Symptoms In Others Research Articles

A threat from within: Learning to fear by observing aversive bodily symptoms in others

Although observational fear learning has been implicated in the development of phobic-related fears, studies investigating observational learning of fear of bodily symptoms remain scarce. Therefore, the aim of the present study was to investigate whether fear in response to bodily symptoms can be acquired simply by observing a fearful reaction to provocation of aversive bodily symptoms in others. Forty healthy participants underwent an observational fear conditioning paradigm consisting of two phases. In the first phase, participants observed a demonstrator reacting to an aversive bodily symptom provocation (unconditioned stimulus or US, i.e., labored breathing) paired with one conditioned stimulus (CS+) but not with the other one (CS-, both CSs were geometric symbols presented on a screen the demonstrator was watching). In the second phase, participants were directly presented with the same conditioned stimuli, but in the absence of the US. Our results revealed enhanced conditioned fear responses in the beginning of the second phase to the CS + as compared to CS-, as indexed by greater skin conductance and subjective fear responses, as well as greater potentiation of startle eyeblink responses to the CS + as compared to the ITI. Taken together, these findings implicate that fear of bodily symptoms can be learned through observation of others, that is, without first-hand experience of bodily threat.

Does noncompliance with COVID-19 regulations impact the depressive symptoms of others?

Before vaccines became commonly available, compliance with nonpharmaceutical only preventive measures offered protection against COVID-19 infection. Compliance is therefore expected to have physical health implications for the individual and others. Moreover, in the context of the highly contagious coronavirus, perceived noncompliance can increase the subjective risk assessment of contracting the virus and, as a result, increase psychological distress. However, the implications of (public) noncompliance on the psychological health of others have not been sufficiently explored in the literature. Examining this is of utmost importance in light of the pandemic's elevated prevalence of depressive symptoms across countries. Using nationally representative data from South Africa, we explore the relationship between depressive symptoms and perceived noncompliance. We examine this relationship using a double machine learning approach while controlling for observable selection. Our result shows that the perception that neighbors are noncompliant is correlated with self-reported depressive symptoms. Therefore, in the context of a highly infectious virus, noncompliance has detrimental effects on the wellbeing of others.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Population genetics of cycas necrotic stunt virus and the development of multiplex RT-PCR diagnostics

Cycas necrotic stunt virus (CNSV) has an extensive host range and is detected in an accelerated pace around the globe in several agricultural crops. One of the plant species affected is peony (Paeonia lactiflora Pall.). The virus is asymptomatic in most peony cultivars, but there have been reports of symptoms in others. It is thus important to study CNSV and its population structure to gain insights into its evolution and epidemiology. The outputs of this study, in addition to the in-depth analysis of the virus population structure, include the development of a multiplex RT-PCR detection protocol that can amplify all published CNSV isolate sequences; allowing for accurate, reliable detection of the virus and safeguarding its susceptible, clonally-propagated hosts.

Psychosocial Factors Affecting Parental Report of Symptoms in Children: A Systematic Review.

Parents make important treatment decisions for their children based on symptoms they perceive their child to be experiencing. Multiple psychological factors are associated with subjective symptom perception, but factors affecting perception of symptoms in others have been explored less. We systematically reviewed the literature to identify parent and child psychological factors associated with parental report of physical symptoms in their child. We searched Embase, Ovid, PsycINFO, and Scopus for studies that investigated associations between psychological factors and parental report of symptoms in their child. Thirty-six citations reporting on 34 studies that assessed the association between parent or child psychological factors and parental report of physical symptoms in the child were included in the review. Three main factors were identified as being associated with parental symptom report. First, there was evidence for an association between parental symptom report and affect, in particular parent and child anxiety. Second, child behavioral and conduct problems, and temperament-related challenges (problems with feeding and sleeping) were associated with parental symptom report. Third, parental expectations and beliefs that symptoms would occur were associated with parental symptom report, although few studies investigated these associations. Parent and child affect, and parental expectations and beliefs may influence parents' cognition, causing them to pay more attention to their child, interpret their child's behavior as symptomatic, and recall symptoms in the child. Given the importance of parental perception of symptoms in driving decisions around care, additional research in this field is needed.

