Reversibility of alexithymia with effective treatment of moderate-to-severe psoriasis: longitudinal data from EPIDEPSO.

BACKGROUND: Alexithymia refers to difficulty in identifying and expressing emotions. Alexithymia is associated with high burden of disease in patients with psoriasis. OBJECTIVES: To investigate whether alexithymia was reversible in patients with psoriasis following real-life therapeutic intervention. METHODS: The Epidemiological Study in Patients with Recently Diagnosed Psoriasis (EPIDEPSO; NCT01964443) was a 1-year multicentre observational study investigating the prevalence of alexithymia and other psychosocial comorbidities in patients with psoriasis with ≤ 10 years' disease duration and eligible for systemic treatment. Alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20) at baseline, 6 months and 1 year. RESULTS: There was a statistically significant decrease in the prevalence of alexithymia in the follow-up cohort, from 26·7% at baseline to 21·2% at 6 months and 18·8% at 1 year. More than half of the patients (n = 77, 53·8%) who were alexithymic at baseline experienced reversion of their alexithymia. Reversion of alexithymia was higher in patients who reached a high level of disease control, defined as ≥ 75% or ≥ 90% improvement in Psoriasis Area and Severity Index. Reversion of alexithymia was associated with dramatic improvement in quality of life, anxiety and depression. Moreover, hazardous alcohol use, highly prevalent in patients with alexithymia, was reduced almost threefold at 1 year. CONCLUSIONS: Alexithymia and associated high disease burden may be reversible in patients with effective treatment of psoriasis. Proactive recognition of patients who are unable to identify and express their feelings is important.

Prevalence of alexithymia in patients with psoriasis and its association with disease burden: a multicentre observational study.

BACKGROUND: Single-centre studies show that alexithymia, defined as difficulty in recognizing and describing emotions, is more prevalent among patients with psoriasis than in the general population. However, its prevalence and the consequences of the association between alexithymia and psoriasis are unclear. OBJECTIVES: The primary objective of this study was to determine the prevalence of alexithymia, as defined by a score ≥ 61 in the 20-item Toronto Alexithymia Scale, in a large sample of patients who had plaque psoriasis for ≤ 10 years and were eligible for phototherapy or systemic treatment. The secondary objectives were to investigate the relationship between alexithymia and the clinical and psychological aspects of psoriasis. METHODS: Data were collected in the framework of an observational, multicentre, international study, the EPidemiological Study In Patients With Recently DiagnosEd PSOriasis (EPIDEPSO), aiming at investigating the prevalence of alexithymia and other psychosocial comorbidities in patients with psoriasis of ≤ 10 years' disease duration. RESULTS: The prevalence of alexithymia within a cohort of 670 patients was 24·8% (95% confidence interval 21·7-28·2). Patients with alexithymia had a higher burden of psoriasis, including significant impairment of quality of life, higher levels of anxiety and depression, a higher risk of alcohol dependency and impairment of work productivity, compared with patients without alexithymia. CONCLUSIONS: It is important to identify alexithymic patients with psoriasis in clinical practice as they experience a higher disease burden and have a lower ability to express their feelings.

Implementing malaria control in South Africa, Eswatini and southern Mozambique during the COVID-19 pandemic.

The COVID-19 pandemic has strained healthcare delivery systems in a number of southern African countries. Despite this, it is imperative that malaria control and elimination activities continue, especially to reduce as far as possible the number and rate of hospitalisations caused by malaria. The implementation of enhanced malaria control/elimination activities in the context of COVID-19 requires measures to protect healthcare workers and the communities they serve. The aim of this review is therefore to present innovative ideas for the timely implementation of malaria control without increasing the risk of COVID-19 to healthcare workers and communities. Specific recommendations for parasite and vector surveillance, diagnosis, case management, mosquito vector control and community outreach and sensitisation are given.

Implications of an inverse branching aftershock sequence model.

The branching aftershock sequence (BASS) model is a self-similar statistical model for earthquake aftershock sequences. A prescribed parent earthquake generates a first generation of daughter aftershocks. The magnitudes and times of occurrence of the daughters are obtained from statistical distributions. The first generation daughter aftershocks then become parent earthquakes that generate second generation aftershocks. The process is then extended to higher generations. The key parameter in the BASS model is the magnitude difference Deltam* between the parent earthquake and the largest expected daughter earthquake. In the application of the BASS model to aftershocks Deltam* is positive, the largest expected daughter event is smaller than the parent, and the sequence of events (aftershocks) usually dies out, but an exponential growth in the number of events with time is also possible. In this paper we explore this behavior of the BASS model as Deltam* varies, including when Deltam* is negative and the largest expected daughter event is larger than the parent. The applications of this self-similar branching process to biology and other fields are discussed.

Near-mean-field behavior in the generalized Burridge-Knopoff earthquake model with variable-range stress transfer.

