Psoriatic Arthritis and Diabetes: A Population-Based Cross-Sectional Study

Background. Diabetes has been associated with psoriasis, but little is known about the association between psoriatic arthritis and diabetes. Methods. Patients diagnosed with psoriatic arthritis by a rheumatologist were compared to age- and sex-matched patients without psoriatic arthritis regarding the prevalence of diabetes in a population-based cross-sectional study using logistic multivariate models. The study was performed utilizing the medical database of Clalit, the largest healthcare provider organization in Israel. Results. The study included 549 patients with psoriatic arthritis ≥21 years and 1,098 patients without psoriatic arthritis. The prevalence of diabetes in patients with psoriatic arthritis was increased as compared to the prevalence in patients without psoriatic arthritis (15.3% versus 10.7%, value = 0.008). The difference was prominent among females (18.7% versus 10.3%, ) but not among males (11.2% in patients with and without psoriatic arthritis, ). In a multivariate analysis, psoriatic arthritis was associated with diabetes among females (OR = 1.60, 95% CI: 1.02–2.52, ) but not among males (OR = 0.71, 95% CI: 0.42–1.22, ). Conclusion. Our study suggests a possible association between psoriatic arthritis and diabetes in women. Women with psoriatic arthritis might be candidates for diabetes screening

Risk of attention-deficit/hyperactivity disorder in children with atopic dermatitis

Atopic dermatitis (AD) is a common, chronic, inflammatory, pruritic skin disorder that affects up to 20% of the children in Western countries. Attention-Deficit/Hyperactivity disorder (ADHD) has been reported to be more frequent in children with AD. The purpose of this study was to explore the risk for ADHD in our population of patients with AD. A population-based case-control study, using the medical database of Clalit Health Services (CHS), the largest healthcare provider organization in Israel. The study included 840 patients with AD between the age of 0-18 years and 900 age and gender frequency-matched patients without AD. The proportion of ADHD in patients with AD was 7.1% as compared to 4.1% in controls. ADHD was more frequent in boys with AD (9.6% vs. 5.2%, odds ratio (OR) 1.9, 95% confidence interval (CI) 1.1-3.2) but not in girls with AD (4.6% vs. 2.9% OR 1.5). In multivariate analyses, AD was associated with ADHD (OR 2.1, 95% CI 1.3-3.4). The current study demonstrated an association between AD and ADHD. This report and earlier observations emphasize the need for detection and treatment of ADHD in atopic patients.  </p

Knowledge, Attitudes, and Practice among Women and Doctors Concerning the Use of Folic Acid

Background and Objective. Daily folic acid intake, prior to conception and in early pregnancy, significantly reduces neural tube defects (NTDs). We compared folic acid consumption among Jewish and Bedouin women and the recommendations of family physicians and gynecologists. Methods. We compared 64 Muslim Bedouin women and 65 Jewish women. We also compared 39 gynecologists and 60 family physicians. Results. Fifty-one Jewish women (78.5%) took folic acid during pregnancy, but only seven (10.8%) before conception. Sixty Bedouin women (93.75%) took folic acid during pregnancy, but only four (6.25%) before conception (P < .05). Five Jewish women (7.7%) and two Bedouin women (3.1%) took folic acid three months before conception. Thirty-three gynecologists (87%) recommend preconception folic acid compared with thirty-six family physicians (60%) (P < .05). Conclusions. The majority of women use folic acid during pregnancy, but only few do so to prevent NTDs. There is a significant difference between doctors' recommendations and actual practice

Empathy’s echo: post-apartheid fellow feeling

The concept of empathy has been set to work, across a range of fields, to mark a break with the relational patterns of apartheid. Similarly, empathy has been identified, historically, as that which, within apartheid and colonial rule more generally, exceeded or escaped relations of domination. This paper approaches the discourse of empathy from a different angle, taking empathy as a concept embedded in colonial thinking. Given that so many claims to empathy have had recourse to psychoanalysis, the paper focuses on empathy in Freud’s work, specifically Dora’s case and Freud’s analysis of Michelangelo’s Moses, which are read alongside the images and installations of contemporary South African artist, Nandipha Mntambo, in particular her collection of images and installations in The Encounter. Three scenes are conjured wherein empathy confronts its impossibility, but rather than foreclose on empathy as a postapartheid condition, it is through the disclosure of the aporias of empathy that it might be brought into the realm of the ethical through a practice of reinscription and through the figure of Echo

Which factors affect the implementation of geriatric recommendations by primary care physicians?

Abstract Background The overall implementation rate for outpatient comprehensive geriatric assessment (OCGAU) recommendations ranges from 48.6 to 71%. The purpose of the study was to identify factors that reduce the implementation rate of geriatric recommendations. Methods The medical records of patients who were assessed in the comprehensive geriatric assessment unit over an 8 year study period were surveyed. Data collected included patient's characteristics (socio-demographic, functional, cognitive, and affective condition, co-morbidity), number of recommendations, the identity of the geriatrician, and data related to the primary physician (age, sex, seniority, number of patients referred for geriatric assessment). Results Three thousand four hundred thirty-four recommendations were made for 488 patients (mean age 83.6 ± 0.6 years) of which 1,634 (47.6%) were implemented by their primary physician. In univariate analyses patients with an implementation rate < 25%, compared to patients with implementation rate ≥75%, had a higher Charlson Comorbidity Index Total Score (CCITS) (2.5 ± 1.9 vs. 1.8 ± 1.7, P < 0.05), a lower Barthel Index (82.8 ± 16.2 vs. 87.0 ± 15.3, P < 0.05), and a lower Instrumental Activity of Daily Living score (7.2 ± 3.5 vs. 8.2 ± 3.7, P < 0.05). There were no differences between these groups in other patient characteristics or the number of recommendations made during the assessment. Similarly, there were no differences in the identity of the geriatrician or the primary physician's characteristics. In the multivariate analysis only higher CCITS was associated with a lower rate of recommendation implementation by primary physicians. Conclusions There is a need to increase the implementation rate by primary physicians by increasing and strengthening the link with them and by further training in the field of geriatrics medicine. Trial registration The Helsinki committee of the Meir Medical Center approved the study (Approval #024/2015 [k])

Catalytic Control in the Facile Proton Transfer in Taxadiene Synthase

Enzymes are highly efficient and usually very specific biocatalysts. However, some enzyme families, such as terpene synthases, are inherently promiscuous due to the extremely challenging chemistry they have evolved to tackle. Here we focus on one such enzyme, taxadiene synthase (TXS), which produces taxa-4(5),11(12)-diene, a key precursor to the chemotherapy agent taxol. A central chemical step in the biosynthesis of taxa-4(5),11(12)-diene by TXS is an intramolecular proton transfer. The inherent out of enzyme energetics for this facile proton transfer dictates a two-step proton transfer as the most favorable pathway, raising the question as to why an enzyme would prefer an indirect pathway that leaves it prone to side-product formation. In the current work, we employ hybrid quantum and molecular mechanical classical and path-integral simulations to address the nature of the intramolecular proton transfer in TXS, and we find that in the enzyme the direct proton transfer is slightly preferred over the indirect two-step pathway. This suggests that the enzyme might have evolved to favor a simpler, direct mechanistic pathway, thereby asserting <i>chemical control</i> by reducing its promiscuity. Understanding the underpinnings of such chemical control is likely to be important when attempting to design natural products in nonenzymatic environments