Subsequent Manifestations Research Articles

Schizotypal cognitions as a predictor of psychopathology in adolescents with mild intellectual impairment

There is evidence to suggest that among young people with mild intellectual disability there are those whose cognitive difficulties may predict the subsequent manifestation of a schizophrenic phenotype. It is suggested that they may be detectable by simple means. To gain adequate cooperation from educational services, parents and students so as to recruit a sufficiently large sample to test the above hypothesis, and to examine the hypothesis in the light of the findings. The sample was screened with appropriate instruments, and groups hypothesised as being likely or not likely to have the phenotype were compared in terms of psychopathology and neuropsychology. Simple screening methods detect a sample whose psychopathological and neuropsychological profile is consistent with an extended phenotype of schizophrenia. Difficulties experienced by some young people with mild and borderline intellectual disability are associated with enhanced liability to schizophrenia. Clinical methods can both identify those with this extended phenotype and predict those in whom psychosis will occur.

Serum cholesterol level in infancy is inversely associated with subsequent allergy in children and adolescents. A 20‐year follow‐up study

Previous studies suggest an association between an altered lipoprotein profile and atopy. The association has been hypothesized to be due to alterations in the dietary fat intake, a factor possibly contributing to the increase of allergic diseases in industrialized countries. We aimed at assessing whether there is an association between the serum lipid levels in infancy and subsequent development of allergic symptoms in childhood and adolescence. A cohort of 200 unselected newborns was prospectively followed up from birth to age 20 years (from 1981 to 2002) with repeated measurements of total cholesterol from birth and throughout the first year of life. The subjects were re-examined at the ages of 5, 11 and 20 years, with assessment of the occurrence of allergic symptoms, skin prick testing (SPT) and measurement of total IgE and of the total, high- and low-density lipoprotein cholesterol. Children and adolescents with allergic symptoms, SPT positivity and an elevated IgE had lower total cholesterol levels in infancy and childhood than the non-atopic subjects. The difference was not detectable in cord blood, but became significant from age 2 months onward. The inverse association between the cholesterol level in infancy and subsequent manifestations of atopy seems not to be due to atopy-related dietary alterations, because it was already present in early infancy, when virtually all the infants were on a similar diet, i.e. on exclusive breastfeeding.

Plastics, Pesticides and PBDEs: Endocrine Disruption and Developmental Disabilities

Many chemicals to which humans are regularly exposed interfere with normal endocrine (hormonal) function, including critical mechanisms underlying brain development. While it is methodologically difficult to directly associate chemical exposures with subsequent manifestations of developmental disabilities, ample evidence exists to justify concern and precautionary action to reduce or eliminate exposures. In this article, we review the literature concerning the endocrine disruptive properties of three commonly encountered classes of substances, plastics, pesticides, and flame retardants (PBDEs), and the mechanisms by which they may be contributing to the apparent increase in prevalence of developmental disabilities. We urge professionals working in disabilities fields to advocate for stronger regulation and public education regarding the toxic properties of such materials.

