Psychosomatic symptoms related to exacerbation of fatigue in patients with medically unexplained symptoms.

Background: Medically unexplained symptoms (MUS) are common conditions that cause various somatic complaints and are often avoided in primary care. Fatigue frequently occurs in patients with MUS. However, the somatic and psychiatric symptoms associated with fatigue in patients with MUS are unknown. This study aimed to clarify the intensity of fatigue and the related somatic and psychiatric symptoms in patients with MUS. Methods: A total of 120 patients with MUS aged 20-64 years who visited the Department of Psychosomatic Medicine, Toho University Medical Center Omori Hospital, between January and March 2021 were considered. The participants' medical conditions were assessed using the Chalder Fatigue Scale (CFS), Somatic Symptom Scale-8 (SSS-8), and Hospital Anxiety and Depression Scale (HADS). We estimated the relationship between CFS, SSS-8 and HADS by using Spearman's rank correlation. Additionally, linear multiple regression analysis with CFS as the objective variable was used to identify symptoms related to fatigue. Results: Fatigue was significantly associated with all symptoms observed (p < 0.01). Linear multiple regression analysis revealed that "dizziness," "headache," and "Sleep medication" were extracted as relevant somatic symptoms (p < 0.05), independent of anxiety and depression, which were already known to be associated with fatigue in MUS. Conclusion: The intensity of anxiety, depression, headache, and dizziness were all associated with the intensity of fatigue in MUS patients. On the contrary, sleeping medication was associated with lower levels of fatigue in MUS.

Utility and optimal cut-off point of the Somatic Symptom Scale-8 for central sensitization syndrome among outpatients with somatic symptoms and related disorders.

BACKGROUND: Central sensitization syndrome (CSS) involves severe functional symptoms due to central sensitization. for patients with severe somatic symptoms and related disorders (SSRDs), central sensitization may be responsible for their functional symptoms. We hypothesized that screening for CSS in patients with SSRDs would identify those with severe disease. The Somatic Symptom Scale-8 (SSS-8) is a simple tool to assess medical conditions related to SSRDs, but the cut-off point to identify severe cases of comorbid CSS is unknown. This study aimed to determine the optimal cut-off point of SSS-8 for screening the CSS of patients with severe SSRDs. METHODS: In total, 143 patients with SSRDs attending outpatient clinics of a university hospital in Japan were included in the study. The participants were evaluated using the SSS-8 for somatic symptoms, Hospital Anxiety and Depression Scale (HADS) for anxiety and depressive symptoms, Pain Catastrophizing Scale (PCS) for catastrophic thoughts, and Central Sensitization Inventory (CSI-A, B) for CSS. Receiver operating characteristic (ROC) curve analysis was performed using the propensity score. The area under the curve (AUC) was calculated using a propensity score considering PCS, age, sex, HADS, and CSI-B as confounders of SSS-8 and CSS to evaluate differences in diagnostic accuracy between patients with and without SSS-8. The sensitivity and specificity of the ROC analysis were then used to determine the cut-off point for discriminating severe cases of SSS-8. RESULTS: Of the 143 participants, 126 responded (51 CSS group and 75 non-CSS group), with a valid response rate of 88.1 percent. In the ROC analysis, the propensity score including SSS-8 was statistically more accurate. The optimal cut-off point was 13, with an AUC of 0.88, sensitivity of 84.3 percent, and specificity of 77.3 percent. CONCLUSIONS: The SSS-8 is a useful tool for discriminating severe cases of SSRDs comorbid with CSS.

Effect of central sensitization on dizziness-related symptoms of persistent postural-perceptual dizziness.

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a chronic functional dizziness symptom triggered by psychological stress, but its pathophysiology is unknown. Central sensitization is considered the cause of functional diseases, such as medically unexplained symptoms, and is a psychosocially affected condition. However, the association between dizziness symptoms in PPPD and central sensitization remains unclear. Thus, we conducted a cross-sectional study on the relation between dizziness symptoms and central sensitization in PPPD. METHODS: We recruited 61 outpatients with dizziness who met the PPPD diagnostic criteria. In addition to the evaluation of dizziness symptoms using the Dizziness Handicap Inventory, the participants were evaluated using the Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Central Sensitization Inventory (CSI). A CSI score of 40 or higher was defined as central sensitization syndrome (CSS), and the severity of each condition in CSS and non-CSS participants was compared. We also evaluated the association between dizziness symptoms and central sensitization and coexisting symptoms using linear multiple regression analysis. RESULTS: We analyzed the data of 50 valid responses (valid response rate of 82.0 percent). Compared with the non-CSS group, the CSS group had a higher degree of disability owing to dizziness and a higher rate of complications of anxiety and depression. The regression analysis results showed that the severity of central sensitization was a related factor that could enhance the dizziness symptoms of PPPD. CONCLUSIONS: Central sensitization may affect the dizziness symptoms of PPPD as an exacerbating factor.

Neck abscess due to Salmonella Choleraesuis: case study and literature review.

Introduction. We herein describe a case with a neck abscess due to non-typhoidal Salmonella (NTS). NTS habitually reside in our environment and colonize all animals including mammals. Colonizations of pigs, chickens, cows and sheep are important because food poisoning episodes in human are often associated with meat. Extra-intestinal infection due to NTS has numerous presentations and complications, with aortic aneurysms being common. Case presentation. A 26-year-old Japanese male complaining of left-sided neck swelling was referred to our hospital for a suspected deep neck abscess. An enhanced computed tomography scan of the neck revealed a low density lesion in the left-sided deep neck area, and consequently the patient underwent urgent incision and drainage. After this urgent operation, Salmonella Choleraesuis was isolated from a greyish-white abscess. The patient ultimately recovered with antimicrobial administration, though re-incision for lymphadenectomy was necessary. The neck abscess may have developed because he had eaten raw meat. Furthermore, untreated diabetes mellitus was diagnosed at presentation. Conclusion.Salmonella enterica serovar Choleraesuis infections are rare in Japan. NTS are generally recognized as important pathogens in food poisoning globally, and attention is required to avoid the development of extra-intestinal infections. In Japan, the increasing lifestyle diversity in recent years highlights the importance of recognizing rare infections.

