Osteoporosis in anorexia nervosa.

Osteoporosis is common in anorexia nervosa. It places these patients at increased lifetime risk for fractures. Bone loss may never recover completely even once weight is restored. The strongest predictors of osteoporosis include low body weight and amenorrhea. Loss of bone density can occur rapidly and very early in the course of anorexia nervosa. The etiology of bone loss in the patient with anorexia nervosa is multifactorial. In addition to reduced estrogen and progesterone, excess cortisol levels and low levels of insulin growth factor (IGF-1), a correlate for bone formation, are observed. Dual energy x-ray absorptiometry screening is important to assess bone density. However, successful treatments to reverse bone loss, in those with anorexia nervosa, are lacking. Early diagnosis and treatment of anorexia nervosa are paramount to prevent initial weight loss and subsequent loss of bone.

Interpreting the complete blood count in anorexia nervosa.

Anemia, leukopenia and thrombocytopenia are frequent complications of anorexia nervosa. The complete blood count provides useful information to diagnose and characterize these findings. Anemia tends to be normocytic and normochromic. Leukopenia manifests as a deficiency of lymphocytes or neutrophils. Thrombocytopenia, if severe, may confer a bleeding risk. A careful history and physical examination should be performed to evaluate for other possible etiologies of cytopenias. Cell line deficiencies related solely to anorexia nervosa often resolve with nutritional rehabilitation. Knowledge of these potential findings and their expected outcomes may help avoid costly and potentially invasive procedures in patients with anorexia nervosa.

Intimate partner violence in women hospitalized on an internal medicine service: prevalence and relationship to responses to the review of systems.

BACKGROUND: Although intimate partner violence is common, the prevalence in patients hospitalized on internal medicine services and whether it is associated with numerous positive responses to the review of systems are not known. OBJECTIVE: The objective of this study was to assess the prevalence of intimate partner violence in women hospitalized on an internal medicine service and to determine whether it is associated with the number or types of positive responses to the review of systems. DESIGN: This was a prospective, cross-sectional survey. SETTING: The setting was a university-affiliated public hospital. PATIENTS: The patients were women, 18 to 60 years old, hospitalized on an internal medicine service. MEASUREMENTS: The measurements were responses to screens for intimate partner violence and a review-of-systems questionnaire. RESULTS: Of the 78 women asked to participate, 72 agreed (92%). The prevalences of experiencing intimate partner violence at any time in the patient's life or within the year prior to presentation were 61% and 22%, respectively. Women with a history of intimate partner violence and women without a history of intimate partner violence had 11 +/- 4 (mean +/- standard deviation) and 8 +/- 5 positive responses to the review of systems, respectively (P < 0.01). Women with 10 or more positive responses were more likely to have a history of intimate partner violence than those with 9 or fewer (odds ratio = 4.82, confidence interval = 1.63-14.23). CONCLUSIONS: Intimate partner violence is common in women hospitalized in an internal medicine service of a university-affiliated public hospital. Although numerous somatic complaints are associated with a history of intimate partner violence, the high prevalence of this problem warrants screening of all women admitted to internal medical services.

A cooperative care model: cardiologists and hospitalists reduce length of stay in a chest pain observation unit.

Chest pain observation units are increasingly used to evaluate patients at low risk for cardiovascular events and are commonly staffed by cardiologists. The role of hospitalists in this setting has not been described. We assessed emergency department (ED) length of stay before and after adding hospitalists to the care team among 493 patients. Prior to intervention, median ED length of stay was 19.3 hours, which decreased to 11.0 hours with the addition of hospitalists (43% decrease, P <0.0001). No significant difference in 30-day cardiac event rate was observed (5% versus 6%, P = 0.68).

The genome sequence of Mycoplasma hyopneumoniae strain 232, the agent of swine mycoplasmosis.

We present the complete genome sequence of Mycoplasma hyopneumoniae, an important member of the porcine respiratory disease complex. The genome is composed of 892,758 bp and has an average G+C content of 28.6 mol%. There are 692 predicted protein coding sequences, the average protein size is 388 amino acids, and the mean coding density is 91%. Functions have been assigned to 304 (44%) of the predicted protein coding sequences, while 261 (38%) of the proteins are conserved hypothetical proteins and 127 (18%) are unique hypothetical proteins. There is a single 16S-23S rRNA operon, and there are 30 tRNA coding sequences. The cilium adhesin gene has six paralogs in the genome, only one of which contains the cilium binding site. The companion gene, P102, also has six paralogs. Gene families constitute 26.3% of the total coding sequences, and the largest family is the 34-member ABC transporter family. Protein secretion occurs through a truncated pathway consisting of SecA, SecY, SecD, PrsA, DnaK, Tig, and LepA. Some highly conserved eubacterial proteins, such as GroEL and GroES, are notably absent. The DnaK-DnaJ-GrpR complex is intact, providing the only control over protein folding. There are several proteases that might serve as virulence factors, and there are 53 coding sequences with prokaryotic lipoprotein lipid attachment sites. Unlike other mycoplasmas, M. hyopneumoniae contains few genes with tandem repeat sequences that could be involved in phase switching or antigenic variation. Thus, it is not clear how M. hyopneumoniae evades the immune response and establishes a chronic infection.

Neurocysticercosis: nursing perspectives.

Management of neurocysticercosis (NCC) is mostly by means of prevention and antihelminthic medications. We reviewed the role of medical and surgical intervention in patients with NCC lesions. We also identified two patients with isolated NCC lesions to determine whether they might be rendered seizure free through surgical removal of the lesion. The two patients, one male and one female, ages 21 and 43 years, respectively, presented with generalized seizures. Electroencephalograms showed focal slowing consistent with the site of the lesion and had failed antiepileptic drug therapy. Magnetic resonance imaging scans showed a distinct single-ring-enhanced lesion in each patient consistent with late-stage NCC. The patients underwent surgery with ultrasonagraphic guidance to remove the cysts. Surgery involved resection of the suspected calcified neurocystic lesion. Both patients have been seizure free since surgery. Patients with a single calcified neurocystic lesion may benefit from surgery for control of seizures. Prospective evaluations are needed to assess the timing of surgery in relation to the stage of the disease. Nurses play a significant role in the primary prevention of this disease and care throughout treatment.