From phaeohyphomycosis to disseminated chromoblastomycosis: A retrospective study of infections caused by dematiaceous fungi.

OBJECTIVE: Infections caused by dematiaceous fungi are more common in tropical and subtropical areas. We aimed to describe the clinical, microbiological and therapeutic aspects of case patients diagnosed at a University Hospital located on an Indian Ocean island. PATIENTS AND METHODS: We performed an observational retrospective study of infections caused by dematiaceous fungi diagnosed at the University Hospital of Saint-Pierre, Reunion, from 2000 to 2015. Mycological identifications were performed at the National Reference Center for Invasive Mycosis and Antifungal Agents (Paris). RESULTS: The review of clinical and microbiological data of 11 patients identified revealed that five were infected by dematiaceous fungi. Two had cutaneous phaeohyphomycosis, two had cerebral phaeohyphomycosis and one had cutaneous chromoblastomycosis with brain and potentially medullary dissemination. Skin lesions and cerebral abscesses were quite varied. CONCLUSION: Infections caused by dematiaceous fungi are rare. Medullary and brain localizations are extremely rare, especially for chromoblastomycosis. Cutaneous manifestations of phaeohyphomycosis are varied; diagnosis is thus more difficult. It is therefore important, when confronted with a chronic tumor-like lesion in endemic areas, to perform a biopsy for pathology and fungal culture. While surgical excision is not always sufficient, medical treatment of these infections is not standardized, but relies on an azole, which can be associated with another antifungal agent.

Extrapyramidal symptoms associated with the adjunct of nortriptyline to a venlafaxine-valproic acid combination.

The onset of extrapyramidal symptoms has been traditionally linked to the prescription of neuroleptic treatment: there are some reports in the international literature describing extrapyramidal effects related to antidepressant. In this paper we present a case under multiple pharmacologic treatment in whom extrapyramidal symptoms developed shortly after the adjunct of nortriptyline to a combination of venlafaxine and valproic acid administered for several months. We describe here the clinical history of this patient, affected by Bipolar Disorder, type II, and the progressive pharmacologic path in his treatment. Possible hypothesis to explain this evidence are discussed.

Illness behaviour and anxiety in dental patients.

The Authors evaluate the influence of illness behaviour (measured by IBQ) on patients' delay in seeking dental treatment for caries or periodontal pathology, and the relationship with anxiety (measured by STAI) and with social--demographic and clinical data. One hundred patients were studied. Delay in coming for a dental visit is influenced by family habit, level of education and fear experienced. The 'late' patients present significantly higher scores for denial on the IBQ. More serious pathology is in relation with greater denial. Anxiety is positively correlated with the IBQ scales dysphoria, hypochondria, disease conviction, irritability and inversely with denial.

Psychosomatic factors and peptic ulcer disease.

The authors present a review of the role of psychological factors in peptic ulcer disease (PU). Three lines of research have been identified: personality, psychological factors and PU; stressful life events and their relationship to PU; possible interactions between biological parameters, the CNS and psychosocial aspects. The analysis of the studies presented shows that there is a certain level of agreement with regard to personality and psychological aspects; PU patients present a personality with dependence/independence problems and high level of anxiety. Data concerning the role of stress appear to be far from uniform and often even contradictory. Much remains to be done with respect to the possible links between psychological and biological parameters; there have been only few studies in man--which have not been duplicated and were performed on a limited number of patients--but a fair number in animals. However, the results concerning the relationship between psyche and secretory patterns are very interesting, and represent one of the most important lines of future research.

Personality factors in chronic gastric and duodenal ulcers: a controlled study.

The personality profiles, as evaluated with Cattell's 16 personality factors test (16 PF), were compared in 25 subjects with gastric ulcer, 25 with duodenal ulcer and 25 healthy controls. Subjects were matched for sex, age, education, geographical area of living and duration of illness (only for patients). The profiles of the gastric and duodenal ulcer patients were substantially similar and characterized by greater anxiety, dependence, introversion, low ego strength and greater adaptability as compared to the controls. Patients with gastric ulcer, however, seemed to be slightly more disturbed than those with duodenal ulcer.

