bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurosyphilis and neuro-AIDS
Authors: Manji Hadi
Published: July 2012

Invasion of the central nervous system occurs early in the course of syphilis infection. Neurosyphilis causes meningitis, myeloradiculopathy due to pachymeningitis, and gummatous cord and brain lesions; endarteritis may cause infarction.

Clinical features—these are protean: neurosyphilis should always be considered in the diagnosis of neurological disorders without a convincing explanation, including (1) stroke—especially in young patients; (2) ocular abnormalities—e.g. optic neuritis, choroidoretinitis, pupillary abnormalities; (3) unexplained cranial nerve disease, including sensorineural deafness and vertigo; (4) dementia—low-grade meningo-encephalitis is associated with generalized changes in the brain and occasionally with frontotemporal dementia; (5) tabes dorsalis—a sensory ataxia caused by disease of the dorsal roots, ganglia and posterior columns....
Inherited neurodegenerative diseases
Authors: Kolodny Edwin H. , Sathe Swati
Published: July 2012

Case History—A 54 yr old man presenting with intermittent focal neurological signs.

Many nervous system disorders have a genetic basis, but may be difficult to diagnose because of nonspecific signs, slow progression, and lack of any family history.

Neurodegenerative disorders present an enormous challenge because of the complexity of the nervous system, the broad clinical and genetic heterogeneity characteristic of these diseases, and the progressive and generally irreversible nature of their neuropathology. A mutated gene is generally at fault, resulting in decreased production of a structural or regulatory protein important for the development or normal functioning of a special part of the nervous system....
Mitochondrial encephalomyopathies
Authors: Chinnery P F , Turnbull D M
Published: July 2012

Abstracts and keywords to be supplied.
The eye in general medicine
Authors: Frith Peggy
Published: July 2012

All physicians should be aware of important eye symptoms, learn how to examine the eye, and in particular be proficient with the ophthalmoscope. Common presentations include (1) red eye—may be due to conjunctivitis, episcleritis, scleritis, iritis, keratitis, or acute glaucoma, some of which require urgent specialist opinion; (2) dry eye—which may have a systemic cause, particularly if accompanied by dryness of the mouth (sicca syndrome), e.g. Sjögren’s syndrome; (3) loss of vision—which, when it affects one eye, is associated with a relative afferent pupillary defect and can be caused by central retinal artery occlusion, ischaemic central retinal vein occlusion, ischaemic optic neuropathy, optic neuritis, extensive retinal detachment, advanced unilateral glaucoma, and optic nerve compression....
Sports and exercise medicine
Authors: Wolman Roger L.
Published: July 2012

Physicians are increasingly confronted with medical problems related to sport.

Female athlete triad—consists of disordered eating, amenorrhoea, and osteoporosis, which are most commonly seen in those pursuing endurance sports or gymnastics. Clinical assessment includes a nutritional screen to assess calorie and calcium intake, measurement of serum tri-iodothyronine level (typically low) and of bone density, along with exclusion of other causes of amenorrhoea. The most effective treatment is to re-establish natural menstruation with a combination of reducing training intensity and increasing calorie intake, both of which the athlete may find hard to accept....
Cancer immunity and clinical oncology
Authors: den Broek Maries van , Boehmer Lotta von , Odunsi Kunle , Knuth Alexander
Published: July 2012

Patients develop immune-mediated defence mechanisms against cancers, which are referred to as the ‘three E’s’: (1) elimination—corresponding to immunological control of the tumour or immunosurveillance; (2) equilibrium—the process by which the immune response iteratively selects/promotes less immunogenic tumour variants; and (3) escape—when the immunologically sculptured tumour expands in an uncontrolled manner....
Infection in the immunocompromised host
Authors: Cohen J.
Published: July 2012

The term ‘immunocompromised host’ embraces a group of overlapping conditions in which the ability to respond normally to an infective challenge is in some way impaired. This includes patients with underlying conditions such as protein–calorie malnutrition and diabetes, as well as organ transplant recipients, those with haematological malignancies and others receiving therapeutic immunosuppression, and patients with HIV infection. Many patients have multiple risk factors that increase the risk of opportunistic infection....
Measles
Authors: Whittle H.C. , Aaby P.
Published: July 2012

Measles is a single-stranded RNA virus that is spread by aerosolized droplets and is highly transmissible. It causes a spectrum of disease ranging from mild in the well nourished to severe in the malnourished or immunosuppressed: mortality is 3 to 10% in Africa.

Clinical features—10 to 14 days after infection the viral prodrome typically consists of runny nose and fever, sometimes also diarrhoea or convulsions; signs include mild conjunctivitis, red mucosae, and (on the buccal mucosa) Koplik’s spots. After 14 to 18 days a morbilliform rash first appears on the forehead and neck, then spreads to involve the trunk and finally the limbs. Other manifestations include severe conjunctivitis (especially in those who are vitamin-A deficient), pneumonitis and enteritis (which may cause profuse diarrhoea). Early complications include (1) pneumonia—caused by ...
Orf
Authors: Warrell David A.
Published: July 2012

Orf (‘ecthyma contagiosum’) is caused by an epitheliotropic parapox DNA virus of sheep and goats that is able to subdue the host’s immune response. It is an occupational zoonosis of people working with these animals. A painful papule/pustule develops, usually on a finger, the site of contact with lesions on the animal’s muzzle. Systemic effects are unusual, but include local lymphadenopathy, fever, erythema multiforme, and other generalized rashes. Spontaneous resolution within 6 weeks is usual. Multiple, giant lesions may develop in the immunosuppressed. Topical cidofovir is effective in severe cases....
Molluscum contagiosum
Authors: Warrell David A.
Published: July 2012

