The epidemiology of panic disorder and agoraphobia in Europe

A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7–2.2) and 1.3% (0.7–2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability

A comparison of seismic risk maps for Italy

National seismic risk maps are an important risk mitigation tool as they can be used for the prioritization of regions within a country where retrofitting of the building stock or other risk mitigation measures should take place. The production of a seismic risk map involves the convolution of seismic hazard data, vulnerability predictions for the building stock and exposure data. The seismic risk maps produced in Italy over the past 10 years are compared in this paper with recent proposals for seismic risk maps based on state-of-the-art seismic hazard data and mechanics-based vulnerability assessment procedures. The aim of the paper is to open the discussion for the way in which future seismic risk maps could be produced, making use of the most up-to-date information in the fields of seismic hazard evaluation and vulnerability assessment

Low- and intermediate-temperature ammonia/hydrogen oxidation in a flow reactor: Experiments and a wide-range kinetic modeling

Understanding the chemistry behind the oxidation of ammonia/hydrogen mixtures is crucial for ensuring the flexible use of such mixtures in several applications, related to propulsion systems and power generation. In this work, the oxidation of ammonia/hydrogen blends was investigated through an experimental and kinetic-modeling study, where the low- and intermediate-temperature conditions were considered. An experimental campaign was performed in a flow reactor, at stoichiometric conditions and near-atmospheric pressure (126.7 kPa). The mole fraction of fuels, oxidizer and final products was measured. At the same time, a comprehensive kinetic model was set up, following a modular and hierarchical approach, and implementing the recently-available elementary rates. Such a model was used to interpret the experimental results, and to extend the analysis to literature data, covering several oxidation features. The reactivity boost provided by H2 addition was found to be approximately linear with its mole fraction in both flow- and jet-stirred-reactor conditions (except for the smallest H2 amounts in the flow reactor), in contrast with the more-than-linear increase in the laminar flame speed. The key role of HO2 in regulating fuel conversion and autoignition at low temperature was confirmed for binary mixtures, with H2NO being the bottleneck to the low-temperature oxidation of NH3-rich blends. On the other hand, the nitrogen fate was found to be mostly regulated by NHx + NO propagation and termination channels

Ophthalmoplegia due to Miller Fisher syndrome in a patient with myasthenia gravis

Here, we describe a 79-year-old man, admitted to our unit for worsening diplopia and fatigue, started a few weeks after an episode of bronchitis and flu vaccination. Past medical history includes myasthenia gravis (MG), well-controlled by Pyridostigmine, Azathioprine, and Prednisone. During the first days, the patient developed progressive ocular movement abnormalities up to complete external ophthalmoplegia, severe limb and gait ataxia, and mild dysarthria. Deep tendon reflexes were absent in lower limbs. Since not all the symptoms were explainable with the previous diagnosis of myasthenia gravis, other etiologies were investigated. Brain MRI and cerebrospinal fluid analysis were normal. Electromyography showed a pattern of predominantly sensory multiple radiculoneuritis. Suspecting Miller Fisher syndrome (MFS), the patient was treated with plasmapheresis with subsequent clinical improvement. Antibodies against GQ1b turned out to be positive. MFS is an immune-mediated neuropathy presenting with ophthalmoplegia, ataxia, and areflexia. Even if only a few cases of MFS overlapping with MG have been described so far, the coexistence of two different autoimmune disorders can occur. It is always important to evaluate possible differential diagnosis even in case of known compatible diseases, especially when some clinical features seem atypical

Subtelomeric FISH analysis in 76 patients with syndromic developmental delay/intellectual disability

<p>Abstract</p> <p>Background</p> <p>Intellectual disability affects approximately 1 to 3% of the general population. The etiology is still poorly understood and it is estimated that one-half of the cases are due to genetic factors. Cryptic subtelomeric aberrations have been found in roughly 5 to 7% of all cases.</p> <p>Methods</p> <p>We performed a subtelomeric FISH analysis on 76 unrelated children with normal standard karyotype ascertained by developmental delay or intellectual disability, associated with congenital malformations, and/or facial dysmorphisms.</p> <p>Results</p> <p>Ten cryptic chromosomal anomalies have been identified in the whole cohort (13,16%), 8 in the group of patients characterized by developmental delay or intellectual disability associated with congenital malformations and facial dysmorphisms, 2 in patients with developmental delay or intellectual disability and facial dysmorphisms only.</p> <p>Conclusion</p> <p>We demonstrate that a careful clinical examination is a very useful tool for pre-selection of patients for genomic analysis, clearly enhancing the chromosomal anomaly detection rate. Clinical features of most of these patients are consistent with the corresponding emerging chromosome phenotypes, pointing out these new clinical syndromes associated with specific genomic imbalances.</p