Prior Illness Research Articles

Unprovoked pulmonary thromboembolism predisposed by hyperhomocysteinemia

The role of hyperhomocysteinemia as a predisposing factor for coronary artery disease has been discussed in several text and reports but its role in venous thrombosis has seldom been discussed. A 42-year-old woman was admitted to our hospital with a history of swelling of lower limbs of 7 days duration, breathlessness of 5 days duration. She had no significant history of prior illness. On physical examination, the temperature was 99.6 °F, pulse rate 86 beats per minute, and blood pressure 100/60 mm Hg. Clinical examination of the cardiovascular system was normal. The routine laboratory analysis was normal. D-dimer level was 1.718 μg/mL. Biochemical studies and urinalysis were in normal range. Based on the clinical, laboratory, and radiological findings, computed tomographic pulmonary angiography (CTPA) was performed. Echocardiogram revealed dilated pulmonary arteries dilated and dysfunctional right ventricle, pulmonary hypertension with severe tricuspid regurgitation. Computed tomographic pulmonary angiography demonstrated the presence of pulmonary embolism involving both the pulmonary artery. Screening for thrombophilic states demonstrated normal protein C, protein S, and anti-thrombin III was negative. Anti-phospholipid antibody was negative. Homocysteine level was 149.6 μmol/which formed the sole predisposing factor for the event in this case. The patient was planned for lifelong prophylactic anticoagulation with acitrom overlapped by heparin initially; along with folic acid, pyridoxine and vitamin B12. The follow up has been uneventful. Initiating supportive medications for hyperhomocysteinemia in patients with thrombotic events may have remarkable effect on prognosis and incidence of recurrence.

Liposomal anthracycline chemotherapy and the risk of second malignancies in patients with Kaposi's sarcoma (KS).

People living with HIV (PLWH) are at increased risk of cancer, both non-AIDS- and AIDS-defining malignancies (NADM and ADM). Systemic chemotherapy also predisposes to secondary cancers. The potential contribution of systemic liposomal anthracycline chemotherapy (SLAC) to the development of second cancers in PLWH is unknown. Since 1998, we have treated 495 PLWH and Kaposi's sarcoma (KS) with a stage-stratified approach including 163 who received SLAC as first-line treatment for KS. Subsequent ADM and NADM diagnosed in this population were recorded. More patients who received SLAC had T1 stage disease (p < 0.0001) and lower CD4 cell counts (p < 0.0001) in line with the stage-stratified treatment, but there were no significant differences in age (p = 0.29), gender (p = 0.18), prior AIDS-defining illness (p = 0.45), plasma HIV viral load (p = 0.15), or HHV8 viral load (p = 0.39) between the two groups. During a median follow-up of 4.6 years (maximum 15 years) from KS diagnosis, 28 patients developed a second cancer (5 ADM and 23 NADM). The 5-year cumulative risk of second cancer is 5.8 % (95 % CI 3.0-8.6 %), and there is no significant difference in the rate between those treated with SLAC and those not (log rank p = 0.19). Most patients (n = 131) were treated with daunoxome (liposomal daunorubicin) chemotherapy, and there was no significant correlation between risk of second cancer and cumulative dose of daunoxome (p = 0.23). Although the risk of second cancer after a diagnosis of KS in PLWH is high, systemic liposomal anthracycline chemotherapy does not appear to increase the risk.

Broken heart syndrome — Is it a psychosomatic disorder?

ObjectiveThe development of somatoform illnesses is often associated with prior psychiatric illness and life stress. Broken heart syndrome has been associated with a range of stressors and we aimed to investigate if psychiatric illnesses are risk factors for developing broken heart syndrome. MethodsWe systematically assessed for antecedent psychiatric risk factors in two groups of cases (people who developed sporadic and earthquake-related broken heart syndrome) and compared them to a control group of healthy volunteers. ResultsWe found that of the ten psychiatric risk factors examined, only ‘neuroticism’ significantly differed between participants with broken heart syndrome and healthy volunteers. ConclusionThere was no association between previous psychiatric illness and development of broken heart syndrome in this study. Clinical assessment of psychiatric risk factors may not identify patients at increased risk of broken heart syndrome.