Performances and the String Quartet n. 2 – Intimate Letters

Speculatively probing the twilight of Czech composer Leos Janacek’s (1854-1928) life and career, an enthusiastic PhD student, Anezka Ungrova, crossexamines the dead Janacek – the subject of her thesis. The setting for the play is the present day when Ungrova is interviewing the deceased Janacek for her doctoral dissertation. She is intrigued by the passions of word and music embodied in this story. Of particular interest to Ungrova are the 700 passionate love letters the composer wrote to Kamila Stosslova over the last 11 years of his life and to what extent this relationship influenced and inspired his later quartets, mainly Quartet No. 2 which the composer called Intimate Letters. Janacek wrote his String Quartet No. 2 over a period of three weeks in January-February 1928. He was then in his 74th year. He died the following August. While he was composing Intimate Letters, every day he wrote extravagant, passionate, at times barely coherent love-letters to Kamila Stosslova, a married woman 37 years his junior. Performances, Friel’s latest play, looks at Janacek’s frantic life during those intoxicated weeks, and specifically at his obsession with Kamila and the manifestation of that passion in the themes of the Quartet. Punctuated only by the intrusion by a string quartet, Ungrova’s relentless questioning of Janacek gradually assumes a shrink/patient relationship and is elevated above the tedium of mere biographical inquiry. This device allows Friel to expertly portray the broader themes of human longing and love, and their subsequent manifestations in art and music. Friel also explores the issue about the way that we tend to prefer the artist to his art and look to the life rather than the work. Musical constructions abound in the work of Friel and it is not unusual to find him structuring sections of his drama after musical forms. This paper sustains that unlike other plays by Friel such as Translations and Philadelphia Here I Come! which can be considered strong political plays, Performances can be remembered as an impulse to combine theatre and music. However, according to critics, Friel “has written this piece with a carefree, almost reckless and disdainful attitude towards popular acclaim” which may disappoint theatregoers who attend on the strength of his previous hit outings, such as Dancing at Lughnasa, Living Quarters or Philadelphia, Here I Come.

Fluid mechanical and physicochemical modeling interprets hypertension to be capable of inducing secondary complications

The relationship of hypertensives and many pathological syndromes still remains unclear. A mathematical model in terms of the fluid mechanics and physicochemical analyses is established to correlate the plasma viscosity, the shear stress and the rate of shear in blood stream with the ligand-receptor dissociation constant. This model has arrived at the conclusive results that high viscosity, high rate of shear created in the blood streams, and the peripheral resistance may act as important preceding factors to induce a serial subsequent pathological clinical manifestations. High viscosity may interfere with the ligand-receptor combination, in contrast, high rate of shear may knock the ligand (s) off the existing ligand-receptor complex, while elevation of peripheral resistance may slow down the blood flow rate, resulting in a diminished dissociation of ligand-receptor complex. This model has successfully interpreted the possible cause of some post-hypertensive abnormal outcome manifestations involving obstructive and degenerative stenosis (such as renal artery stenosis), growth retardation, blood vessel detriment, coarctation of aorta, coronary thrombotics, atherosclerosis, hyperinsulinemia, diabetes, obesity, hypothyroidism, infertility, and at the worst, carcinoma, etc.

Elevated Soluble Thrombomodulin in the Febrile Stage Related to Patients at Risk for Dengue Shock Syndrome

Children with dengue hemorrhagic fever (DHF) are at risk to develop dengue shock syndrome (DSS) for which neither marker has been demonstrated. The study was designed to investigate the markers of vascular endothelial cell injuries and dysfunction that might be used as early predictors of the subsequent manifestation of DSS. The blood samples from 111 patients with dengue fever, DHF and other febrile illness (OFI) were collected daily from the day of admission until discharge and at convalescent stage. The sample from the day of defervescence was defined as day 0, 1 day before defervescence was defined as day -1 and so on. Also, 1 day after defervescence was defined as day +1 and so on. Increased soluble thrombomodulin (sTM) was demonstrated in dengue-infected patients via an enzyme-linked immunosorbent assay. Patients with DSS (DHF grades III and IV) had higher concentrations of sTM than those with dengue fever, DHF grade I, II and OFIs from day -3 until day +2. Increased circulating endothelial cells were detected from day 0 until day +2 in DSS patients as compared with other groups. In addition, increased soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1 and soluble E-selectin were also found in dengue virus-infected patients as compared with OFIs. Blood sTM may be useful as an early predictor of DSS in dengue infected patients in the febrile stage. However, a further evaluation in a large prospective series is needed.

Sister Mary Joseph's nodule as a metastasis of gallbladder carcinoma

Umbilical metastasis, alias Sister Mary Joseph's nodule, is a rare clinical phenomenon. It indicates neoplasm of inner organs mostly located in the gastrointestinum or the pelvis. However, in approximately 15-30% the primary tumor remains occult. In most cases Sister Joseph's nodule appears as an early and sometimes the only symptom of the malignoma. Here we report on an umbilical metastasis of a gallbladder carcinoma with subsequent manifestation of other tumor complications such as extensive thrombosis of arm veins.

