While several studies have noted smell impairment in schizophrenia, it is unclear whether this impairment extends to acute psychosis and whether it is associated with more severe illness as expressed in extended hospitalization.To evaluate the olfactory function of patients in an acute psychotic state and correlate it with clinical symptomatology and length of hospitalization.Olfactory function was assessed in 20 patients with schizophrenia in their first week of hospital admission for acute psychosis compared with matched controls. Olfaction was evaluated via three stages: threshold, discrimination, and identification of different odors utilizing the Sniffin' Sticks test battery.Schizophrenia patients scored significantly lower on total smell score, discrimination, and identification abilities. A significant association was observed between hospitalization duration and total smell score and smell discrimination. No significant associations between smell and clinical symptomatology were observed.Study observations confirm impaired sense of smell in schizophrenia patients and suggest that smell impairment may be a potential marker of more serious illness as expressed in longer hospital stay.
Chlamydia trachomatis is a primary cause of acute or silent salpingitis leading to infertility and ectopic pregnancy. The C. trachomatis epidemic, undiscovered in most cases, spreads, mostly in adolescents, during the years following the onset of sexual activity. As opposed to gonococcal infection which has greatly decreased, C. trachomatis cervical and urethral infection is commun in young occidentals. More then 30 different studies covering 200-12000 subjects screened in family planning centers, college women and men, students and military recruits in different parts of the USA, in Scandinavian countries and France, indicate a prevalence of 5-20% (mean 10%) in apparently healthy young females < 25 years and 5-10% in males. Female prevalence is strongly related to age, being highest (5-20%) in women < 20 years old. Several cost-benefit analysis show that the total cost of the general screening in young populations, which can easily be carried out for women in family planning centers, could save twice the cost of treatment for pelvic inflammatory disease caused by C. trachomatis and six times the total cost of C. trachomatis epidemics if late sequelae are taken into account (tubal infertility treatment, ectopic pregnancy). In France, screening should save 12 to 48 millions French francs each year, depending of the cost of detection. The final benefit of detection should be the eradication of the epidemic as obtained to date in Scandinavian countries.
Few if any methodologically robust studies of first-episode psychosis have been carried out in the ultra-Orthodox Jewish population. The opening of an inpatient psychiatry department within an ultra-Orthodox neighborhood in Israel offered the unique opportunity to study the specifics of first -episode psychosis in this subpopulation. Medical records of 60 ultra-Orthodox male Jewish patients with first-episode psychosis were examined over the first 18 months of the new department’s operation. Data regarding the patients’ demographical status, anamnestic information, clinical presentation, and psychiatric care were analyzed. Participants were 18–30 years old; 15 (25%) were already engaged or married. Most patients (37, 61.7%) had not been employed in any formal activity prior to their hospitalization, with 21 patients (35%) studying in a Talmudical school. Religion-related delusions were noted in 20 patients (33.3%), and community/rabbi-related delusions in 18 patients (30%). Only three patients (5%) reported suicidal attempts. Duration of untreated psychosis (DUP) ranged between 1–48 months (mean 10.4, SD 9.5). In contrast to other first-episode psychosis studies, this study highlights specific features of first-episode psychosis in the ultra-Orthodox Jewish population, which is characterized by a high marriage rate, short DUP, low rates of substance use and suicidal attempts, expression of religious- and community-related themes in delusion content, and limited cooperation with health care providers. A better understanding of the cultural specifics of first-episode psychosis in this subpopulation may enable earlier treatment, improve prognosis, and facilitate compliance with medications and rehabilitation programs.
