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PubMed2001

Resource utilization of patients with hypochondriacal health anxiety and somatization.

OBJECTIVES: To examine the resource utilization of patients with high levels of somatization and health-related anxiety. DESIGN: Consecutive patients on randomly chosen days completed a self-report questionnaire assessing somatization and health-related, hypochondriacal anxiety. Their medical care utilization in the year preceding and following completion of the questionnaire was obtained from an automated patient record. The utilization of patients above and below a predetermined threshold on the questionnaire was then compared. PATIENTS AND SETTING: Eight hundred seventy-six patients attending a primary care clinic in a large, urban, teaching hospital. OUTCOME MEASURES: Number of ambulatory physician visits (primary care and specialist), outpatient costs (total, physician services, and laboratory procedures), proportion of patients hospitalized, and proportion of patients receiving emergency care. RESULTS: Patients in the uppermost 14% of the clinic population on somatization and hypochondriacal health anxiety had appreciably and significantly higher utilization in the year preceding and the year following completion of the somatization questionnaire than did the rest of the patients in the clinic. After adjusting for group differences in sociodemographic characteristics and medical comorbidity, significant differences in utilization remained. In the year preceding the assessment of somatization, their adjusted total outpatient costs were $1,312 (95% CI $1154, $1481) versus $954 (95% CI $868, $1057) for the remainder of the patients and the total number of physician visits was 9.21 (95% CI 7.94, 10.40) versus 6.33 (95% CI 5.87, 6.90). In the year following the assessment of somatization, those above the threshold had adjusted total outpatient costs of $1,395 (95% CI $1243, $1586) versus $1,145 (95% CI $1038, $1282), 9.8 total physician visits (95% CI 8.66, 11.07) versus 7.2 (95% CI 6.62, 7.77), and had a 24% (95% CI 19%, 30%) versus 17% (95% CI 14%, 20%) chance of being hospitalized. CONCLUSIONS: Primary care patients who somatize and have high levels of health-related anxiety have considerably higher medical care utilization than nonsomatizers in the year before and after being assessed. This differential persists after adjusting for differences in sociodemographic characteristics and medical morbidity.

Adult↗
PubMed2001

Preparing for bioterrorism: category A agents.

September 11, 2001, brought the possibility of biologic acts of terrorism against the United States into the national consciousness. As the American people brace themselves for this new threat to the national well-being, clinicians must understand how to prevent, recognize, and treat the biologic agents that could be used in terrorist attacks. This article discusses the most likely biologic agents, including diagnostic laboratory procedures, treatment options, psychological effects, special populations, and reporting requirements.

Anthrax↗
PubMed1987

Characteristics of coagulase-negative staphylococci from infants with bacteremia.

Twenty-nine infants were identified as having coagulase-negative staphylococcal (C-S) bacteremia. Fourteen infants had pneumonia and 10 had central line-associated bacteremia. Twenty-four of 29 (83%) had invasion of the mucocutaneous barrier at the time the positive blood culture was drawn. Clinical signs and symptoms were nonspecific. Apnea/bradycardia was the most prevalent clinical feature, occurring in 20 (69%) infants. Staphylococcus epidermidis was the most frequent blood culture isolate, occurring in 21 (72%) cases. Slime production by C-S blood culture isolates occurred in 23 (79%) cases. There was no prevalent antibiotic resistance pattern, phage type or plasmid profile among blood culture isolates from infants with bacteremia. Mucocutaneous isolates of C-S from infants with bacteremia were compared with those from infants without invasive disease. Infants with bacteremia had a significantly higher percentage of slime-producing organisms (75% vs. 58%, P = 0.027) and a significantly higher percentage of S. epidermidis species (79% vs. 53%, P = 0.001) than isolates from infants without bacteremia. Our data support the relationship of slime production and the S. epidermidis species of C-S as virulence factors in infants with foreign bodies. Testing C-S for slime production is a relatively simple laboratory procedure which may be an additional aid in the evaluation of their clinical significance.

Bacteriophage Typing↗
PubMed1981

Effect of stressful stimulation on the incidence of streptozotocin-induced diabetes in mice.

