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Clinicians and scientists suggest that up to 40% of dementia cases are potentially preventable. Data on awareness of dementia risk and protective factor among older adults can inform and facilitate designing educational interventions to prevent dementia. We aimed to quantify awareness of dementia risk and protective factors using a telephone survey. The modified Lifestyle for Brain Health scale was used to assess dementia risk and prevention knowledge. A representative sample of 1,005 older adults, mean age 64.02 (standard deviation + 1.4; range: 50-74 years) completed the survey (77% response rate). Under representation of non-European ethnicities was noted. Participants Respondents were all New Zealanders, more women (n=518, 51.5%), mostly European (n=921, 91.6%) and well educated (n=347, 34.5%, university or post-graduate degree). Only 6/14 modifiable risk or protective factors for dementia were adequately identified. Three clusters of dementia literacy were identified: psychosocial, medical and activities. These findings support personalizing dementia prevention efforts via targeted educational packages.

BackgroundSuicide is one of the leading causes of death worldwide, yet clinicians find it difficult to reliably identify individuals at high risk for suicide. Algorithmic approaches for suicide risk detection have been developed in recent years, mostly based on data from electronics health records (EHRs). These models typically do not optimally exploit the valuable temporal information inherent in these longitudinal data.MethodsWe propose a temporally enhanced variant of the Random Forest model - Omni-Temporal Balanced Random Forests (OTBRFs) - that incorporates temporal information in every tree within the forest. We develop and validate this model using longitudinal EHRs and clinician notes from the Mass General Brigham Health System recorded between 1998 and 2018, and compare its performance to a baseline Naive Bayes Classifier and two standard versions of Balanced Random Forests.ResultsTemporal variables were found to be associated with suicide risk. RF models were more accurate than Naive Bayesian classifiers at predicting suicide risk in advance (AUC=0.824 vs. 0.754 respectively). The OT-BRF model performed best among all RF approaches (0.339 sensitivity at 95% specificity), compared to 0.290 and 0.286 for the other two RF models. Temporal variables were assigned high importance by the models that incorporated them.DiscussionWe demonstrate that temporal variables have an important role to play in suicide risk detection, and that requiring their inclusion in all random forest trees leads to increased predictive performance. Integrating temporal information into risk prediction models helps the models interpret patient data in temporal context, improving predictive performance.

Background While short-term safety data of COVID-19 vaccination has been reassuring, it is theoretically possible that the vaccine-associated immune activation could trigger immune dysregulation and thus exacerbation of IBD. We used the epi-Israeli IBD Research Nucleus (IIRN) database to perform a population-based study exploring the effect of COVID-19 vaccination on disease course in IBD patients. Methods We included all IBD patients insured in two of the four Israeli HMOs, covering 35% of the population, by validated algorithms, and selected those who received two doses of Pfizer BNT162b2 vaccine. These were matched to unvaccinated IBD patients by demographics, parameters of disease severity at baseline generated by hierarchical clustering of laboratory data, and length of time from previous exacerbation to baseline. The primary outcome was rate of IBD exacerbation as defined by proxies of hospitalizations, treatment escalation, and commencement of corticosteroid or enema. The study period was December, 2020 to June, 2021 Results 707 pairs of vaccinated and unvaccinated IBD patients were compared. The pairs matched exactly for gender, district, IBD type and disease severity, and ±1 year for age at IBD diagnosis and at vaccination. Mean age was 38.5±13.5 years and median follow-up was 98 days (IQR 16–143). No difference in the outcome was found between the groups from the 2nd vaccination to the end of follow-up, with risk of exacerbation in vaccinated patients of 29% and risk in unvaccinated patients 26% (p=0.3). Conclusion COVID-19 vaccinated IBD patients demonstrated a rate of IBD exacerbation following vaccination that was no different from that of unvaccinated patients. The multifaceted immune activation induced by the vaccine did not result in worsening IBD disease course. These results provide further reassurance for IBD patients receiving the vaccine.

Background Some studies have shown decreased serological response to vaccination in patients on anti-tumor necrosis factor (TNF) medications. While the large majority of these patients do seroconvert after vaccination, titers have generally been lower and one study showed reduced neutralizing and inhibitory functions. One real-world population-based study compared found no increased infection rate in anti-TNF treated patients, but infection rates were low. The low event rate mandates exploration in longer-term population-based data. We used the epi-Israeli IBD Research Nucleus (IIRN) database to explore the effectiveness of COVID-19 vaccination in IBD patients in Israel. Methods We included all IBD patients insured in two of the four Israeli HMOs, covering 35% of the population, by validated algorithms, and selected those who received two doses of Pfizer BNT162b2 vaccine. These were matched by date of vaccination ±3 days and demographic variables to non-IBD controls. The primary outcome was incidence of positive COVID-19 PCR following vaccination between December, 2020 to June, 2021. Results 12,640 IBD patients received two vaccine doses; the matched cohort included 4,946 matched pairs (total 9,892 subjects). Mean age was 50.5±16.1 years and median follow-up was 22 weeks (range 4.1–24.4). Fifteen (0.3%) vaccinated IBD patients tested positive compared with 15 (0.3%) vaccinated non-IBD controls (OR=1 [95%CI 0.49–2.05], p=1.0). Patients on anti-TNF and/or corticosteroids did not have a higher incidence of positivity – neither compared to the entire group nor to IBD patients treated with vedolizumab/ustekinumab, even after precise matching for demographics, underlying diseases and IBD severity. Conclusion In a large population-based cohort of IBD patients in Israel, vaccine effectiveness was equivalent to non-IBD controls and was not influenced by treatment with anti-TNF or corticosteroids. Notwithstanding previous findings of impaired serological response in anti-TNF treated IBD patients, this real-world large-scale study shows that vaccine protection is robust in IBD patients, including those on immunosuppressive medications.

Fracture toughness of a material depends on its microstructure and the imposed loading conditions. Intuitively, the resultant fracture surfaces must contain the information about the interlacing of these intrinsic (microstructure) and extrinsic (imposed loading) characteristics. Mandelbrot’s revelation that fracture surfaces are fractals, excited both the scientific and engineering communities, spurring a series of works focused at correlating the fracture toughness and the fracture surface roughness. Unfortunately, these studies remained inconclusive and later on it was shown that the fractal dimension of the fracture surface roughness is in fact universal. Here, we show that by going beyond the universality, a definite correlation between the fracture toughness and indices of the fracture surface roughness is obtained. To this end, fracture experiments on an aluminum alloy were carried over a wide range of loading rates ( $$10^{-2}$$ – $$10^{6}\,\mathrm{MPa}\sqrt{\mathrm{m}}\mathrm{s}^{-1}$$ ), and the resulting fracture surface were reconstructed using stereography. The correlation lengths, extracted from the reconstructed surfaces, were found to be linearly correlated with the measured fracture toughness. The correlation unraveled in our work, along with the proposed mechanistic interpretation, revives the hope of correlating fracture toughness and fracture surface roughness, allowing quantitative failure analysis and a potential reconstructive approaches to designing fracture resistant materials.

Background In order to make reliable clinical decisions in relation to when injured or surgically operated athletes may return to daily functional and weight-bearing sporting activities, there is a need to establish referent average weight-bearing values in common sporting activities. Objectives To evaluate average percentage body weight (APBW) values and weight-bearing distribution percentages (WBDP) between sports activities in a referent adult population, and to suggest clinical implications. Design Original research study. Setting Lerner Sports Center, Hebrew University, Mount Scopus, Jerusalem, Israel. Participants 75 asymptomatic volunteers, mean age=33.5(19–72) years SD=15.1, mean weight (kg)=70.7 (43–113) SD=14.1. Interventions 4 tests were conducted: 1. Overground walking (OGW) over a 20m distance, 2. Overground jogging (OGJ) over a 20m distance, 3.Treadmill jogging (TJ) at a constant speed of 8.5 km/hr for a 15-second interval and 4. Elliptical exercise (EE) for a 20 second period at a resistance and incline level of 10, and a steady pace within the range of 70–95 steps/min. Main outcome measure The Smartstep™ weight-bearing gait analysis system. Results The APBW value on the entire foot in OGW was 112% (SD=15.57), in OGJ, 201% (SD=31.24, in TJ, 175% (SD=25.48) and in EE, 73% (SD=13.8). Regarding WBDP, the swing phase in OGJ and TJ was significantly longer than the stance phase (P Conclusions EE significantly reduces weight-bearing as compared to other common functional and sporting activities. This information is also useful from a repetitive loading standpoint (to prevent overuse injury) or for exercise recommendations for those at greater risk for exacerbating chronic joint pathology.

Hyperbaric oxygen-induced seizures are classified as brief, generalized tonic-clonic seizures. They are believed to cause no residual cognitive damage, although this has not been investigated in depth. In the present study, we examined whether hyperbaric oxygen-induced seizures cause impairment of behavioral and cognitive abilities. Cognitive status was assessed using four behavioral tests: Y-maze, novel object recognition, the elevated plus maze, and a passive avoidance task. Three time intervals were examined: 24h, and 7 and 30 days after the seizures. We found transient impairment of performance in the compressed group on three tests (the novel object recognition paradigm, the Y-maze paradigm, and the passive avoidance task). On the elevated plus maze test, the impairment persisted. The time interval to the appearance of deficits and to eventual recovery was not the same for the different tests. We conclude that hyperbaric oxygen-induced seizures result in transient impairment of performance on behavioral tests in a mouse model. Further investigation is required to establish the mechanism and location of injury, and to determine whether the performance decrement on the elevated plus maze test represents permanent damage or transient damage with slow resolution. These new findings should be taken into account when planning hyperbaric oxygen treatments, to ensure that the chosen protocol is therapeutic yet minimizes the risk of CNS oxygen toxicity.

The objective of this study was to find out whether the use of multiple velocity (30, 60, 90 and 120 ◦ /s) isokinetic as well as a single angle isometric testing was justified for assessing unilateral muscular weakness. Twenty one unilateral knee patients (16 men, 5 women), mostly with ACL pathology, with a mean post-injury time of 36 ± 33 m, were conveniently sampled. All patients filled in a functional questionnaire which indicated good recovery. The relative weakness of the involved (I) side was determined using the uninvolved (U) side as reference. Patients were also asked to rank the difficulty in performing the tests. The mean (based on the 4 velocities) eccentric weakness (19.7%) was significantly higher than in both the concentric (14.9%) or the isomteric (13.9%) modes. However within either the concentric or eccentric modes no between-velocity differences were noted. Side dominance had a significant effect on quadriceps weakness in all test modes. In conclusion, and with respect to the specific patient group, the use of one or, at most, two test velocities is sufficient to portray muscular insufficiency.

This study aims to validate the Multiple Sclerosis (MS) International Quality of Life (MusiQoL) questionnaire, a multi-dimensional, self-administered questionnaire, available in 14 languages, as a disease-specific quality of life scale that can be applied internationally. A total of 1992 patients with different types and severities of MS from 15 countries were recruited. At baseline and day 21 ± 7, each patient completed the MusiQoL, a symptom checklist and the short-form (SF)-36 QoL questionnaire. Neurologists also collected socio-demographic, MS history and outcome data. The database was randomly divided into two subgroups and analysed according to different patient characteristics. For each model, psychometric properties were tested and the number of items was reduced by various statistical methods. Construct validity, internal consistency, reproducibility and external consistency were also tested. Nine dimensions, explaining 71% of the total variance, were isolated. Internal consistency and reproducibility were satisfactory for all the dimensions. External validity testing revealed that dimension scores correlated significantly with all SF-36 scores, but showed discriminant validity by gender, socio-economic and health status. Significant correlations were found between activity in daily life scores and clinical indices. These results demonstrate the validity and reliability of the MusiQoL as an international scale to evaluate QoL in patients with MS. Multiple Sclerosis 2008; 14: 219—230. http://msj.sagepub.com

BACKGROUND: Mental health professionals are at a high risk of burnout. Positive psychology outcomes of staff in acute in-patient psychiatric wards are poorly researched and unclear. AIMS: To quantify the satisfaction with life and work-life satisfaction of mental health staff at a large university-affiliated tertiary psychiatric centre. METHODS: We utilized the Satisfaction with Life Scale (SWLS) and the Work-Life Satisfaction Questionnaire (WLSQ). RESULTS: Two hundred and nine out of 450 staff members (46%) participated; mean age 48.2 + 9.9 years; 63% were male. On average the participants had been practising their speciality for 21.1 + 9.8 years (range: 2-48). The mean total SWLS scores differed significantly between professions (P < 0.05). The highest levels of happiness were reported by psychologists and social workers, followed by the administrative staff, the psychiatrists and finally the nursing staff. Staff scored the highest for work as a 'calling' followed by work as a 'career' and the lowest rating for work as a 'job'. The mean total WLSQ score differed between professions, (P < 0.01). The highest levels of work as a calling were reported by psychiatrists (mean 2.87 of possible 5.0), followed by psychologists and social workers, nursing staff and finally administrative staff. CONCLUSIONS: Satisfaction with life and work orientation do not correlate among mental health professionals. Although highly motivated and perceiving psychiatry as a 'calling' psychiatrists score low on levels of satisfaction with life. Improving staff happiness may contribute to increase in moral and counter burnout.

The purpose of this study is to assess the ability of clinicians to identify false isokinetic strength test of the knee flexors and extensors, based only on the shape of the torque curve. The concentric strength was measured bilaterally using an isokinetic dynamometer at 60°/sec. Each subject performed two modes of testing: a) A Genuine strength test (GST) which consisted of five consecutive cycles of knee extension and flexion at maximal effort, b) A false strength test (FST) which consisted of five consecutive cycles of knee extensions and flexion attempting to feign pain. For each test, the torque curves were printed and presented to four judges to mark each of the tests as a GST or a FST based on the shape of the torque curves. The mean percentage of success in identifying a GST and a FST for the 4 judges was 91.9% (range = 87.5-97.5%) and 90.6% (range = 82.5-95%) respectively In conclusion, in spite of the constraints, which were imposed on the judges, the rate of correct classification was high.

Psychogeriatrics and especially psychiatric services in nursing and old-age homes are sorely lacking in research. Four years ago we developed and implemented a model for service delivery for old-age homes within our hospitals' catchment area. In the first year of operation 48 of 373 residents (13%) were evaluated and treated by a psychogeriatrician. The aim of the present study was to evaluate outcome of these patients three years later. All patients and medical records were re-assessed. During the three-year period 16/48 subjects (33.3%) passed away; of these half were previously diagnosed as suffering from a major depressive episode. None of the subjects who died had attempted suicide. Following a preliminary diagnosis of affective spectrum disorder, 4/48 patients (8.3%) were re-diagnosed at follow up as suffering from dementia. Full or partial remission of the original symptomatology was achieved in 18/32 surviving subjects (50.7%); mostly depressed or anxious patients. We conclude that although mortality rate among elderly psychiatric patients is high persistent interventions lead to successful remission in the majority of patients.

Summary. The membranes of human spermatozoa contain an extremely high concentration of polyunsaturated fatty acids and are therefore susceptible to lipid peroxidation damage. The aim of this study was to retrospectively determine the association between the lipid peroxidation levels of washed spermatozoa, as indicated by thiobarbituric-acid-reactive substance concentration, and: (a) semen quality evaluated by basic routine, biochemical, cytological and quantitative ultra-morphological analyses; (b) IVF fertilization rate. Semen samples from 45 male partners of couples who had been referred for IVF treatment due to a female infertility factor were evaluated for quality as well as for thiobarbituric-acid-reactive substance concentrations. The latter were found to have a negative correlation with total sperm count, semen volume, zinc/fructose ratio, and the integrity of sperm acrosome and axonema. It was suggested that lipid peroxidation has a deleterious effect on the ultramorphological status of the sperm cells and, thereby, on the male fertilization potential. The content of the seminal fluid, about 30% of which is produced by the prostate, may protect spermatozoa from this destructive process. A negative correlation was also found between thiobarbituric-acid-reactive substance concentrations and IVF fertilization rate. When the patients were subdivided into fertilizing (fertilization rate >0%) and nonfertilizing (fertilization rate = 0%) subgroups (n= 33 and n= 12, respectively), the former exhibited significantly lower thiobarbituric-acid-reactive substance concentrations than the latter. A new IVF fertilization index based on the lipid peroxidation level was established. This index had a predictive power of 93% (94% sensitivity and 92% specificity). The clinical value of this index should be further verified.

ResumenLa ansiedad y la depresión están entrelazadas a menudo, como demuestran los estudios clínicos, epidemiológicos, psicofarmacológicos e incluso genéticos. Sin embargo, son escasos los datos bioquímicos y electrofisiológicos sólidos de la unión o separación de los trastornos del estado de ánimo y de ansiedad. Los potenciales evocados auditivos del tallo cerebral (BSAEPs) se pueden medir de manera sencilla y no invasiva en los pacientes psiquiátricos y reflejan procesos neurofisiológicos en este lugar del cerebro. El propósito del presente estudio era evaluar los BSAEPs en pacientes que sufrían trastorno de pánico o depresión mayor y no tomaban medicación y compararlos con controles sanos. Se diagnosticó a los pacientes (n = 26; pánico = 16, depresión = 10) según los criterios del Manual Diagnóstico y Estadístico (DSM) III-R evaluados por las Escalas de Valoración de Hamilton para la Ansiedad y para la Depresión, y todos pasaron por un período de limpieza del organismo de las medicaciones de 3 semanas. Todos los sujetos (n = 36) completaron el estudio. La latencia del componente N3 disminuyó en el grupo de pacientes (P < 0,05), el intervalo N3-5 se alargó (P < 0,05), la latencia del componente N3 correlacionó con las puntuaciones de ansiedad y las puntuaciones de depresión correlacionaron con los períodos de latencia de los componentes N3 y N5. En conclusión, la pequeña muestra que utilizamos demostró la presencia de variables electrofisiológicas compartidas en el trastorno de pánico y la depresión, lo que da nuevo apoyo al concepto de trastorno de espectro.

ResumenSe emprendió un estudio de la satisfactión de los clientes en dos clínicas ambulatorias psiquiátricas de adultos. Doscientos tres participantes respondieron al cuestionario anónimo de autoinforme que cubría variables demográficas, del entorno y la satisfactión con el servicio. La edad media de los sujetos era 42,5 ± 19 anos, con una pequeña mayona (58,6%) de mujeres. La satisfacción global con la asistencia psiquiátrica era alta (79,8%). Ninguna de las variables demográficas o del entorno correlacionó significativamente con la satisfactión. La psicoeducacion correlacionaba significativamente con el nivel de satisfactión con los servicios. Estos hallazgos acentuan mas la importancia de la psicoeducacion por los suministradores de los servicios en salud mental.

A client satisfaction survey was undertaken in two adult psychiatric outpatient clinics. The anonymous self-report questionnaire covering demographic, setting and satisfaction with service variables was endorsed by 203 participants. The mean age of the subjects was 42.5 ± 19 years, with a small majority (58.6%) of females. Overall satisfaction with psychiatric care was high (79.8%). None of the demographic or setting variables correlated significantly with satisfaction. Psychoeducation was significantly correlated with level of satisfaction with services. These findings further emphasize the importance of psychoeducation by service providers in mental health.

Multiple sclerosis (MS) is a chronic debilitating disease that will cause significant disability to the majority of patients overtime [1]. Previous studies of the natural course of the disease showed that disability will accumulate in more that 90% of patients and additional relapses may result in significant handicap [2]. Assessment of patients with a diagnosis of probable MS with positive brain magnetic resonance imaging (MRI) demonstrated that the risk of relapsing within 1 year is 57.6% [3]. Treating patients early means treating patients with less disability. We describe the rationale for early treatment in patients with the first episode of neurological symptomatology suggestive of clinically probable MS, and the design of a randomized, double-blind, placebo-controlled trial of early treatment with intravenous immunoglobulin (IVIg, Omrix, Israel) in these patients. The primary objective of this study was to investigate the efficacy of IVIg treatment, administered at 0.4 g/kg per day for 5 consecutive days, as a loading dose, and 0.4 g/kg per day every 6 weeks thereafter as a booster dose, for a 1-year period, on the risk of patients with clinically probable MS and positive brain MRI to convert to clinically definite MS.

Acute hypoxia tolerance varies substantially among healthy individuals. We hypothesized that this variability results from a difference in autonomic (ANS) response to hypoxic stress.Peripheral oxygen saturation, respiration and ECG were recorded from 21 healthy subjects (age, 29 +/- 7 yr) in an altitude chamber during normoxia, severe hypoxia (282 mm Hg), and mild hypoxia (360 mm Hg). Cardiovascular control was assessed by time-frequency decomposition of the heart rate signal applying the Selective Discrete Transform Algorithm (SDA). This procedure uses a variable time window, thus providing reliable physiological data even during transient states. Autonomic activity was quantified by power spectral density integrals over a 3-dimensional time-dependent spectral distribution of heart rate fluctuations.Subjects who had slower peripheral oxygen desaturation during severe hypoxia onset (mean 92.9 vs. 58.4 s) were those who displayed higher ANS activity in all ambient states, namely normoxia and hypoxia. These same subjects withstood hypoxia for significantly longer time periods (mean 313 vs. 244 s).Improved hypoxia tolerance is linked to enhanced autonomic activity, involving a better management of peripheral blood flow.

The authors describe two cases of tamoxifen-induced organic delusional syndrome that resulted from administration of 40 mg daily for the adjuvant treatment of breast carcinoma. After discontinuation of the tamoxifen therapy, the psychiatric episode resolved within 2 to 4 weeks. Because tamoxifen might cause delusional syndrome, the authors recommend full psychiatric evaluation in appropriate cases. Cancer 1992; 69:1415-1417.

Hereditary nonspherocytic hemolytic anemia (HNSHA) is a rare manifestation of glucose-6-phosphate dehydrogenase (G6PD) gene mutations, caused mainly by mutations located in exon 10 of the G6PD gene and less commonly by mutations in other parts of the gene. A new, exon 9, single-base mutation representing a T --> C transition at cDNA nucleotide 964 was found in three brothers and their carrier mother of Jewish Ethiopian descent. Biochemical characterization of the resultant protein was not performed. Though clinical manifestations included HNSHA in all cases, the severity of hemolysis and the transfusion requirement differed markedly. Severe congenital neutropenia (Kostmann's syndrome)--a disorder never reported before in conjunction with G6PD deficiency--was observed in one case. Levels of white blood cell G6PD activity of the three patients were 0-5% of normal controls. Neutrophil oxidative and bactericidal activities were inherently impaired in the patient with Kostmann's syndrome, but were well preserved in his two siblings.

The process of appointing a guardian in the mental health field is a complex and important one. The guardian's duty is to protect a patient who is incompetent in making his own decisions. The guardian's role can be to correct past mistakes made by the patient (i.e. loss of property), manage the patient's present affairs and prevent future undesirable consequences. Characteristics of patients who are in need of guardianship have not previously been studied in Israel. We examined the characteristics of 60 hospitalized patients for whom a guardian was appointed, comparing them with another group of patients. Variables relating to disease severity such as diagnosis, duration of illness and employment status contrasted the groups. We may tentatively conclude that patients in need of legal guardianship are more severely ill than other mentally ill.

The beneficial effect of aprotinin, a naturally occurring protease inhibitor, on preservation of organs such as the liver, kidney and lung has been documented.To explore the effects of hepatic ischemia and reperfusion on both liver and myocardial function, using a dual isolated perfused organ model with and without aprotinin.Isolated rat livers were stabilized for 30 minutes with oxygenated modified Krebs-Henseleit solution at 37 degrees C. Livers were then perfused continuously with KH or KH + aprotinin 10(6) KIU/L for an additional 135 min. Livers of two other groups were made globally ischemic for 120 min, then perfused for 15 min with KH or with KH + aprotinin. Isolated hearts (Langendorff preparation) were stabilized for 30 min and then reperfused with KH or KH + aprotinin exiting the liver for 15 min. The liver's circuit was disconnected, and hearts were re-circulated with the accumulated liver + heart effluent for an additional 50 min.In the ischemia and ischemia + aprotinin groups, portal vein pressure (1 and 15 min reperfusion) was 331 +/- 99% and 339 +/- 61% vs. 308 +/- 81% and 193 +/- 35% of baseline, respectively (P0.03 vs. ischemia). There were no other differences in the enzyme leakage between aprotinin-treated or untreated ischemic livers. Left ventricular pressure was stable in the controls. However, LV pressure in groups perfused with ischemic liver effluent declined within 65 min reperfusion, whether aprotinin treated or not (84 +/- 8% and 73 +/- 5% of baseline, respectively, P0.004 only for ischemia vs. control).When aprotinin was used, LV pressure was inclined to be higher while liver portal vein pressure was lower, thus providing protection against liver and heart reperfusion injury.

Thirteen patients with DSM-III-R diagnosis of either major depression or bipolar I depression participated in the study. The control group consisted of 10 subjects evaluated for headache or suspected meningitis, none of whom were found to suffer from any organic disease. CSF was withdrawn from all subjects for the measurement of soluble interleukin 2 receptor (sIL-2R). CSF sIL-2R levels were found to be lower in patients as compared to controls (df = 1, 20; F = 84; p0.000001).

This study evaluates the comorbidity of epilepsy as a variable supporting a viral hypothesis in Autism. Data covering a 30-year period (1960-1989), including general population live births, autistic births, and incidence of viral encephalitis and viral meningitis, were collected for Israel. 290 autistic births were evaluated. The annual birth pattern of subjects with comorbid epilepsy fit the seasonality of viral meningitis. These findings support the role of viral C.N.S. infections in the causality of this disorder.

The attitude of the public toward mental illness and toward psychiatric patients raises a serious and sensitive issue that indirectly affects the development of community mental health services. Most citizens feel that there is an association between mental illness and dangerous or violent behavior. Studies undertaken among police personnel in the 1970s demonstrated that their attitudes were similar to those of the general public in Israel. The objective of the present study was to assess the attitudes of police officers toward mental illness and psychiatric patients by means of a self-report questionnaire. Ninety-three policemen from five police stations within the Y. Abarbanel Mental Health Center catchment area participated in the study. All were young males (average age 32.1 years) and 75 percent had a high school education or higher. More than half (54.5%) had personally known a psychiatric patient in the past, and 20.4 percent of the police personnel graded mental illness as the severest form of disease in medicine. A minority (14.3%) of policemen agreed with the statement: "A psychiatric hospital should be fenced and manned by guards." One-third did not know whether psychiatric patients are dangerous. We conclude that training of police officers is called for to effect changes in their misconceptions about psychiatric patients. Psychoeducation may lead to improved handling by the police of incidents involving the mentally ill.

Tardive dyskinesia is an involuntary movement disorder developing following treatment with neuroleptics. As many as 50% of chronic psychotic patients develop this disabling condition. No treatment has been found effective for tardive dyskinesia. This study was undertaken to meta-analyze the effects of vitamin E (alpha-tocopherol) reported in the last decade. All studies published since 1987, focusing on vitamin E and tardive dyskinesia are reviewed. Double-blind studies are analyzed using measures of effect and variance as described by secondary analysis of magnitude of effects in pooled data. A total of 223 patients received vitamin E treatment (400-1600 IU/day) for tardive dyskinesia, in 12 studies. A significant subgroup (28.3%) showed a modest improvement. Vitamin E was well tolerated, and only rarely did side effects occur-of no clinical significance. Vitamin E is a safe, well-tolerated compound that may provide some beneficial effects in patients suffering from neuroleptic-induced tardive dyskinesia.

During the 4-year period 1989-1992, 18,227 neonates were born at Kaplan Hospital and 614 (3.4%) were admitted to the neonatal intensive care unit. During this period, 120 episodes (6.6/1000 live births) of neonatal sepsis were recorded in 109 neonates (6/1000 live births). The incidence of early-onset sepsis was 19/109 (17%). The main pathogens of early-onset sepsis were S. agalactiae (42%) and E. coli (32%). Seven of the 8 S. agalactiae cases were recorded during 1989-1990. The main pathogens of late-onset sepsis were Klebsiella spp. (31%), coagulase-negative staphylococci (18%) and Candida spp (16%). There were 11 cases (10%) of meningitis, 5 due to Klebsiella spp. The overall fatality rate due to sepsis was 14% (0.8/1000 live births) with an early-onset sepsis death rate of 37%. The mortality from S. agalactiae sepsis was 63%. The main trends recorded during the period of the study were 1) the emergence of S. agalactiae as the main pathogen of early-onset sepsis, followed by a sharp decrease in its incidence during the last part of the study, 2) the emergence of extremely virulent, multi-antibiotic-resistant Klebsiella organisms, and 3) the persistent high incidence of Candida sepsis.

To investigate the association and prevalence of sleep disturbances and fibromyalgia (FM) in a group of patients with primary Sjögren's syndrome (pSS).Sixty-five patients with pSS were investigated. A 10-point Mini Sleep Questionnaire (MSQ) was completed focusing on sleep complaints. The same questionnaire was also used in three control groups: Group A-67 patients with rheumatoid arthritis. Group B-53 patients with rheumatoid arthritis (RA) and sicca symptoms; Group C-31 patients with osteoarthritis. All patients with pSS were also studied fro the presence of FM.Moderate or severe sleep disturbances were reported by 49 out of 65 pSS patients (75%). This frequency was significantly higher than that reported by patients in the three control groups (p0.001). FM was present in 36 out of 65 pSS patients (55%) and was associated with sleep disturbances. FM or sleep disturbances were not associated with any clinical or laboratory parameters.Our results suggest that sleep abnormalities and FM in pSS patients are frequent and their etiology might involve other mechanisms besides joint pain or sicca symptomatology.

Seasonal variations in births of autistic subjects have been reported for the United States, Canada, Sweden, Japan, and Israel. Here, data from England, Japan, and Israel are reanalyzed using spectral analysis for the cosine function. A sample of 583 autistic births occurring over 40 years (1947-1989) is meta-analyzed, focusing on rhythmicity. Major periodicities of 17.6, 18.6, and 21.8 years, on which minor periodicities ranging from 2.2 to 4.1 years were superimposed, yielded the best-fitting cosine function to significantly explain variance of autistic birth patterns. It is interesting that the function composed of a major period with several minor periods is remarkably similar in each of the three ethnic groups. In all three countries the acrophases (calculated function) aggregate in the period 1963-1970. In light of this apparent universality of rhythms in autistic births across continents, we call for further investigations into the role of environmental factors, possibly viral pandemics, in the etiology of autism.

The purpose of this study was to examine the sexual complaints and severity of sexual dysfunction in relapsing-remitting multiple sclerosis patients and to correlate them with psychological, neurological, and radiological variables. Frequency and characteristics of sexual disturbances were reported by 41 multiple sclerosis patients (32 females, 9 males; mean age 35.4 +/- 10.2 y). Clinical neurologic variables tested were disease duration, exacerbation rate, and disability; psychological variables tested were anxiety and depression. All patients underwent a brain magnetic resonance imaging (MRI) scan at the time of this study. The sexual dysfunction questionnaire included items based on the 3 phases of human sexual response: loss of libido, excitement (arousal difficulties, impotence, premature ejaculation), and anorgasmia. Five males (55.5%) and 16 females (50.0%) reported at least 1 sexual disturbance. The most frequent dysfunctions were loss of libido (26.8%) and arousal difficulties (19.5%). Females rated their difficulties as more severe. Sexual dysfunctions correlated with depression, (r = 0.68, P = 0.001). No correlation between MRI score and depression was found. Anorgasmia correlated with brain stem and pyramidal abnormalities (r = 0.56, P = 0.011; r = 0.56, P = 0.012, respectively). The total area of lesions (plaques) on the brain MRI scan also correlated with anorgasmia (r = 0.41, P = 0.02). Sexual dysfunctions in multiple sclerosis patients are frequent, are mild to moderate in severity, correlate with depression and in some cases central nervous system (CNS) demyelinating process, and thus may be related either to the psychological impact of this disease or to specific organic lesions in the brain.

Neuroblastoma (NB) is one of the few tumors known to undergo spontaneous regression. Its progression, however, often leads to bone marrow (BM) metastasis. Proliferation and differentiation of human NB cells may be regulated in vitro by a variety of biologic agents, some of which are released by low-density BM and peripheral blood (PB) cells. Little is known regarding BM cell-derived control of NB cell growth and differentiation.The proliferative and differentiative responses of NB cells, to BM cell-, and to PB cell-derived conditioned medium (CM) were evaluated in comparison to cytokine-induced responses.CM from unstimulated cultures of low density BM and PB cells, from healthy donors, from newborn infants, and from NB patients, significantly and reproducibly stimulate NB cell growth in vitro. The intensity of CM-induced stimulation was not attained by recombinant human tumor necrosis factor (rhTNF), interferon (rhIFN), or granulocyte-monocyte colony stimulating factor (rhGM-CSF); and although epidermal growth factor (rhEGF) and transforming growth factor alpha (rhTGF alpha) were strongly stimulatory, neutralizing antibodies against each of these agents did not affect CM-derived activity. In contrast to growth stimulation, differentiation of CM-treated NB cells, was reproducibly suppressed, as reflected in abrogation of neuronal cell morphology as well as of neurofilament and neuron specific enolase expression.Spontaneous regression of NB tumors, on one hand and BM metastasis on the other may be associated with the extent and nature of the NB cell response to regulatory activity released by BM and PB cells.

Acute febrile neutrophilic dermatosis (Sweet syndrome) is rare in children and is regularly associated with underlying malignancies or inflammtory diseases. A 5-year-old girl with glycogen storage disease type Ib, neutropenia, and recurrent infections developed characteristic skin eruption of Sweet syndrome after 2 years of granulocyte colony-stimulating factor (G-CSF) therapy. This association points to a possible role of G-CSF-induced granulopoiesis and granulodyte activation in the pathogenesis of Sweet syndrome.

Background The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. The efficacy of antipsychotics in CBS is based on sketchy evidence. The use of serotonin selective re-uptake antidepressants (SSRI) for CBS is anecdotal. Aim To describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment. Methods Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after 8 weeks of treatment. All had undergone brain -CT and cognitive assessment. Results There were 4 men and 4 women, mean age 81.7 ± 7.3 years. Brain-CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had MMSE scores ≥ 27/30. Previous antipsychotic treatment was mostly with risperidone 1.0 to 3.0 mgs/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p Conclusions This is the first case-series to show that SSRIs are an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in the CBS.

The realization that cytosine in cyclobutyl pyrimidine dimers rapidly deaminates to uracil raised the possibility that this chemical transformation, rather than an enzymatic polymerase error, is the major mutagenic step in UV mutagenesis. We have established a sensitive bioassay system that enabled us to determine the rate of deamination of cytosine in cyclobutyl pyrimidine dimers in plasmid DNA. This was done by in vitro UV irradiation and deamination of a plasmid carrying the cro gene, followed by photoreactivation, and assaying uracils in DNA by their ability to cause Cro- mutations in an indicator strain that was deficient in uracil DNA N-glycosylase. DNA sequence analysis revealed that 27 out of 29 Cro- mutants carried GC --AT transitions, as expected from deamination of cytosine. Deamination of cytosines in the cro gene in UV-irradiated plasmid pOC2 proceeded at 37 degrees C with first-order kinetics, at a rate of (3.9 +/- 0.6) x 10(-5) s-1, corresponding to a half-life of 5 h. Physiological salt conditions increased the half-life to 12 h, whereas decreasing the pH increased deamination. The temperature dependence of the rate constant yielded an activation energy of 13.6 +/- 3.3 kcal/mol. These kinetics data suggest that deamination of cytosine-containing dimers is too slow to play an important role in UV mutagenesis in Escherichia coli. However, it is likely to play an important role in mammalian cells, where the mutagenic process is slower.

A 4-year-old boy presented with developmental delay, aggressive behavior, and incoordination. His EEG showed a diffuse encephalopathy. At age 10 he developed convulsions and severe migraine-like headaches. Muscle wasting, arreflexia, and lactic acidemia following exercise were noted. Electromyography was myopathic and nerve conduction studies revealed a peripheral neuropathy. Muscle biopsy demonstrated variation in fiber size and an excess of lipid droplets. He than had several stroke-like episodes and periods of unconsciousness, associated with severe metabolic acidosis. Muscle cytochrome C oxidase was abnormally low. This boy displayed the classical clinical and biochemical features of MELAS syndrome, namely Mitochondrial myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like episodes. Treatment included carnitine, vitamin C, vitamin K, riboflavin, coenzyme Q10, and corticosteroids. He died at the age of 14 years following an episode of seizures, coma, and gastrointestinal hemorrhage. This is the first reported case of MELAS syndrome in Israel.

Twelve women who developed an average postpartum weight gain of 18.3kgs (SD +/- 6.09) entered an open trial, for three months, of fluoxetine 20 mg daily. The weight gain during their pregnancies was nearly twice that recommended by the treating gynecologists. Seventy-five percent success rate was achieved -8/12 were +/- 5% of their pre-pregnancy weights upon completion of the trial. Mean weight upon entering the trial was 82.25kgs (SD +/- 13.39), and at termination, 65.75kgs (SD +/- 8.59), P0.001. Anorexia and weight loss (more than 5% of body weight) have been reported in the literature in 9% and 13%, respectively, of depressed patients treated with fluoxetine. The use of this drug to promote weight loss is here reported in a selected population of women without signs or symptoms of depression, whose weight gain during pregnancy was excessive.