Electrocardiogram analysis in Anderson-Fabry disease: a valuable tool for progressive phenotypic expression tracking.

Background: Electrocardiogram (ECG) has proven to be useful for early detection of cardiac involvement in Anderson-Fabry disease (AFD); however, little evidence is available on the association between ECG alterations and the progression of the disease. Aim and Methods: To perform a cross sectional comparison of ECG abnormalities throughout different left ventricular hypertrophy (LVH) severity subgroups, providing ECG patterns specific of the progressive AFD stages. 189 AFD patients from a multicenter cohort underwent comprehensive ECG analysis, echocardiography, and clinical evaluation. Results: The study cohort (39% males, median age 47 years, 68% classical AFD) was divided into 4 groups according to different degree of left ventricular (LV) thickness: group A ≤ 9 mm (n = 52, 28%); group B 10-14 mm (n = 76, 40%); group C 15-19 mm (n = 46, 24%); group D ≥ 20 mm (n = 15, 8%). The most frequent conduction delay was right bundle branch block (RBBB), incomplete in groups B and C (20%,22%) and complete RBBB in group D (54%, p < 0.001); none of the patients had left bundle branch block (LBBB). Left anterior fascicular block, LVH criteria, negative T waves, ST depression were more common in the advanced stages of the disease (p < 0.001). Summarizing our results, we suggested ECG patterns representative of the different AFD stages as assessed by the increases in LV thickness over time (Central Figure). Patients from group A showed mostly a normal ECG (77%) or minor anomalies like LVH criteria (8%) and delta wave/slurred QR onset + borderline PR (8%). Differently, patients from groups B and C exhibited more heterogeneous ECG patterns: LVH (17%; 7% respectively); LVH + LV strain (9%; 17%); incomplete RBBB + repolarization abnormalities (8%; 9%), more frequently associated with LVH criteria in group C than B (8%; 15%). Finally, patients from group D showed very peculiar ECG patterns, represented by complete RBBB + LVH and repolarization abnormalities (40%), sometimes associated with QRS fragmentation (13%). Conclusions: ECG is a sensitive tool for early identification and long-term monitoring of cardiac involvement in patients with AFD, providing "instantaneous pictures" along the natural history of AFD. Whether ECG changes may be associated with clinical events remains to be determined.

Invertase production of common storage moulds in food and feed grains as a possibility for rapid detection of Aspergillus flavus group and Aspergillus fumigatus.

Invertase production of grain storage moulds was studied. Aspergillus spp. and Penicillium spp. were grown in a sucrose based liquid medium, at 37 degrees C. The A. flavus group (A. flavus, A. parasiticus, A. nomius, A. oryzae) and A. fumigatus showed a fast growth and intense invertase activity, while other Aspergillus spp. and Penicillium spp. grew slower and produced less invertase. The pattern of accumulated reducing sugar after 20 and 48 h of incubation was characteristic to the species studied. From inoculation studies the detection limit was calculated as: 1-10 conidia of A. flavus group and A. fumigatus, as compared to 10(3)-10(4) for the other species studied. The method may be recommended as a rapid test for the detection of A. flavus group and A. fumigatus in food and feed grains.

A method for understanding admission decision making in a psychiatric emergency room.

OBJECTIVE: To increase understanding of decisions about inpatient admission, a four-step algorithm was used to examine 2,073 consecutive visits to a public hospital psychiatric emergency room, 684 of which resulted in admission. METHODS: Admission decision outcomes and patient data were cross-tabulated to identify conditions, or rules, under which outcome was almost certain. Discriminant function models were then made of individual clinicians' decision-making process and of individual diagnostic groups. To understand cases not covered in previous steps, a third discriminant function model was constructed. RESULTS: The four-step method successfully predicted outcomes in 85 percent of cases at a minimum of an 80 percent confidence level. The variables of psychosis and violence combined into the most powerful predictor of admission. Twelve rules that applied to 41.4 percent of all cases were found. Eleven models of individual clinicians' decision policies applied to slightly more half of all cases and successfully classified about 95 percent of them. Eleven models of diagnostic groups applied to 93.2 percent of all cases and correctly predicted about 75 percent. The final discriminant model for the 171 cases not covered by the by the first three steps correctly classified about 90 percent of residual cass. CONCLUSIONS: Psychiatric admission decisions are influenced by multiple variables that should be studied by examining general admission criteria and differences between clinicians.

Differential use of admission status in a psychiatric emergency room.

The goal of this study is to understand how different admission statuses of varying degrees of restrictiveness (informal, voluntary, emergency admission, and involuntary admission on medical certification) are used in the psychiatric emergency room. The study included 656 consecutively admitted patients from a psychiatric emergency room over 28 months. Data were analyzed univariately and using two discriminant function models. Only six (0.9%) patients were informal admissions. Voluntary admissions (24.9%, n = 163) tended to be for patients with affective disorders, those who were self-referred, suicidal risks, those who had a marital or family problem, and those who were over age 60. Nonvoluntary admissions (74.2%) tended to be for patients with schizophreniform symptoms and those referred by police or court. Involuntary admission on medical certification (53.2%, n = 349) tended to be for patients who were family referred, younger than 20 years old, had social interpersonal nonfamily stressors, were suicidal risks, were or had been married, had organic psychotic disorder, history of violence, and manic episode or schizophrenia. Emergency admission patients (21%, n = 138) were characterized by being between 40 to 50 years old, having a diagnosis of psychoactive substance abuse, having previous outpatient treatment, and having been referred by emergency service. The major difference between involuntary admissions and voluntary was that the former were more often actively psychotic or referred by police or court. The major difference between emergency admission and involuntary admission on medical certification seemed to be that patients with a more available support system, whose primary diagnoses was not substance abuse and who were suicidal, were preferred for involuntary admission on medical certification.

