Symptoms Of Varying Severity Research Articles

Neurophysiological Distinction between Schizophrenia and Schizoaffective Disorder.

Schizoaffective disorder (SA) is distinguished from schizophrenia (SZ) based on the presence of prominent mood symptoms over the illness course. Despite this clinical distinction, SA and SZ patients are often combined in research studies, in part because data supporting a distinct pathophysiological boundary between the disorders are lacking. Indeed, few studies have addressed whether neurobiological abnormalities associated with SZ, such as the widely replicated reduction and delay of the P300 event-related potential (ERP), are also present in SA. Scalp EEG was acquired from patients with DSM-IV SA (n = 15) or SZ (n = 22), as well as healthy controls (HC; n = 22) to assess the P300 elicited by infrequent target (15%) and task-irrelevant distractor (15%) stimuli in separate auditory and visual ”oddball” tasks. P300 amplitude was reduced and delayed in SZ, relative to HC, consistent with prior studies. These SZ abnormalities did not interact with stimulus type (target vs. task-irrelevant distractor) or modality (auditory vs. visual). Across sensory modality and stimulus type, SA patients exhibited normal P300 amplitudes (significantly larger than SZ patients and indistinguishable from HC). However, P300 latency and reaction time were both equivalently delayed in SZ and SA patients, relative to HC. P300 differences between SA and SZ patients could not be accounted for by variation in symptom severity, socio-economic status, education, or illness duration. Although both groups show similar deficits in processing speed, SA patients do not exhibit the P300 amplitude deficits evident in SZ, consistent with an underlying pathophysiological boundary between these disorders.

Hormones and Their Interaction with the Pain Experience

Sex differences in the prevalence of painful conditions appear after pubertyVariation in symptom severity across the menstrual cycle occurs in a number of clinical pain conditionsSex steroid hormones act at a number of sites in both the peripheral and central nervous systems and in both reproductive and non-reproductive tissuesSex steroid hormones have traditionally been thought to alter transcription; however, there is evidence that there are also non-genomic effectsSex steroid hormones can have organisational effects from as early as in uteroThe relationship between sex hormones and pain is complex.

Real-time evaluation of dyspeptic symptoms and gastric motility induced by duodenal acidification using noninvasive transnasal endoscopy

Although different pathophysiological mechanisms have been suggested to be involved in functional dyspepsia, a practical method to clarify them has not been established. The aim of this study was to evaluate dyspeptic symptoms and gastric motility induced by duodenal acidification using transnasal endoscopy. Fourteen healthy volunteers (mean age, 32 years) were enrolled. Transnasal endoscopy was performed on all fasting volunteers. Dyspeptic symptoms and antral contractions were evaluated before and after duodenal infusions of pure water (20 ml/min for 5 min) and acid (0.1 N HCl, 20 ml/min for 5 min). The severity of various symptoms was assessed by each subject using a 10-cm visual analog scale every 2 min. The maximum severity scale was calculated as the mean of the individual maximum values. The motility number was defined as the mean number of antral contractions in 1 min. The maximum severity score for a heavy feeling in the stomach and other symptoms significantly increased after the acid infusion compared with after the pure water infusion. During pure water infusion, there were no changes in the motility number. On the other hand, the motility number significantly decreased after duodenal acidification (before vs. after, 2.93 +/- 0.12 times vs. 1.11 +/- 0.23 times, P < 0.0001). Duodenal acid exposure induces dyspeptic symptoms and inhibits antral motility. Transnasal endoscopy enabled us to evaluate both dyspeptic symptoms and gastric motility simultaneously.

Quality of life among patients with primary, metastatic and recurrent cancer

Diagnosis of cancer is an emotionally traumatic event that significantly impacts the quality of life (QoL) of the patients. Progression to metastasis or recurrence of cancer after first diagnosis poses a greater threat to life that further increases this emotional trauma and can worsen the QoL. In this research we sought to explore the differences in QoL (symptom severity and physical functioning) experienced by primary non-metastatic (PNM), primary metastatic (PM) and recurrent (RC) cancer patients. Cancer patients recruited in two cognitive intervention trials formed the sample for this analysis. Data were analysed using longitudinal mixed models, with two interaction terms. Least square means were calculated and compared. Over the period of study RC patients reported the worst symptom severity and physical function followed by PM and PNM patients. Primary non-metastatic patients showed a steady decline in severity whereas PM and RC showed slight gains after the first follow-up. Primary non-metastatic patients displayed best physical functioning followed by PM and RC patients, and remained stable over time. Breast cancer patients displayed most variation in symptom severity among the three progression groups, whereas significant variation in physical function among the three groups was observed within all cancer sites.