Premature arthritis in an elderly woman

We, in this study, report a 72-year-old woman presenting with premature osteoarthritis of the spine, the hips, the knees and the shoulders symptomatic since the age of 50 years. The initial presentation of backache led to a mistaken diagnosis of ankylosing spondylitis. Subsequent manifestation of characteristic discoloration of her sclera and overnight dark urine led to the correct diagnosis of ochronosis.

Macrophages induce an allergen-specific and long-term suppression in a mouse asthma model

Increasing evidence suggests that macrophages (Mphi) play a crucial downregulatory role in the initiation and progression of allergic asthma. Recently, the current authors demonstrated that ovalbumin (OVA)-loaded Mphi (OVA-Mphi) suppress subsequent OVA-induced airway manifestations of asthma and that this effect could be potentiated upon selective activation. In the present study, the authors further delineated the underlying pathway by which Mphi exert this immunosuppressive effect. To examine the migration of OVA-Mphi, cells were labelled with 5'chloromethylfluorescein diacetate (CMFDA) and were administered (i.v.) into OVA-sensitised BALB/c mice. After 20 h, the relevant organs were dissected and analysed using fluorescent microscopy. Allergen-specificity was investigated by treating OVA-sensitised mice with keyhole limpet haemocyanin (KLH)-Mphi activated with immunostimulatory sequence oligodeoxynucleotide (ISS-ODN). By lengthening the period between treatment and challenge to 4 weeks it was examined whether OVA-Mphi exerted an immunosuppressive memory response. Strikingly, CMFDA-labelled Mphi were not trapped in the lungs, but migrated to the spleen. ISS-ODN-stimulated KLH-Mphi failed to suppress OVA-induced airway manifestations of asthma. Moreover, treatment with ISS-ODN-stimulated OVA-Mphi was still effective after lengthening the period between treatment and challenge. These data demonstrate that allergen-loaded macrophages can induce an indirect immunosuppressive response that is allergen-specific and long lasting, which are both hallmarks of a memory lymphocyte response.

Management of paraproteinemic renal disease

PURPOSE OF REVIEW Paraproteinemic renal diseases comprise a group of renal disorders that are difficult to manage, in part because of subtleties in the clinical presentation and confusion regarding diagnosis and appropriate therapy. Often, nephrologists make the diagnosis of the underlying plasma cell dyscrasia following renal biopsy. This review seeks to provide a greater understanding of the mechanism of disease and recent approaches to the management of patients who have AL-amyloidosis, monoclonal light-chain and light and heavy-chain deposition disease [termed ML(H)CDD], and cast nephropathy. All three renal lesions are caused by deposition of immunoglobulin light chains. This review seeks to provide a greater understanding of the mechanism of disease and recent approaches to the management of these patients. RECENT FINDINGS The immunoglobulin light chain takes the center stage in the pathogenesis of AL-amyloidosis, ML(H)CDD and cast nephropathy. Modifications in the variable domain are responsible for the affinity of the light chain for a given segment of the nephron and the subsequent toxic manifestations. Therapy aimed at eradicating the offending clone of plasma cells that secrete the monoclonal light chain should be beneficial, but this hypothesis lacks confirmation. Four nonrandomized studies have now demonstrated clinical benefit, including return of renal function, of high-dose chemotherapy with autologous stem cell transplantation (HDT/SCT) in the treatment of patients who have AL-amyloidosis or ML(H)CDD. SUMMARY While randomized trials are lacking, the data support the clinical efficacy of more aggressive treatments designed to reduce the plasma cell clone responsible for these renal disorders.

