Prospective examination of daily life traumatic stress symptom expression following motor vehicle collisions

OBJECTIVE

Motor vehicle collisions (MVCs) are a common source of traumatic stress, which could lead to the development of posttraumatic stress disorder. However, the natural course of symptom development is still poorly understood. The current study aimed to prospectively examine the expression of traumatic stress symptoms in mild-moderate injured MVC survivors, using a novel daily life repeated measurement approach.

METHOD

Participants (N = 70) were screened and recruited upon hospital arrival. Daily assessments of traumatic stress symptoms were conducted via mobile phones, and the data during days 2-6 (acute phase) and 27-31 (1-month phase) following the MVC were used for the current study.

RESULTS

Latent growth curve analyses showed that at the acute phase, traumatic stress symptoms followed a reducing trajectory, with significant intercept and negative slope factors. At the 1-month phase, traumatic stress symptoms followed a low-stable trajectory, with a lower intercept and a nonsignificant slope factor. The acute-phase intercept and slope were both positively associated with 1-month symptomatology, such that higher initial symptoms and slower recovery rates were associated with greater traumatic stress symptoms at 1-month post-MVC. Trauma history and peritraumatic perceived life threat were indirectly associated with the 5-days end-of-the-month traumatic stress symptoms, through the mediation of the acute-phase intercept.

CONCLUSIONS

An early screen of traumatic stress symptoms in the first few days following trauma exposure, together with trauma history and perceived peritraumatic life threat, may assist in identifying individuals at risk for subsequent posttraumatic psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

[Strongyloides stercoralis hyperinfection]

Strongyloides stercoralis (SS) is an intestinal nematode which infects a large proportion of tropical and subtropical populations. The endemic areas are southeast Asia, South America and sub-Saharan Africa. Infection is acquired when the worms penetrate the skin, pass via the blood stream to the lungs, ascend the respiratory tract, are swallowed and grow into adult worms in the mucosa of the small intestine. The eggs laid by the female release larvae which pass down the lumen and reach the soil via the feces. While passing down the intestinal tract, a few of the rhabditiform larvae may be transformed into infective filariform larvae which can penetrate the distal intestinal and anal mucosa, returning to the blood stream. This "autoinfection" cycle is unique to SS, and explains why the infection can be perpetuated without further exposure to exogenous, infective larvae and can persist decades after departure from endemic areas. A substantial proportion of those affected are asymptomatic, but overwhelming infection may occur in immunosuppressed patients. This "hyperinfection" state is characterized by severe gastrointestinal and respiratory tract involvement, along with skin rash, Gram-negative bacteremia and cerebral signs. While frequently fatal, it is curable when diagnosed and treated promptly. We present a 79-year-old woman with idiopathic polymyositis, who was immunosuppressed by prolonged corticosteroid treatment. Her illness was complicated by SS hyperinfection. Diagnosis was made from stool and bronchial smears. Treatment with thiabendazole was started early and within a week there was complete cure. This is the fourth reported case of SS hyperinfection treated in Israel.

A comparative study of dirithromycin and erythromycin in bacterial pneumonia

Dirithromycin, a new once-daily macrolide, was studied in a multicentre, randomised, double-blind trial in community-acquired bacterial pneumonia. A total of 591 patients received either a single daily dose of dirithromycin, 500 mg, or erythromycin, 250 mg, four times daily. Clinical response rates were similar in both treatment groups (127 dirithromycin-treated and 118 erythromycin-treated patients): at the time of the final consultation, the clinical and bacteriological response rates for dirithromycin-treated patients were 94.5% and 93.0%, while for erythromycin-treated patients, they were 92.1% and 90.3%, respectively. The nature and frequency of treatment-emergent events were comparable. We conclude that dirithromycin, 500 mg, once daily, is safe and effective in the treatment of community-acquired bacterial pneumonia. The once daily dose is likely to improve compliance, making it preferable to erythromycin.