Symptom Severity 1 to 4 Months After Thoracotomy for Lung Cancer

Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery. To describe symptom severity during the first 4 months after thoracotomy for non-small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months. Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies-Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms. Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months. Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.

GRAY MATTER ABNORMALITIES AND COGNITIVE FUNCTION IN SUBJECTS AT RISK FOR PSYCHOSIS: LONGITUDINAL PERSPECTIVES

La schizophrénie est une maladie complexe qui semblerait résulter d’interactions entre gène et environnement. Cet article présente l’état des connaissances actuelles sur le rôle des mécanismes épigénétiques dans la schizophrénie. L’épigénétique est l’étude des changements de l’expression génique, secondaires à des mécanismes transmis par la mitose, mais réversibles, sans qu’il n’y ait de modification de la séquence d’ADN génomique sous-jacente. Ces changements pourraient être secondaires à un facteur environnemental. Ils sont le résultat notamment de la méthylation de l’ADN (au niveau de gènes impliqués dans le neurodéveloppement ou dans les voies de neurotransmission glutamatergique et GABAergique) ou de la modification des histones (au niveau de la signalisation GABAergique). Se pose cependant le problème de biais de réalisation des études et d’une absence de généralisation des résultats, les processus sous-tendant cette interaction restant mal connus. Ces facteurs de régulation épigénétique peuvent eux-mêmes être le siège d’une vulnérabilité génétique fragilisant la régulation épigénétique, en interaction ou non avec des facteurs d’environnement à risque.Schizophrenia is a frequent and disabling disease associated with heterogeneous psychiatric phenotypes. It emerges during childhood, adolescence or young adulthood and has dramatic consequences for the affected individuals, causing considerable familial and social burden, as well as increasing health expenses. Although some progress has been made in the understanding of their physiopathology, many questions remain unsolved, and the disease is still poorly understood. The prevailing hypothesis regarding psychotic disorders proposes that a combination of genetic and/or environmental factors, during critical periods of brain development increases the risk for these illnesses. Epigenetic regulations, such as DNA methylation, can mediate gene x environment interactions at the level of the genome and may provide a potential substrate to explain the variability in symptom severity and family heritability. Initially, epigenetics was used to design mitotic and meiotic changes in gene transcription that could not be attributed to genetic mutations. It referred later to changes in the epigenome not transmitted through the germline. Thus, epigenetics refers to a wide range of molecular mechanisms including DNA methylation of cytosine residues in CpG dinucleotides and post-translational histone modifications. These mechanisms alter the way the transcriptional factors bind the DNA, modulating its expression. Prenatal and postnatal environmental factors may affect these epigenetics factors, having responsability in long-term DNA transcription, and influencing the development of psychiatric disorders.The object of this review is to present the state of knowledge in epigenetics of schizophrenia, outlining the most recent findings in the matter.We did so using Pubmed, researching words such as ‘epigenetics’, ‘epigenetic’, ‘schizophrenia’, ‘psychosis’, ‘psychiatric’. This review summarizes evidences mostly for two epigenetic mechanisms: DNA methylation and post-translational histone modifications.First, in terms of epidemiology and transmission, the theoretical model of epigenetics applies to schizophrenia. Then, most environmental factors that have proved a link with this disease, may generate epigenetic mechanisms. Next, mutations have been found in regions implied in epigenetic mechanism among populations with schizophrenia. Some epigenetic alterations in DNA regions have been previously linked with neurodevelopmental abnormalities. In psychosis, some authors have found methylation differences in COMT gene, in reelin gene and in some genes implicated in dopaminergic, serotoninergic, GABAergic and glutamatergic pathways. Histone modifications have been described, in particular the H3L4 histone methylation. Finally, we tried to underline the difficulties in epigenetic research, notably in psychiatry, and the limits in this matter.The epigenetic field may explain a lot of questions around the physiopathology of the complex psychiatric disease that is schizophrenia. It may be a substratum to the prevailing hypothesis of gene x environment interaction. The research in the matter is definitely expanding. It justifies easily the need to improve the effort in the domain to overpass some limits inherent to the matter.