Molluscum contagiosum is caused by a Molluscipox DNA virus which infects keratinocytes of the epidermal stratum spinosum, producing distinctive small umbilicated papules on the skin. Its genome encodes a variety of proteins that suppress the host’s immune response. In children it is spread by skin contact, producing few or many lesions, while in sexually active adults it causes anogenital lesions. Molluscum is self-limiting within a few years in the immunocompetent, but those with preexisting atopic eczema and immunosuppression, notably AIDS, commonly develop persistent diffuse eruptions with larger papules. Lesions can be removed mechanically or chemically. More severe infections can be treated with imiquimod or cidofovir....
Diphtheria
Authors: Benthell Delia B. , Hien Tran Tinh
Published: July 2012

Diphtheria is a potentially lethal infection caused by toxin-producing strains of Corynebacterium diphtheria, a Gram-positive bacillus. Humans are the only known reservoir, with spread via respiratory droplets or direct contact with skin lesions. Although now rare in developed countries, this vaccine-preventable disease remains an important problem in countries with poor or failing health systems, and is estimated to cause about 5000 deaths per year worldwide, most in children under 5 years of age....
Pneumococcal infections
Authors: Scott Anthony
Published: July 2012

Streptococcus pneumoniae is an encapsulated Gram-positive bacterium that lives almost exclusively in the human nasopharynx. Each pneumococcus expresses one of more than 90 immunologically distinguishable capsular polysaccharides that are the principal target of systemic human immunity and define its serotype.

Pneumococci are transmitted through contact with infected nasal secretions or by airborne dissemination, and most preschool children carry them in their nasopharynx. The risk of acquisition is increased by contact with other children, crowded environments, and cold weather. The incidence of pneumococcal disease is highest in young children and elderly people, and also increased in males, certain indigenous populations, smokers, alcoholics, and patients with chronic medical illnesses or immune susceptibility, including HIV infection, sickle cell disease, and splenectomy....
Neisseria gonorrhoeae
Authors: Barlow D. , Sherrard Jackie , Ison C.
Published: July 2012

Neisseria gonorrhoeae is a Gram-negative, intracellular diplococcus that primarily colonizes the columnar epithelium of lower genital tract, only occasionally spreading to the upper genital tract or causing systemic disease. It is almost exclusively transmitted by sexual activity.

Clinical features—(1) Oropharyngeal and rectal infections usually produce no symptoms; (2) men—dysuria (50%) and urethral discharge (98%) develop after a median of more than 5 days; complications, e.g. epididymitis, orchitis, are rare; (3) women—there are no specific symptoms in the absence of complications, e.g. salpingitis, bartholinitis; (4) disseminated gonococcal infection—a comparatively benign bacteraemia affecting joints (particularly shoulder and knee) and skin; more common in women than men....
Bordetella infection
Authors: Grant Cameron
Published: July 2012

Bordetella are small Gram-negative coccobacilli, of which Bordetella pertussis is the most important human pathogen. It is the cause of whooping cough, which is one of the 10 leading causes of childhood death. Transmission of this highly infectious organism is primarily by aerosolized droplets.

Clinical features—presentation varies with age, immunization and previous infection: (1) infants—apnoea, cyanosis, and paroxysmal cough; (2) nonimmunized children—cough, increasing in severity with distressing, repeated, forceful expirations followed by a gasping inhalation (the ‘whoop’); (3) children immunized in infancy—whooping, vomiting, sputum production; (4) adults—cough, post-tussive vomiting. Atypical mild illness is common. Complications include pneumonia, pulmonary hypertension, seizures and encephalopathy. Most deaths occur in those less than 2 months old....
Tetanus
Authors: Thwaites C.L. , Yen Lam Minh
Published: July 2012

Clostridium tetani is a Gram-positive, spore-forming anaerobic bacterium that is ubiquitous, being found throughout the world in human and animal faeces, soil, and street dust. In children and adults, superficial skin wounds are the common entry sites, although in 20% no portal of entry can be found....
Tuberculosis
Authors: Chaisson Richard E. , Nachega Jean B.
Published: July 2012

Tuberculosis is caused by organisms of the Mycobacterium tuberculosis complex, including M. tuberculosis (the most important), M. bovis, and M. africanum. It has been present since antiquity and is the second leading infectious cause of death after HIV infection. An estimated 2 billion people worldwide carry latent infection, when ...
Disease caused by environmental mycobacteria
Authors: van Ingen J. , Davies P.D.O.
Published: July 2012

Introduction—there are over 130 species of mycobacteria; species other than M. tuberculosis complex and M. leprae are collectively referred to as the nontuberculous or environmental mycobacteria. Nontuberculous mycobacteria (NTM) are divided into two groups, the slow growers and the rapid growers. The most common organisms causing human disease are the slow-growing species ...
Relapsing fevers
Authors: Warrell David A.
Published: July 2012

Louse-borne relapsing fever (LBRF) and tick-borne relapsing fevers (TBRF) are characterized by repeated episodes of high fever separated by afebrile period. They are caused by borrelia spirochaetes distinct from those responsible for Lyme borrelioses. Untreated patients may suffer as many as five (LBRF) or ten (TBRF) febrile relapses of decreasing severity....
Leptospirosis
Authors: Watt George
Published: July 2012

