bluuebunny/crossref_metadata_2025 huggingface dataset:
New-Onset Atrial Fibrillation in Bacteremia Is Not Associated with C-Reactive Protein, but Is an Indicator of Increased Mortality during Hospitalization
Authors: Kindem Ingvild A. , Reindal Eva K. , Wester Astrid L. , Blaasaas Karl G. , Atar Dan
Published: April 2008

Background: Several studies have associated elevated C-reactive protein (CRP) levels to the occurrence of atrial fibrillation (AF). We sought to estimate the frequency and prognostic impact of AF in patients with bacteremia, and to study the possible association between AF and CRP as well as between AF and mortality in this population. Methods: We retrospectively evaluated patient charts of patients with bacteremia with Escherichia coli or Streptococcus pneumoniae admitted to the Aker University Hospital in Oslo between 1994 and 2004. Known cardiac risk factors for AF, signs and mode of conversion of AF, and, if applicable, date of death were registered, as were characteristics of infection, such as systemic inflammatory response syndrome and white blood cell count. Initial CRP values were categorized into 4 strata. Odds ratios of the 3 highest CRP categories compared with the lowest were obtained from logistic models adjusting for known cardiac risk factors for AF as well as possible factors that may have had an impact on the odds ratios for the different CRP levels. Cox regression analysis was used to compare new-onset AF and death during the first 2 weeks after hospitalization. Results: A total of 672 patient charts were studied; 104 patients (15.4%) had new-onset AF. Peak incidence of new-onset AF occurred on the day of admission. Peak CRP values were reached during the following 2 days. High CRP level at admission did not predict the occurrence of AF. The observed mortality was higher among patients with new-onset AF (p = 0.001) during the first 2 weeks after hospitalization, but this effect disappears when adjusted for relevant factors. Conclusions: The frequency of new-onset AF in bacteremia is substantial. Initial CRP levels or white blood cell count do not seem to predict new-onset AF, as opposed to systemic inflammatory response syndrome. On the other hand, in patients with bacteremia, new-onset AF should be viewed as an indicator of increased mortality and morbidity.
MRSA-Associated Bacterial Myocarditis Causing Ruptured Ventricle and Tamponade
Authors: LeLeiko Rebecca M. , Bower David J. , Larsen Christopher P.
Published: April 2008

We report a case of an 81-year-old man with bacterial myocarditis presenting with elevated troponins and sepsis, who succumbed due to a ruptured ventricle. The infecting organism was found to be methicillin-resistant Staphylococcus aureus. Bacterial myocarditis is a rare occurrence when independent of infective endocarditis. Generally, this is a complication of bacteremia that is discovered post-mortem. Rarely, as in our patient, it causes significant necrosis of the myocardium leading to rupture of a ventricle. As with viral myocarditis, this disease can present with signs and symptoms of acute myocardial infarction, complicating the diagnosis. Much of the available data on bacterial myocarditis was collected before the development of many modern diagnostic tests and before antibiotics. Accordingly, the appropriate workup, diagnosis and treatment remain unclear. Our patient represents the first reported case of ventricular rupture due to methicillin-resistant S. aureus-associated bacterial myocarditis.
Epidemiology and Outcome of Tachyarrhythmias in Tertiary Pediatric Cardiac Centers
Authors: Massin Martial M. , Benatar Avram , Rondia Gilles
Published: April 2008

Introduction: Little is known about the real importance of pediatric arrhythmias. Methods: We analyzed the epidemiology, presentation and outcome of all clinically relevant tachyarrhythmias followed up in our pediatric institutions from 1995 to 2006. Results: A total of 250 cases were identified. The mean age ± SD at diagnosis was 4.7 ± 5.3 years, 45 cases were neonatal (18%). Supraventricular arrhythmias were noted in 210 children (84%), ventricular arrhythmias in 40 (16%). The most frequent symptoms were palpitations (n = 71) and syncope (n = 48) in older children, as well as monitoring of diseases (n = 62) and heart failure (n = 49) in younger patients. Recurrence was noted under or after therapy in 75 cases, mostly in cases diagnosed beyond infancy. At long-term follow-up, 169 patients have no recurrence without treatment (of whom 34 had required catheter ablation), 71 are under therapy and 10 died. Conclusion: Supraventricular arrhythmias in younger children are often an incidental diagnosis, respond to antiarrhythmic therapy and have a high incidence of resolution. In older children with supraventricular arrhythmias and in those with ventricular arrhythmias, delayed diagnosis or misdiagnosis is not rare, the arrhythmias are unlikely to resolve spontaneously and long-term antiarrhythmic treatment or catheter ablation is necessary.
Cardiac Tamponade in Medical Patients: A 10-Year Follow-Up Survey
Authors: Cornily Jean-Christophe , Pennec Pierre-Yves , Castellant Philippe , Bezon Eric , Le Gal Grégoire , Gilard Martine , Jobic Yannick , Boschat Jacques , Blanc Jean-Jacques
Published: April 2008

