Susan Messing

Vitamin D deficiency and psychotic features in mentally ill adolescents: A cross-sectional study

BackgroundVitamin D deficiency is a re-emerging epidemic, especially in minority populations. Vitamin D is crucial not only for bone health but for proper brain development and functioning. Low levels of vitamin D are associated with depression, seasonal affective disorder, and schizophrenia in adults, but little is known about vitamin D and mental health in the pediatric population.MethodsOne hundred four adolescents presenting for acute mental health treatment over a 16-month period were assessed for vitamin D status and the relationship of 25-OH vitamin D levels to severity of illness, defined by presence of psychotic features.ResultsVitamin D deficiency (25-OH D levels <20 ng/ml) was present in 34%; vitamin D insufficiency (25-OH D levels 20–30 ng/ml) was present in 38%, with a remaining 28% in the normal range. Adolescents with psychotic features had lower vitamin D levels (20.4 ng/ml vs. 24.7 ng/ml; p = 0.04, 1 df). The association for vitamin D deficiency and psychotic features was substantial (OR 3.5; 95% CI 1.4-8.9; p <0.009). Race was independently associated with vitamin D deficiency and independently associated with psychosis for those who were Asian or biracial vs. white (OR = 3.8; 95% CI 1.1‒13.4; p < 0.04). Race was no longer associated with psychosis when the results were adjusted for vitamin D level.ConclusionsVitamin D deficiency and insufficiency are both highly prevalent in adolescents with severe mental illness. The preliminary associations between vitamin D deficiency and presence of psychotic features warrant further investigation as to whether vitamin D deficiency is a mediator of illness severity, result of illness severity, or both. Higher prevalence of vitamin D deficiency but no greater risk of psychosis in African Americans, if confirmed, may have special implications for health disparity and treatment outcome research.

Temporal and Demographic Factors Influencing the Desire for Plastic Surgery after Gastric Bypass Surgery

Background: An increasing number of gastric bypass patients desire plastic surgery after massive weight loss. However, the timing of interest and factors influencing the desire for body contouring have not been studied. Methods: Two thousand five hundred one gastric bypass patients were surveyed. Outcome measures included years since gastric bypass, laparoscopic versus open procedures, body mass indexes, income, prior plastic surgery, desire for body contouring, and need for a payment plan. Multiple variables were assessed by univariate and multivariate analysis. Results: Nine hundred twenty-six patients (817 women and 109 men; mean age, 47.2 years) responded. Eight hundred eleven patients were considering body contouring: 685 patients (84.5 percent) desired body contouring after gastric bypass and 126 wanted no further surgery (15.5 percent). Desire was inversely related to age (p < 0.0001), years since gastric bypass (p = 0.052), and open versus laparoscopic gastric bypass (p = 0.04), but was two times more likely in women (p = 0.008) and divorced versus married individuals (p = 0.04). Patients desiring a payment plan were younger (p = 0.0210) and had lower post–gastric bypass body mass indexes (p = 0.007). Age was inversely related to desire for a payment plan but directly related to the inability to afford or lack of desire for body contouring (p = 0.02). Conclusions: A majority of post–bariatric surgery patients desire body contouring; younger, divorced, female patients who had laparoscopic gastric bypass voiced the strongest interest in body contouring. Thus, efforts should be directed toward facilitating body contouring in this subpopulation because they appear the most motivated.

Trait Neuroticism, Depression, and Cognitive Function in Older Primary Care Patients

OBJECTIVE Prior studies on the association of trait neuroticism and cognitive function in older adults have yielded mixed findings. The authors tested hypotheses that neuroticism is associated with measures of cognition and that depression moderates these relationships. DESIGN Cross-sectional observational study. SETTING Primary care offices. PARTICIPANTS Primary care patients aged > or =65 years. MEASUREMENTS Trait neuroticism was assessed by the NEO-Five Factor Inventory. Major and minor depressions were determined by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and depressive symptom severity by the Hamilton Depression Rating Scale (Ham-D). Cognitive measures included the Mini-Mental State Examination (MMSE), Initiation-Perseveration subscale of the Mattis Dementia Rating Scale, and Trail-Making tests A and B. RESULTS In multiple regression analyses, neuroticism was associated with MMSE score independent of depression diagnosis (beta = -0.04, chi2 = 14.2, df = 1, p = 0.0002, 95% confidence interval [CI] = -0.07 to -0.02) and Ham-D score (beta = -0.04, chi2 = 8.97, df = 1, p = 0.003, 95% CI = -0.06 to -0.01). Interactions between neuroticism and depression diagnosis (chi2 = 7.21, df = 2, p = 0.03) and Ham-D scores (chi2 = 0.55, df = 1, p = 0.46) failed to lend strong support to the moderation hypothesis. CONCLUSION Neuroticism is associated with lower MMSE scores. Findings do not confirm a moderating role for depression but suggest that depression diagnosis may confer additional risk for poorer global cognitive function in patients with high neuroticism. Further study is necessary.