Development of an Ovarian Cancer Symptom Index: Possibilities for Earlier Detection

Ovarian cancer is the second most common gynecologic malignancy in the US and-because more than 70% of women affected are diagnosed with advanced-stage disease-the deadliest. Contrary to what might be expected, screening has not lessened mortality even in high-risk populations. The idea of targeting women having specific symptoms to be screened is relatively recent because of the general belief that symptoms have limited specificity. The authors undertook a case-control study of 149 women with ovarian cancer. An exploratory group served to estimate odds ratios for self-reported symptoms of variable severity, frequency, and duration. The results of logistic regression analysis were used to develop a symptom index, which then was tested in a confirmatory group. The group with ovarian cancer included 55 women with early-stage disease, 88 with late-stage disease, and 6 whose disease stage was not known. Thirty-one of the women with early-stage disease and all but 2 of those with advanced-stage disease had invasive tumors. In the exploratory group, symptoms that were significantly associated with ovarian cancer, when occurring more than 12 days a month and for less than a year, included pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating/feeling full. On logistic regression analysis, pelvic/ abdominal pain, increased abdominal size/bloating, and difficulty eating/feeling full were independently associated with the presence of ovarian cancer. The symptom index was considered to be positive if any of these 6 symptoms occurred more than 12 times a month and had been present for less than 12 months. In the confirmatory group, the symptom index was 56.7% sensitive for early-stage disease and 79.5% sensitive for advanced-stage disease. The index was 90% specific for women older than 50 years of age and 86.7% specific for younger women. When analyzing 1709 women presenting to a primary care clinic, 45 of them (2.6%) tested positive and would have been identified as having symptoms very suggestive of ovarian cancer. The proportions of women less than 50 years of age and those aged 50 and older who tested positive were 3.3% and 1.4%, respectively. The presence of specific symptoms, taking their duration and frequency into account, can help point to women who harbor ovarian cancer. Calculating the symptom index is a relatively simple means of identifying women who should be promptly and thoroughly evaluated.

Further Validation of the Alcohol Dependence Scale as an Index of Severity*

The Alcohol Dependence Scale (ADS) yields continuous scores purported to reflect the severity of the dependence syndrome. We evaluated the concurrent validity of the ADS as a general measure of severity and the screening accuracy of the total score and subscales to detect Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), physiological dependence. Treatment-seeking, alcohol-dependent individuals entering the Combining Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study (N = 1,372; 69% men) completed the ADS, diagnostic interviews, and other measures before randomization. Analyses of variance tested differences between ADS quartiles on alcohol- related measures. Areas under the receiver operating characteristic (AUROC) curve assessed screening accuracy for DSM-IV physiological dependence (tolerance or withdrawal) or withdrawal alone. ADS quartiles differed on age, other demographics, and prior treatment episodes. Linear correlation showed moderate to large magnitude associations with alcohol-related self-report measures and most indices of consumption. ADS quartiles differed significantly on proportion with DSM-IV physiological dependence, but AUROC curves indicated that the ADS had limited accuracy as a continuous measure to detect DSMIV physiological dependence (AUROC = .75 [95% confidence interval {CI}: .70-.79] and .67 [95% CI: .60-.74] for men and women, respectively; p = .08) or withdrawal alone (AUROC = .77 [95% CI: .74-.80] and .74 [95% CI: .69-.79] for men and women, respectively; p = .30). Screening accuracy was comparably limited based on ADS subscales reflecting psychoperceptual or psychophysical withdrawal. The ADS reflected variation in symptom severity but did not adequately identify physiological dependence or withdrawal in treatment-seeking individuals with DSM-IV alcohol dependence.

First Record of Verticillium dahliae on Potato in Malta.