The mental health benefits of regular physical activity, and its role in preventing future depressive illness

There is a large body of literature which examines the mental health benefits of physical activity. In general, studies report an inverse, dose dependent relationship between leisure-time physical activity participation, and mental health outcomes. Studies also show a positive association between maximal aerobic capacity and general well-being. More recent studies have confirmed the positive effects of physical activity participation on cognition, includ - ing the treatment and prevention of dementia. The current exercise prescription suggested for the treatment of depression is similar to that recommended to the general population for the development and maintenance of cardiorespiratory fitness. There is also strong evidence from large population level studies that long term physical activity participation reduces the risk of future depressive illness. From the available evidence, it would appear that physical activity performed at a frequency, intensity, and duration which is substantially less than that required for the development and maintenance of cardiorespiratory and muscular fitness in the general population, may afford significant benefits in reducing the risk of future depressive illness. This may be particularly encouraging for people with prior depressive illness, or at high risk of future depressive illness, since this vulnerable population already faces significant barriers to physical

Plasma and lymphocyte Hsp72 responses to exercise in athletes with prior exertional heat illness

We investigated the effect of exercise in the heat on both intracellular and extracellular Hsp72 in athletes with a prior history of exertional heat illness (EHI). Two groups of runners, one consisting of athletes who had a previous history of EHI, and a control group (CON) of similar age (29.7 ± 1.2 and 29.1 ± 2 years CON vs. EHI) and fitness [maximal oxygen consumption [Formula: see text] 65.7 ± 2 and 64.5 ± 3 ml kg(-1) min(-1) CON vs. EHI] were recruited. Seven subjects in each group ran on a treadmill for 1 h at 72 % [Formula: see text] in warm conditions (30 °C, 40 % RH) reaching rectal temperatures of ~39.3 (CON) and ~39.2 °C (EHI). Blood was collected every 10 min during exercise and plasma was analysed for extracellular Hsp72. Intracellular Hsp72 levels were measured in both monocytes and lymphocytes before and immediately after the 60-min run, and then after 1 h recovery at an ambient temperature of 24 °C. Plasma Hsp72 increased from 1.18 ± 0.14 and 0.86 ± 0.08 ng/ml (CON vs. EHI) at rest to 4.56 ± 0.63 and 4.04 ± 0.45 ng/ml (CON vs. EHI, respectively) at the end of exercise (p < 0.001), with no difference between groups. Lymphocyte Hsp72 was lower in the EHI group at 60 min of exercise (p < 0.05), while monocyte Hsp72 was not different between groups. The results of the present study suggest that the plasma Hsp72 response to exercise in athletes with a prior history of EHI remained similar to that of the CON group, while the lymphocyte Hsp72 response was reduced.

Correlates of real world executive dysfunction in bipolar I disorder

BackgroundBipolar disorder is characterized by impairments in cognitive functioning, both during acute mood episodes and periods of euthymia, which interfere with functioning. Cognitive functioning is typically assessed using laboratory-based tests, which may not capture how cognitive dysfunction is experienced in real-life settings. Little is known about the specific illness characteristics of bipolar disorder that contribute to cognitive dysfunction in everyday life. MethodsParticipants met DSM-IV criteria for bipolar I disorder (n = 68) in a depressed or euthymic state. Everyday executive functioning was evaluated using the Behavior Rating Inventory of Executive Functioning (BRIEF) and the Frontal Systems Behavior Rating Scale (FrSBe). Participants completed clinician rated measures of mood state (Hamilton Depression Rating Scale, Young Mania Rating Scale), prior illness course and co-morbidities (Mini International Neuropsychiatric Interview), as well as self-report measures of psychotropic medication use and medical co-morbidity. ResultsIndividuals in this study reported significant impairment in every domain of executive functioning. These deficits were associated with a multitude of illness factors, some directly impacted by mood symptoms and others shaped by illness chronicity, psychiatric comorbidity, medical co-morbidity, and medication use. DiscussionExecutive functioning problems observed in everyday functioning in bipolar disorder are not entirely mood-state dependent. Cognitive rehabilitation for executive dysfunction should be considered an important adjunctive treatment for many individuals with bipolar disorder.