Impact of pharmacological agents on mitochondrial function: a growing opportunity?

Present-day drug therapies provide clear beneficial effects as many diseases can be driven into remission and the symptoms of others can be efficiently managed; however, the success of many drugs is limited due to both patient non-compliance and adverse off-target or toxicity-induced effects. There is emerging evidence that many of these side effects are caused by drug-induced impairment of mitochondrial function and eventual mitochondrial dysfunction. It is imperative to understand how and why drug-induced side effects occur and how mitochondrial function is affected. In an aging population, age-associated drug toxicity is another key area of focus as the majority of patients on medication are older. Therefore, with an aging population possessing subtle or even more dramatic individual differences in mitochondrial function, there is a growing necessity to identify and understand early on potentially significant drug-associated off-target effects and toxicity issues. This will not only reduce the number of unwanted side effects linked to mitochondrial toxicity but also identify useful mitochondrial-modulating agents. Mechanistically, many successful drug classes including diabetic treatments, antibiotics, chemotherapies and antiviral agents have been linked to mitochondrial targeted effects. This is a growing area, with research to repurpose current medications affecting mitochondrial function being assessed in cancer, the immune system and neurodegenerative disorders including Parkinson's disease. Here, we review the effects that pharmacological agents have on mitochondrial function and explore the opportunities from these effects as potential disease treatments. Our focus will be on cancer treatment and immune modulation.

Intolerance of uncertainty moderates the relationship between high personal standards but not evaluative concerns perfectionism and eating disorder symptoms cross-sectionally and prospectively

Two dimensions of perfectionism related to eating disorder (ED) symptoms are evaluative concerns and high standards. Evaluative concerns are consistently linked with ED symptoms, whereas there are conflicting results regarding high standards and ED symptoms. High standards are unrelated to ED symptoms in some studies and are linked to higher ED symptoms in others. Intolerance of uncertainty (IU) may influence the relation between high standards and ED symptoms; individuals elevated in both IU and high standards may find it distressing to be uncertain about future situations for fear of not living up to high expectations and use ED behaviors to cope with such uncertainty. In the current study (N = 216), we explored whether IU moderates the relationships between high standards and evaluative concerns and ED symptoms, both cross-sectionally and prospectively across two weeks. IU significantly moderated high standards and ED symptoms both cross-sectionally and across time while accounting for baseline ED symptoms, but did not moderate the relationship between evaluative concerns and ED symptoms. Higher standards were associated with greater ED symptoms in individuals higher, but not lower in IU. These findings suggest high standards may only contribute to ED symptoms when individuals are also high in IU.

Congenital myasthenic syndromes

Congenital myasthenic syndromes (CMS) are a group of genetically heterogeneous disorders of the neuromuscular transmission, clinically characterized by muscle weakness and fatigability. Mutations in several proteins affecting structure, development and function of the neuromuscular junction result in CMS by compromising the safety margin of neuromuscular transmission through a variety of mechanisms. Defects in postsynaptic proteins are the most frequent cause of CMS, but presynaptic proteins have been increasingly recognized as causative of these disorders. In addition, it has become evident that myasthenia can be a part of a more complex phenotype featured also by central nervous system involvement. Disease-onset ranges from prenatal life to adulthood while the clinical phenotype spans from severe generalized weakness to mild predominant cranial muscle weakness. Low frequency repetitive nerve stimulation often demonstrates a decremental response. Single-fiber EMG or conditioning with exercise or high frequency nerve stimulation may be needed to unmask the neuromuscular synaptic defect in some cases. Only some presynaptic CMS show facilitation (hallmark of the autoimmune presynaptic defect of neuromuscular transmission), depending on the characteristics of the underlying quantal release defect. The molecular diagnosis and the understanding of the disease mechanism of a specific CMS are crucial to individualize patient care. Cholinergic drugs (such as pyridostigmine or 3,4-diamynopyridine) improve the myasthenic symptoms in certain CMS subtypes patients but worsen the symptoms in others, who respond positively to beta-adrenergic agonists (such as salbutamol) or long-lived acetylcholine receptor channel blockers (such as fluoxetine). The combination of a cholinergic drug and a beta-adrenergic agonist can further optimize the pharmacological treatment of certain CMS subtypes.