Objectives: Cardiac tamponade represents a life-threatening condition that may complicate almost any cause of pericarditis. We conducted a 10-year prospective survey on patients with cardiac tamponade requiring an emergency drainage. Methods: From 1996 to 2005, 114 consecutive patients were admitted to the University Hospital of Brest for medical cardiac tamponade. Data on medical history, and volume, characteristics and histology of the pericardial fluid as well as short- and long-term follow-up data were collected. Results: Malignant disease was the primary cause of medical tamponade (74 patients; 65%), followed by viral history (11; 10%) and intra-pericardial bleeding due to anti-coagulation treatment (4; 3%). In 12 cases, aetiology remained unknown (10%). Pericardiocentesis was immediately performed in 80 cases and surgical pericardiotomy in 34. The mean volume drained was 593 ± 313 ml. In-hospital mortality was 10% without any difference between malignant and non-malignant diseases (p = 0.8). One-year mortality was 76.5% in patients with malignant disease and 13.3% in those without malignant disease (p < 0.0001). Median survival in case of malignant disease was 150 days. Conclusion: Compared to previously published data, our survey shows a decrease in some historical causes of tamponade such as tuberculosis, myxoedema or uraemia. The leading cause is currently malignant disease, which carries a very poor prognosis.
The Relationship between Ventricular Repolarization Duration and RR Interval in Normal Subjects and Patients with Myocardial Infarction
Authors: Zhu Yujie , Lee Peter J. , Pan Jiapu , Lardin Harvey A.
Published: April 2008

Objectives: When either ventricular myocardium becomes ischemic or autonomic nervous system activity changes with age, the relationship between ventricular repolarization duration and RR interval will change as well. We studied the relationship between ventricular repolarization duration and RR interval among normal subjects in different age groups and between patients with myocardial infarction (MI) and age-matched healthy subjects. Methods: Ventricular repolarization duration variability (RDV) spectra were separated into RR-dependent and RR-independent components. We compared spectral measures among normal subjects in different age groups and between patients with MI and age-matched healthy subjects. Results: The RR-dependent component of RDV spectra, which is correlated with autonomic nervous system activity, significantly decreased with age for healthy subjects. The RR-independent component significantly increased in MI patients compared to age-matched healthy subjects. Conclusions: We demonstrated the increase in RDV upon decreasing age and in the presence of MI. Our results support the idea that the RR-dependent part corresponds to the physiology-related part of the RDV spectra and the RR-independent part corresponds to the pathology-related part of the RDV spectra. Our study suggests that these spectral measures are likely to be helpful in the evaluation of a patient with MI and merit further investigation.
A Case of Hereditary Protein S Deficiency Presenting with Cerebral Sinus Venous Thrombosis and Deep Vein Thrombosis at High Altitude
Authors: Nair Velu , Mohapatro A.K. , Sreedhar M. , Indrajeet I.K. , Tewari A.K. , Anand A.C. , Mathew O.P.
Published: April 2008

A 35-year-old healthy male with no history of any past medical illness developed severe headache, vomiting and drowsiness while at high altitude (4,572 m) in the eastern Himalayan ranges. He was evacuated to a tertiary-care hospital where he was diagnosed to have cerebral sinus venous thrombosis (CSVT) on magnetic resonance imaging, with deep vein thrombosis (DVT) of his right popliteo-femoral vein on color Doppler study. Investigation for thrombophilia revealed protein S (PS) deficiency in this patient. Family screening revealed low levels of PS in two elder brothers. One brother had a history of ‘stroke in young’ at the age of 20 years with the other being asymptomatic. This established the hereditary nature of PS deficiency. We are not aware of any previously published report on hereditary PS deficiency combined with CSVT and DVT occurring at high altitude. However, 1 case of protein C deficiency with CSVT has been reported previously.
Increased Homocysteine Levels in Tear Fluid of Patients with Primary Open-Angle Glaucoma
Authors: Roedl J.B. , Bleich S. , Schlötzer-Schrehardt U. , von Ahsen N. , Kornhuber J. , Naumann G.O.H. , Kruse F.E. , Jünemann A.G.M.
Published: April 2008