Potato is an important and highly valued crop throughout the Maltese Archipelago. Much of the production is exported to Holland. In January 2005, minor wilts and chlorosis of potato plants were observed in a field at Hal-Farrug, Luqa (Malta). Verticillium dahliae Kleb (1) was isolated on potato dextrose agar (PDA) from vascular tissue excised from the base of the plants. Three different isolates were obtained, all of which were typically distinguished by verticillately shaped conidiophores and the abundant production of microsclerotia on PDA. In May 2005, colonies of these three isolates were cultured in potato dextrose broth (PDB), from which conidial suspensions of each isolate were prepared with sterile distilled water to a concentration of 107 ml-1. For each isolate, 10 7-day-old potato seedlings were inoculated via root immersion in the inoculum suspension and transplanted to 20-cm diameter plastic pots containing a soil/peat mixture (1:1 [v/v]). Seedlings treated in the same way with sterile distilled water were used as a control. All plants were kept under controlled glasshouse conditions (20 ± 3°C) and watered to field capacity as required. Minor chlorosis and wilt of the pair of lower-most leaves was noted 7 days after inoculation. During subsequent weeks, wilt began to appear in the typical half-leaf form, while chlorosis was noted on all organs of the plants, including the principal stem (3). Symptoms were absent on the control plants. Measuring the weight of the new tubers produced by each plant revealed no apparent difference between inoculated and healthy plants; nevertheless, inoculated plants resulted in more tubers with a smaller diameter in respect to those of the uninoculated plants. V. dahliae was never isolated from tubers. Little to no variation in symptom severity was noted among plants inoculated with the three individual isolates. At the end of June, V. dahliae was reisolated on PDA from all inoculated plants, in particular, from vascular tissues originating from principal and lateral stems, crowns, and roots. All attempts to isolate the pathogen from control plants were unsuccessful. Molecular detection of the pathogen by using species-specific primers and real-time Scorpion PCR (2) confirmed the results obtained by the classical isolation method. The low symptom severity observed by the growers in the field, usually mistaken for normal dieback of aged plants, might explain why V. dahliae was never reported before on potatoes in the Maltese Archipelago.

Validation of the M. D. Anderson symptom inventory (MDASI-BT)

1546 Background: The occurrence of symptoms has been shown to predict treatment course and survival in a number of solid tumor patients. Primary brain tumor patients are unique in the neurologic symptoms that occur. Currently, no instrument exists that measures both neurologic and cancer-related symptoms. Methods: Patients diagnosed with Primary Brain Tumors (PBT) participated in this study. Data collection tools included a patient completed demographic data sheet, an investigator completed clinician checklist, and the core M.D. Anderson Symptom Inventory to which 18 neurologic symptoms were added (M.D. Anderson Symptom Inventory-Brain Tumor Module, MDASI-BT). The study evaluated the reliability and validity of the MDASI-BT in primary brain tumor patients. Results: 201 patients participated in this study. Mean symptom severity of items as well as cluster analysis was used to reduce the number of total items to 22. Regression analysis showed more than half (56%) of the variability in symptom severity was explained by the 9 remaining brain tumor items. Factor analysis was then performed to determine the underlying constructs being evaluated by the remaining items. The 22 item MDASI-BT measures six underlying constructs including affective, cognitive, focal neurologic deficit, constitutional, generalized symptom, and a gastrointestinal related factor. The internal consistency (reliability) of the sets of items comprising the six factors and also the interference scale were .87, .82, .72, .81, .69, .67 and .91 respectively). Test-retest reliability was good in a subset of 19 patients completing the instrument at two points in time. The MDASI-BT was sensitive to disease severity based on Karnofsky performance status (KPS) based on mean symptom severity (1.7 versus 3.8, p &lt; .001) and mean symptom interference (2.2 versus 6.1, p &lt; .001). Conclusions: The 22 item MDASI-BT demonstrated validity and reliability in patients with PBT. This instrument can be used to describe symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management. [Table: see text]

Validation of the M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT)

Symptom occurrence has been shown to predict treatment course and survival in patients with solid tumors. Primary brain tumor (PBT) patients are unique in the occurrence of neurologic symptoms. Currently, no instrument exists that measures both neurologic and cancer-related symptoms. Patients diagnosed with PBT participated in this study. Data was collected at one point in time and included demographic and clinical factors, and the M.D. Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT). The study evaluated the reliability and validity of the MDASI-BT in primary brain tumor patients. Two hundred and one patients participated in this study. Mean symptom severity of items as well as cluster analysis was used to reduce the number of total items to 22 (13 core, 9 brain tumor items). Regression analysis showed more than half (56%) of the variability in symptom severity was explained by brain module items. The MDASI-BT measures six underlying constructs including affective, cognitive, focal neurologic deficit, constitutional, generalized symptom, and a gastrointestinal related factor. The internal consistency (reliability) of the instrument was 0.91. The MDASI-BT was sensitive to disease severity based on performance status (P<0.001), tumor recurrence (P<0.01), and mean symptom interference (P<0.001). The 22 item MDASI-BT demonstrated validity and reliability in patients with PBT. This instrument can be used to identify symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management.