Adirondack Park Incidents: A Retrospective Review of Search and Rescue Reports of 2008 and 2009

The Adirondack Park encompasses a mixture of mountains, forest, wetlands, and waterways and is the largest park in the lower 48 states of the United States. Locals and tourists use this land for hiking, camping, canoeing, hunting, fishing, trapping, snowmobiling, skiing, mountain biking, and rock climbing. Given the large number of people who use the Adirondacks for recreation, there is an equally large number of accidents, injuries, and illness that occur in areas ranging from state-operated campgrounds to remote backcountry. The purpose of this study was to gain insight into the demographics of search and rescue operations in the Adirondack Park. This study is a retrospective review of the Adirondack Park Forest Ranger search and rescue reports from January 1, 2008, through December 31, 2009. Epidemiologic data, including subject demographics, incident, reason for injury, medical care needed, preparation of subject, and prior medical conditions, was gathered from the NY State Department of Environmental Conservation for each report. Between 2008 and 2009, 239 search and rescue missions were carried out for 349 subjects. Twenty-eight percent of cases involved an injured subject and 9% involved illness. Fifty-six percent of the subjects had a known prior illness or medical condition or were medication dependent. Twenty-one percent of cases were thought to be due to subjects exceeding their abilities. Of the search missions, 54% of subjects had little experience with the activity and 9% had no experience at all. Only 43% of subjects had any form of orientation equipment with them at the time of rescue. This study highlights the importance of continued surveillance of injury and illness in the Adirondack Park. That will aid in educating subjects on the preparation needed for wilderness activities as well as tailoring search and rescue resources to the demographics of injury and illness within the park.

Discriminating Risk and Resilience Endophenotypes From Lifetime Illness Effects in Familial Major Depressive Disorder

The neural systems that confer risk or vulnerability for developing familial depression, and those that protect against or confer resilience to becoming ill, can be disentangled from the effects of prior illness by comparing brain imaging measures in previously ill and never ill persons who have either a high or low familial risk for depression. To distinguish risk and resilience endophenotypes for major depression from the effects of prior lifetime illness. We used functional magnetic resonance imaging to measure and compare brain function during performance of an attentional, self-regulatory task across a large sample of multigenerational families ascertained specifically to be at either high or low risk for developing major depression. Study procedures were performed in a university setting. A total of 143 community participants were followed up prospectively for more than 20 years in a university setting. The sample was enriched with persons who were at higher or lower familial risk for developing depression based on being biological offspring of either a clinical sample of persons with major depression or a community control sample of persons with no discernible lifetime illness. Task-related change in blood oxygen level-dependent functional magnetic resonance imaging signal. A risk endophenotype included greater activation of cortical attention circuits. A resilience endophenotype included greater activation of the dorsal anterior cingulate cortex. The effects of prior lifetime illness were common to both risk groups and included greater deactivation of default-mode circuits. These findings identify neural systems that increase risk for depression, those that protect from illness, and those that endure following illness onset, and they suggest circuits to target for developing novel preventive and therapeutic interventions.

Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups.