Clinical disease activity and acute phase reactant levels are discordant among patients with active rheumatoid arthritis: acute phase reactant levels contribute separately to predicting outcome at one year

IntroductionClinical trials of new treatments for rheumatoid arthritis (RA) typically require subjects to have an elevated acute phase reactant (APR), in addition to tender and swollen joints. However, despite the elevation of individual components of the Clinical Disease Activity Index (CDAI) (tender and swollen joint counts and patient and physician global assessment), some patients with active RA may have normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels and thus fail to meet entry criteria for clinical trials. We assessed the relationship between CDAI and APRs in the Consortium of Rheumatology Researchers of North America (CORRONA) registry by comparing baseline characteristics and one-year clinical outcomes of patients with active RA, grouped by baseline APR levels.MethodsThis was an observational study of 9,135 RA patients who had both ESR and CRP drawn and a visit at which CDAI was >2.8 (not in remission).ResultsOf 9,135 patients with active RA, 58% had neither elevated ESR nor CRP; only 16% had both elevated ESR and CRP and 26% had either ESR or CRP elevated. Among the 4,228 patients who had a one-year follow-up visit, both baseline and one-year follow-up modified Health Assessment Questionnaire (mHAQ) and CDAI scores were lowest for patients with active RA but with neither APR elevated; both mHAQ and CDAI scores increased sequentially with the increase in number of elevated APR levels at baseline. Each individual component of the CDAI followed the same trend, both at baseline and at one-year follow-up. The magnitude of improvement in both CDAI and mHAQ scores at one year was associated positively with the number of APRs elevated at baseline.ConclusionsIn a large United States registry of RA patients, APR levels often do not correlate with disease activity as measured by joint counts and global assessments. These data strongly suggest that it is appropriate to obtain both ESR and CRP from RA patients at the initial visit. Requiring an elevation in APR levels as a criterion for inclusion of RA patients in studies of experimental agents may exclude some patients with active disease.

Factors Independently Associated With Complications and Length of Stay after Hip Arthroplasty : Analysis of the National Surgical Quality Improvement Program

By analysis of the American College of Surgeons National Surgical Quality Improvement Program database, we identified factors associated with postoperative complications and increased hospital stay after total hip arthroplasty in 4281 patients. There was a minor complication rate of 2.7%, a major complication rate of 4.2%, and a mortality rate of 0.26% within 30 days of the procedure. After adjusted analysis, obesity, preoperative anemia, and longer operative time were all associated with wound complications. Preoperative anemia, higher American Society of Anesthesiologists class, and prolonged operative time were associated with development of a major complication. A predischarge major complication resulted in an increased length of stay of 6.248 days (±0.286, P < .0001). One in 25 hip arthroplasty patients developed a major postoperative complication, and 1 in 16, a medical complication after elective hip arthroplasty.

A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn's disease: An analysis of outcomes from the NSQIP database

Aim  Studies to date examining the impact of laparoscopy in resection for Crohns disease on short‐term morbidity have been limited by small study populations. The aim of this study was to establish the impact of the operative approach (laparoscopic or open) on outcomes after ileocolic resection for Crohn’s disease.

Patterns of plastic surgical use after gastric bypass: who can afford it and who will return for more.

Background: More patients are undergoing plastic surgery after gastric bypass. Socioeconomic factors influencing the decision to have body contouring after gastric bypass have not been studied in the current literature. Methods: In this study, 2501 consecutive gastric bypass patients were surveyed. Outcome variables were assessed by univariate and multivariable analyses. Results: Nine hundred twenty-six patients (817 women and 109 men) responded (40.3 percent of the 2296 surveys that at least may have been received), with a mean follow-up of 2.4 years. One hundred five (11.3 percent) underwent body contouring. Thirty-four patients assumed all costs for body contouring, and of these, 47 percent had multiple operations. Sixty-eight patients had some insurance coverage; 26 percent of these patients personally paid for additional body contouring. Having multiple procedures was not explained by any variables in our model. Body contouring was related to years since gastric bypass (p < 0.0001), post-gastric bypass body mass index (p < 0.03), change in body mass index (p < 0.0001), open versus laparoscopic gastric bypass (p < 0.0001), and income category greater than