Sexually transmitted AIDS represents 72-82% of the cases reported. While the proportion of cases transmitted heterosexually is still small (7%), this will increase over time (it was only 1% in 1981). Heterosexual AIDS affects 4 times more women than men and occurs essentially in partners of HIV+ subjects, those with AIDS, and subjects at high risk. Many in vitro and in vivo studies have shown that the correct and systematic use of condoms is the sole means of preventing sexual AIDS. In vitro spermicides (nonoxynol-9 and benzalkonium chloride) inactivate the HIV virus. Having many sexual partners, rectal contact, and the STDs increase the risk of HIV transmission. Only mutual monogamy and sexual relations between seronegative subjects (taking into account the serological lag period of a few weeks to 6 months) are safe. In all other cases, it is necessary to systematically use a good quality condom (along with a spermicide), even if other contraception is used, avoid anal contact, and decrease the number and improve the selectivity of sexual partners if possible. Heterosexual males and females at high risk of HIV infection should use an effective method of contraception (the oral contraceptive) in addition to condoms. According to WHO, IUDs are not recommended. Seropositive heterosexuals or those affected by AIDs should abstain from all sexual contact involving penetration, whether vaginal, anal, or oral. They should use the same contraception as high risk heterosexuals. The WHO is undertaking research programs on possible beneficial or detrimental interactions between the modern methods of contraception and HIV infection.
Objective The Protectaid® sponge (Gefar Pharma, Switzerland) is a new feminine barrier contraceptive method containing three low-dose spermicidal agents. In order to evaluate its efficacy and safety profiles, an international, multicenter study has been conducted in four countries. Methods Healthy, presumably fertile and sexually active women were enrolled in this study and were followed at 15 days, 3, 6, 9 and 12 months. Contraceptive efficacy was assessed by a pregnancy test, while safety was evaluated by performing gynecological examinations as well as reporting adverse events. The 'acceptability' of the sponge by the women was assessed through a standard questionnaire. Results A total of 129 women were enrolled in the study, generating 1182 cycles of use of the sponge. The overall efficacy rate was 77%, with no significant influence of age or parity. Acceptability was high, with 85% of subjects being symptom- or problem-free while using the sponge. Finally, the safety profile was very good, with no clinically significant evidence of local or systemic adverse reactions. Conclusion The new Protectaid sponge is a safe and effective non-hormonal contraceptive method for women.
A 1985 prospective study at the Saint-Louis Hospital in Paris indicated that 138 of 252 abortions (53.8%), were associated with problems of contraception and 114 were not. The percentages of cases involving problems with contraception varied from 34% to 58.2% according to the physicians participating in the study. Despite the very subjective nature of the estimates, at least 1/3 of abortions at this hospital are associated with difficulties in contraception. In 64 of 138 cases, the problems were caused by psychological factors, including ambivalent desire for pregnancy in 24 cases, psychological refusal of contraception in 15 cases, psychological immaturity in 4 cases, various psychological problems in 4 cases, and a psychological factor associated with some other difficulty in 17 cases. Among the various psychological problems were 1 woman using abortion as a contraceptive method who had undergone 9 abortions and 1 case of cultural resistance to contraception. Among the 17 cases where the psychological problem was associated with some other difficulty there were 7 cases of ambivalent desire for pregnancy, 4 cases of psychological refusal of contraception, and 6 cases of various psychological problems. Among these cases, available contraceptive methods were contraindicated or poorly tolerated apart from the psychological difficulty. Among the 74 cases of contraceptive difficulty not associated with psychological factors were: 12 cases of nulliparity and nontoleration of combined oral contraceptives (OCs); 22 cases of nulliparity and OCs contraindicated or inadvisable; 22 cases of OCs and IUDs contraindicated, inadvisable, or refused; 5 cases of IUD failure with OCs not possible; 2 cases of failure of local methods with other methods not possible; and 11 cases of various difficulties including 4 of difficulties of communication for linguistic reasons and 7 cases of repeated forgetting or incorrect taking of pills. It is not known whether the 252 cases in this survey are representative of the entire population. Problems in contraception are common among women seeking abortions and appear to affect at least 1 in 3 such women. The psychological factor is very significant among these women. Cases of contraceptive problems apart from psychological factors have primarily referred to nulliparous women unable to take pills and other women unable to use either OCs or IUDs. Vaginal contraceptive methods are not used as much as they could be in such cases. 4 cases are briefly described to illustrate the problems some women encounter in finding a suitable contraceptive method.
Only 5 cases of cerebrovascular accidents following contraception with progestin alone are to be found in the French literature on the subject. 2 such cases are described in detail in this article; one patient was on Lynestrenol, and another on Norethindrone. The pathogenesis of cerebrovascular accidents under progestin treatment is totally unknown. Patients under this type of contraception should be closely surveilled, both clinically and biologically.