Conforming Disconformity: "Mestizaje," Hybridity, and the Aesthetics of Mexican Nationalism

This article sets up a dialogue between postcolonal theory and Latin American studies. Although some forms of intentional hybridization are contestatory, others, such as the aesthetic statism that developed in postrevolutionary Mexico after the 1920s, are authoritative. Moving from the works of foundational thinkers such as Jose Vasconcelos and Manuel Gamio, to the centrality of art in the policies they engendered, and to subsequent manifestations of aesthetic statism in the exemplary centers of urban space and in anthropology museums, the article traces some of the links in the genealogy of mestizo nationalism in postrevolutionary 20th-century Mexico.

Early presence of thought disorder as a prospective sign of mental disorder

The purpose of this study was to assess whether premorbid signs, such as thought disorder, could predict the subsequent manifestation of psychiatric disorders. A group of 75 adoptees at high genetic risk for schizophrenia and 96 low-risk adoptees without any psychiatric disorder at the initial assessment were assessed blindly with the Thought Disorder Index (TDI). Their psychiatric status was re-assessed according to DSM-III-R criteria in a re-interview 11 years later and based on available registers 16 years later. High scores on several TDI variables at the initial assessment predicted a psychiatric disorder of all adoptees at follow-up. Prediction was statistically unsuccessful among the high-risk adoptees because of the small number of cases, but high scores at the 0.50 severity level did predict mental disorders among the low-risk adoptees.

Premorbid functioning in schizophrenia: relation to baseline symptoms, treatment response, and medication side effects.

Impaired premorbid functioning prior to the onset of acute psychosis has frequently been noted in schizophrenia. This study examined retrospectively the premorbid status of patients in their first episode of psychosis in order to determine relationships with baseline symptoms, treatment response, and medication side effects. One hundred eleven schizophrenic and schizoaffective patients participating in a large prospective study of first episode schizophrenia were evaluated with the Premorbid Adjustment Scale (PAS). Premorbid functioning in males became progressively worse over time. Deficit state patients exhibited worse premorbid functioning. A third of patients exhibited sustained poor premorbid functioning. At various developmental stages, lower "sociability and withdrawal" scores correlated with increased time to treatment response, more severe negative symptoms, increased drug-induced parkinsonism, and deterioration of premorbid functioning. Various mean PAS scores predicted susceptibility to tardive dyskinesia. Our findings suggest that prior to acute psychosis onset there are certain behavioral precursors reflected in premorbid functioning that may predict subsequent illness manifestations. Measures of premorbid functioning indicate that disease pathogenesis is manifest, albeit more subtly, prior to presentation of first psychotic symptoms.

Early onset of alcohol use and health problems: spurious associations and prevention

The association between age at onset of drinking and subsequent alcohol-related consequences, including alcohol dependence, is well established in the literature. Although the vast majority of these studies are based on cross-sectional analyses, the association finds support in longitudinal studies (Andersen et al. 2003). The follow-up periods in longitudinal studies, however, tend to be of short duration, limited in number and include large proportions of respondents who have not passed through the risk period for developing alcohol use disorders. Alcohol use tends to increase during the adolescent years until about 21–23 years of age before leveling off and, for the majority, decreasing thereafter. The normative decline in heavy drinking with increasing age has been associated with the assumption of adult behaviors (e.g. employment, marriage, parenting, etc.). Comparable age trajectories of alcohol-related consequences and other problem behaviors suggest a categorization of substance abuse as ‘adolescent-limited’ and ‘life-course persistent’ (Moffitt 1993). Irrespective of these categorizations, early onset of drinking provides a powerful behavioral context in risk exposure among adolescents and young adults, prompting many in the health field to suggest that delaying the onset of alcohol and other drug use is a critical component in the development of preventive and educational efforts. While early users have greater potential for problems, Robins (1984) cautions that early onset may be an indicator of other psychiatric disorders and is not a direct factor in subsequent problem manifestation. Other studies indicate that the question is indeed much more complicated. Aside from psychiatric disorders, precursors of early onset have been related to personality (i.e. impulsivity), social class (i.e. early detachment from educational pursuits), differential association (i.e. street subculture) and social structure (alcohol availability). Donovan & Jessor (1985) proposed that the associations between problem drinking with other problem behaviors such as poor school performance, precocious sexual behavior, illicit drug use, etc. comprise a single behavioral syndrome which has ties to the broader social environment. Elucidation of the role of precursors in problem behavior must also address the nature of the mediation between precursors and behavioral outcomes. For example, Bates & Labouvie (1997) demonstrate that early risk behaviors have indirect effects on later alcohol-related problem consequences (i.e. the association between early risk factors and subsequent consequences are mediated by the intensity of current use). The paper from Andersen et al. (2003) reveals that intensity of alcohol use at age 15 predicts excessive consumption at age 19 and directs attention to identifying factors which sustain the increase in drinking behavior. Prescott & Kendler (1999) offer evidence which suggests that early onset and alcohol dependence are both manifestations of a general vulnerability to problem behavior and argue that attempts to prevent the development of alcohol dependence by delaying drinking onset are unlikely to be successful. Because much of the literature on earlier onset is based on secondary analyses in which many critical variables are absent, the complete picture awaits further study. This by no means implies that preventive and educational efforts related to early onset of drinking must remain on hold. While educational efforts appear to have limited impact, social control policies which curb alcohol availability have been shown to be effective interventions. Of course, it remains to be seen whether fuller understanding of the aforementioned associations will lead to more effective prevention.