In three experiments, groups of 8-18, 45-day-old male CD-1 mice were injected with a single dose of streptozotocin (STZ) and were followed for 12-31 weeks. Experimental groups were given periodic. light-shock stimulation beginning at various times after streptozotocin injection. Blood samples were taken biweekly from all mice. Blood glucose levels were attenuated over a 22 week period in mice that were stimulated during the first 72 hours after STZ injection. Incidence of insulin-dependent diabetes (blood glucose levels over 150 mg%) was also significantly reduced in stimulated mice. Progressively increasing correlations between sampling order and blood glucose levels, which were significant over the last 12 weeks of one experiment, indicated that blood glucose levels of caged, diabetic mice responded markedly to laboratory procedures.

Animals↗
PubMedDate not supplied

Psychophysiologic correlates of nocturnal penile tumescence in normal males.

Despite increasing clinical reliance on nocturnal penile tumescence (NPT) testing for the differential diagnosis of male impotence, little is known at present about the relationship between NPT and other aspects of sleep and waking psychophysiology. This study investigated patterns of NPT, sleep, and EEG hemispheric asymmetry in 20 male subjects, using standard polysomnographic laboratory procedures for the assessment of sleep and NPT, and a method of EEG amplitude integration developed by Goldstein. Additionally, the effects of daytime sexual activity and mood state on the duration and amplitude of NPT were studied. Overall, the results of this study confirmed the well-documented relationship between NPT and stage REM, as well as demonstrating a strong association between NPT phase and nondominant hemisphere activation. Furthermore, this association appeared to strengthen over the course of the night. Hemispheric asymmetry and stage REM were also closely linked throughout. On the other hand, no significant correlations were found between daytime sexual activity or mood state and NPT. It is suggested that concurrent assessment of hemispheric asymmetry may strengthen the diagnostic power of NPT testing in impotence cases involving central organic etiology.

Adult↗
PubMed2000

Retrievable cement-retained implant-tooth-supported prosthesis: a new technique.

Clinicians often encounter difficulties with connecting natural teeth and osseointegrated implants. A new clinical technique with laboratory procedures are presented. The technique involves cementation of a two-part prosthesis over natural teeth and customized implant gold cylinders. This method achieved a passive-fit fixed bridge with retrievability maintained.

Adolescent↗
PubMed2001

The significance of passive framework fit in implant prosthodontics: current status.

The clinical and laboratory procedures employed for framework fabrication are inadequate to provide an absolute passive fit for implant-supported fixed superstructures. Although some prosthetic complications are attributed to the lack of passive fit, its effect on implant success is questionable. Nevertheless, the clinical results of increasing applications of advanced technology to improve framework fit seem promising. This article reviews the clinical significance of passive fit and the factors that affect the final fit of implant-supported frameworks.

Dental Prosthesis Design↗
PubMed2001

Implant-retained removable prosthesis with ball attachments in partially edentulous maxilla.

This clinical report presents a restorative option for the partially edentulous maxilla utilizing an implant-retained removable partial denture without retentive clasps. This approach required (1) fewer patient visits and laboratory procedures; (2) the use of minimal number of implants; (3) lower financial obligations; and (4) no sinus elevation surgery. The use of O-ring attachments provided excellent retention and stability. The detachable prosthesis over implants allows easier oral hygiene by the patient and provides superior esthetics and phonetics in cases involving advanced ridge resorption.

Bone Resorption↗
PubMedDate not supplied

DDAVP therapy controls bleeding in Ehlers-Danlos syndrome.

PURPOSE: Patients with Ehlers-Danlos syndrome (EDS), especially types IV, VI, and VIII, are at increased risk of bleeding, and most do not have specific hemostatic deficiencies that would be amenable to replacement therapy. We have investigated the ability of DDAVP (desmopressin acetate) to control bleeding in EDS. PATIENTS AND METHODS: Two children with EDS, types VIII and VI, presented with hemorrhagic symptoms and scheduled surgical procedures. Ivy bleeding times (BTs) were measured before and after intravenous (i.v.) DDAVP challenge, and i.v. DDAVP was used prophylactically for their procedures. Laboratory testing was performed to rule out other hemostatic disorders. RESULTS: Both patients had prolonged BTs that corrected following i.v. DDAVP therapy; all other laboratory values were normal. Both patients had excellent clinical hemostasis with surgery, and one has continued to use intranasal DDAVP to control epistaxis and gingival bleeding. CONCLUSIONS: The bleeding time in both patients was corrected with DDAVP, and the patients did not have any postoperative bleeding. DDAVP should be considered in other patients who have EDS with bleeding tendencies.

