North American Journal of Medicine and Science
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The Relationship between Internet Addiction and Internalizing Problems in Overweight/Obese Adolescents: A Moderated Mediation Model
Get PDFTo explore the relationship of Internet addiction, coping styles, stressful life events and internalizing problems in overweight/obese adolescents, this research surveyed 1438 middle school students among which 245 overweight and obesity (non-clinical cases) were screened based on the body mass index (BMI) percentile criteria of Working Group on Obesity in China (WGOC) by a series of questionnaires and anthropometric indices. The results indicated as follows: (1) Negative coping styles played a partial mediating role in the relationship between Internet addiction and internalizing problems among overweight/obese adolescents, which means Internet addiction had a direct effect on internalizing problems and also indirectly affected internalizing problems through negative coping styles. (2) The mediating effect of negative coping styles was moderated by stressful life events. The effect of negative coping styles on internalizing problems was in positive proportion to internalizing problems. Internet addiction, coping styles, stressful life events and internalizing problems among overweight/obese adolescents constructed a moderated mediating model.[N A J Med Sci. 2017;10(4):139-147. DOI: 10.7156/najms.2017.1004139
ASD and Sleep Disorders
Get PDFAutism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social communication deficits and repetitive behaviors/limited interests. There have been accumulated reports of significant sleep problems in ASD. The most common sleep problems include difficulties in sleep initiation and maintenance, irregular sleep- awakening rhythm, and disordered sleep pattern. Some investigators have suggested that sleep problems in children with ASD may be due to abnormal circadian rhythm. Neuroendocrine markers provided another perspective to study biological clock, these biomarkers are nearly not affected by social domains, such as cortisol and melatonin levels in ASD. Many sleep related genes are associated with ASD, especially single nucleotide polymorphisms in core circadian clock genes have been convinced the linkage. The abnormal expression of key genes causes alteration of protein synthesis in some critical pathways associated with ASD. Effective sleep therapy is critical to the improvement of the core symptoms of ASD.[N A J Med Sci. 2017;10(4):164-170. DOI: 10.7156/najms.2017.1004164]
ZAP70 Related Severe Combined Immunodeficiency Initially Diagnosed as Incomplete (Atypical) Kawasaki Disease
Get PDFZAP70-related severe combined immunodeficiency (SCID) is a defect of the immune system characterized by absent or extremely low CD8+ T-cells and abnormal T-cell receptor signaling. This form of SCID is relatively rare with about 20 cases currently described in the literature and typically presents in infancy with recurrent opportunistic infections, failure to thrive, and gastrointestinal symptoms. This report describes a case of ZAP70-related SCID that was initially diagnosed as incomplete (atypical) Kawasaki disease. A 7-month-old infant presented with two weeks of fever, leukocytosis (33.5 K/μL) and anemia. No infectious etiology was identified and clinical presentation, along with laboratory work-up, suggested incomplete Kawasaki disease. He was treated with a single infusion of IVIG and 72 hours of high dose aspirin with resolution of fever. Seven months later, he presented again with three weeks of fever, persistent leukocytosis, failure to thrive and varicella infection following vaccination. During hospital admission, flow cytometric analysis was conducted to characterize atypical lymphocytes present in peripheral blood. The results revealed nearly absent CD8+ T-cells with a CD4+/CD8+ ratio of 40:1. Subsequent studies demonstrated the absence of ZAP70 expression on T-cells and NK-cells by flow cytometry. Additional testing revealed markedly decreased to absent CD45+ total lymphocyte proliferative response to mitogens and antigens. The patient was diagnosed with ZAP70-related SCID and was referred for further evaluation and bone marrow transplantation. He is currently doing well, apart from minor GVHD, 2 years post-transplant. [N A J Med Sci. 2017;10(1):29-31. DOI: 10.7156/najms.20171001029
The Prevalence of alpha-Thalassemia in Anemic US Veterans without Nutritional Deficiency or Abnormal Hemoglobin HPLC Pattern
Get PDFAlpha-thalassemia is one of the most common hemoglobin genetic abnormalities. The primary defect is the reduced or absent production of the alpha globin chains, which underlines 4 clinical conditions: 1) alpha+-thalassemia (loss of one alpha globin), 2) alpha0-thalassemia (loss of 2 alpha globins), 3) HbH disease (loss of 3 alpha globins), and 4) Hb Bart hydrops fetalis syndrome (loss of all alpha globins). Among the anemic US veteran patients, one subpopulation defies extensive workup and remains etiology unknown (normal status of iron, VitB12, and Folate, normal hemoglobin HPLC pattern, etc.). Here we present the data of alpha-thalassemia DNA analysis in this subpopulation. 156 patients were analyzed of the alpha-globin gene locus by multiplex ligation-dependent probe amplification (LabCorp, RTP, NC). The prevalence of alpha0-thalassemia was 5%, alpha+-thalassemia 26%, and negative 69%. We believe alpha-thalassemia DNA analysis might be a useful test choice in mild anemic patients with uncertain etiology. [N A J Med Sci. 2017;10(1):1-4. DOI: 10.7156/najms.2017.1001001
Uterine Malignant Mixed Mullerian Tumor: Review of Recent Literature
