Commentary on Multiple Personality and Channeling

In her paper, Multiple Personality and Channeling, Dr. Rogers compares and contrasts the two phenomena, tries to outline some distinctions between them, and expresses concern lest persons who have the ability to channel be pathologized for their capacity to engage in a creative social activity which is currently very much in vogue (p.11 ) (1). I appreciate her efforts and here will offer some additional observations and reflections from my own work and experience

Subsequent Pregnancy in Women with a History of Postpartum Psychosis

Postpartum psychosis stands out among the psychiatric syndromes associated with child birth, not able for the variability of its symptom profile and the potential severity of its course, if unrecognized. Significant questions regarding nosology, etiology, prevention and treatment remain only partially answered (1). While controversy surrounds many of the critical issues regarding postpartum psychosis, including its definition, current epidemiologic data indicates severe, frequently psychotic episodes occur following 1-2 per 1,000 of all births (2). As diagnosis and treatment of puerperal conditions have evolved, clinicians now are frequently involved in assisting women with a history of postpartum psychosis with decision making about subsequent pregnancies. The purpose of this paper is to review the fundamental issues related to postpartum psychosis, examine the risk of subsequent episodes of psychiatric illness in postpartum and non-postpartum periods, and review three cases of women hospitalized with postpartum psychosis who went on to deliver a second child without incident, focusing on issues of prediction, prophylax is and intervention

Frank Siebert -- Then, And More Than Forty Years On”

Richard B. Singer; M.D., is a consultant in medical risk appraisal and lives in Falmouth, Maine. He and Frank Siebert went to school together in the late 1920s. At a class reunion in 1980, they rediscovered each other and have corresponded since. In what follows, Singer describes their encounters over the past seven decades

Therapeutic Alliance and Involuntary Commitment of a Minor

Children are legally entitled to be present throughout the commitment hearing for continued hospitalization. The effect of this process on the therapeutic alliance between the child and the psychiatrist warrants examination. A case study of a 14 year-old boy who participated in the court proceedings is presented. The outcome of the hearing resulted in a disruption of the therapeutic alliance. Alter natives to current commitment procedures for minors are discussed

Atovaquone Compared with Dapsone for the Prevention of Pneumocystis carinii Pneumonia in Patients with HIV Infection Who Cannot Tolerate Trimethoprim, Sulfonamides, or Both

BACKGROUND Although trimethoprim–sulfamethoxazole is the drug of choice for the prevention of Pneumocystis carinii pneumonia, many patients cannot tolerate it and must switch to an alternative agent. METHODS We conducted a multicenter, open-label, randomized trial comparing daily atovaquone (1500-mg suspension) with daily dapsone (100 mg) for the prevention of P. carinii pneumonia among patients infected with the human immunodeficiency virus who could not tolerate trimethoprim–sulfamethoxazole. The median follow-up period was 27 months. RESULTS Of 1057 patients enrolled, 298 had a history of P. carinii pneumonia.P. cariniipneumonia developed in 122 of 536 patients assigned to atovaquone (15.7 cases per 100 person-years), as compared with 135 of 521 in the dapsone group (18.4 cases per 100 person-years; relative risk for atovaquone vs. dapsone, 0.85; 95 percent confidence interval, 0.67 to 1.09; P=0.20). The relative risk of death was 1.07 (95 percent confidence interval, 0.89 to 1.30; P=0.45), and the relative risk of discontinuation of the assigned medication because of adverse events was 0.94 (95 percent confidence interval, 0.74 to 1.19; P=0.59). Among the 546 patients who were receiving dapsone at base line, the relative risk of discontinuation because of adverse events was 3.78 for atovaquone as compared with dapsone (95 percent confidence interval, 2.37 to 6.01; P CONCLUSIONS Among patients who cannot tolerate trimethoprim–sulfamethoxazole, atovaquone and dapsone are similarly effective for the prevention ofP. carinii pneumonia. Our results support the continuation of dapsone prophylaxis among patients who are already receiving it. However, among those not receiving dapsone, atovaquone is better tolerated and may be the preferred choice for prophylaxis against P. cariniipneumonia

Adverse Cerebral Outcomes after Coronary Bypass Surgery

ABSTRACT Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury. Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures). Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (47 percent, 30 percent, and 8 percent; P0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol. Conclusions Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or long-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury. (N Engl J Med 1996;335:1857-63.)

Biomedical data retrieval utilizing textual data in a gene expression database by Richard Lu, MD.

Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2010.Cataloged from PDF version of thesis.Includes bibliographical references (p. 68-74).Background: The commoditization of high-throughput gene expression sequencing and microarrays has led to a proliferation in both the amount of genomic and clinical data that is available. Descriptive textual information deposited with gene expression data in the Gene Expression Omnibus (GEO) is an underutilized resource because the textual information is unstructured and difficult to query. Rendering this information in a structured format utilizing standard medical terms would facilitate better searching and data reuse. Such a procedure would significantly increase the clinical utility of biomedical data repositories. Methods: The thesis is divided into two sections. The first section compares how well four medical terminologies were able to represent textual information deposited in GEO. The second section implements free-text search and faceted search and evaluates how well they are able to answer clinical queries with varying levels of complexity. Part I: 120 samples were randomly extracted from samples deposited in the GEO database from six clinical domains-breast cancer, colon cancer, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), type I diabetes mellitus (IDDM), and asthma. These samples were previously annotated manually and structured textual information was obtained in a tag:value format. Data was mapped to four different controlled terminologies: NCI Thesaurus, MeSH, SNOMED-CT, and ICD- 10. The samples were assigned a score on a three-point scale that was based on how well the terminology was able to represent descriptive textual information. Part II: Faceted and free-text search tools were implemented, with 300 GEO samples included for querying. Eight natural language search questions were selected randomly from scientific journals. Academic researchers were recruited and asked to use the faceted and free-text search tools to locate samples matching the question criteria. Precision, recall, F-score, and search time were compared and analyzed for both free-text and faceted search. Results: The results show that the NCI Thesaurus consistently ranked as the most comprehensive terminology across all domains while ICD-10 consistently ranked as the least comprehensive. Using NCI Thesaurus to augment the faceted search tool, each researcher was able to reach 100% precision and recall (F-score 1.0) for each of the eight search questions. Using free-text search, test users averaged 22.8% precision, 60.7% recall, and an F-score of 0.282. The mean search time per question using faceted search and free-text search were 116.7 seconds, and 138.4 seconds, respectively. The difference between search time was not statistically significant (p=0. 734). However, paired t-test analysis showed a statistically signficant difference between the two search strategies with respect to precision (p=O.001), recall (p=O.042), and F-score (p<0. 001). Conclusion: This work demonstrates that biomedical terms included in a gene expression database can be adequately expressed using the NCI Thesaurus. It also shows that faceted searching using a controlled terminology is superior to conventional free-text searching when answering queries of varying levels of complexity.S.M

Comprehensive Characterization of Escherichia coil O104:H4 Isolated from Patients in the Netherlands

In 2011, a Shiga toxin-producing Enteroaggregative Escherichia coli (EAEC Stx2a+) O104:H4 strain caused a serious outbreak of acute gastroenteritis and hemolytic-uremic syndrome (HUS) in Germany. In 2013, E. coli O104:H4 isolates were obtained from a patient with HUS and her friend showing only gastrointestinal complaints. The antimicrobial resistance and virulence profiles of these isolates together with three EAEC Stx2a+ O104:H4 isolates from 2011 were determined and compared. Whole-genome sequencing (WGS) was performed for detailed characterization and to determine genetic relationship of the isolates. Four additional genomes of EAEC Stx2a+ O104:H4 isolates of 2009 and 2011 available on NCBI were included in the virulence and phylogenetic analysis. All E. coli O104:H4 isolates tested were positive for stx2a, aatA, and terD but were negative for escV. All, except one 2011 isolate, were positive for aggR and were therefore considered EAEC. The EAEC Stx2a+ O104:H4 isolates of 2013 belonged to sequence type (ST) ST678 as the 2011 isolates and showed slightly different resistance and virulence patterns compared to the 2011 isolates. Core-genome phylogenetic analysis showed that the isolates of 2013 formed a separate cluster from the isolates of 2011 and 2009 by 27 and 20 different alleles, respectively. In addition, only a one-allele difference was found between the isolate of the HUS-patient and that of her friend. Our study shows that EAEC Stx2a+ O104:H4 strains highly similar to the 2011 outbreak clone in their core genome are still circulating necessitating proper surveillance to prevent further outbreaks with these potentially pathogenic strains. In addition, WGS not only provided a detailed characterization of the isolates but its high discriminatory power also enabled us to discriminate the 2013 isolates from the isolates of 2009 and 2011 expediting the use of WGS in public health services to rapidly apply proper infection control strategies