On the historical significance of Beijerinck and his contagium vivum fluidum for modern virology.

This paper considers the foundational role of the contagium vivum fluidum-first proposed by the Dutch microbiologist Martinus Beijerinck in 1898-in the history of virology, particularly in shaping the modern virus concept, defined in the 1950s. Investigating the cause of mosaic disease of tobacco, previously shown to be an invisible and filterable entity, Beijerinck concluded that it was neither particulate like the bacteria implicated in certain infectious diseases, nor soluble like the toxins and enzymes responsible for symptoms in others. He offered a completely new explanation, proposing that the agent was a "living infectious fluid" whose reproduction was intimately linked to that of its host cell. Difficult to test at the time, the contagium vivum fluidum languished in obscurity for more than three decades. Subsequent advances in technologies prompted virus researchers of the 1930s and 1940s-the first to separate themselves from bacteriologists-to revive the idea. They found in it both the seeds for their emerging virus concept and a way to bring hitherto opposing thought styles about the nature of viruses and life together in consensus. Thus, they resurrected Beijerinck as the founding father, and contagium vivum fluidum as the core concept of their discipline.

A modified anthrax toxin-based enzyme-linked immunospot assay reveals robust T cell responses in symptomatic and asymptomatic Ebola virus exposed individuals.

BackgroundEbola virus (EBOV) caused more than 11,000 deaths during the 2013–2016 epidemic in West Africa without approved vaccines or immunotherapeutics. Despite its high lethality in some individuals, EBOV infection can produce little to no symptoms in others. A better understanding of the immune responses in individuals who experienced minimally symptomatic and asymptomatic infection could aid the development of more effective vaccines and antivirals against EBOV and related filoviruses.Methodology/Principle findingsBetween August and November 2017, blood samples were collected from 19 study participants in Lagos, Nigeria, including 3 Ebola virus disease (EVD) survivors, 10 individuals with documented close contact with symptomatic EVD patients, and 6 control healthcare workers for a cross-sectional serosurvey and T cell analysis. The Lagos samples, as well as archived serum collected from healthy individuals living in surrounding areas of the 1976 Democratic Republic of Congo (DRC) epidemic, were tested for EBOV IgG using commercial enzyme-linked immunosorbent assays (ELISAs) and Western blots. We detected antibodies in 3 out of 3 Lagos survivors and identified 2 seropositive individuals not known to have ever been infected. Of the DRC samples tested, we detected antibodies in 9 out of 71 (12.7%). To characterize the T cell responses in the Lagos samples, we developed an anthrax toxin-based enzyme-linked immunospot (ELISPOT) assay. The seropositive asymptomatic individuals had T cell responses against EBOV nucleoprotein, matrix protein, and glycoprotein 1 that were stronger in magnitude compared to the survivors.Conclusion/SignificanceOur data provide further evidence of EBOV exposure in individuals without EVD-like illness and, for the first time, demonstrate that these individuals have T cell responses that are stronger in magnitude compared to severe cases. These findings suggest that T cell immunity may protect against severe EVD, which has important implications for vaccine development.

Transthyretin V122I (pV142I)* cardiac amyloidosis: an age-dependent autosomal dominant cardiomyopathy too common to be overlooked as a cause of significant heart disease in elderly African Americans.