Aims: We assessed homocysteine (Hcy) levels in tear fluid and plasma of patients with primary open-angle glaucoma (POAG). We determined the association between Hcy levels, dry eye syndrome and B vitamin status. Methods: This prospective case-control study included 36 patients with POAG and 36 controls. Hcy concentrations were measured by high-performance liquid chromatography. Results: Patients with POAG had significantly higher mean Hcy levels both in tear fluid (205 ± 84 nmol/l; p < 0.001, t test) and in plasma (13.43 ± 3.53 µmol/l; p = 0.001, t test) than control subjects (130 ± 53 nmol/l and 10.50 ± 3.33 µmol/l, respectively). Hcy in tear fluid was significantly correlated with plasma Hcy in POAG patients (r = 0.459; p = 0.005, Pearson’s correlation), but not in controls (r = 0.068; p = 0.695). POAG patients with dry eye disease had significantly higher Hcy levels both in tear fluid and plasma than POAG patients without dry eye disease. There was no association between Hcy levels and B vitamin status in subjects with POAG. Conclusions: The study suggests increased Hcy levels in tear fluid and plasma of patients with POAG. Elevated Hcy levels might be a risk factor for POAG and dry eye syndrome in subjects with glaucoma.
Effects of Erythropoietin on Blood-Brain Barrier Disruption in Focal Cerebral Ischemia
Authors: Chi Oak Z. , Hunter Christine , Liu Xia , Weiss Harvey R.
Published: April 2008

This study was performed to test whether systemically administered erythropoietin (EPO) could attenuate the blood-brain barrier (BBB) disruption in focal ischemia. Rats were injected intraperitoneally with 2,500 IU/kg of recombinant human EPO or normal saline 24 h before middle cerebral artery (MCA) occlusion. The transfer coefficient (Ki) of 14C-α-aminoisobutyric acid was determined to measure the degree of BBB disruption 1 h after MCA occlusion. In the control animals, the Ki of the ischemic cortex (IC) was significantly higher than that of the contralateral cortex (CC; +128%, p = 0.0002). In the EPO-treated animals, the Ki of the IC was not significantly different from that of the CC and was significantly lower (–44%, p = 0.003) than that of the control animals. Our data suggest that MCA occlusion increased BBB disruption, and the disruption was attenuated with EPO pretreatment.
Pharmacological Effects of Solifenacin on Human Isolated Urinary Bladder
Authors: Masunaga Koichi , Yoshida Masaki , Inadome Akito , Murakami Shigetaka , Sugiyama Yutaka , Satoji Yo , Maeda Yoshihiro , Ueda Shoichi
Published: April 2008

To investigate the effects of solifenacin on human detrusor smooth muscles, we evaluate the effects of solifenacin on the contractions induced by carbachol, KCl, CaCl2 and electrical field stimulation (EFS), and the EFS-induced acetylcholine release from detrusor smooth muscle strips by using the muscle bath and microdialysis technique. The effects of solifenacin were also compared with effects of other antimuscarinic agents (atropine, oxybutynin and propiverine). Pretreatment with various antimuscarinic agents caused parallel shifts to the right of the concentration-response curves to carbachol. The pA2 value of the Schild plots for solifenacin was similar to that for oxybutynin. Atropine did not inhibit the KCl- and CaCl2-induced contractions, while solifenacin, oxybutynin and propiverine significantly inhibited these contractions. EFS-induced contractions were inhibited by various antimuscarinic drugs in a concentration-dependent manner. In the presence of atropine, solifenacin tended to inhibit the residual atropine-resistant contractions induced by EFS, but it was not significant. However, oxybutynin and propiverine inhibited them under the same conditions. Although pretreatment with atropine and propiverine did not cause significant changes in EFS-induced acetylcholine release, solifenacin and oxybutynin caused significant decreases in acetylcholine release. The present results suggest that solifenacin inhibits contractions of human detrusor smooth muscles mainly by the antimuscarinic action and that the high concentration of solifenacin has Ca2+ channel antagonist action. Moreover, solifenacin may block not only postjunctional receptors, but also prejunctional receptors to modulate acetylcholine releases in cholinergic nerve endings in human detrusor smooth muscles. The findings support that muscarinic-receptor-inhibitory actions in human bladder mainly contribute to the usefulness of solifenacin as a therapeutic drug for overactive bladder.
GABAergic Mechanisms Are Involved in the Antihyperalgesic Effects of Carbamazepine and Oxcarbazepine in a Rat Model of Inflammatory Hyperalgesia
Authors: Stepanović-Petrović Radica M. , Tomić Maja A. , Vučković Sonja M. , Kocev Nikola , Ugrešić Nenad D. , Prostran Milica Š. , Bošković Bogdan
Published: April 2008

