The Editorial Office, IMAJ.
D. Itzhaky, D. Amital, K. Gorden, A. Bogomolni, Y. Arnson and H. Amital
Background: Vitamin D is increasingly associated with the pathology of cognition and mental illness. Vitamin D receptors have been detected on neurons that regulate behavior.
Objective: To assess vitamin D serum concentrations in patients with major depression and schizophrenia as compared to healthy controls and to determine if a correlation exists between serum levels of vitamin D and disease activity.
Methods: We recruited 50 patients with schizophrenia and compared them to 33 patients with major depression and 50 controls with no major psychopathology. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia and the Hamilton Depression scale for depression were administered on the same day the blood samples were drawn. We used LIAISON® 25-OH vitamin D (DiaSorin) immunoassay to measure serum concentrations of 25-OH vitamin D.
Results: Lower serum vitamin D concentrations were detected among patients with schizophrenia (15.0 ± 7.3 ng/ml) compared to patients with depression (19.6 ± 8.3 ng/ml) and to controls (20.2 ± 7.8 ng/ml, P < 0.05). We found no correlation between disease activity, measured by the PANSS score, and vitamin D levels.
Conclusions: Serum vitamin D levels were lower in patients with schizophrenia as compared to patients with depression and to healthy controls. No correlation was found between serum concentration and disease activity. Additional studies are needed to elucidate the role of vitamin D in the autoimmune mechanism and in the pathogenesis of schizophrenia.
L. Nesher, K. Riesenberg, L. Saidel-Odes, F. Schlaeffer and R. Smolyakov
Background: The southern region of Israel has recently experienced an influx of African refugees from the Eastern Sub-Sahara desert area. These influxes led to a significant increase in incidence of tuberculosis (TB) in that region.
Objectives: To review the data of African refugees diagnosed with TB between January 2008 and August 2010 at a tertiary care regional hospital.
Results: Twenty-five TB cases were diagnosed, 22 of which presented with pulmonary TB, 3 with extra-pulmonary TB (EPTB), and 7 with combined pulmonary and EPTB. Only one case had concomitant human immunodeficiency virus (HIV) infection and multidrug-resistant TB. Fifteen patients underwent extensive radiological investigations including chest, abdominal and spine computed tomography, 1 was reviewed by magnetic resonance imaging, and 9 underwent tissue biopsy. Eighteen patients were admitted as suspected TB and 4 as suspected pneumonia or pulmonary infiltrates that could have been defined as suspected TB. All 24 HIV-negative cases were sensitive to first-line drugs for TB except one case that was resistant to streptomycin and one to rifampicin. All patients responded well to first-line therapy. The average duration of hospitalization was 8.7 days (range 1–36). Following diagnosis 23 patients were transferred to a quarantine facility.
Conclusions: We identified overutilization of medical resources and invasive procedures. For African refugees from the eastern Sub-Sahara who were HIV-negative and suspected of having TB, a sputum acid-fast smear and culture should have been the primary investigative tools before initiating treatment with four drugs (first-line), and further investigations should have been postponed and reserved for non-responders or for patients for whom the culture was negative. Physicians should maintain a high index of suspicion for EPTB in this population.
M. Vardi, T. Kochavi, Y. Denekamp and H. Bitterman
Background: Extended-spectrum beta-lactamase (ESBL) resistance is a growing concern in and outside hospitals. Physicians often face a true clinical dilemma when initiating empirical antibiotic treatment in patients admitted to internal medicine departments.
Objectives: To determine the prevalence of risk factors for ESBL resistance in patients with urinary tract infection (UTI) admitted to internal medicine departments.
Methods: We conducted a retrospective analysis of the medical records of patients with UTI admitted to an internal medicine division in a community-based academic hospital over a 1 year period. We collected clinical, laboratory and imaging data that were available to the treating physician at admission. Outcome measures included ESBL resistance and death.
Results: Of the 6754 admissions 366 patients were included in the study. Hospitalization during the previous 3 months (odds ratio 3.4, P < 0.0001), residency in a long-term-care facility (OR[1] 2.4, P = 0.004), and the presence of a permanent urinary catheter (OR 2.2, P = 0.015) were correlated to ESBL resistance with statistical significance. These risk factors were extremely prevalent in our patient cohort.
Conclusions: ESBL resistance is becoming prevalent outside hospital settings, and patients admitted to an internal medicine department with UTI frequently carry risk factors for harboring resistant bacteria. In such patients a high index of suspicion and early targeted antibiotic treatment for ESBL-producing Enterobacteriaceae may be justified.
OR = odds ratio