Bleeding Time↗
PubMedDate not supplied

Aspirin resistance: mechanisms and clinical implications.

Acetylsalicylic acid (aspirin) has been shown to irreversibly interfere with platelet function, an effect that is associated with a reduction in morbid and mortal arterial thrombotic events in multiple clinical studies. This clinical benefit appears to be attenuated by resistance to the antiplatelet effects of aspirin in up to 35% of patients. The mechanisms for aspirin resistance are multifactorial and include noncompliance with aspirin therapy, diabetes mellitus, cell-cell and drug-drug interactions, genetic polymorphisms, and coronary artery disease. It has not been determined what the best laboratory procedure is to screen for aspirin resistance. Those individuals at high risk for aspirin resistance might best be treated with an additional oral antiplatelet drug (eg, clopidogrel) to achieve maximal protection against arterial thrombotic events.

Aspirin↗
PubMedDate not supplied

Variability of response to clopidogrel: possible mechanisms and clinical implications.

Clopidogrel has been shown to inhibit adenosine diphosphate-induced platelet aggregation and has been demonstrated to be effective in reducing the risk of arterial thrombotic events in several large clinical studies. However, the clinical benefit could be attenuated by the variability of response to the antiplatelet effects of clopidogrel in as many as 30% of patients. Multiple mechanisms likely contribute to clopidogrel variability of response, including inappropriate dosing or underdosing of clopidogrel, drug-drug interactions, and genetic polymorphisms. The best laboratory procedure to screen for possible clopidogrel variability of response remains to be determined.

Brain Ischemia↗
PubMed2003

The heat-activated solderless passivation (HASP) technique for correcting nonpassive-fitting bars without soldering.

The fabrication of a cast noble alloy overdenture bar entails a variety of clinical and laboratory steps, each of which can potentially generate distortions that result in the non-passive fit of the finished product. Traditional laboratory procedures to correct the misfit of cast bars entail sectioning the bar, then reconnecting the bar segments by soldering or welding. After such procedures, research has shown that the bar may still not fit passively on the implant abutments in the patient's mouth. In addition, the overall structure of the bar would be weaker at the mended joints. The heat-activated solderless passivation (HASP) technique involves a two-step process of correcting the master cast, then attaching the cast bar to a soldering index and applying heat to relax the metal until the tensile forces of the retention screws pull the bar into a passive fit.

Composite Resins↗
PubMed2003

One-piece dowel-crown on single endosseous implants.

The unitized (one-piece) dowel-crown technique described in this article uses routine clinical and laboratory procedures, minimizes clinical appointments, and provides a simplified prosthetic restoration for a single dental implant.

Dental Abutments↗
PubMed2005

Effects of positive affect on speech disorder in schizophrenia.

Speech disorder exacerbates when negative affect is aroused in patients with schizophrenia. However, little is known about the effects of positive affect on speech disorder. A well-validated laboratory procedure was used to determine whether arousal of positive affect would modulate speech disorder in 57 stable outpatients with schizophrenia and 48 community controls. Overall, the level of speech disorder modulation was negligible for both groups, although there was considerable variability in whether patients' speech disorder exacerbated or ameliorated. Results suggest that arousal of positive affect has an ameliorative effect on speech disorder for certain patients who have relatively severe symptomatology.

Adult↗
PubMed2006

Same-sex behavior and high rates of HIV among men attending sexually transmitted infection clinics in Pune, India (1993-2002).