Background/Aims: The purpose of this study was to investigate the involvement of GABAergic mechanisms in the antihyperalgesic effect of carbamazepine and oxcarbazepine by examining the effect of bicuculline (GABAA receptor antagonist) on these effects of antiepileptic drugs. Methods: Rats were intraplantarly (i.pl.) injected with the proinflammatory compound concanavalin A (Con A). A paw-pressure test was used to determine: (1) the development of hyperalgesia induced by Con A; (2) the effects of carbamazepine/oxcarbazepine on Con A-induced hyperalgesia, and (3) the effects of bicuculline on the carbamazepine/oxcarbazepine antihyperalgesia. Results: Intraperitoneally injected bicuculline (0.5–1 mg/kg, i.p.) exhibited significant suppression of the systemic antihyperalgesic effects of carbamazepine (27 mg/kg, i.p.) and oxcarbazepine (80 mg/kg, i.p.). When applied intraplantarly, bicuculline (0.14 mg/paw, i.pl.) did not produce any change in the peripheral antihyperalgesic effects of carbamazepine (0.14 mg/paw, i.pl.) and oxcarbazepine (0.5 mg/paw, i.pl.). Bicuculline alone did not produce an intrinsic effect in the paw-pressure test. Conclusion: These results indicate that the antihyperalgesic effects of carbamazepine and oxcarbazepine against inflammatory hyperalgesia involve in part the GABAergic inhibitory modulation of pain transmission at central, but not at peripheral sites, which is mediated via GABAA receptor activation.
Efficacy of Disease-Modifying Therapies in Relapsing Remitting Multiple Sclerosis: A Systematic Comparison
Authors: Freedman Mark S. , Hughes Bruce , Mikol Daniel D. , Bennett Randy , Cuffel Brian , Divan Vamil , LaVallee Nicole , AL-Sabbagh Ahmad
Published: April 2008

The treatment of relapsing-remitting multiple sclerosis (RRMS) has become more effective over the last decade with the advent of the currently available disease-modifying therapies (DMTs). Pivotal clinical studies differ in many characteristics, such that cross-comparisons of relative risk reductions are of limited value and can be misleading. Our objective was to compare the clinical efficacy of currently approved first-line DMTs in patients with RRMS, applying an evidence-based medicine approach. We reviewed all phase III pivotal trials of DMTs. Six clinical trials of Avonex®, Betaseron®, Copaxone®, Rebif® and Tysabri® in patients with RRMS were identified for analysis. Only randomized, placebo-controlled, double-blind studies were included. The clinical efficacy endpoints compared were: proportion of relapse-free patients at 1 and 2 years; annualized relapse rate at 2 years; proportion of progression-free patients at 2 years, and proportion of patients free of gadolinium-enhancing lesions at 1 year or 9 months. Based on these analyses, Betaseron, Rebif, and Tysabri show comparable effects, whereas for several endpoints Avonex or Copaxone did not significantly differ from placebo. In the absence of head-to-head studies for all products used to treat RRMS, it still may be possible to compare treatment effects by applying evidence-based medicine principles.
Ian McEwan – Novels about Neurological and Psychiatric Patients
Authors: Rot Uroš
Published: April 2008

Ian McEwan, a respected contemporary British writer, sometimes uses neurological and psychiatric patients as main characters of his stories. In his recent novels one can find beautiful descriptions of patients with Huntington’s disease, variant Creutzfeldt-Jakob disease, de Clerambault syndrome and also details about some neurosurgical procedures.
Progressive Cerebellar Ataxia with Variable Episodic Symptoms – Phenotypic Diversity of R1668W CACNA1A Mutation
Authors: Marti Sarah , Baloh Robert W. , Jen Joanna C. , Straumann Dominik , Jung Hans H.
Published: April 2008

