Chlamydia pneumoniae, strain TWAR, infection in patients with chronic obstructive pulmonary disease.

TWAR, the only known serovar of Chlamydia pneumoniae, is a newly described bacterium that has been identified as a cause of both epidemics and endemic cases of pneumonia. The role of TWAR infection in patients with chronic obstructive pulmonary disease (COPD) is not known. We conducted a prospective study to establish whether TWAR infection is a common cause of acute exacerbations of COPD. We studied two groups of patients: 44 patients admitted to the hospital with acute exacerbations of COPD, and 65 stable clinic patients with COPD. We found that evidence of acute TWAR infection was infrequent in patients with exacerbations (5%). In contrast, the majority of patients from both groups had serologic evidence of previous TWAR infection (77%). This was not significantly greater than the prevalence found in a small group of patients of similar age and sex without lung disease from the same institution (73%). TWAR was not isolated from the oropharyngeal specimens obtained from 97 subjects, suggesting that it does not colonize the respiratory tract of patients with COPD. This study shows that at the time of low incidence in the community, acute TWAR infection is uncommon in patients with acute exacerbations of COPD. The majority of patients with COPD have, however, been infected with TWAR in the past. The clinical manifestations of these infections are not known and should be the focus of further studies.

Depression, hopelessness, and suicidal behavior in Chinese and American psychiatric patients.

The authors compared 37 patients in the People's Republic of China and 46 patients in the United States who were having difficulty with suicidal thinking or behavior. Hopelessness, reasons for living, and suicidal efficacy showed none of the expected relationships with suicidal intent among the Chinese patients, but the two groups were similar on many variables theoretically related to suicidality. Chinese patients were less likely to communicate suicidal intent and rated suicide as less effective at solving problems. The authors examine such variations in the light of possibly different cultural approaches to suicidal behavior.