What the asthma end points we know and love do and do not tell us

Asthma is a disorder characterized by common features of reversible airflow obstruction and bronchial hyperreactivity in the setting of airway mucosal and submucosal inflammation. However, the clinical manifestations are syndromic and not unimodal. There is marked variability in severity of symptoms, natural history, risks of adverse outcomes, pathologic characteristics, and response to therapy. Understanding the relationship between these factors has been complicated by the variability of outcomes and the lack of correlation between them. There is a striking absence of correlation among the pathologic, physiologic, and clinical manifestations of the asthmatic disorders. Lung function tends to correlate poorly with clinical outcomes, and there is only modest correlation between clinical outcomes. Response to therapy is variable both externally (between patients) and internally, depending on which outcome is evaluated. A more complete understanding of the variability of disease and the genetic and environmental causes of the variability likely will change how we approach asthma and its therapy.

Inflammatory mediators in allergic rhinitis

Allergic rhinitis (AR) is part of a systemic disease complex. There is a close relationship between AR and asthma, which has led to the "one airway, one disease" concept. Both conditions share common immunopathology and pathophysiology. In patients with AR, allergen-triggered early and late responses are mediated by a series of inflammatory cells. Within minutes of contact with allergen, IgE-sensitized mast cells degranulate, releasing both preformed and newly synthesized mediators. Immunologic processes in both nasal and bronchial tissue involve T H 2 lymphocytes and eosinophils. Eosinophils are the predominant cell in the chronic inflammatory process characteristic of the late-phase allergic response. Eosinophils release an array of proinflammatory mediators, including cysteinyl leukotrienes, cationic proteins, eosinophil peroxidase, and major basic protein, and might serve as a major source of IL-3, IL-5, GM-CSF, and IL-13. Neuropeptides also appear to contribute to the pathophysiology of AR symptoms. Both AR and asthma exhibit marked day-night variation in symptom severity. Acknowledging both the chronobiology of AR and circadian rhythm-dependent attributes of antiallergy medications might enhance the beneficial effects of allergy therapies.

Use and interpretation of on/off diaries in Parkinson’s disease

Objective: To explore the use and interpretation of self reported on/off diary data for assessment of daily motor fluctuations in Parkinson’s disease. Methods: 26 consecutive non-demented patients with fluctuating Parkinson’s...

Treatment of social phobia by endoscopic thoracic sympathicotomy.

To analyse the severity of various symptoms and the developmental life history in social phobia. To estimate the value of ETS in the treatment of chronic social phobia. Prospective study. Clinic for Psychoneurology and Surgery in Tampere, Finland. Consecutive series of patients (n = 51). Endoscopic thoracic sympathicotomy. Qualitative ideographic inquiry. Questionnaire of the symptom severity using visual analogue scale. The life history included mental and physical abuse in 61%, paternal alcoholism in 26%. Four family subtypes were named: quarrelsome, cruel, alcoholic, and perfectionist. The pathognomonic symptoms of social phobia: hyperhidrosis, palpitation, blushing, tremor, and anxiety, were all highly significantly (p < 0.001) alleviated by ETS. 88% of the patients were satisfied with the result. There were no complications. ETS seems a promising alternative to conservative therapy for social phobia.

A 15-year follow-up study of patients with panic disorder

Background. – Panic disorder (PD) is generally regarded as a chronic condition with considerable variation in severity of symptoms. Aims. – To describe the long-term outcome of naturalistically treated PD. Methods. – Fifty-five outpatients with PD, who participated in a placebo-controlled drug trial of the efficacy of alprazolam and imipramine 15 years ago were reassessed with the same instruments used in the original study. Results. – Complete recovery (no panic attacks and no longer on medication during the last 10 years) was seen in 18% of patients, and an additional 13% recovered but were still on medication. Fifty-one percent experienced recurrent anxiety attacks whereas 18% still met diagnostic criteria for PD. The incidence of agoraphobia decreased from 69% to 20%. Patients with agoraphobia at admission tended to have a poorer long-term outcome according to daily functioning compared with patients without agoraphobia at admission, although both groups reported improved daily functioning at follow-up. Maintenance medication was common. No benzodiazepine abuse was reported. Conclusion. – PD has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment. The short-term treatment given in the drug trial had no influence on the long-term outcome.

The role of negative interpretations of grief reactions in emotional problems after bereavement

This study explored the role of negative interpretations of grief reactions in emotional problems after bereavement, with 234 individuals who had been confronted with the death of a close relative. It was found that negative interpretations of grief reactions were highly associated with the degree to which these reactions were experienced as distressing, the degree to which mourners engaged in avoidance behaviours and the severity of symptoms of traumatic grief and depression, even when controlling for the frequency of grief reactions and the influence of relevant background variables. Furthermore, behavioural and cognitive avoidance strategies were significantly related to the severity of traumatic grief and depression. Negative interpretations of grief reactions and rumination explained most variance in symptom severity, when controlling for the shared variance between the predictor variables. The results have implications for the treatment of emotional problems after bereavement.