Comparative Analysis of Disease Activity Measures, Use of Biologic Agents, Body Mass Index, Radiographic Features, and Bone Density in Psoriatic Arthritis and Rheumatoid Arthritis Patients Followed in a Large U.S. Disease Registry

20,000 (p < 0.03). Expenditures for body contouring were greater if the patient assumed costs versus had some insurance (p < 0.03), but were not related to income. Patients who assumed all costs of body contouring had lower pre-gastric bypass and post-gastric bypass body mass indexes (p < 0.007). Conclusions: A minority of patients underwent body contouring. Patients assuming the costs of body contouring were twice as likely to have additional surgery. These results suggest that socioeconomic factors play an important role in the decision to have body contouring but may not predict who will have concomitant or additional procedures.

Site-specific mesenchymal control of inflammatory pain to yeast challenge in vulvodynia-afflicted and pain-free women.

Objective. To compare disease activity, radiographic features, and bone density in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) matched cohorts. Methods. Disease activity and radiographic data in the Consortium of Rheumatology Researchers of North America database from 2001 to 2008 were compared for 2481 patients with PsA and 17,107 patients with RA subsequently matched for age, gender, and disease duration. Radiographic outcomes included presence of erosions, and joint deformity. In addition, bone mineral density (BMD) scores for lumbar spine (L-spine) and femoral neck were compared using the same matching criteria plus weight and smoking status. Results. Tender (4.5 vs 3.4, p < 0.001) and swollen (4.4 vs 2.9, p < 0.012) joint counts, and modified Health Assessment Questionnaire scores were significantly higher (0.4 vs 0.3, p < 0.001) in patients with RA compared with patients with PsA. Patient general health and pain scores were also higher in patients with RA vs patients with PsA. Joint erosions (47.4% vs 37.6%, p = 0.020) and deformity (25.2% vs 21.6%, p = 0.021) were more prevalent in RA than PsA. In multivariate analysis, a reduced prevalence of erosions in PsA vs RA was noted (OR 0.609, p < 0.001). After matching, T-scores for L-spine (−0.54 vs −0.36, p = 0.077) and femoral neck (−0.88 vs −0.93, p = 0.643) were similar in patients with RA and patients with PsA, although body weight was a major confounder. Conclusion. The level of disease activity and radiographic damage was significantly higher for RA vs PsA subjects, although the magnitude of differences was relatively small. BMD levels were comparable between cohorts. Outcomes in patients with PsA and patients with RA may be more similar than previously reported.

Smoking in dialysis patients: a systematic review and meta-analysis of mortality and cardiovascular morbidity.

Abstract Fibroblast strains were derived from 2 regions of the lower genital tract of localized provoked vulvodynia (LPV) cases and pain-free controls. Sixteen strains were derived from 4 cases and 4 controls, age and race matched, after presampling mechanical pain threshold assessments. Strains were challenged with 6 separate stimuli: live yeast species (Candida albicans, Candida glabrata, Candida tropicalis, and Saccharomyces cerevisiae), yeast extract (zymosan), or inactive vehicle. Production of prostaglandin E2 (PGE2) and interleukin 6 (IL-6) were proinflammatory response measures. Highest IL-6 and PGE2 occurred with vestibular strains after C albicans, C glabrata, and zymosan challenges, resulting in the ability to significantly predict IL-6 and PGE2 production by genital tract location. After C albicans and C glabrata challenge of all 16 fibroblast strains, adjusting for dual sampling of subjects, PGE2 and IL-6 production significantly predicted the presampling pain threshold from the genital tract site of sampling. At the same location of pain assessment and fibroblast sampling, in situ immunohistochemical (IHC)(+) fibroblasts for IL-6 and Cox-2 were quantified microscopically. The correlation between IL-6 production and IL-6 IHC(+) was statistically significant; however, biological significance is unknown because of the small number of IHC(+) IL-6 fibroblasts identified. A low fibroblast IL-6 IHC(+) count may result from most IL-6 produced by fibroblasts existing in a secreted extracellular state. Enhanced, site-specific, innate immune responsiveness to yeast pathogens by fibroblasts may be an early step in LPV pathogenesis. Fibroblast strain testing may offer an attractive and objective marker of LPV pathology in women with vulvodynia of inflammatory origin.