Neural and non-neural origin of calcitonin gene-related peptide (CGRP) in the gastric mucosa.

We have used immunohistochemistry and in situ hybridization histochemistry to visualize CGRP and the mRNA encoding the CGRP precursor in the stomach. CGRP is present in nerve fibers in the mucosa. CGRP mRNA and CGRP itself are also found in non-neural cells in the lamina propria. These cells are likely to be macrophages or B-lymphocytes.

A new clinical information system for emergency psychiatry.

A unique and novel Clinical Information System has been set up to link all of the Psychiatric Emergency Rooms in The Bronx, New York. The system is designed from a clinician's perspective and it is an inexpensive system using personal computers. This new system of information exchange utilizes two interesting aspects of applying computer technology to assist clinicians: 1) use of a scannable medical record form to speed the input of data; and, 2) information exchange among many emergency rooms via a dial up access to a central database.

Development of an optically scanned consultation-liaison data base.

Every clinical service must record certain data about its patient care activities. In low-volume services, such as Psychiatric Inpatient Services, with perhaps 20-30 admissions per month, and an average patient stay of 2-4 weeks, a large amount of data on each patient can be obtained during the contact time with the patient. On the other hand, very large-volume psychiatric services, such as Emergency and Consultation-Liaison (C-L) Services, may not need or be able to gather such a large amount of data on every patient seen. This article describes the development of a brief, optically scannable, and computerized minimal data base form for patients seen by a very large division of C-L Psychiatry. The system is feasible and easily auditable for completeness and reliability. This data base has already served many important functions beyond providing an administrative statistical summary of services rendered. It is presented as a model for the development of similarly efficient data collection methods for other high-volume psychiatric services.

Termination patterns of calcitonin gene-related peptide-immunoreactive nerve fibers in the dorsal horn of the human spinal cord.

CGRP-immunoreactive varicose nerve fibers displayed three kinds of termination patterns in the cervical, thoracic and lumbar segments of the human spinal cord. Bundles of immunoreactive fibers formed a loose network in lamina I. A homogenous band of immunoreactive fibers filled lamina II. Multiple bundles of CGRP-positive fibers coursed through the superficial laminae towards deep portions of the grey matter. In the lumbar segments, in contrast to the cervical and thoracic segments, the bundles could be followed deep into the dorsal funiculus. Bundles of varicose immunoreactive fibers were seen to twine around the dendrites of neurons located in lamina I, in the dorsal funiculus of the lumbar segments and deep in the dorsal horn (laminae III-V). The corresponding types of large and medium-sized neurons were found in silver impregnated adjacent spinal cord sections. It is suggested that neurons in the above locations preferentially receive multiple contacts from CGRP-containing nerve fibers along their extensive dendritic arborizations (CGRP-target neurons).

Institutional self-help therapy for alcoholism: clinical outcome.

Self-help peer-led therapy can yield improved cost effectiveness and clinical outcome in hospital-based alcoholism treatment. This was demonstrated by comparing two ambulatory alcoholism treatment programs: a control program operated solely by professional staff, and an experimental one based on peer-led self-help (SH). The SH program was staffed by only half as many primary therapists as the control. Patients in both programs were evaluated over the course of one year. By means of the Patient Status Form, a clinical assessment instrument applied monthly, SH patients were found to score significantly higher on social adjustment, although retention and drinking rates, and utilization of Alcoholics Anonymous and disulfiram were no different from controls. This study is the continuation of an initial comparison in which SH patients were found to have enhanced retention in treatment after discharge from an impatient service.

A lithium clinic in a community mental health center.

A community mental health center established a group lithium clinic to introduce a medical model of treatment for manic-depressive patients and to reduce staff time in caring for these patients. Clinical maintenance consisted of a monthly group meeting with a psychiatrist and a social worker; the social worker led general discussions on symptomatology, the toxic side-effects of lithium, and the importance of medication compliance, while the psychiatrist reviewed the effectiveness of the pharmacotherapy with each patient individually. Drug compliance was good, and patients seemed pleased to discuss their problems with others having similar diagnoses. Most patients ended or reduced visits to their therapists, and staff time spent on lithium-taking patients was greatly reduced.

The assessment of depression: a model for quality review of emergency psychiatry.

Of 167 patients appearing in the psychiatric emergency room of a metropolitan hospital, 68 were categorized as significantly depressed by the Zung depression scale but only 43 were considered depressed by clinician-interviewers. The use of a patient self-rating scale, which in this setting permitted the identification of deficiencies in the recognition of depression, is applicable to quality review in a variety of clinical settings.