Research agenda for understanding Alzheimer disease in diverse populations: work group on cultural diversity, Alzheimer's association.

The emerging evidence of ethnic variations in apolipoprotein polymorphism and Alzheimer disease risk shows that one cannot generalize findings based on a single cultural group too broadly ( Tang et al., 2001). Presence of one apolipoprotein E epsilon 4 allele is a stronger risk factor for Alzheimer disease in whites and Asians than in blacks ( Farrer et al., 1997). Environmental or genetic cofactors may modulate the effects of epsilon 4 on beta-amyloid metabolism differently in different subpopulations ( Shadlen, 1998). Recognizing this, the Alzheimer's Association has extended its goals to strengthen the scientific information base on the interactions of population diversity and Alzheimer disease heterogeneity ( NIA, 1998). This new focus is timely since minority elderly are the most rapidly increasing segment of the elderly population ( Lilienfeld and Perl, 1994, Brookmeyer et al., 1998). In this article, the authors highlight recent progress in research on Alzheimer disease among culturally diverse populations with a special emphasis on gaps in the knowledge base. The authors recommend four priorities for future Alzheimer disease research: (1) determine whether genetic causative factors interact differently in different populations; (2) reexamine the nature and role of cerebral ischemia and infarction and variations in symptom severity of Alzheimer disease; (3) explore the interaction of genes and environmental influences that are protective against Alzheimer disease; and (4) recruit and enroll ethnically diverse subjects in Alzheimer disease clinical trials.

Genome organization of Tobacco leaf curl Zimbabwe virus, a new, distinct monopartite begomovirus associated with subgenomic defective DNA molecules.

The complete DNA A of the begomovirus Tobacco leaf curl Zimbabwe virus (TbLCZWV) was sequenced: it comprises 2767 nucleotides with six major open reading frames encoding proteins with molecular masses greater than 9 kDa. Full-length TbLCZWV DNA A tandem dimers, cloned in binary vectors (pBin19 and pBI121) and transformed into Agrobacterium tumefaciens, were systemically infectious upon agroinoculation of tobacco and tomato. Efforts to identify a DNA B component were unsuccessful. These findings suggest that TbLCZWV is a new member of the monopartite group of begomoviruses. Phylogenetic analysis identified TbLCZWV as a distinct begomovirus with its closest relative being Chayote mosaic virus. Abutting primer PCR amplified ca. 1300 bp molecules, and cloning and sequencing of two of these molecules revealed them to be subgenomic defective DNA molecules originating from TbLCZWV DNA A. Variable symptom severity associated with tobacco leaf curl disease and TbLCZWV is discussed.

PID27: DOES A DAY STILL MAKE A DIFFERENCE? A DECISION ANALYSIS OF ADULT STREPTOCOCCAL PHARYNGITIS

OBJECTIVES: Adults presenting with acute sore throats is one of the most common complaints encountered by primary care clinicians, yet the proper management of adult patients with pharyngitis is still somewhat controversial. This study proposes to identify the appropriate clinical management of adult pharyngitis using both cost-benefit analysis and cost-effectiveness analysis METHODS: Cost-Benefit Analysis and Cost-Effectiveness Analysis. Six management strategies were considered in these analyses: empiric treatment, performing a rapid test, obtaining a bacterial culture, empiric treatment with a confirmatory bacterial culture, or a combination of the rapid test with a bacterial culture of negative rapid tests. In addition, the study incorporates differing probabilities of streptococcal disease based upon on previously published symptomatically derived logistic regression scores. Using an internet-based survey, information is collected on undergraduate and graduate students' willingness-to-pay and time trade-off of presented health states. RESULTS: Preliminary results indicate that patients presenting with 3 or more indicative symptoms (3 days of fever> 39°C, tender anterior cervical nodes, enlarged tonsils with purulent exudates, and lack of cough) should be treated empirically. Those adult patients that complain of only two symptoms should be managed by a combination of a rapid diagnostic test with a bacterial culture on those rapid tests with negative results. CONCLUSIONS: This study presents findings that should provide clinicians with a better guide in the treatment of adult patients with pharyngitis. Performing normative analyses of currently accepted clinical management, the study employs adult's preferences as well as variation in severity of symptoms.