Simple models of earthquake faults are important for understanding the mechanisms for their observed behavior in nature, such as Gutenberg-Richter scaling. Because of the importance of long-range interactions in an elastic medium, we generalize the Burridge-Knopoff slider-block model to include variable range stress transfer. We find that the Burridge-Knopoff model with long-range stress transfer exhibits qualitatively different behavior than the corresponding long-range cellular automata models and the usual Burridge-Knopoff model with nearest-neighbor stress transfer, depending on how quickly the friction force weakens with increasing velocity. Extensive simulations of quasiperiodic characteristic events, mode-switching phenomena, ergodicity, and waiting-time distributions are also discussed. Our results are consistent with the existence of a mean-field critical point and have important implications for our understanding of earthquakes and other driven dissipative systems.

Structure of fluctuations near mean-field critical points and spinodals and its implication for physical processes.

We analyze the structure of fluctuations near critical points and spinodals in mean-field and near-mean-field systems. Unlike systems that are non-mean-field, for which a fluctuation can be represented by a single cluster in a properly chosen percolation model, a fluctuation in mean-field and near-mean-field systems consists of a large number of clusters, which we term fundamental clusters. The structure of the latter and the way that they form fluctuations has important physical consequences for phenomena as diverse as nucleation in supercooled liquids, spinodal decomposition and continuous ordering, and the statistical distribution of earthquakes. The effects due to the fundamental clusters implies that they are physical objects and not only mathematical constructs.

Ergodicity in natural earthquake fault networks.

Numerical simulations have shown that certain driven nonlinear systems can be characterized by mean-field statistical properties often associated with ergodic dynamics [C. D. Ferguson, W. Klein, and J. B. Rundle, Phys. Rev. E 60, 1359 (1999); D. Egolf, Science 287, 101 (2000)]. These driven mean-field threshold systems feature long-range interactions and can be treated as equilibriumlike systems with statistically stationary dynamics over long time intervals. Recently the equilibrium property of ergodicity was identified in an earthquake fault system, a natural driven threshold system, by means of the Thirumalai-Mountain (TM) fluctuation metric developed in the study of diffusive systems [K. F. Tiampo, J. B. Rundle, W. Klein, J. S. Sá Martins, and C. D. Ferguson, Phys. Rev. Lett. 91, 238501 (2003)]. We analyze the seismicity of three naturally occurring earthquake fault networks from a variety of tectonic settings in an attempt to investigate the range of applicability of effective ergodicity, using the TM metric and other related statistics. Results suggest that, once variations in the catalog data resulting from technical and network issues are accounted for, all of these natural earthquake systems display stationary periods of metastable equilibrium and effective ergodicity that are disrupted by large events. We conclude that a constant rate of events is an important prerequisite for these periods of punctuated ergodicity and that, while the level of temporal variability in the spatial statistics is the controlling factor in the ergodic behavior of seismic networks, no single statistic is sufficient to ensure quantification of ergodicity. Ergodicity in this application not only requires that the system be stationary for these networks at the applicable spatial and temporal scales, but also implies that they are in a state of metastable equilibrium, one in which the ensemble averages can be substituted for temporal averages in studying their spatiotemporal evolution.

Co-trimoxazole and trimethoprim in complicated urinary tract infection.

Previous work has suggested that co-trimoxazole may be superior to trimethoprim in the treatment of complicated urinary tract infection. A prospective study has been done to assess the relative value of the drugs in this situation using trimethoprim at higher than normal dosage. Fifty three patients (33 women and 20 men) were randomly allocated to either a fourteen-day course of co-trimoxazole tabs, 2 twice a day (27 patients) or trimethoprim 250 mg twice a day (26 patients). After patient withdrawals from the study, 17 (77%) of the co-trimoxazole group achieved a sterile urine three weeks after starting treatment compared with 15 (65%) in the trimethoprim group (X2 = 0.80). When those patients with sterile urine at three weeks who could be reassessed four weeks later were analyzed, 8 (89%) of the co-trimoxazole patients maintained a sterile urine against 7 (58%) in the trimethoprim group (X2 = 1.09). Although statistical significance was not attained, the results suggest that even at increased dosage, trimethoprim would not appear to be as efficient as co-trimoxazole in complicated urinary tract infection.

Flushing. Long-term side effect of orchiectomy in treatment of prostatic carcinoma.

Orchiectomy is considered a safe and simple procedure, free from serious side effects, in the treatment of prostatic carcinoma. We have found that 76 percent of patients experienced postorchiectomy flushes, and 30 percent believed their symptoms warranted treatment. The flushing started at between one and twelve months (average 2.7 months) postoperatively and lasted an average of thirty months or, in some cases, up to the time of death (average 33 months). No single precipitating factor was found, and no single hormone seemed to be responsible. Special attention was given to the nonflushers to see whether or not it was of prognostic significance, and it appears that the slight elevation in the testosterone level sufficient to prevent flushing may indicate a nontesticular source of androgen. Medroxyprogesterone acetate (Provera), 5 mg twice daily, appeared to be an effective agent for controlling the flushes.

Genitourinary tuberculosis in patients under twenty-five years of age.

There were 29 patients under the age of twenty-five years in a series of 230 patients with genitourinary tuberculosis. Younger patients were less likely to have had previous tuberculosis but more likely to have a family history of tuberculosis. Abdominal or loin pain was a more common presenting feature in those under twenty five, and they were less likely to require surgery than older patients.