Pain and personality in duodenal ulcer: a preliminary report.

Personality factors measured by the Cattell's 16 Personality Factor Questionnaire were assessed for 78 duodenal ulcer patients with moderate to severe pain and in 30 duodenal ulcer patients with mild or no pain. The two groups were comparable for relevant sociodemographic variables. Patients with moderate to severe pain were significantly more tender-minded, kindly, and tended to be more introspective and glum than those reporting mild or no pain. However, the reported differences are small; adjustment of the p values to avoid Type I errors makes these differences no longer statistically significant. These results must be considered preliminary; further studies are necessary to understand the topic better.

Psychological stress and gastric emptying in normal subjects.

Gastric emptying half-time was measured in 10 healthy volunteers on two different occasions over a one-week interval, with an identical test meal. The first was the control evaluation, and at the second assessment, psychological stress was induced by the technique of dichotomous listening. Psychological and physiological parameters were assessed before and during the test period. No significant or consistent modifications of gastric-emptying time were induced by the stress procedure. Looking at individual subjects instead of mean values, gastric emptying was unchanged in 5 subjects, slower in 3, and faster in the remaining 2. These 3 groups had different mean values on two subscales of the Sixteen Personality Factor Questionnaire.

Social adjustment in bipolar and unipolar single-episode and recurrently depressed inpatients.

Social adjustment scores were compared using the Social Adjustment Scale for 24 inpatients with single-episode major depression, 72 with recurrent major depression, and 28 with bipolar disorder. There were no differences between the three groups either in overall score or on single scales.

Pulmonary manifestations of leptospirosis.

BACKGROUND: Pulmonary manifestations in leptospirosis are considered a major complication and are related to a poor prognosis. We present a large series of patients with pulmonary involvement using a practical approach based on the presence of acute respiratory failure (ARF). METHODS: A retrospective study of patients with confirmed leptospirosis. RESULTS: One hundred and sixty-nine patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. One hundred and thirty-four patients (36.7±14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of ARF. Univariate analysis found the following factors related to severe pulmonary leptospirosis: dyspnoea (OR=10.14, p<0.0001), pulmonary crepitations (OR=4.8, p<0.0004), abnormal chest X-ray (OR=9.88, p<0.007) with alveolar shadowing (OR=8.12, p<0.0001), oliguria/anuria (OR=5.48, p<0.0001), hepatomegaly (OR=7.11, p< 0.0001), shock (OR=8.38, p< 0.0001), ICU admission (OR=60.08, p< 0.0001), dialysis (OR=4.87, p< 0.001), mechanical ventilation (OR=216, p< 0.0001) and development of nosocomial infection (OR=21.5, p< 0.0001). The mortality rate was significantly different between severe (40%) and non-severe (5.3%) pulmonary forms (OR=11.87, p< 0.0001). Multivariate analysis found two independent factors related to severe pulmonary involvement: dyspnoea (OR=10.18, p< 0.0001) and oliguria/anuria (OR=4.87, p< 0.0009). We performed a multivariate analysis to assess independent factors related to mortality and found: mechanical ventilation requirement (OR=27.85, p< 0.0001) and AST greater than 150 IU/L (OR=4.57, p< 0.02). Haemoptysis was associated with survival (OR=0.2, p< 0.02). CONCLUSIONS: Severe pulmonary involvement in leptospirosis is associated with extensive disease involving other organs. The association of multiple factors is associated with severe forms of the disease and a high mortality rate.

[Pulmonary manifestations of leptospirosis]. / Manifestations pulmonaires de la leptospirose.