We describe a family with an R1668W mutation in the CACNA1A gene who presented with a broader clinical spectrum and more variable features than previously reported. The mother had a pure progressive cerebellar ataxia of late onset with downbeat nystagmus, whereas her daughter suffered from episodic ataxia, hemiplegic migraine, and progressive cerebellar ataxia with horizontal gaze-evoked and rebound nystagmus. In both patients, treatment with acetazolamide was ineffective and worsened baseline ataxia, whereas flunarizine ameliorated episodic symptoms. Our report highlights profound phenotypic variability that can be associated with CACNA1A mutations and adds important therapeutic considerations.
Clinical and Etiological Profile of Tropical Ataxic Neuropathy in Kerala, South India
Authors: Madhusudanan Mohan , Menon Murali K. , Ummer Karaden , Radhakrishnanan Kurupath
Published: April 2008

Background/Aims: Very little is known about the occurrence of tropical ataxic neuropathy (TAN) from southern India. This study describes the clinical spectrum of TAN from Kerala, southern India, and explores its etiology. Methods: We reviewed the clinical and laboratory profile of 40 TAN cases diagnosed in a tertiary referral center in central Kerala. We enquired the consumption of cassava foods and estimated the thiocyanate levels in the serum, urine and sural nerve. Results: The notable demographic characteristics included female preponderance, peak age at onset in the thirties, rural residence and poor socioeconomic status. The diet in the majority comprised a large amount of tapioca, which is low in protein. In addition to sensory peripheral neuropathy, 90% had decreased hearing, 50% had decreased vision, and 25% had spasticity involving the lower extremities. None had signs of overt vitamin deficiencies or malabsorption syndrome. Compared to the controls, the serum, urine and sural nerve thiocyanate levels were significantly elevated in the patients. With cessation of cassavaintake and better nutrition, improvement in the neurological disability occurred in the majority. Conclusions: This study, for the first time, provides evidence for the occurrence of TAN in south India and the possible etiological role of cassava intake.
Deep Brain Stimulation Improves Performance of Complex Instrumental Paradigms
Authors: Ellrichmann Gisa , Harati Ali , Müller Thomas
Published: April 2008

Patients with Parkinson’s disease (PD) show deficits of motion behaviour and cognitive function, which were assessed with various instrumental paradigms. Objectives of the present trial were to investigate the effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on the performance of complex and simple movement series, on the execution of simple reaction time (SRT) paradigms following an acoustic or a visual stimulus, on scored motor symptoms and the interrelation of the various study parameters in PD patients. Motor symptoms, operation of complex movements, and the execution of SRT tasks significantly improved when the stimulator was switched on. Execution of simple movement series did not differ between the on and off conditions of the stimulator. Instrumental test results significantly correlated with scored motor symptoms in particular during the off condition. During the on state, significant correlations were found between the performance of complex motion sequences and the SRT outcomes. PD patients treated with DBS of the STN show better results for more complex instrumental paradigms with a higher need for cognitive effort during the on situation due to improvements in motor performance, function of the basal ganglia-thalamocortical circuitry and cognitive function.
Clinical Features of Opticospinal Multiple Sclerosis with Anti-Aquaporin 4 Antibody
Authors: Kanzaki Mami , Mochizuki Hitoshi , Ogawa Go , Tanaka Keiko , Araki Manabu , Motoyoshi Kazuo , Hammond-Tooke Graeme , Kamakura Keiko
Published: April 2008

Background: We have followed 9 Japanese patients with opticospinal multiple sclerosis (OSMS), some of whom showed longitudinally extensive spinal cord lesions, deep sensory disturbances and resistance to treatment. We investigated the patients for anti-aquaporin 4 (AQP4) antibodies and related this to their neuroimaging, clinical and laboratory features. Methods: We studied the clinical course, neurological findings, cerebrospinal fluid (CSF), and electrophysiological findings, and determined the presence of anti-AQP4 antibody and human leukocyte antigen DPB1 and DRB1 alleles. Results: Five patients (56.6%) had anti-AQP4 antibody. Antibody-positive patients displayed female predominance, longitudinally extensive spinal cord lesions, higher frequency of exacerbations, severe disability, and higher cell counts and total protein content without IgG oligoclonal bands in the CSF. They also showed poor steroid responsiveness and poor therapeutic response to interferon β1b. Conclusions: The presence of anti-AQP4 antibodies correlates with clinical severity and poor prognosis in OSMS.
Transient Directional Disorientation as a Manifestation of Cerebral Ischemia
Authors: Ino Tadashi , Usami Hideo , Tokumoto Kazuki , Kimura Toru , Ozawa Kyoko , Nakamura Shigenobu
Published: April 2008