Since the identification of a valine-to-isoleucine substitution at position 122 (TTR V122I; pV142I) in the transthyretin (TTR)-derived fibrils extracted from the heart of a patient with late-onset cardiac amyloidosis, it has become clear that the amyloidogenic mutation and the disease occur almost exclusively in individuals of identifiable African descent. In the United States, the amyloidogenic allele frequency is 0.0173 and is carried by 3.5% of community-dwelling African Americans. Genotyping across Africa indicates that the origin of the allele is in the West African countries that were the major source of the slave trade to North America. At autopsy, the allele was found to be associated with cardiac TTR amyloid deposition in all the carriers after age 65 years; however, the clinical penetrance varies, resulting in substantial heart disease in some carriers and few symptoms in others. The allele has been found in 10% of African Americans older than age 65 with severe congestive heart failure. At this time there are potential forms of therapy in clinical trials. The combination of a highly accurate genetic test and the potential for specific therapy demands a greater awareness of this autosomal dominant, age-dependent cardiac disease in the cardiology community.Genet Med advance online publication 19 January 2017.

Effectiveness and cost-effectiveness of a patient-initiated botulinum toxin treatment model for blepharospasm and hemifacial spasm compared to standard care: study protocol for a randomised controlled trial.

BackgroundBlepharospasm and hemifacial spasm are debilitating conditions that significantly impact on patient quality of life. Cyclical treatment with botulinum toxin injections offers temporary relief, but the duration of treatment efficacy is variable. The standard model of patient care defines routine fixed-time based scheduled treatment cycles which may lead to unnecessarily frequent treatment for some patients and experience of distressing symptoms in others, if symptoms return before the scheduled follow-up period.Methods/DesignA randomised controlled trial will compare a patient-initiated model of care, where patients determine botulinum toxin treatment timing, to the standard model of care in which care is scheduled by the clinical team. A sample of 266 patients with blepharospasm or hemifacial spasm will be recruited from Moorfields Eye Hospital (MEH), London. The trial will be accompanied by a mixed-methods evaluation of acceptability of the new service. Patients who meet eligibility criteria will be assessed at baseline and those in the intervention group will be provided with instructions on how to book their own treatment appointments. Patients in both groups will be followed up 3 and 9 months into the trial and all patients will be returned to usual care after 9 months to meet safety protocols. Primary outcome measures include disease severity (questionnaire), functional disability (questionnaire) and patient satisfaction with care (questionnaire). Secondary outcomes include disease-specific quality of life (questionnaire), mood (questionnaire), illness and treatment perceptions (questionnaire and semi-structured interviews), economic impact (questionnaire) and acceptability (questionnaire and semi-structured interviews).DiscussionThis trial will assess the effectiveness and cost-effectiveness of a patient-led care model for botulinum toxin therapy. If the new model is shown to be effective in reducing distress and disability in these populations and is found to be acceptable to patients, whilst being cost-effective, this will have significant implications for service organisation across the NHS.Trial registrationUK Clinical Research Network (UKCRN) Portfolio 18660. Clinicaltrials.gov ID NCT102577224 (registered 29 October 2015)

Early Complications of Hyperleukocytosis and Leukapheresis in Childhood Acute Leukemias.

Hyperleukocytosis in children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) is associated with early morbidity and mortality. The benefit from leukapheresis is controversial, and its complications are not well defined. We analyzed the frequency of early complications in children with ALL and AML presenting with white blood cell (WBC) count >100 × 10(9)/L, and the type and frequency of complications related to leukapheresis. During a 12-year period, 84 of 634 (13%) ALL and 18 of 143 (12.5%) AML patients presented with hyperleukocytosis. Leukapheresis was performed in 18 ALL and 12 AML patients. The median initial WBC was 474 × 10(9)/L in the leukapheresis group compared with 175 × 10(9)/L in the nonleukapheresis group. Neurological leukostasis occurred in 6 ALL (7.1%) and 4 AML (22.2%) patients. Pulmonary leukostasis occurred in 16 ALL (19%) and 4 AML patients (22.2%). Neurological symptoms improved in few patients after leukapheresis, except in patients with very high WBC (>650 × 10(9)/L in ALL and >400 × 10(9)/L in AML). Leukapheresis improved respiratory symptoms in some patients but caused worsening symptoms in others. Early death was associated with neurological complications, AML diagnosis, and coagulopathy. Leukapheresis did not delay initiation of chemotherapy, nor did it impact early response to chemotherapy or long-term survival. Complications included femoral vein thrombosis, electrolyte imbalances, and hemodynamic instability, which were all reversible. The role of leukapheresis as a cytoreductive procedure in childhood hyperleukocytic leukemia remains to be well defined.

