Sleepwalking Associated with Hyperthyroidism

ObjectiveTo report several cases of hyperthyroidism in patients presenting with the unusual symptom of sleepwalking and to discuss the possible pathophysiologic basis for this novel association.MethodsAfter encountering and reporting the first case of new-onset somnambulism in a patient presenting with thyrotoxicosis at our institution, we routinely inquired about the sleep history of patients with thyrotox-icosis, questioning both the patients and family members when applicable. Those patients who actually had sleepwalking episodes coinciding with the onset of thyrotoxi-cosis underwent close follow-up, and the relationship between the sleepwalking and the results of thyroid function tests was analyzed. In addition, we reviewed the literature on psychiatric disorders and sleep problems, and the pathophysiologic rationale for a cause-and-effect relationship is discussed.ResultsWe collected 8 cases of patients with new-onset sleepwalking episodes that coincided with the start of thyrotoxicosis. The disappearance of the sleepwalking with successful achievement of euthyroidism supports a cause-and-effect relationship. This hypothesis is further supported by the absence of a family history, the adult onset, and the relapse of sleepwalking in 2 of the patients when their thyrotoxicosis became poorly controlled as a result of noncompliance with medications and its subsequent disappearance with reachievement of euthyroidism. Of note, such a presentation was seen only in patients with thyrotoxicosis caused by diffuse toxic goiter or Graves’ disease and never in patients with other causes of thyro-toxicosis.ConclusionNew-onset sleepwalking could be caused by thyrotoxicosis or, more specifically, by thyrotoxicosis resulting from diffuse toxic goiter. The mechanism is hypothesized to be related to the combination of prolongation of non-rapid eye movement sleep and the associated fatigue. Specific inquiry about this unusual presentation of thyrotoxicosis is encouraged, and more studies are needed to confirm and evaluate its extent. (Endocr Pract. 2005;11:5-10)     

Drugs Associated with More Suicidal Ideations Are also Associated with More Suicide Attempts

Context

In randomized controlled trials (RCTs), some drugs, including CB1 antagonists for obesity treatment, have been shown to cause increased suicidal ideation. A key question is whether drugs that increase or are associated with increased suicidal ideations are also associated with suicidal behavior, or whether drug–induced suicidal ideations are unlinked epiphenomena that do not presage the more troubling and potentially irrevocable outcome of suicidal behavior. This is difficult to determine in RCTs because of the rarity of suicidal attempts and completions.

Objective

To determine whether drugs associated with more suicidal ideations are also associated with more suicide attempts in large spontaneous adverse event (AE) report databases.

Methodology

Generalized linear models with negative binomial distribution were fitted to Food and Drug Administration (FDA) Adverse Event (AE) Reporting System (AERS) data from 2004 to 2008. A total of 1,404,470 AEs from 832 drugs were analyzed as a function of reports of suicidal ideations; other non-suicidal adverse reactions; drug class; proportion of reports from males; and average age of subject for which AE was filed. Drug was treated as the unit of analysis, thus the statistical models effectively had 832 observations.

Main Outcome Measures

Reported suicide attempts and completed suicides per drug.

Results

832 drugs, ranging from abacavir to zopiclone, were evaluated. The 832 drugs, as primary suspect drugs in a given adverse event, accounted for over 99.9% of recorded AERS. Suicidal ideations had a significant positive association with suicide attempts (p<.0001) and had an approximately 131-fold stronger magnitude of association than non-suicidal AERs, after adjusting for drug class, gender, and age.

Conclusions

In AE reports, drugs that are associated with increased suicidal ideations are also associated with increased suicidal attempts or completions. This association suggests that drug-induced suicidal ideations observed in RCTs plausibly represent harbingers that presage the more serious suicide attempts and completions and should be a cause for concern.     

Fungal Infections Associated with Travel

International travel is increasing. As fungal infections associated with travel are rare diseases, they are often underestimated and misdiagnosed. Thus, updated knowledge in this area is of key importance for physicians not only for pretravel counselling but also for the management of patients upon their return. We present an update of data published in 2012 and 2013. We present an overview of epidemiological changes, especially new endemic areas, and the implications of climate and natural disasters. Through experimental and clinical data, new insights into the pathophysiology of fungal infections associated with travel have been obtained, especially for Cryptococcus spp. Recently published diagnostic tools could lead to faster and more accurate diagnosis. Lastly, recent prognostic and therapeutic data are emphasized.     

Denitrification Associated with Periphyton Communities

Scrapings of decomposing Cladophora sp. mats (periphyton) covering stream bed rocks produced N₂O when incubated under N₂ plus 15% C₂H₂. Denitrification (N₂O formation) was enhanced by NO₃⁻ and was inhibited by autoclaving, Hg²⁺, and O₂. No N₂O was formed in the absence of C₂H₂ (air or N₂ atmosphere). Chloramphenicol did not block N₂O formation, indicating that the enzymes were constitutive. In field experiments, incubation of periphyton scrapings in the light inhibited denitrification because of algal photosynthetic O₂ production. The diurnal periphyton-associated denitrification rate was estimated to be 45.8 μmol of N₂O·m⁻²·day⁻¹, as determined by averaging light, aerobic plus dark, and anaerobic rates over a 24-h period.     

Coma Associated with Vincristine Therapy

Three cases of coma after vincristine therapy are described. One patient had hyponatraemia and other features of inappropriate secretion of antidiuretic hormone. The effects were temporary, and full recovery occurred in all three patients.     

甘露聚糖结合凝集素相关丝氨酸蛋白酶

甘露聚糖结合凝集素（MBL）是一种重要的天然免疫防御分子,通过激活MBL相关丝氨酸蛋白酶（MAST）而启动补体激活凝集素途径来清除病原体。本文就MASP的基因、分子结构及功能等方面研究概况作一介绍。