Intermittent thiazide therapy in recurrent stone formers.

An intermittent thiazide regimen consisting of bendrofluazide, 5 mg. daily, with potassium supplements was given to 17 recent stone formers for period ranging between fifteen months to eight years (mean four years two months). No new stone formation was evident in 8 patients with no radiologic evidence of stones on starting treatment who previously had a stone incidence rate of 0.59 incidents per patient-year. In an additional 9 patients with radiologic evidence of stones on starting treatment the stone recurrence rate was reduced from 0.45 to 0.34 incidents per patient-year. Mild side effects were observed in 2 patients which resolved on discontinuing the treatment regimen.

Precursory dynamics in threshold systems.

A precursory dynamics, motivated by the analysis of recent experiments on solid-on-solid friction, is introduced in a continuous cellular automaton that mimics the physics of earthquake source processes. The resulting system of equations for the interevent cycle can be decoupled and yields an analytical solution in the mean-field limit, exhibiting a smoothing effect of the dynamics on the stress field. Simulation results show the resulting departure from scaling at the large-event end of the frequency distribution, and support claims that the field leakage may parametrize the superposition of scaling and characteristic regimes observed in real earthquake faults.

The treatment and eradication of sheep lice and ked with cyhalothrin--a new synthetic pyrethroid.

A new synthetic pyrethroid, cyhalothrin, has been evaluated as both a sheep dip and a jetting fluid for the control of body lice (Damalinia ovis), face lice (Linognathus ovillus), foot lice (Linognathus pedalis) and the sheep ked (Melophagus ovinus). A dip wash concentration of 1.25 ppm cyhalothrin eradicated D. ovis from sheep. A jetting fluid at a concentration of 20 ppm also eradicated D. ovis. In the field cyhalothrin was evaluated at 20 ppm as a dip wash and at 50 ppm as a jetting fluid. These field trials confirmed the ability of cyhalothrin to eradicate D. ovis from short and long-woolled sheep. The sucking lice, L. ovillus and L. pedalis, were also found to be very susceptible to cyhalothrin at a dip wash concentration of 20 ppm, but it was necessary to treat the predilection sites infested by these parasites twice within a 3-week period to achieve their eradication. Sheep ked (M. ovinus) were eradicated from an infected flock of sheep after plunge dipping in cyhalothrin at 20 ppm.

Genito-urinary tuberculosis in Glasgow 1970 to 1979: a review of 230 patients.

Two hundred and thirty patients with genito-urinary tuberculosis presenting between 1970 and 1979 were reviewed. In 22 per cent there was a history of previous tuberculosis and a family history in 14 per cent. Night sweats and weight loss were uncommon. The mean duration of medical treatment was 17 months. Surgery was necessary in 49 per cent of patients but reconstructive procedures were only performed in 7 per cent of cases. The mean follow-up period after diagnosis was 46 months. Patients with initial renal calcification were followed-up for a similar time to those with no calcification. Complications during follow-up were no more common in those with initial renal calcification than in those without this feature. With the exception of 1971 and 1972, there was a steady incidence of 20 or so new cases of genito-urinary tuberculosis per year in Glasgow.

Cellular automaton model of damage.

We investigate the role of equilibrium methods and stress transfer range in describing the process of damage. We find that equilibrium approaches are not applicable to the description of damage and the catastrophic failure mechanism if the stress transfer is short ranged. In the long-range limit, equilibrium methods apply only if the healing mechanism associated with ruptured elements is instantaneous. Furthermore we find that the nature of the catastrophic failure depends strongly on the stress transfer range. Long-range transfer systems have a failure mechanism that resembles nucleation. In short-range stress transfer systems, the catastrophic failure is a continuous process that, in some respects, resembles a critical point.

Simulation of the Burridge-Knopoff model of earthquakes with variable range stress transfer.

Simple models of earthquake faults are important for understanding the mechanisms for their observed behavior, such as Gutenberg-Richter scaling and the relation between large and small events, which is the basis for various forecasting methods. Although cellular automaton models have been studied extensively in the long-range stress transfer limit, this limit has not been studied for the Burridge-Knopoff model, which includes more realistic friction forces and inertia. We find that the latter model with long-range stress transfer exhibits qualitatively different behavior than both the long-range cellular automaton models and the usual Burridge-Knopoff model with nearest-neighbor springs, depending on the nature of the velocity-weakening friction force. These results have important implications for our understanding of earthquakes and other driven dissipative systems.

A simulation-based approach to forecasting the next great San Francisco earthquake.

In 1906 the great San Francisco earthquake and fire destroyed much of the city. As we approach the 100-year anniversary of that event, a critical concern is the hazard posed by another such earthquake. In this article, we examine the assumptions presently used to compute the probability of occurrence of these earthquakes. We also present the results of a numerical simulation of interacting faults on the San Andreas system. Called Virtual California, this simulation can be used to compute the times, locations, and magnitudes of simulated earthquakes on the San Andreas fault in the vicinity of San Francisco. Of particular importance are results for the statistical distribution of recurrence times between great earthquakes, results that are difficult or impossible to obtain from a purely field-based approach.