Monetizing illness: The influence of disability assistance priming on how we evaluate the health symptoms of others

For low-income families in the United States disability assistance has emerged as a critical income support program in the post-welfare reform era. This article explores how this monetization of illness—tying receipt of government assistance to a physical or mental condition—influences how individuals evaluate the severity of another individual's health symptoms. Using data collected through a nationally representative survey experiment of adults in the United States (n = 1005) in May 2013, I find that respondents who are primed to consider the existence of disability assistance are less likely to rate the symptoms described in a hypothetical vignette as severe relative to the control group. I find evidence that this effect holds for both physical (back pain) and mental (depression) conditions for adults and behavioral conditions (ADHD) in children. Moreover, respondents in the experimental group were more likely to blame the individual for her health condition and this measure was found to partially mediate the effect of the disability assistance prime. These findings have important implications for researchers, policymakers and medical practitioners by illustrating how premising state assistance on a health condition may in turn shape how individuals evaluate the health symptoms of others.

A qualitative study to explore how patients identify and assess symptoms as adverse drug reactions

To explore how Thai patients assess symptoms as adverse drug reactions (ADRs). Out-patients at two hospitals in Thailand previously reporting suspected ADRs to statins were purposively selected to cover factors relevant to the accuracy of ADR reports. Semi-structured interviews explored the mechanisms participants used to work out whether their symptoms were related to their statin. All interviews were audio-recorded, transcribed and independently thematically analyzed by two researchers. One hundred interviews were suitable for analysis; 52 were male, age range was 36 to 77 years (mean ± S.D.: 59.83 ± 9.14) and most (92) were taking other medicines in addition to statins. Patient assessment of symptoms as ADRs fell into two major themes: medicine-related factors and external factors. Timing relationships were mentioned most frequently (74), followed by information received (55), seeing similar symptoms in others (7) and diagnosis through blood tests (4). Use of multiple medicines, consideration of the medicine versus diseases, symptoms occurring with more than one medicine or relieved through treatment reduced confidence in ADR attribution. Many participants proposed alternative explanations for symptoms, including old age. Lack of information and knowledge were obstacles to the assessment process. Patients assessed possible ADRs most often by considering timing relationships. While they also used medicine information, Thai patients received inadequate information to help them assess their symptoms. Patients expressed uncertainty and difficulties in deciding attribution when concomitant medicines and diseases were involved. The findings could support the development of a patient-friendly systematic tool for identifying and assessing possible ADRs.

The prognostic implications of lack of palpitations in patients hospitalised with atrial fibrillation: observations from a 20-year registry