BACKGROUND: Pulmonary manifestations in leptospirosis are considered a major complication, and are related to a poor prognosis. We present a large series of patients with pulmonary involvement using a practical approach based on the presence of acute respiratory failure (ARF). METHODS: A retrospective study of patients with confirmed leptospirosis. RESULTS: 169 patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. 134 patients (36.7 + or - 14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of acute respiratory failure. Univariate analysis found the following factors related to severe pulmonary leptospirosis: dyspnoea (OR 10.14, p<0.0001), pulmonary crepitations (OR 4.8, p<0.0004), abnormal chest X Ray (OR 9.88, p<0.007) with alveolar shadowing (OR 8.12, p<0.0001), oliguria/anuria (OR 5.48, p<0.0001), hepatomegaly (OR 7.11, p<0.0001), shock (OR 8.38, p<0.0001), ICU admission (OR 60.08, p<0.0001), dialysis (OR 4.87, p<0.001), mechanical ventilation (OR 216, p<0.0001) and development of nosocomial infection (OR 21.5, p<0.0001). The mortality rate was significantly different between severe (40%) and non-severe (5.3%) pulmonary forms (OR 11.87, p<0.0001). Multivariate analysis found 2 independent factors related to severe pulmonary involvement: dyspnoea (OR 10.18, p<0.0001), and oliguria/anuria (OR 4.87, p<0.0009). We performed a multivariate analysis to assess independent factors related to mortality and found: Mechanical ventilation requirement (OR 27.85, p<0.0001) and ASAT>150 UI/L (OR 4.57, p<0.02). Haemoptysis was associated with survival (OR 0.2, p<0.02). CONCLUSION: Severe pulmonary involvement in leptospirosis is associated with extensive disease involving other organs. The association of multiples factors is associated with severe forms of the disease and a high mortality rate.

Serum cholesterol and psychological distress in hospitalized depressed patients.

OBJECTIVE: To assess the relationship between total serum cholesterol and various psychosocial variables in depressed in-patients. METHOD: One hundred and eighty-six patients had their total fasting serum cholesterol assessed following admission; psychiatric diagnoses were obtained with the structured clinical interview for DSM-IV (SCID) interview. Psychopathology was measured with a clinician rated scale [Montgomery and Asberg Depressive Rating Scale (MADRS)] and a self-rating scale [Symptom checklist-90 (SCL-90)]. RESULTS: Univariate analyses showed lower total serum cholesterol levels being correlated with higher scores in several psychopathological areas. Multivariate analyses indicated that male gender, lower age and higher MADRS scores were the most predictive variables for lower cholesterol levels. CONCLUSION: The data suggest, in this depressed population, an association between serum cholesterol and depressive symptoms. What is the cause and what is its effect is not possible to say from this cross-sectional study.

The role of stressful life events in duodenal ulcer recurrence: a prospective study.

This study prospectively assessed whether stressful life events (LE) were predictive of duodenal ulcer (DU) recurrence during remission of disease. We administered Paykel's Interview for Recent Life Events to 80 patients to assess events that occurred 12 months prior to the first interview and again 6 to 12 months later for LE that occurred during the interval. Upper gastrointestinal endoscopy detected DU recurrence in 11 patients. Prospective data analysis showed no significant difference in LE between relapsing and relapse-free groups, whereas retrospective analysis showed significantly more LE (p > .03) among relapsing patients. LE seems to have played a marginal role in DU recurrence.

Personality and duodenal ulcer response to antisecretory treatment.

Two groups of duodenal ulcer (DU) patients, responders and nonresponders, have been compared in order to verify if psychological factors are linked to relapse. Responders are defined as those patients who on endoscopy did not present proven relapse during treatment with maintenance doses of antisecretory drugs (cimetidine 400 mg/day, ranitidine 150 mg/day, pirenzepine 50 mg/day) for a period of 12 months after healing of the lesion. Nonresponders were all patients presenting with at least one relapse during treatment with antisecretory drugs. One hundred and twelve DU patients (81 responders, 31 nonresponders) were examined with the Cattell 16 Personality Factors Questionnaire (16PF) form C. There were no significant differences between the two groups for age, sex, duration of illness and type of drug treatment. The 16 PF scores of responders and nonresponders were not statistically different except in the case of factor E (dominance), in which the nonresponder subjects scored higher than responder subjects (p less than 0.01). However, when the significance level was corrected for the number of variables involved, the above finding is not considered to be meaningful.