Get PDFUterine Malignant Mixed Mullerian Tumor (MMMT) is an uncommon neoplasm with aggressive clinical course. It shares similar etiology, clinical and pathologic features of high-grade endometrial carcinoma. As such, uterine MMMT has been recently regarded as high grade de-differentiated endometrial carcinoma. Histologically, uterine MMMT is composed of an admixture of malignant epithelial and mesenchymal components. Substantial immunohistochemical and molecular genetic evidence has suggested that these two components share the same cellular origin and the mesenchymal component might derive from the epithelial component via epithelial-mesenchymal transition. This article reviews the recent literature related to the pathogenesis, histopathology, diagnosis, and management of uterine MMMT. [N A J Med Sci. 2017;10(3):110-115. DOI: 10.7156/najms.2017.1003110
Small Bowel Ischemic Necrosis Secondary to Idiopathic Intimal and Medial Hyperplasia of Mesenteric Vessels: A Case Report
Get PDFSmall bowel ischemic necrosis secondary to idiopathic intimal and medial hyperplasia of mesenteric small vessels is rare. The mesenteric vascular diseases were recently classified as two vascular diseases: fibromuscular dysplasia (FMD) of artery and mesenteric arteriovenous dysplasia/vasculopathy (MAVD/V). FMD usually involves medium size mesenteric arteries in younger individuals. In contrast, MAVD/V tends to affect multiple small mesenteric arteries and veins without vascular lesions in other organs. We reported that a 54-year-old female presented to emergency room with acute onset abdominal pain, nausea and vomiting. CT angiography showed “string of beads” in mesenteric vessels, but did not reveal any vascular narrowing elsewhere in the full body scan. The patient had small bowel ischemic necrosis secondary to idiopathic intimal and medial concentric smooth muscle hyperplasia in mesenteric vessels. The overall picture is consistent with MAVD/V. [N A J Med Sci. 2017;10(1):25-28. DOI: 10.7156/najms.2017.1001025
Nail Lacquer: A Common Artifact That May Go Unrecognized
Get PDFNail specimens are being submitted with increased frequency to confirm a diagnosis of onychomycosis, diagnose an inflammatory dermatosis, or identify clues to an underlying neoplasm. Samples often are associated with a variety of lacquers (aka polish, varnish, enamel) or gels that may vary in their appearance. Some lacquers or gel polishes add challenges to maintaining an even plane of sectioning, obscure underlying findings, or separate from the nail in processing and be misinterpreted as terra firma. We review the histologic appearance of common lacquers and gel polishes so that dermatopathologists recognize these different presentations in clinical practice. [N A J Med Sci. 2017;10(2):65-69. DOI: 10.7156/najms.2017.1002065
Introduction of a New Video-Based Eye Tracking Paradigm for Early Detection of ASD
Get PDFRecently, there is growing interest inapplying eye tracking technology to study infants and young children with Autism Spectrum Disorder (ASD). As a non-invasive and convenient measurement, it uses relatively objective parameters, which will greatly avoid the possibility of bias in traditional subjective evaluations caused by asymmetric information between patients (or parents) and examiners. As a result, it has been considered as having the greatest direct clinical potential for early screening for ASD. This study aims to introduce a new video-based eye tracking paradigm. The paradigm consists of 10 video scenarios, with each scenario targeting a different aspect of ASD in infants and children. The total paradigm lasts about 2 minutes. We believe this eye tracking paradigm may be a useful tool for early screening for ASD.[N A J Med Sci. 2017;10(4):133-135. DOI: 10.7156/najms.2017.1004133
Malignant Pleural Effusion, an Unusual Presentation of Metastatic Adenoid Cystic Carcinoma: A Case Report and Review of the Literature
Get PDFAdenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm of the major and minor salivary glands that is known to have a long clinical course, behaving in an insidious and indolent fashion with multiple recurrences preceding distant metastasis. Reported here is a case of a patient presenting with shortness of breath and recurrent pleural effusion. Exfoliated ACC cells were observed on cytological evaluation, a rare occurrence. Mediastinal lymph node involvement was also confirmed on cytology. A primary site of origin was not found. In summary ACC can present in various body sites and pathologists should consider ACC in the differential diagnosis of a basaloid carcinoma of uncertain origin.[N A J Med Sci. 2017;10(1):8-12. DOI: 10.7156/najms.2017.1001008]
Overcoming Communication Barriers to Healthcare for Culturally and Linguistically Diverse Patients
Get PDF The growing diversity in the United States brings with it multiple cultures, languages, and communication styles. Effective communication between healthcare providers and patients is essential for quality healthcare. Barriers to communication contribute to health disparities among racial/cultural minority groups. In this article, we analyzed both verbal and nonverbal barriers to effective communication with Limited English Proficiency (LEP) patients, including issues with using interpreters. Following the analysis, we explored strategies to overcome the barriers at systemic and individual levels. The available literature indicates that most of the legislative initiatives took place in three domains: (1) continuing education on serving LEP patients for health professionals, (2) certification of healthcare interpreters, and (3) reimbursement for language services for Medicaid/SCHIP enrollees. Additional strategies recommended by previous studies include (4) informing all LEP patients about their legal rights, the resources available to them, and the actions they can take when these are not enforced or made accessible. We proposed adding two more strategies: (5) increasing awareness of both verbal and nonverbal (proxemics, kinesics and paralanguage) barriers to cross-cultural communication, and (6) increasing multicultural competencies of health providers.[N A J Med Sci. 2017;10(3):103-109. DOI: 10.7156/najms.2017.1003103