It is well recognised that patients differ in the clinical presentation of atrial fibrillation (AF), ranging from the typical symptom of palpitations, atypical symptoms in others and a substantial that are asymptomatic. Whether the different patterns of presentation are associated with differences in outcomes is not known. The aim of this study was to evaluate the prevalence and the prognostic implications of lack of palpitations among patients hospitalised with AF in a large prospective registry. Retrospective analysis of all patients hospitalised with AF in Qatar from 1991 to 2010 was made. Patients were divided into two groups according to the presence or absence of palpitations on presentation. Clinical characteristics and outcome were analysed. During the 20-year period, 3850 patients were hospitalised for AF; 1724 (44.8%) had palpitations on presentation while 2126 (55.2%) had no palpitations. Patients who lacked palpitations were 9 years older, had a higher prevalence of diabetes mellitus (64.7% vs. 35.3%), underlying coronary artery disease (CAD; 14.6% vs. 6.2%) and severe left ventricular dysfunction on echocardiography (25.5% vs. 6.6%), (all, p = 0.001). There were 141 deaths among the group with no palpitations compared with 19 among the group with palpitations (6.6% vs. 1.1%). Multivariate analysis of mortality predictors identified 'lack of palpitations' as an independent predictor of in-hospital mortality (relative risk 5.56; 95% confidence interval 1.20-25.0, p = 0.03). Our study demonstrates for the first time that lack of palpitations as the presenting symptom of patients with AF is associated with worse in-hospital outcome independent of other risk factors or therapy. The underlying mechanisms and the role of confounders warrant further investigation.

Am I Abnormal? Relative Rank and Social Norm Effects in Judgments of Anxiety and Depression Symptom Severity

ABSTRACTOverdetection and underdetection of depression and anxiety in primary care are common and may partly reflect individuals' misperceptions of the severity of symptoms they experience. Here, we explore how people's judgments about the severity of their own symptoms are influenced by their beliefs about the distribution of symptoms experienced by the rest of the population. We apply the rank‐based decision by sampling cognitive model of judgment to symptom severity. The model proposes that judgments depend on the relative rank of an item within a mental sample of comparable items. It is predicted that judgments of symptom severity will be context dependent and more specifically that an individual's judgments will be invalid to the extent that the individual has inaccurate beliefs about the relevant social context. Two studies found that participants' assessments of symptom severity were rank based. Study 1 elicited participants' beliefs about the social distribution of symptoms and found that participants' judgments of whether they were depressed or anxious were mainly predicted not by their symptoms' objective severity but rather by where participants ranked the severity of their symptoms in comparison with the believed symptoms of others. Study 2 varied symptom distributions experimentally and again found relative rank effects as predicted. It is concluded that the real‐world application of contextual models of judgment requires investigation of individual differences in participants' background beliefs. Copyright © 2012 John Wiley & Sons, Ltd.

Improved Survival using Dual Monoclonal Antibody Therapy with Aggressive Anti-Microbial Prophylaxis In Steroid-Refractory Acute Graft-Versus-Host Disease