Antibiotics are of limited overall clinical benefit for uncomplicated lower respiratory tract infection (LRTI) but there is uncertainty about their effectiveness for patients with features associated with higher levels of antibiotic prescribing. To estimate the benefits and harms of antibiotics for acute LRTI among those producing coloured sputum, smokers, those with fever or prior comorbidities, and longer duration of prior illness. Secondary analysis of a randomised controlled trial of antibiotic placebo for acute LRTI in primary care. Two thousand and sixty-one adults with acute LRTI, where pneumonia was not suspected clinically, were given amoxicillin or matching placebo. The duration of symptoms, rated moderately bad or worse (primary outcome), symptom severity on days 2-4 (0-6 scale), and the development of new or worsening symptoms were analysed in pre-specified subgroups of interest. Evidence of differential treatment effectiveness was assessed in prespecified subgroups by interaction terms. No subgroups were identified that were significantly more likely to benefit from antibiotics in terms of symptom duration or the development of new or worsening symptoms. Those with a history of significant comorbidities experienced a significantly greater reduction in symptom severity between days 2 and 4 (interaction term -0.28, P = 0.003; estimated effect of antibiotics among those with a past history -0.28 [95% confidence interval = -0.44 to -0.11], P = 0.001), equivalent to three people in 10 rating symptoms as a slight rather than a moderately bad problem. For subgroups not specified in advance antibiotics provided a modest reduction in symptom severity for non-smokers and for those with short prior illness duration (<7 days), and a modest reduction in symptom duration for those with short prior illness duration. There is no clear evidence of clinically meaningful benefit from antibiotics in the studied high-risk groups of patients presenting in general practice with uncomplicated LRTIs where prescribing is highest. Any possible benefit must be balanced against the side-effects and longer-term effects on antibiotic resistance.

A Rare Presentation of Carcinosarcoma in a Long Standing Parotid Mass

A Rare Presentation of Carcinosarcoma in a Long Standing Parotid Mass Introduction: Parotid tumours represent one of common tumours seen in the field of Otorrhinolaryngology. Common benign tumours include pleomorphic adenoma and warthins tumour while most common malignant parotid gland tumour is mucoepidermoid carcinoma. This case, however, highlights a rare parotid tumour in a long standing parotid mass. Objective: To present a rare case of parotid carcinosarcoma ex pleomorphic adenoma. Clinical Report: A 35 year old Malay gentleman with no prior medical illness first presented on 22nd October 2013 with history of left parotid swelling for more than 10 years in which he had not seeked treatment before. He was compelled to seek treatment after a drastic increase in size within 2 weeks prior to swelling. Patient has been an active smoker past 20 years. Examination revealed a large, lobulated left parotid mass measuring 10 cm x 9 cm x 8 cm which was hard, not tender and fixed to overlying skin. There were no palpable neck nodes and facial nerve was intact. Fine needle aspiration cytology revealed mucoepidermoid carcinoma ex pleomorphic adenoma. He underwent tracheostomy, left extended total parotidectomy, left supraomohyoid neck dissection with soft tissue reconstruction with free fasciocutaneous anterolateral thigh (ALT) flap on 11th March 2014. Histopathological examination of the parotid mass revealed carcinosarcoma ex pleomorphic adenoma. Conclusion: This case report highlights a rare malignant transformation of a long standing parotid mass to form carcinosarcoma of the parotid gland.

Incidence of psychoses among drug dependent patients in primary care with no psychiatric history: a retrospective observational matched-cohort study

Background and Objectives: While several studies have indicated a link between illicit drug use and the development of psychosis, the confounding role of pre-existing psychiatric illness is unclear. This study controls for this factor to a greater extent than has hitherto been possible, using a retrospective observational matched-cohort design controlling for age, gender, socioeconomic status and prior psychiatric illness. Methods: 592 cases (diagnosed with drug misuse/dependence) and 592 controls (no recorded history of drug misuse/dependence) were drawn from all patients aged 16-44 in 183 practices within the General Practice Research Database (UK). On study entry, cases and controls had never had a psychiatric diagnosis since registering with their practice. The average look-back period was 17.7 years. The main outcome measure was diagnosis of psychosis (including schizophrenia) from study entry onwards. Results: Patients with a drug misuse/dependence diagnosis are significantly more likely to be diagnosed with psychosis than those with no drug misuse/dependence history (RR = 2.10, 95% C.I. = 1.23-3.59) with the relative risk increasing as the definition of psychosis gets narrower. Conclusions: This study has established that, when the confounding presence of previous psychiatric illness is removed, the onset of problematic substance misuse severe enough to warrant primary care consultation is a risk factor for future onset of first-ever psychotic illness. Thus, there is a distinct sub-group of psychotic patients among whom drug misuse/dependence, with no prior psychiatric illness, is a risk factor for the development of psychoses.