OBJECTIVES: To determine HIV/sexually transmitted infection (STI) prevalence, trends, and risk behaviors of men who have sex with men (MSM) and compare these with those of non-MSM attending STI clinics in Pune, India over a 10-year period. DESIGN: Cross-sectional. METHODS: From 1993 through 2002, men attending 3 STI clinics in Pune underwent HIV/STI screening. Demographic, risk behavior, clinical, and laboratory data were collected using standardized questionnaires and laboratory procedures. RESULTS: Of 10,785 men screened, 708 (6.6%) were MSM. Among these 708 MSM, 189 (31.7%) had 10 or more lifetime partners, 253 (35.7%) were married, 163 (23.1%) had sex with a hijra (eunuch), and 87 (13.3%) had exchanged money for sex. A total of 134 (18.9%) were HIV-positive, 149 (21.5%) had genital ulcer disease (GUD), 37 (5.8%) had syphilis, and 29 (4.3%) had gonorrhea (GC). Over the decade, neither HIV nor GC prevalence changed among MSM (P = 0.7), but syphilis and GUD decreased significantly (P < 0.0001). Compared with non-MSM, MSM were more likely to initiate sexual activity at age <16 years, to have >10 lifetime partners, to have sex with a hijra, and to use condoms regularly, but they did not differ significantly in HIV prevalence and had a lower prevalence of GC, GUD, and syphilis. Independent factors associated with HIV among MSM were employment (adjusted odds ratio [AOR] = 3.08; P = 0.02), history of GUD (AOR = 1.86; P = 0.003), and syphilis (AOR = 2.09; P = 0.05). CONCLUSIONS: Same-sex and high-risk sexual behaviors are prevalent among men attending STI clinics in India. Although syphilis and GUD rates decreased, HIV prevalence remained high during the decade, highlighting the importance of additional targeted efforts to reduce HIV risk among all men, including MSM, in India.

Adult↗
PubMed1995

Calibration of thromboplastins.

Anticoagulant therapy with coumarin drugs requires tests on the patient's blood to determine the dose rate for the drug. The tests involve measuring the effect of a preparation of a certain reagent, thromboplastin, in accelerating the clotting of the patient's blood. Features of the World Health Organization's recommendation on the appropriate laboratory procedure for a calibration assay and evaluation of results call for comment. The standard method involves estimation of a linear structural relation, a statistical technique long known but seldom finding practical application. This paper reviews its history, as a prelude to discussing strange mistakes in earlier publications; it also examines assessment of the precision of estimation and other aspects of the statistical method.

Humans↗
PubMed2002

PCR identification of dermatophyte fungi Trichophyton rubrum, T. soudanense and T. gourvilii.

Diagnosis of dermatophytosis employing conventional laboratory procedures has been complicated by the slow growth and varied morphological features shown by dermatophytes. After analysis of the nucleotide base sequences of a 1.2-kb fragment amplified from a dermatophyte fungus Trichophyton rubrum by arbitrarily primed PCR with random primer OPD18, a pair of primers (TRIF and TR1R) was designed and evaluated for specific identification of T. rubrum. The sensitivity of the primers TR1F and TR1R was high, as a specific PCR band of c. 600 bp was detected from as little as 7 pg of T. rubrum DNA. By examining 92 dermatophyte strains and clinical isolates, it was found that this pair of primers reacted in PCR with T. rubrum, T. soudanense and T. gourvilii through formation of the specific fragment of 600 bp, but not with any other of the dermatophyte species or varieties, fungi, yeasts or bacteria tested. As T rubrum is one of the most frequently isolated dermatophyte fungi, and T. soudanense and T. gourvilii are relatively uncommon in many parts of the world, these primers can be used for rapid, sensitive and specific identification and differentiation of T. rubrum from other fungi and micro-organisms.

DNA, Fungal↗
PubMed2006

Identification, subtyping and virulence determination of Listeria monocytogenes, an important foodborne pathogen.

Listeria monocytogenes is an opportunistic intracellular pathogen that has become an important cause of human foodborne infections worldwide. Given its close relationship to other Listeria species and its tendency to produce non-specific clinical symptoms, the availability of rapid, sensitive and specific diagnostic tests for the differentiation of L. monocytogenes from other Listeria species is helpful for selecting appropriate treatment regimens. In addition, with L. monocytogenes comprising a diversity of strains of varying pathogenicity, the ability to precisely track the strains involved in listeriosis outbreaks and speedily determine their pathogenic potential is critical for the control and prevention of further occurrences of this deadly disease. Extensive research in recent decades has revealed significant insights regarding the molecular mechanisms of L. monocytogenes infection. This in turn has facilitated the development of laboratory procedures for enhanced detection and identification of L. monocytogenes, and has also contributed to the implementation of improved control and prevention strategies against listeriosis. The purpose of this review is to summarize recent progress in the species-specific identification, subtyping and virulence determination of L. monocytogenes strains, and to discuss future research needs pertaining to these important areas of listeriosis.

Animals↗