AbstractAbstract 1262Steroid-refractory acute graft versus host disease (aGVHD) is associated with a poor prognosis. Although clinical responses occur to second line therapy they are associated with high rates of infection and dismal long-term survival. Blockade at 2 different points in the cytokine cascade with infliximab and daclizumab (double antibody therapy, DAT), along with aggressive infection prophylaxis may improve outcomes. We retrospectively reviewed our experience using DAT in steroid-refractory aGVHD. Between December 2005 and December 2009, 22 patients were treated of which 20 are evaluable. All patients had persistent or progressive aGVHD despite 1–2 mg/kg/d steroids for a median of 9 days (range 2–55). Five patients had failed 2nd line systemic aGVHD therapy and 1 patient failed 3rd line therapy prior to DAT. Combination therapy was given for aGVHD grade 2 (n=3), 3 (n=13), or 4 (n=4). GVHD involved the skin in 7 patients, the liver in 9 patients and GI tract in 16 patients. The median age at time of therapy was 55 years (range 29–69). Grafts were from HLA identical siblings (9), 10 locus matched unrelated donors (5), 9/10 locus matched unrelated donors (3), cord blood (2) or 5/10 haploidentical donor (1). The conditioning regimen was myeloablative in 10 patients, and either nonmyeloablative or reduced intensity in 10 patients. Indications for stem cell transplant were acute leukemia (7), chronic myelogenous leukemia (2), chronic lymphocytic leukemia (1), myelodysplastic syndrome (4), non-Hodgkins lymphoma (5), and multiple myeloma (1). Most patients received methotrexate (MTX) with tacrolimus (FK)(14) or mycophenolate (MMF) (4) for GVHD prophylaxis; one patient received MTX with FK and MMF and one FK alone. Fifteen patients developed aGVHD after the primary transplant and five after donor lymphocyte infusion. Daclizumab was given (1mg/kg) day 1,4,8,15, and 22, and infliximab (10mg/kg) days 1,8,15, and 22. Steroid therapy was aggressively tapered upon commencement of DAT. Maximal response achieved by day 60 post initiation of therapy was assessed. Five pts (25%) attained a CR (resolution of all symptoms), 10 (50%) PR (improvement in ≥ 1 organ & no progression in others), 2(10%) MR (improvement in ≥ 1 organ & deterioration or new symptoms in others) and 3 (15%) no response. Five patients received 1–2 additional courses of DAT at a median of 60 days. Three patients (15%) were concurrently on an investigational protocol utilizing mesenchymal stem cells. All patients received antifungal (azole with mold coverage or echinocandin), anti-Herpes virus, and Pneumocystis prophylaxis. Patients with gastrointestinal GVHD also received antibacterial prophylaxis irrespective of neutropenia. Patients were monitored once or twice weekly for CMV reactivation and received preemptive therapy upon reactivation. Only two patients had documented fungal infections: Mucormycosis in 1 and Candida parapsilosis in 1. Sixteen (80%) of patients had bacterial infections, including 21 gram-positive infections and 13 gram-negative infections. Viral infections, primarily CMV reactivation, occurred in 16 patients (80%). As of August 2010, 12 patients have died after a median of 102 days from initiation of DAT (range 14–658) (5 from relapsed or progressive disease, 3 from aGVHD, 2 from cGVHD, and 2 from organ failure). With a median follow up of 511 days for living patients, the estimated probability of survival at 6 months and 12 months is 55% and 50%, respectively. DAT is an effective therapy for steroid-refractory aGVHD. Survival beyond 6 months can be achieved in approximately half the patients using this strategy. Aggressive antifungal and antiviral prophylaxis may have contributed to this outcome. Disclosures:Off Label Use: Infliximab and daclizumab are not FDA approved for GVHD.

Paget’s: The neglected bone disease

After osteoporosis, Paget’s disease is the next most common metabolic bone disease in the UK where it occurs in approximately 2% of adults over the age of 55, rising to 8% of men and 5% of women by the eighth decade of life. Patients with this disease are managed in varied clinical settings including orthopaedics with some complaining about lack of awareness amongst health professionals, with delays in diagnosis and starting appropriate treatment being the major problems. Paget’s disease which is characterised by focal increases in bone turnover affects one or multiple bones in the skeleton and occurs most commonly in the skull, spine, hip and pelvis. Whilst many people have few symptoms in others it can result in pain at the affected site, marked bone deformity, deafness, neurological symptoms, pathological fractures and may be associated with an increased risk of developing osteoarthritis. Both viral and genetic factors have been implicated in the causation of Paget’s disease with most recent research tending to favour genetic causation. At present Paget’s disease cannot be cured, but early recognition and treatment with either oral or intravenous bisphosphonates will help to control its progress and minimise complications. On occasions however a small number of patients will require surgery, commonly for joint replacement, fracture fixation and correction of bone deformities.

Did Evagrius Ponticus (AD 346–99) have obsessive–compulsive disorder?

Evagrius Ponticus was one of the most important and influential spiritual writers in the early Christian church. This author argues that he suffered from obsessive-compulsive disorder: in particular, the demonic 'thoughts' which he repeatedly describes meet all the criteria for obsessions. If this is true, it offers a new perspective on the relation between pastoral theology and psychiatric disorders: the spiritual tradition which Evagrius helped found may, as a result, have tended to exacerbate such symptoms in others, but it also possessed the resources to address them in a practical way.