Ophthalmological evaluation in thyroid-associated ophthalmopathy.

Thyroid-associated ophthalmopathy (TAO) is an autoimmune disorder associated with Graves' disease and can seriously decrease quality of life. Current therapeutic regimens have considerable side-effects and are not always able to restore normal function and appearance. Timing and a proper choice of therapy are critical but require careful patient evaluation. The present paper aims to describe clinical symptoms and signs of TAO and their relevance for management. Thyroid-associated ophthalmopathy has an initial active inflammatory phase which usually lasts for 6-24 months but which may not infrequently continue for several years. The severity of the subsequent clinical manifestations is determined by the degree of optic nerve involvement, corneal involvement, eye muscle dysfunction and exophthalmus, and also by the degree of subjective illness and disfigurement. Disease severity is the key determinant of indication for therapy, while inflammatory activity is the key determinant of therapeutic choice. Immunosuppressive therapy may be used in the inflammatory stage, while reconstructive surgery should be postponed to the inactive phase. Emergency surgery may be needed for vision-threatening situations during the active stage.

Crush injury and crush syndrome: a review.

Crush injuries and the subsequent systemic manifestations are well described, but there is limited evidence on which to base protocols for optimal management. Given that in most environments such in-juries are relatively rare, there is, however, an undoubted need for such guidelines. This article reviews the currently available evidence and summarizes the treatment options available.

Helicobacter pylori: pathogen and symbiont

There are puzzles in defining the exact role of Helicobacter pylori infection in humans. The bacterium, which is associated with human disease of the upper gastrointestinal tract, may otherwise exist as a commensal with probable symbiotic association in some human hosts. Although virulence associated genes have been detected in some strains which explain their pathogenicity, their pathogenic effect and subsequent clinical manifestations seem to vary in different human populations or geographical locations. Some human hosts remain predominantly asymptomatic in spite of the "virulent" H. pylori strain(s) they harbour. There are probable benefits of H. pylori colonisation of the human gastric mucosa. Thus the recommendation of eradication therapy in patients with known peptic ulcer disease may be more advantageous than the "test and treat policy", which suggests treatment of uninvestigated dyspeptic patients, who may not have any lesions.

Is the spatial distribution of brain lesions associated with closed-head injury in children predictive of subsequent development of posttraumatic stress disorder?