Clinical features of outpatients with somatization symptoms treated at a Japanese psychosomatic medicine clinic.

BACKGROUND: Somatization is produced due to the summation of psychological factors, irrespective of the presence or absence of physical factors. A group of diseases with severe pain and other disorders exhibit so-called Medically Unexplained Symptoms (MUS), and the characteristics of patients with MUS are largely unexplained. In this paper, the characteristics of a series of new patients with somatization treated in a Japanese university hospital are discussed. METHOD: The subjects were 871 patients who newly visited the Department of Psychosomatic Medicine, Toho University Omori Medical Center between January and December of 2015. Under the assumption that the definition of somatization is same as that of MUS, the correlation between somatization and the age, sex, academic background, chief complaints, reasons for visiting the medical center, diagnosis, symptoms, presence or absence of a referral form, continued treatment after the first visit, and marital status of these patients at the time of their respective examinations were evaluated. RESULTS: Of the patients studied, 68% suffered from somatization. Among them, 11% met the definition of Functional Somatic Symptoms (FSS) and 74% had somatization associated with mood disorder or anxiety disorder. Digestive symptoms were reported by 33%, headaches by 24%, and unusual sensations by 21%. Whereas no correlation was found between somatization symptoms and the patients' academic background, marital history, or medical history after the first visit, a positive correlation (p < 0.05) was found between somatization and patients who had been referred by their doctor. CONCLUSION: Many of the studied patients who suffered from somatization, regardless of age and sex, were referred to us by doctors from other hospitals. It was concluded that many patients difficult to diagnose or deal with are referred the Department of Psychosomatic Medicine of Japanese university hospitals, thus these hospitals must assume great responsibility for preventing mistaken diagnoses by conducting effective psychological treatment and thorough medical examinations.

Development of (Trifluoromethyl)zinc Reagent as Trifluoromethyl Anion and Difluorocarbene Sources.

The trifluoromethylation of carbonyl compounds is accomplished by the stable (trifluoromethyl)zinc reagent generated and then isolated from CF3I and ZnEt2, which can be utilized as a trifluoromethyl anion source (CF3(-)). The reaction proceeds smoothly with diamine as a ligand and ammonium salt as an initiator, providing the corresponding trifluoromethylated alcohol products. Moreover, the (trifluoromethyl)zinc reagent can also be employed as a difluorocarbene source (:CF2) not only for gem-difluoroolefination of carbonyl compounds with phosphine but also for gem-difluorocyclization of alkenes or alkynes via the thermal decomposition, respectively.

Pulmonary Nocardiosis due to Nocardia asiatica in an Immunocompetent Host.

We describe a case of pulmonary nocardiosis due to Nocardia asiatica in an immunocompent 64-year-old-female. Wadowsky-Yee-Okuda-α-ketoglutarate (WYOα) agar, a selective media for Legionella species, was useful for the detection based on the growth-inhibition of normal oral flora and growth-promotion of Nocardia species.

Stable but reactive perfluoroalkylzinc reagents: application in ligand-free copper-catalyzed perfluoroalkylation of aryl iodides.

The aromatic perfluoroalkylation catalyzed by a copper(I) salt with bis(perfluoroalkyl)zinc reagents Zn(RF)2(DMPU)2, which were prepared and then isolated as a stable white powder from perfluoroalkyl iodide and diethylzinc, was accomplished to provide the perfluoroalkylated products in good-to-excellent yields. The advantages of this reliable and practical catalytic reaction are 1) air-stable and easy-to-handle bis(perfluoroalkyl)zinc reagents can be utilized, 2) the reagent is reactive and hence the operation without activators and ligands is simple, and 3) not only trifluoromethylation but also perfluoroalkylation can be attained.

Paradigm shift from alkaline (earth) metals to early transition metals in fluoroorganometal chemistry: perfluoroalkyl titanocene(III) reagents prepared via not titanocene(II) but titanocene(III) species.

Perfluoroalkyl (RF) titanocene reagents [Cp2Ti(III)RF] synthesized via [Cp2Ti(III)Cl] rather than [Cp2Ti(II)] show new types of perfluoroalkylation reactions. The [Cp2Ti(III)RF] reagents exhibit a wide variety of reactivity with carbonyl compounds including esters and nitriles, and selectivities far higher than those reported for conventional RFLi and RFMgX reagents.

Cu-catalyzed trifluoromethylation of aryl iodides with trifluoromethylzinc reagent prepared in situ from trifluoromethyl iodide.

The trifluoromethylation of aryl iodides catalyzed by copper(I) salt with trifluoromethylzinc reagent prepared in situ from trifluoromethyl iodide and Zn dust was accomplished. The catalytic reactions proceeded under mild reaction conditions, providing the corresponding aromatic trifluoromethylated products in moderate to high yields. The advantage of this method is that additives such as metal fluoride (MF), which are indispensable to activate silyl groups for transmetallation in the corresponding reactions catalyzed by copper salt by using the Ruppert-Prakash reagents (CF3SiR3), are not required.