Prevalence and clinical profile of diabetes mellitus in productive aged urban Indonesians.

To estimate the prevalence and clinical profile of diabetes mellitus in productive aged urban Indonesians based on the National Basic Health Research 2007. The statistical analyses of a cross-sectional survey included the data of 15,332 adults, aged 18-55years, living in an urban area. Blood glucose was measured by an automatic clinical chemistry analyzer by 2-h, 75-g post glucose load after an overnight fast. Weight, height, waist circumference and blood pressure data were measured and recorded, whereas the sociodemographic and prior illness data were collected by interviewing the participants. The prevalence of diabetes mellitus in productive age urban Indonesians was 4.6%, consisting of 1.1% previously diagnosed diabetes mellitus and 3.5% undiagnosed diabetes mellitus. Diabetes mellitus affected more women than men, which increased with age, was higher among the high socioeconomic group and increased with increasing body mass index. The prevalence of diabetes mellitus was higher in centrally obese people. Hypertension was highly related with diabetes mellitus occurrence. The prevalence of previously diagnosed diabetes mellitus with overweight or obese was 68.4%, with central obesity 41.7%, with hypertension 41.4% and with dyslipidemia more than 50%. The prevalence of undiagnosed diabetes respondents with overweight or obese was 68,7%, with central obesity 43.8%, with hypertension 49.4% and with dyslipidemia more than 50%. These results show that comprehensive strategies for the prevention and control of the problem of diabetes are urgently required.

Beyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment

Neonates have a higher perioperative mortality risk largely due to the degree of prior illness of the infants, the complexity of their surgeries, and infant physiology. It is important to consider contributing anesthetic factors during the perioperative period that may affect cerebral perfusion and neurocognitive outcome, such as alterations in hemodynamics and ventilation. Limitations of blood pressure as a marker for cerebral perfusion are discussed, as well as the effect of hypocapnia on the brain.

Donor-Derived Anti-CD19 Chimeric-Antigen-Receptor-Expressing T Cells Cause Regression Of Malignancy Persisting After Allogeneic Hematopoietic Stem Cell Transplantation