To determine whether there is an association between the spatial distributions of lesions detected at magnetic resonance (MR) imaging of the brain in children, adolescents, and young adults after closed-head injury (CHI) and development of the reexperiencing symptoms of posttraumatic stress disorder (PTSD). Data obtained in 94 subjects without a history of PTSD as determined by parental interview were analyzed. MR images were obtained 3 months after CHI. Lesions were manually delineated and registered to the Talairach coordinate system. Mann-Whitney analysis of lesion distribution and PTSD status at 1 year (again, as determined by parental interview) was performed, consisting of an analysis of lesion distribution versus the major symptoms of PTSD: reexperiencing, hyperarousal, and avoidance. Of the 94 subjects, 41 met the PTSD reexperiencing criterion and nine met all three PTSD criteria. Subjects who met the reexperiencing criterion had fewer lesions in limbic system structures (eg, the cingulum) on the right than did subjects who did not meet this criterion (Mann-Whitney, P =.003). Lesions induced by CHI in the limbic system on the right may inhibit subsequent manifestation of PTSD reexperiencing symptoms in children, adolescents, and young adults.

Normalization of brain death-induced injury to rat renal allografts by recombinant soluble P-selectin glycoprotein ligand.

Donor brain death has been considered a significant risk factor for both early and late organ allograft dysfunction. This central injury not only evokes an upsurge of catecholamines with resultant peripheral tissue vasoconstriction and ischemia but also promotes release of hormones and inflammatory mediators that may also affect the organs directly. One of the resultant influences of these events is the rapid upregulation of the acute-phase adhesion molecules, the selectins. These initiate leukocyte adhesion to vascular endothelium and trigger subsequent cellular and molecular changes in the compromised tissues. An established F344 --> LEW rat model of chronic rejection was used to examine (1) whether the initial inflammatory events that develop within kidney allografts from brain-dead donors could be normalized using a recombinant soluble form of P-selectin glycoprotein ligand and (2) whether amelioration of these early changes would alter the inexorable progression of chronic allograft rejection. Untreated living donor controls experienced unrelenting chronic rejection over time. This complex process was accelerated in brain-dead donor kidneys. Treatment with P-selectin glycoprotein ligand prevented the early inflammatory changes in the transplanted organs and their subsequent (200 d) functional and morphologic manifestations, particularly when the soluble ligand was administered both to the donor before organ removal and to the recipient after engraftment. This strategy of using a naturally occurring selectin ligand to prevent donor-associated chronic graft dysfunction may be of special clinical interest in cadaver donor transplantation.

Long-term follow-up of patients with nonparalytic poliomyelitis

Rekand T, Karlsen B, Langeland N, Aarli JA. Long-term follow-up of patients with nonparalytic poliomyelitis. Arch Phys Med Rehabil 2002;83:533-7. Objective: To examine patients with previous nonparalytic poliomyelitis in search of muscle atrophy, weakness, and other late symptoms of poliomyelitis. Design: A mailed questionnaire followed up with neurologic and neurophysiologic examinations of respondents who reported symptoms possibly related to the late sequelae of polio. Setting: Neurology department at a university hospital. Participants: Thirty-nine of 47 patients diagnosed with nonparalytic poliomyelitis and hospitalized at a Norwegian hospital between 1950 and 1954, during the Norwegian polio epidemic. Interventions: Not applicable. Main Outcome Measures: Electromyography to determine function of the anterior tibialis, vastus lateralis, and biceps brachii muscles; nerve conduction studies of the sural, peroneal, and tibial nerves; motor and sensory nerve conduction velocity, and compound muscle and sensory nerve action potentials, and distal latencies. Results: Twenty-five of 47 patients (53.2%) reported symptoms possibly related to the late sequelae of poliomyelitis. Eight of 20 examined symptomatic patients had normal neurologic and neurophysiologic findings, whereas 9 others had other medical conditions that could explain the symptoms. Three patients (6.7%) had neurologic and neurophysiologic findings and development of symptoms consistent with motoneuron damage. Conclusion: Some nonparalytic patients may have subclinical acute motoneuron damage with subsequent development and manifestation of motor weakness and neuromuscular symptoms many years later. These symptoms should be considered a differential diagnosis in patients who have a history of nonparalytic poliomyelitis. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation