sick Children, Great Ormond Street, London, between 1957 and 1977. It is important in the future, if a plan is considered for the study of a fresh epidemic, to include systematic EEG studies covering a period of 2 to 3 years. The EEG alterations found in this limited survey, though modest, would suggest that cerebral function was disturbed with somewhat variable distribution by an insidious illness which has not yet been identified.

Emphysema and proteinuria in men casting copper-cadmium alloys.

Diseases of occupational origin occur as acute or chronic illnesses. The former are usually dramatic and the connexion between symptoms and occupa tion is obvious. An insidious illness developing over many years and due to long exposure to small quantities of a poisonous substance may long go unrecognized as being of occupational origin. Since all the recorded cases of chronic cadmium poisoning had occurred among men employed in the alkaline accumulator industry, it was decided to investigate other industries where cadmium is used. This paper describes five cases of chronic cadmium poisoning and reports the results of an investigation of men employed at two factories in England where an alloy of copper and cadmium is manufactured. Because cadmium increases the wear and dura bility of copper without reducing significantly its electrical conductivity the alloy is used to replace pure copper for certain purposes. These include post-office telephone wires, high-tension electrical conductor cables, and overhead contact wire for electrically powered omnibuses and trains.