▪Progressive malignancy is a leading cause of death in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT). To improve treatment of B-cell malignancies that persist despite alloHSCT, we conducted a clinical trial of allogeneic T cells genetically modified to express a chimeric antigen receptor (CAR) targeting the B-cell antigen CD19. Ten patients were treated on this trial. Four patients were recipients of human-leukocyte-antigen (HLA)-matched unrelated donor (URD) transplants and 6 patients were recipients of HLA-matched sibling transplants. T cells for genetic modification were obtained from each patient's healthy alloHSCT donor. Patients received a single infusion of anti-CD19-CAR T cells. Cell doses ranged from 1x106 to 10x106 T cells/kg. A mean of 58% of the infused cells expressed the CAR. Patients did not receive chemotherapy or other anti-malignancy therapy with the CAR-T-cell infusions, so the responses observed in these patients are not confounded by the effects of chemotherapy. In contrast to other reports of successful treatment of B-cell malignancies with anti-CD19-CAR T cells, the patients on this study were not lymphocyte-depleted at the time of the CAR-T-cell infusions.Two patients with chronic lymphocytic leukemia (CLL) refractory to standard unmanipulated allogeneic donor lymphocyte infusions (DLIs) had regressions of large malignant lymph node masses after infusion of allogeneic anti-CD19-CAR T cells. One of these CLL patients obtained a complete remission that is ongoing 9 months after treatment with allogeneic anti-CD19-CAR T cells. This patient also had complete eradication of blood B cells within 9 days after her CAR-T-cell infusion. Another patient had tumor lysis syndrome requiring rasburicase treatment as his CLL dramatically regressed in lymph nodes, bone marrow, and blood within 2 weeks of his anti-CD19-CAR-T-cell infusion. A patient with mantle cell lymphoma obtained a partial remission that is ongoing 3 months after infusion of anti-CD19-CAR T cells. A fourth patient with diffuse large B-cell lymphoma has ongoing stable disease 11 months after infusion of anti-CD19-CAR T cells. The other 6 treated patients all had short periods of stable malignancy or progressive disease after their CAR-T-cell infusions. Specific eradication of blood B cells occurred after infusion of CAR T cells in 3 of 4 patients with measurable blood B cells pretreatment. None of the patients treated on this study developed GVHD after their anti-CD19-CAR-T-cell infusions, despite the fact that 6 of 10 treated patients had experienced GVHD at earlier time-points after their most recent alloHSCT. One patient, who had a history of cardiac dysfunction with prior acute illnesses, had temporary cardiac dysfunction after infusion of anti-CD19-CAR T cells. The most prominent toxicities experienced by patients were fever and hypotension; these peaked 5 to 12 days after CAR-T-cell infusions and resolved within 14 days after the T-cell infusions. Two patients had Grade 3 fever, and 2 patients had Grade 3 hypotension. No patients experienced Grade 4 toxicities that were attributable to the CAR-T-cell infusions. Elevated levels of serum interferon gamma were detected in 3 patients at the time that they were experiencing toxicities.We detected cells containing the anti-CD19-CAR gene in the blood of 8 of 10 patients. The peak blood levels of CAR T cells varied from undetec to 2.8% of peripheral blood mononuclear cells. The persistence of the CAR T cells in the blood of patients was limited to one month or less. When we assessed T cells from the blood of patients ex vivo, we found elevated levels of the T-cell inhibitory molecule programmed cell death protein-1 (PD-1) on CAR+ T cells compared to CAR-negative T cells. These results show for the first time that small numbers of donor-derived allogeneic anti-CD19-CAR T cells can cause regression of highly treatment-resistant B-cell malignancies after alloHSCT without causing GVHD. Malignancies that were resistant to standard DLIs regressed after anti-CD19-CAR-T-cell infusions. Future goals for improving this approach include enhancing the persistence of anti-CD19-CAR T cells and reducing toxicities. Infusion of allogeneic T cells genetically modified to recognize malignancy-associated antigens is a promising approach for treating residual malignancy after alloHSCT. Disclosures:No relevant conflicts of interest to declare.

Unmasking Lymphoma Immune Reconstitution Inflammatory Syndrome Among HIV-Infected Individuals In The Center For AIDS Research Network Of Integrated Clinical Systems

IntroductionCohort studies have demonstrated increased incidence of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) among HIV-infected individuals during the first 6 months after antiretroviral therapy (ART) initiation, perhaps due to unmasking immune reconstitution inflammatory syndrome (IRIS). Unmasking IRIS is characterized by the diagnosis of a new HIV-associated condition soon after ART that was not apparent prior to ART, coupled with evidence of ART effectiveness. It has been well described for opportunistic infections and Kaposi sarcoma. However, clinical characteristics and survival for unmasking lymphoma IRIS have not been described. MethodsWe studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) from 1996 until 2011. Unmasking lymphoma IRIS was defined as HL or NHL occurring within 6 months after ART initiation accompanied by a ≥0.5 log10copies/mL reduction in HIV RNA between values taken prior to ART and at lymphoma diagnosis. Differences in presentation and survival were examined between lymphoma IRIS and non-IRIS cases. ResultsOf 482 lymphoma patients, 48 (10%) met criteria for unmasking lymphoma IRIS. Of these, 10 (21%) had HL, 19 (40%) diffuse large B-cell lymphoma (DLBCL), 4 (8%) Burkitt lymphoma (BL), 9 (19%) primary central nervous system lymphoma (PCNSL), and 6 (12%) other NHL (Table). Median CD4 cell count at lymphoma diagnosis among IRIS cases was 163 cells/mL (interquartile range 67-302), and 54% had suppressed HIV RNA (< 400 copies/ml). No significant differences were identified between lymphoma IRIS and non-IRIS cases, with the exception of possible earlier stage (47% stage I/II versus 24%, p=0.03), more frequent hepatitis B/C co-infection (31% versus 19%, p=0.05), and more frequent prior AIDS illness (92% versus 79%, p=0.05), as well as expected lower HIV RNA at lymphoma diagnosis likely resulting from the IRIS case definition. Additionally, no differences in cumulative mortality 5 years after lymphoma diagnosis were identified between IRIS and non-IRIS cases, although there was a suggestion of increased early mortality among IRIS cases (Figure). [Display omitted] ConclusionsIn a large HIV-associated lymphoma cohort in the United States, 10% of patients met a standardized unmasking lymphoma IRIS case definition. No major differences between lymphoma IRIS and non-IRIS cases were identified. Possible effects of subclinical lymphoma leading to care seeking behavior and subsequent ART initiation prior to lymphoma diagnosis could not be excluded. Disclosures:No relevant conflicts of interest to declare.

Effect of zinc supplementation on duration of hospitalization in Tanzanian children presenting with acute pneumonia.

Zinc supplementation prevents incident pneumonia in children; however, the effect for pneumonia treatment remains unclear. A randomized, double-blind, placebo-controlled trial of zinc supplements (daily 25 mg) adjunct to antibiotic treatment of radiology-confirmed acute pneumonia was conducted among hospitalized children (6-36 months) in Dar es Salaam, Tanzania. The trial was stopped early due to low enrollment, primarily owing to exclusion of children outside the age range and >3 days of prior illness. Among children enrolled (n = 94), zinc supplementation indicated no beneficial effect on the duration of hospitalization (IRR: 0.69; 95% CI 0.45-1.06; p = 0.09) or the proportion of children who were hospitalized for <3 days (RR: 0.85; 95% CI: 0.57-1.25; p = 0.40) or <5 days (RR: 1.01; 95% CI: 0.83-1.23; p = 0.92) (IRRs and RRs >1.0 favor zinc). Although underpowered, this randomized trial provided no evidence for a beneficial effect of zinc supplementation adjunct to antibiotics for hospitalized children.

Pesticide exposure and suicidal ideation in rural communities of Wardha district of Central India.

1. Background In India, 70% of population lives in villages. Approximately 58% of total workers is still dependent on agriculture either as cultivators or agricultural labourers. Most common methods of suicide are by consumption of pesticides. Majority of villagers are farmers few works in industries and other places. Most common pesticide used in India is Organophosphate. Endosulfanis still used in India but have been banned in manyWestern nations. In view of this factor the study was conducted Aims To find out association of suicidal ideation and pesticide exposure as compared to villagers who are not exposed to it. 2. Methods Study Design: It is a cross sectional comparative study. Study setting: Study was conducted in rural community of Wardha district in Central India. Sample size: 78 farmers were included in the study who were exposed to pesticides. Age, sex matched 78 controls who were not exposed to pesticides. Sampling procedure: samples were randomly selected. Tools used: Indian Version of Self Reporting Questionnaire (SRQ) Including criteria: Farmers were included for the study group who are exposed to pesticides.Control group were villagers belonging to other professions included who are not exposed to pesticides . Excluding criteria: Farmers having prior psychiatric illness and suicide in family. 3. Results: It was found in the study that 30% of the study sample (i.e. farmers included in the study exposed to pesticide) was having suicidal ideation as compared to control group 8% of the sample had suicidal ideation. It is also noticed that those who got suicidal ideation were having depressive symptoms as well on SRQ as compared to controls. 4. Conclusion: Is it depressive symptoms which cause suicidal ideation or both are independent as compared to those who are not exposed to insecticides. It is likely that pesticide exposure may be associated with suicidal ideation. Organic farming is the demand of the future.

Pertussis Vaccination of Health Care Workers

Pertussis Vaccination of Health Care Workers

Family Environment as a Predictor of Psychological Hardiness among Adolescents

Family environment is considered as a system where the behaviour and relationship among all family members is interdependent. A stimulating physical environment, encouragement of achievement and affection and repeatedly linked to better performance of children. Every individual bears an impact of the environment in which is brought up. Family is almost the exclusive environmental factor, which influences the first few primitive years of life. The family environment maintains its importance for the psychological development of the child. Research shows that those adolescents shows more success in Ufe who belong to households in which parents are both supportive and are accepting of the childs needs for more psychological independence (Olsson et al., 1999; Madhu & Matla, 2004; Powell, 2006; Lee et al., 2006; Deepshikha & Bhanot, 2011)..Over the past 20 years, the psychological hardiness construct has emerged as a buffer in the relationship between stressors and illness and has been shown to enhance performance, conduct, and morale (Maddi, 1999). As part of a 12 year research program at Illinois Bell Telehone, the initial study of hardiness (Kobasa, 1979) found high-stressed, hardy individuals reported lower in cadences of illness than high stressed, no hardy persons. While her first study could not identify causality, subsequent research by Kobasa and colleagues (Kobasa et al., 1981; Kobasa et al., 1982) employed longitudinal data to test the relationship of hardiness to stressful life events. Consistent with the earlier findings, Kobasa et al. ( 1982) results from a 31 /2 year longitudinal study provided evidence suggesting that when individuals are experiencing stressful life events, hardiness decreases the like hood of detrimental effects associated with that stress. In the same study, the researchers also reported hardiness predicted both current and future well-being even after controlling for prior illness. In a similar study, Wiebe and McCallum (1986) found individuals' hardiness scores were associated with later well-being.Thus, hardiness is a personality construct formed of three interrelated beliefs about oneself in interaction with the world, namely, commitment, control, and challenge. The commitment belief leads one to try to find, in whatever is being experienced, that which seems interesting and important, rather than lapsing to feelings of alienation. The control belief leads one to try to influence the directions and outcomes of whatever is going on, rather than lapsing into passivity and powerlessness and the challenge belief leads one to seek growth and wisdom through experience, whether positive or negative, rather than to feel entitled to easy comfort and security in a predictable world. It is a personality style that encourages human survival and the enrichment of Ufe though development (Lambert & Lambert, 2003) and is a pervasive aspect of personality reflecting a general tendency towards psychological (the opposite of neuroticism), extroversion, openness, and to a lesser extent agreeableness and conscientiousness. People who have courage (hardiness) to simultaneously favour involvement with others and events (commitment), keep trying to influence the outcomes going on around them learning from their influence the outcomes going on around them learning from their experiences, whether positive or negative (challenge), have more fulfilling, satisfying, resilient, and remarkable Uves (Maddi et al., 2002). Hardiness has been conceptualized as an indicator of vigorous mental health (Maddi & Khoshaba, 1994; Florian et al., 1995 and Maddi et al., 2002) and has been found to promote well-being (Carson & Green, 1922; Stokes-Crowe, 1998; Sims, 2000; Pollachek, 2001; Smith et al., 2004). Psychological hardiness have been found to be associated with mental as well as physical (Maddi et al., 2002; Beasley et al., 2003; Darej et al., 2003; Maddi, 2006 and Ramzi and Beharat, 2010). …

Peripartum Cardiomyopathy

Peripartum Cardiomyopathy