Leptospirosis is a worldwide zoonosis of greatest importance in the tropics that is caused by spirochaetes of the 16 species of the genus Leptospira. Rodents are the most important reservoir, with transmission of infection usually occurring through contact with contaminated water or moist soil. Organisms enter the human body through abrasions of the skin or through mucosal surfaces....
Bartonella bacilliformis infection
Authors: Llanos-Cuentas A. , Maguiña-Vargas C.
Published: July 2012

Bartonellosis (Carrión´s disease, verruga Peruana, Oroya fever, Guaitará fever) is caused by the Gram-negative bacillus Bartonella bacilliformis. It is endemic in the western Andes and inter-Andean valleys of Peru, and is still occasionally reported in Ecuador, with infection resulting from the bite of various female sandflies....
Chlamydial infections
Authors: Taylor-Robinson David , Mabey David
Published: July 2012

Chlamydiae are pathogenic bacteria that probably evolved from host-independent, Gram-negative ancestors and are specialized for an intracellular existence. The chlamydial infectious elementary body binds to and enters the host cell by ‘parasite-specified’ endocytosis, with a new generation of elementary bodies being released 30 to 48 h later....
A check list of bacteria associated with infection in humans
Authors: Paul J.
Published: July 2012

In addition to the relatively small number of well-known pathogenic bacteria that are able to infect otherwise healthy people, e.g. Staphylococcus aureus, Mycobacterium tuberculosis, and Streptococcus pyogenes, there is a steadily growing list of less well known organisms, many of which are able to cause disease only under special circumstances....
Coccidioidomycosis
Authors: Anstead Gregory M. , Graybill John R.
Published: July 2012

Coccidioidomycosis results from inhalation of arthroconidia of Coccidioides spp., which are soil fungi endemic to the south-western United States of America and parts of Latin America. Most infections are asymptomatic, but primary infection may resemble community-acquired pneumonia, sometimes with hypersensitivity manifestations such as erythema nodosum, erythema multiforme, and arthritis. Acute pulmonary infection usually resolves spontaneously, but—especially in immunocompromised patients, African Americans, and Filipinos—it may progress to persistent pulmonary disease or disseminate to skin, soft tissues, the osteoarticular system, and the central nervous system. Diagnosis is by culture, histopathology or serology. Fluconazole and itraconazole are usually the initial drugs of choice, with amphotericin B reserved for severe pulmonary and disseminated disease, and in pregnancy. In refractory cases, posaconazole and voriconazole are alternative antifungal agents....
Malaria
Authors: Warrell David A. , Hemingway Janet , Marsh Kevin , Sinden Robert E. , Butcher Geoffrey A. , Snow Robert W.
Published: July 2012

According to WHO’s World Malaria Report for 2010, there were an estimated 216 million cases of malaria worldwide in 2010 with 655 000 deaths, 5% fewer than in 2009 and 26% fewer than in 2000. Africa accounted for 81% of the cases and 91% of deaths; 86% of the deaths were in children aged less than 5 years. Malaria remains endemic in 106 countries. Nigeria, Democratic Republic of Congo, Burkina Faso, Mozambique, Ivory Coast, and Mali account for 60% of malaria deaths....
Sarcocystosis (sarcosporidiosis)
Authors: Cooper John E.
Published: July 2012

Sarcocystosis is characterized by the invasion of muscles and sometimes other tissues by protozoa of the genus Sarcocystis, of which S. hominis (intermediate host domestic cattle) and S. suihominis (domestic pig) are the most significant to humans, to whom they are transmitted by ingestion of uncooked beef or pork. Humans serve as either intermediate or final host: (1) intermediate host—presence of cysts in muscle is usually asymptomatic, but may cause myositis or myopathy; detected on clinical examination or muscle biopsy; (2) final host—may be asymptomatic or cause fever and gastrointestinal upset; oocysts or sporocysts can be detected in faeces. There is no specific treatment. Prevention is by not eating uncooked meat from any animal....
Blastocystis hominis infection
Authors: Knight Richard
Published: July 2012

Blastocystis hominis is an anaerobic unicellular non-invasive colonic parasite of animals and humans. It is transmitted faeco-orally, with human infection associated with travel, institutions, animal handlers and immunodeficiency. Case reports strongly suggest that it causes a self-limited diarrhoeal illness. Diagnosis is by microscopic examination of faecal smears or concentrates. A trial of treatment with metronidazole is justified in patients who are immunocompromised, also when symptoms are prolonged....
Lymphatic filariasis
Authors: Knight Richard , Molyneux D.H.
Published: July 2012

Wuchereria bancrofti, Brugia malayi, and B. timori are mosquito-borne nematode parasites that are important causes of morbidity, disability, and social stigma in tropical and subtropical countries. Bancroftian filariasis due to W. bancrofti, which has no animal reservoir, accounts for 90% of human infections worldwide.

Acute lymphatic filariasis—(1) lymphadenitis and lymphangitis—most common in the inguinal and femoral nodes; (2) acute genital—usually tender fusiform or cylindrical swelling of the spermatic cord; (3) abscess and fever—affected nodes may break down to produce an open ulcer....
Gnathostomiasis
Authors: Bussaratid Valai , Suntharasamai Pravan
Published: July 2012

Gnathostomiasis is an extraintestinal infection with larval or immature nematodes of the genus Gnathostoma (order Spirurida), the most common mode of human infection being consumption of undercooked freshwater fish. Clinical manifestations include recurrent cutaneous migratory swellings (common), creeping eruption (rare), and neurological deficits (occasional). Definitive diagnosis is by identification of the worm in surgical specimens; serological testing for antibody against gnathostoma antigen can confirm a presumptive diagnosis. Treatment of choice is albendazole or if possible, surgical removal of the worm in accessible areas and when the parasite can be located. Prevention is by avoiding all dishes that contain raw or poorly cooked flesh of animals or fish in or imported from endemic areas....
Cyclophyllidian gut tapeworms
Authors: Knight Richard
Published: July 2012

The cyclophyllidean tapeworms are cestodes that maintain anchorage to the host small-gut mucosa by means of a scolex bearing four suckers; mature reproductive proglottids develop at the end of the worm. The life cycle involves a cystic larval stage, usually in a nonhuman host species. Humans are an obligatory part of the life cycle in four gut species; in the rest they are an accidental host....
Intestinal trematode infections
Authors: Grove David I.
Published: July 2012

Intestinal trematode infections are widespread, but most common in Asia as a reflection of cultural culinary factors.

Echinostomiasis and fasciolopsiasis—infection of the intestines with flukes (flatworms) of the family Echinostomatidae is acquired by the ingestion of undercooked freshwater fish, molluscs, frogs, or vegetation. Heavy infections with these worms (2–20 mm long) may cause abdominal discomfort and diarrhoea. ...
Common Indian poisonous plants
Authors: Pillay V.V.
Published: July 2012

Common poisonous plants encountered in India include (1) irritant plants, e.g. castor, colocynth, croton, glory lily, marking nut, mayapple, red pepper, rosary pea; (2) cardiotoxic plants, e.g. aconite, autumn crocus, common oleander, yellow oleander, suicide tree; (3) neurotoxic plants, e.g. calotropis, cassava, chickling pea, datura, strychnos; (4) hepatotoxic plants, e.g. neem; and (5) miscellaneous toxic plants and plant products, including arecanut, ...
Occupational safety
Authors: Waterman Lawrence
Published: July 2012

Any approach to occupational health must acknowledge that accidents in the workplace result in many injuries. Construction, agriculture, and primary extraction are the main causes of fatalities and serious injuries, but many more minor injuries result from all kinds of work.

Health and safety law has developed with an emphasis on accident prevention that is based on designing and managing the working environment by (1) defining appropriate processes and work practices that are safe; (2) developing and maintaining a health and safety culture; and (3) influencing behaviour so that everyone is focused on the best and safest way to do their work....
Vibration
Authors: Aw Tar-Ching
Published: July 2012

Various occupations can lead to exposure to vibration, which can be transmitted to the whole body or localized to the hands. The main clinical effect of whole body vibration exposure is low back pain. Effects from hand-transmitted vibration can be (1) vascular, with manifestations of secondary Raynaud’s phenomenon; (2) neurological, often presenting as paraesthesia and reduced sensory perception; and (3) musculoskeletal, including reduced grip strength and loss of manual dexterity. Management requires exclusion of differential diagnoses, and the identification and reduction of exposure to vibration at source. Diagnosis of an index case should prompt further investigation and (if possible) modification of the workplace to prevent other cases....
Ovarian disorders
Authors: Franks Stephen , Webber Lisa J.
Published: July 2012

The ovary produces (1) gametes—germ cells in the ovary have undergone the first meiotic division to become oocytes in primordial follicles by the time of birth, with about 400 of these ovulating during reproductive life; and (2) hormones—oestradiol, progesterone, androgens, and two nonsteroidal glycopeptides, inhibin A and B....
Thrombosis in pregnancy
Authors: Greer I.A.
Published: July 2012

Aetiology—features that predispose to venous thromboembolism include (1) pregnancy is a thrombophilic state; (2) there is relative venous stasis during pregnancy; and (3) some endothelial damage to the pelvic vessels occurs during delivery.

Epidemiology— venous thromboembolism complicates around 1 in 1000 pregnancies, with highest risk just after delivery. Deep venous thromboses usually occur on the left side, and a much higher proportion are ileofemoral than in patients who are not pregnant....
Investigation of gastrointestinal function
Authors: Walters Julian R.F.
Published: July 2012

Many blood measurements of absorbed dietary components (such as iron, folate, vitamin B12, cholesterol, and triglycerides) or their metabolic products (such as haemoglobin or albumin) can be abnormal when gastrointestinal function is impaired, and their serial changes can be used to follow progress of disease. Specific assessment of the function of the gastrointestinal tract complements the findings of imaging, endoscopy, and histology in the diagnosis of digestive diseases....
Differential diagnosis and investigation of malabsorption
Authors: Walters Julian R.F.
Published: July 2012

Malabsorption by the gastrointestinal tract results in excess loss of dietary nutrients in the faeces and, if dietary intake does not increase to compensate, nutritional deficiency in the body. Digestion and absorption involve multiple processes in the entire gastrointestinal tract and hence a large number of different conditions can result in specific or generalized patterns of malabsorption....
Pulmonary Langerhans’ cell histiocytosis
Authors: Bourke S.J. , Hendrick D.J.
Published: July 2012

Pulmonary Langerhans’ cell histiocytosis is characterized by a reactive monoclonal proliferation of activated histiocytes in the distal bronchioles. It presents, nearly always in smokers, with cough, breathlessness, and (sometimes) systemic symptoms. Pneumothorax (sometimes bilateral) is a common complication. Chest radiography typically shows micronodules, reticulation, and small cysts, with fibrosis in advanced cases. Patients must stop smoking. About 25% of cases resolve, 50% stabilize, and 25% lose lung function. Corticosteroids and/or cytotoxic drugs are usually given for progressive disease, but the benefits are unclear....
Radiation pneumonitis
Authors: Bourke S.J. , Hendrick D.J.
Published: July 2012

The lungs can be injured by radiation used in cancer treatment, with the rapidly dividing endothelial cells and type II pneumocytes most affected. Immediate injury is followed by an inflammatory response and at a later stage by fibrosis. Chest radiography reveals asymptomatic changes in about 50% of patients after radiotherapy. ...
Systemic sclerosis
Authors: Denton Christopher P. , Black Carol M.
Published: July 2012

The scleroderma spectrum of disorders includes a number of diseases that have Raynaud’s phenomenon or skin sclerosis in common, comprising (1) limited cutaneous scleroderma; (2) systemic sclerosis (SSc)—the most important form of scleroderma—limited cutaneous SSc, diffuse cutaneous SSc, and overlap syndromes (with features of another autoimmune rheumatic disease, e.g. systemic lupus erythematosus); (3) Raynaud’s phenomenon—autoimmune (with antinuclear or other SSc-associated antibodies) or primary. These conditions affect women four times as often as men, most often beginning in the fifth decade....
Membranous nephropathy
Authors: Adu Dwomoa
Published: July 2012

Membranous nephropathy, which accounts for 20 to 30% of cases of the nephrotic syndrome in adults, is defined histologically by the presence of subepithelial immune deposits on the outer surface of the glomerular basement membrane. The immune mechanisms that lead to this are uncertain, and most cases are of unknown cause (idiopathic), but the condition can be associated with autoimmune diseases (systemic lupus erythematosus), malignancy (in 10% of cases, most commonly lung and prostate cancer), drugs, and infections....
The classification of leukaemia
Authors: Erber Wendy N.
Published: July 2012

Leukaemia is a malignant neoplasm of haematopoietic cells originating in the marrow and spreading to the blood and other tissues, such as the lymph nodes, spleen, and liver. The characteristic feature of the neoplastic cells is that they retain the ability to proliferate but fail to differentiate normally into functional haematopoietic cells. This results in replacement of the normal bone marrow by the leukaemic cells....
Neurological complications of systemic disease
Authors: Scolding Neil
Published: July 2012

Primary neuroimmune disorders such as multiple sclerosis or the Guillain–Barré syndrome are well recognized (and described elsewhere in this section), but there are numerous diverse systemic inflammatory, infective, or immunological disorders that can affect the nervous system.

Autoimmune rheumatic disorders—(1) Systemic lupus erythematosus—neurological manifestations include headache, acute or subacute encephalopathy, fits, myelitis, strokes and movement disorders (including chorea and other extrapyramidal disorders), ataxia and brainstem abnormalities, cranial and peripheral neuropathies, and psychiatric and cognitive disturbances. Risk of stroke is particularly associated with the lupus anticoagulant and the primary antiphospholipid syndrome. (2) Other conditions—(a) rheumatoid arthritis: mononeuritis, cervical cord compression; (b) Sjögren’s syndrome: sensory neuropathy, myositis, various central nervous system complications; (c) Reiter’s disease: polyneuritis, radiculitis, various central nervous system manifestations....
The patient who has attempted suicide
Authors: Hawton Keith
Published: July 2012

Attempted suicide includes all acts of intentional self-poisoning or self-injury, with most cases seen in hospitals involving self-poisoning. It is a substantial health care problem in many countries, especially in young people, hence all large general hospitals should have dedicated services for patients who have attempted suicide....
Medically unexplained symptoms in patients attending medical clinics
Authors: Sharpe Michael
Published: July 2012

Patients commonly present to doctors with symptoms, and doctors seek disease to explain these symptoms. However, in about one-third of medical outpatients the symptoms remain inadequately explained by disease, even after exhaustive assessment. The size of the problem of medically unexplained symptoms, their cost to services, and public health importance are all becoming increasingly clear....
Eating disorders
Authors: Fairburn Christopher G.
Published: July 2012

Eating disorders affect about 5% of adolescent girls and young adult women. They are much less common among men. They typically begin in adolescence and may run a chronic course, interfering with psychological, physical, and social functioning.

Three eating disorders are distinguished: (1) anorexia nervosa; (2) bulimia nervosa; and (3) a residual diagnostic category—the most common seen in routine clinical practice— termed ‘eating disorder not otherwise specified’ (eating disorder NOS). They all share a distinctive ‘core psychopathology’, the overevaluation of shape and weight, and patients frequently move between the categories, hence a case may be made for adopting a ‘transdiagnostic’ perspective....
Psychological treatment in medical practice
Authors: Sharpe Michael , Wessely Simon
Published: July 2012

Patients have minds as well as bodies, and medical treatment must often address both if it is to be effective.

Psychological treatments—these may be divided into general and specialist types. All medical consultations have an important and inescapable psychological effect, hence all physicians are general psychotherapists. All medical consultations have the potential for both psychological help and for harm. Helpful consultations educate the patient, reassure them, and achieve adherence to treatment. Harmful consultations leave the patient confused or with inaccurate ideas about their health, increase anxiety, and make adherence to the physician’s treatment less likely. Being able to deliver a psychologically helpful consultation is therefore a core medical skill....
Brief interventions against excessive alcohol consumption
Authors: Heather Nick , Kaner Eileen
Published: July 2012

Treatment and prevention of alcohol-related harm includes attention to the full range of alcohol problems that occur, including hazardous and harmful drinking as well as alcohol dependence. The prevalence of these problems is high, amounting to about one in four of the adult population of the United Kingdom, which is similar to the numbers who smoke....
Forensic medicine and the practising doctor
Authors: Busuttil Anthony
Published: July 2012

Doctors have to keep in mind their legal responsibilities and duties from the very first day of their practice. The services of a medical practitioner are often called upon when injuries and other forms of abuse have taken place, and also when death has occurred, particularly if death was sudden and unexpected. As a direct consequence, the doctor may acquire information that suggests a suspicious and potentially criminal event. In such instances, the doctor’s duty of care and bond of confidentiality to the patient must be carefully balanced against their duties as a citizen of a country in which homicide cannot go undetected and crime cannot be condoned....
Medicine in old age
Authors: Wilcock Gordon , Rockwood Kenneth
Published: July 2012

Frailty occurs in a mainly older or geriatric population, is linked to the accumulation of a number of different health-related problems, and may influence disease presentation. A frequently used clinical definition recognizes presentations comprising weight loss, exhaustion, slow movement, a low level of physical activity, and weakness. It can also be graded by degree of disability: (1) very mild frailty describes someone who has given up complex hobbies; (2) mild frailty implies some dependence on ‘instrumental activities of daily living’; (3) moderate frailty involves intermediate self-care activities; and (4) severe frailty requires personal-care dependence. The complexity of frailty underlies the difficulties that often arise when managing the care of an older person. Understanding the concept and consequences of frailty is essential to the problems of and successful management of many older people....
Renal failure
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: July 2012

This chapter on renal failure covers decisions regarding dialysis, symptom control, causes of pain, analgesic usage in renal failure, and other symptoms in renal failure. The chapter also includes a formulary.
Specific conditions
Authors: Forsyth Rob , Newton Richard
Published: July 2012

Acquired brain injury 210

Acquired spinal cord injury 215

Autoimmune disease of the central nervous system 218

‘Autoinflammatory’ conditions 223

Autoimmune encephalitides 224

Cerebral palsies 227

Care of the disabled child 240

Feeding 248

Communication 251

Special senses 252

Respiratory disease in neurodisability 254

Demyelinating disease ...
Pharmacopoeia
Authors: Forsyth Rob , Newton Richard
Published: July 2012

Pharmacopoeia: A–Z 574

Acute sedation protocols 619

Interactions of anti-epileptic drugs 619

This section is not intended to override advice contained in national or hospital formularies. It is intended as general guidance. The doses quoted have been obtained from a variety of sources and/or used over a number of years by experienced neurologists. At times they may appear to exceed recommended dosages in formularies....
FxkR Provides the Missing Link in the fixL-fixK Signal Transduction Cascade in Rhizobium etli CFN42
Authors: Zamorano-Sánchez David , Reyes-González Alma , Gómez-Hernández Nicolás , Rivera Patricia , Georgellis Dimitris , Girard Lourdes
Published: July 2012

Transcriptional control of the fixK gene in Rhizobium etli and R. leguminosarum bv. viciae is governed by a two-component signal transduction system that diverts from the conventional FixL-FixJ cascade that occurs in model rhizobia. Although a fixL gene, encoding a hybrid histidine kinase (hFixL), is present in R. etli, no fixJ, the cognate response regulator, has been identified. In this work, we present evidence that the pRet42f-located open reading frame RHE_PF00530 (fxkR) encodes a novel response regulator indispensable for fixKf activation under microaerobic growth. Moreover, results from complementation assays demonstrate that the activation of fixKf expression requires the presence of both hFixL and FxkR, and that the fxkR ortholog from R. leguminosarum bv. viciae is able to substitute for FxkR transcriptional control in R. etli. In addition, in these two organisms, hFixL- and FxkR-related proteins were identified in other bacteria, located in close proximity to a fixK-related gene. Using reporter fusions, site-directed mutagenesis, and electrophoretic mobility shift assays, we identified the FxkR binding site upstream from the transcriptional start site of fixKf. Similar to our previous observations for fixL and fixKf mutants, a null mutation in fxkR does not affect the symbiotic effectiveness of the strain. Thus, our findings reveal that FxkR is the long-standing missing key regulator that allows the transduction of the microaerobic signal for the activation of the FixKf regulon.
The movement protein encoded by gene 3 of rice transitory yellowing virus is associated with virus particles
Authors: Hiraguri Akihiro , Hibino Hiroyuki , Hayashi Takaharu , Netsu Osamu , Shimizu Takumi , Uehara-Ichiki Tamaki , Omura Toshihiro , Sasaki Nobumitsu , Nyunoya Hiroshi , Sasaya Takahide
Published: July 2012

Gene 3 in the genomes of several plant-infecting rhabdoviruses, including rice transitory yellowing virus (RTYV), has been postulated to encode a cell-to-cell movement protein (MP). Trans-complementation experiments using a movement-defective tomato mosaic virus and the P3 protein of RTYV, encoded by gene 3, facilitated intercellular transport of the mutant virus. In transient-expression experiments with the GFP-fused P3 protein in epidermal leaf cells of Nicotiana benthamiana, the P3 protein was associated with the nucleus and plasmodesmata. Immunogold-labelling studies of thin sections of RTYV-infected rice plants using an antiserum against Escherichia coli-expressed His6-tagged P3 protein indicated that the P3 protein was located in cell walls and on virus particles. In Western blots using antisera against E. coli-expressed P3 protein and purified RTYV, the P3 protein was detected in purified RTYV, whilst antiserum against purified RTYV reacted with the E. coli-expressed P3 protein. After immunogold labelling of crude sap from RTYV-infected rice leaves, the P3 protein, as well as the N protein, was detected on the ribonucleocapsid core that emerged from partially disrupted virus particles. These results provide evidence that the P3 protein of RTYV, which functions as a viral MP, is a viral structural protein and seems to be associated with the ribonucleocapsid core of virus particles.
Chum salmon Oncorhynchus keta respond to moonlight during homeward migrations
Authors: Hasegawa E. I.
Published: July 2012

The swimming depth of chum salmon Oncorhynchus keta equipped with archival tags was investigated off the Pacific Ocean coast of Hokkaido and North Honshu, Japan. As shown from movements of the fish with disc tags, O. keta swam at shallower depths during the full‐moon phase than in the other phases and their swimming speed during this phase was faster compared to other phases. In addition, the circadian rhythm suggests a biological clock. These observations are all consistent with the view that O. keta make use of moonlight in order to navigate at night‐time during homeward migration.
Spawning migrations of the endemic Labeobarbus (Cyprinidae, Teleostei) species of Lake Tana, Ethiopia: status and threats
Authors: Anteneh W. , Getahun A. , Dejen E. , Sibbing F. A. , Nagelkerke L. A. J. , De Graaf M. , Wudneh T. , Vijverberg J. , Palstra A. P.
Published: July 2012

The reproductive biology of the only known intact species flock of large cyprinids, the 16 Labeobarbus species of Lake Tana (Ethiopia), has been extensively studied for the past two decades. Seven species of Labeobarbus are known to migrate >50 km upstream into tributary rivers for spawning during the rainy season (July to October), whereas eight other species are absent from these rivers and probably developed a new strategy of lacustrine spawning (macro‐spatial segregation). One species (L. intermedius) probably spawns in the lake as well as in the rivers. Between the early 1990s and 2000s, the riverine spawners showed a decline of 75% in both biomass and number in both fishery independent surveys and in commercial catches. Reproductive migration makes fishes vulnerable to fisheries and other threats like habitat modifications. Lacustrine spawners are probably more resilient as they are not known to form spawning aggregations that can easily be exploited by fishermen. In addition, upstream rivers and catchments around Lake Tana are highly degraded by erosion and recently subjected to intensive habitat modification for irrigation and hydroelectric power generation. This article reviews results of field studies on the Labeobarbus spawning migration from Lake Tana to spawning rivers, giving emphasis on segregation and homing. It also summarizes existing and emerging threats which form potential causes for the decline of the migratory Labeobarbus species. Knowledge gaps on the reproductive biology are identified for further investigation.
A critical life stage of the Atlantic salmon Salmo salar: behaviour and survival during the smolt and initial post‐smolt migration
Authors: Thorstad E. B. , Whoriskey F. , Uglem I. , Moore A. , Rikardsen A. H. , Finstad B.
Published: July 2012

The anadromous life cycle of Atlantic salmon Salmo salar involves long migrations to novel environments and challenging physiological transformations when moving between salt‐free and salt‐rich waters. In this article, (1) environmental factors affecting the migration behaviour and survival of smolts and post‐smolts during the river, estuarine and early marine phases, (2) how behavioural patterns are linked to survival and (3) how anthropogenic factors affect migration and survival are synthesized and reviewed based on published literature. The timing of the smolt migration is important in determining marine survival. The timing varies among rivers, most likely as a consequence of local adaptations, to ensure sea entry during optimal periods. Smolts and post‐smolts swim actively and fast during migration, but in areas with strong currents, their own movements may be overridden by current‐induced transport. Progression rates during the early marine migration vary between 0·4 and 3·0 body lengths s−1 relative to the ground. Reported mortality is 0·3–7·0% (median 2·3) km−1 during downriver migration, 0·6–36% (median 6·0) km−1 in estuaries and 0·3–3·4% (median 1·4) km−1 in coastal areas. Estuaries and river mouths are the sites of the highest mortalities, with predation being a common cause. The mortality rates varied more among studies in estuaries than in rivers and marine areas, which probably reflects the huge variation among estuaries in their characteristics. Behaviour and survival during migration may also be affected by pollution, fish farming, sea lice Lepeophtheirus salmonis, hydropower development and other anthropogenic activities that may be directly lethal, delay migration or have indirect effects by inhibiting migration. Total mortality reported during early marine migration (up to 5–230 km from the river mouths) in the studies available to date varies between 8 and 71%. Hence, the early marine migration is a life stage with high mortalities, due to both natural and human influences. Factors affecting mortality during the smolt and post‐smolt stages contribute to determine the abundance of spawner returns. With many S. salar populations in decline, increased mortality at these stages may considerably contribute to limit S. salar production, and the consequences of human‐induced mortality at this stage may be severe. Development of management actions to increase survival and fitness at the smolt and post‐smolt stages is crucial to re‐establish or conserve wild populations.
The Anguilla spp. migration problem: 40 million years of evolution and two millennia of speculation
Authors: Righton D. , Aarestrup K. , Jellyman D. , Sébert P. , van den Thillart G. , Tsukamoto K.
Published: July 2012

Anguillid eels Anguilla spp. evolved between 20 and 40 million years ago and possess a number of remarkable migratory traits that have fascinated scientists for millennia. Despite centuries of effort, the spawning areas and migrations are known only for a few species. Even for these species, information on migratory behaviour is remarkably sketchy. The latest knowledge on the requirements for successful migration and field data on the migrations of adults and larvae are presented, how experiments on swimming efficiency have progressed the understanding of migration are highlighted and the challenges of swimming at depth considered. The decline of Anguilla spp. across the world is an ongoing concern for fisheries and environmental managers. New developments in the knowledge of eel migration will, in addition to solving a centuries old mystery, probably help to identify how this decline might be halted or even reversed.
Model of translational cancer research in multiple myeloma
Authors: Yasui Hiroshi , Ishida Tadao , Maruyama Reo , Nojima Masanori , Ikeda Hiroshi , Suzuki Hiromu , Hayashi Toshiaki , Shinomura Yasuhisa , Imai Kohzoh
Published: July 2012

Recently, intensive laboratory and preclinical studies have identified and validated therapeutic molecular targets in multiple myeloma (MM). The introduction of novel agents such as the proteasome inhibitor bortezomib and the immunomodulatory drugs thalidomide and lenalidomide, which were rapidly translated from preclinical studies at the Dana‐Farber Cancer Institute into clinical trials, has changed the treatment paradigm and markedly extended overall survival; MM has therefore become a remarkable example of translational cancer research in new drug development. In this article, with the aim of determining the key factors underlying success in translational research, we focus on our studies of MM at Dana‐Farber Cancer Institute as well as at our institutes. The identification of these key factors will help to promote translational cancer research not only in MM but also in other hematologic malignancies and solid tumors, to develop novel therapies, to overcome drug resistance, and to thereby improve the prognosis of cancer patients. (Cancer Sci, doi: 10.1111/j.1349‐7006.2012.02384.x, 2012)
Disease emergence and invasions
Authors: Hatcher Melanie J. , Dick Jaimie T. A. , Dunn Alison M.
Published: July 2012

Emerging infectious diseases (EIDs) are recognized as having significant social, economic and ecological costs, threatening human health, food security, wildlife conservation and biodiversity. We review the processes underlying the emergence of infectious disease, focusing on the similarities and differences between conceptual models of disease emergence and biological invasions in general.

Study of theIUCN's list of the world's worst invaders reveals that disease is cited as a driver behind the conservation, medical or economic impact of nearly a quarter of the species on the data base.

The emergence of novel diseases in new host species are, in essence, examples of invasions by parasites. Many of the ecological and anthropogenic drivers of disease emergence and classical invasions are also shared, with environmental change and global transport providing opportunities for the introduction and spread of invaders and novel parasites.

The phases of disease emergence and biological invasions have many parallels; particularly the early and late phases, where demographic and anthropogenic factors are key drivers. However, there are also differences in the intermediate phases, where host–parasite co‐evolution plays a crucial role in determining parasite establishment in novel hosts.

Similar opportunities and constraints on control and management occur at the different phases of invasions and disease emergence. However, exploitation of host immune responses offers additional control opportunities through contact control and vaccination againstEIDs. We propose that cross‐fertilization between the disciplines of disease emergence and invasion biology may provide further insights into their prediction, control and management.
FoxP3+ T regulatory cells in oral lichen planus and its correlation with the distinct clinical appearance of the lesions
Authors: Pereira Joabe S. , Monteiro Bárbara V. , Nonaka Cassiano F. , Silveira Éricka J. , Miguel Márcia C.
Published: July 2012

The aim of this study was to evaluate the presence of FoxP3+ cells in oral lichen planus (OLP) and to correlate the findings with clinical and histopathological features of these lesions. The sample consisted of 32 cases of OLP (17 reticular and 15 erosive cases) and 10 cases of inflammatory fibrous hyperplasia (IFH). Clinical examination, histopathological and histomorphometric analysis, and immunohistochemistry (anti‐FoxP3 antibody) were performed. Cells were counted in juxtaepithelial and intraepithelial regions of the lesions, and the results are expressed as the mean and range. Most erosive lesions were keratinized and exhibited epithelial atrophy, whereas most reticular lesions were hyperkeratinized. Mean epithelial thickness and mean density of the inflammatory infiltrate were higher in reticular lesions than in erosive OLP. Juxtaepithelial FoxP3+ cells were slightly more frequent in erosive lesions (mean: 1.7 and range: 0–9.4) than in reticular lesions (mean: 1.5 and range: 0–8.3). There was a significant difference in the frequency of these cells between OLP (mean: 1.6 and range: 0–9.4) and IFH (mean: 0.5 and range: 0–1.4) (P < 0.05). The number of intraepithelial FoxP3+ cells was higher in reticular OLP and IFH when compared with erosive lesions. The larger number of juxtaepithelial FoxP3+ cells in OLP compared to IFH might be related to the distinct etiopathogenesis of these lesions. High disease activity or action of the oral microbiota may explain the slightly higher frequency of FoxP3+ cells in erosive lesions.