The authors describe 2 patients who presented with transient directional disorientation (TDD) as a manifestation of cerebral ischemia. The patients suddenly lost sense of direction in a familiar environment despite preserved ability to recognize landmarks, and recovered within a short time. Brain MRI revealed an ischemic lesion in the right medial occipital lobe and the corpus callosum in case 1 and in the right parieto-occipital sulcus (POS) in case 2. After ictus, fMRI study of a navigation task was performed, which demonstrated the activation of the POS unilaterally in case 1 and bilaterally in case 2. We propose that TDD of our patients is related to temporary dysfunction of bilateral POS.
The Role of Anemia Management in Improving Outcomes for African-Americans with Chronic Kidney Disease
Authors: Lea Janice P. , Norris Keith , Agodoa Lawrence
Published: April 2008

Chronic kidney disease (CKD) is a serious threat to African-American public health. In this population CKD progresses to end-stage renal disease (ESRD) at quadruple the rate in Caucasians. Factors fueling progression to ESRD include diabetes and hypertension, which show high prevalences and accelerated renal damage in African- Americans, as well as possible nutritional, socioeconomic, and genetic factors. Anemia, a common and deleterious complication of CKD, is more prevalent and severe in African-American than Caucasian patients at each stage of the disease. Proactive management of diabetes, hypertension, anemia, and other complications throughout the course of CKD can prevent or delay disease progression and alleviate the burden of ESRD for the African-American community. Currently, African-Americans with CKD are less likely than Caucasian patients to receive anemia treatment before and after the onset of dialysis. Although African-Americans often require higher doses of erythropoiesis-stimulating agents, this may result from late treatment initiation, lower hemoglobin levels, or the presence of comorbidities such as diabetes and inflammation, although racial differences in response cannot be excluded. This review explores racial-specific challenges and potential solutions in renal anemia management to improve outcomes in African-American patients.
Perinatal Risk Factors and Mode of Delivery Correlated to Survival and Psychomotor Disability in Extremely Low Birth Weight Infants
Authors: Vimercati A. , Scioscia M. , Panella E. , Nardelli C. , Coluccia A. , Camporeale C. , DeCosmo L. , Laforgia N. , Selvaggi L.
Published: April 2008

Background/Aims: Extreme preterm birth, <28 weeks of gestation, represents a public health concern with major economic implications, being the leading cause of neonatal mortality and morbidity. Methods: A single-centre retrospective cohort study was carried out to assess the role of caesarean section and to identify perinatal factors affecting neonatal survival and psychomotor development in these infants. 57 cases with complete maternal, obstetrical and neonatological information were selected for this study and neurological development was assessed for at least 18 months of life. Results: Infant survival and neurological morbidity rates were directly and inversely correlated to birth weights and gestational age at birth, respectively. In multivariate analysis only extreme prematurity (≤25 weeks) and birth weight <500 g were significantly associated with mortality, whereas no factor correlated to neuromotor impairment. Conclusions: The management of preterm labour at the limit of viability is always challenging. Knowledge of risk factors associated with obstetrical situations may affect medical management and indeed offer useful information for parent counselling.
Proton Spectroscopy in Alzheimer’s Disease and Cognitive Impairment No Dementia: A Community-Based Study
Authors: Azevedo Dionísio , Tatsch Mariana , Hototian Sergio R. , Bazzarella Mario C. , Castro Cláudio C. , Bottino Cássio M.C.
Published: April 2008

Objective: To describe the findings of proton magnetic resonance spectroscopy (1H-MRS) in Alzheimer’s disease (AD) and cognitive impairment, no dementia (CIND) elderly from a community-based sample. Methods: Thirteen patients with AD, 12 with CIND and 15 normal individuals were evaluated. The 1H-MRS was performed in the right temporal, left parietal and medial occipital regions studying the metabolites N-acetylaspartate (NAA), creatine (Cr), choline (Cho) and myoinositol (mI). The clinical diagnosis was based on standardized cognitive tests – MMSE and CAMDEX – and the results correlated with the 1H-MRS. Results: Parietal Cho was higher in control individuals and lower in CIND subjects. AD and control groups were better identified by temporal and parietal mI combined with the temporal NAA/Cr ratio. CIND was better identified by parietal Cho. Conclusion: The 1H-MRS findings confirmed the hypothesis that metabolic alterations are present since the first symptoms of cognitively impaired elderly subjects. These results suggest that combining MRS from different cerebral regions can help in the diagnosis and follow-up of community elderly individuals with memory complaints and AD.
Influence of Gestational Age on the Vasodilatory Response of Serotonin in Human Umbilical Arteries Perfused in vitro
Authors: Haugen Guttorm
Published: April 2008

Background: Serotonin (5-hydroxytryptamine) is a potent vasoactive substance in human umbilical arteries (HUA). Aim: To investigate the vasodilatory response pattern of serotonin in HUA from pregnancies complicated by preterm deliveries as compared to uncomplicated term pregnancies. Methods and Subjects: Umbilical cord segments were perfused in vitro. These were taken from pregnancies complicated by preterm delivery before 34 weeks’ gestation (group 1, n = 8), between 34 and 37 weeks’ gestation (group 2, n = 7), and uncomplicated term pregnancies (group 3, n = 17). All women were normotensive and without proteinuria, and showed no signs of infection. Results: Serotonin induced monophasic vasoconstrictory responses or biphasic responses with a transient vasodilation succeeded by a vasoconstriction. The frequency of preparations displaying a biphasic response increased with gestational age. The frequencies were 1/8, 3/7 and 12/17 in groups 1, 2 and 3, respectively (p = 0.023). The correlation between the maximum dilatory response obtained in each preparation and gestational age was positive and significant (r = 0.49, p = 0.004). No significant differences were observed in the constrictory responses between the groups. Conclusion: In in vitro perfused HUA, the vasodilatory response is dependent on gestational age.
Facial Cosmetic Filler Injections as Possible Target for Systemic Sarcoidosis in Patients Treated with Interferon for Chronic Hepatitis C: Two Cases
Authors: Descamps Vincent , Landry Jennifer , Francès Camille , Marinho Eduardo , Ratziu Vlad , Chosidow Olivier
Published: April 2008

Background: Cosmetic filler injections are now a very common procedure for aesthetic purposes. Today no contra-indication is given anymore to any patient for an intradermal filling. Objectives: We draw attention to a possible side effect of facial fillers in a population at risk. Results: We report 2 similar cases of systemic sarcoidosis in patients who both developed a sarcoidal granuloma at the location of a cosmetic filler injection during combined interferon and ribavirin treatment for chronic hepatitis C infection. Cosmetic fillers were hyaluronic acid for one patient and probably silicone for the other. Conclusion: Patients with chronic hepatitis C have a higher risk of interferon-induced sarcoidosis. Physicians must be aware of the risk that a granuloma can develop after a dermal filler injection especially in patients treated with interferon for chronic hepatitis C. These reactions may reveal a systemic sarcoidosis. We propose to perform a test for a hepatitis C virus infection before injecting a dermal filler and to inform the patient of this risk in case of a hepatitis C infection that could necessitate an interferon treatment.
Disseminated Eruptive Giant Mollusca Contagiosa in an Adult Psoriasis Patient during Efalizumab Therapy
Authors: Weisenseel Peter , Kuznetsov Alexander Vasilevic , Flaig Michael , Prinz Jörg Christoph
Published: April 2008

Molluscum contagiosum is a common viral skin infection in children with atopic diathesis and not rare in HIV patients. We report a 45-year-old psoriasis patient who developed eruptive mollusca contagiosa during an antipsoriatic treatment with efalizumab.
Clinical and Epidemiological Study of Cutaneous Tuberculosis in Northern Ethiopia
Authors: Terranova Margherita , Padovese Valeska , Fornari Ugo , Morrone Aldo
Published: April 2008

Background: Tuberculosis is a major public health problem in Ethiopia but cutaneous tuberculosis (CT) has not been documented. Objective: This study was conducted to determine its existence and its clinical pattern in Tigray, a northern region of Ethiopia. Methods: We report 202 cases of CT who attended the Italian Dermatological Centre in the 34-month period between January 2005 and October 2007. The diagnosis was made on a clinical, cytological and histological basis. Results: Clinically, 143 cases of scrofuloderma, 22 of lupus vulgaris, 18 of gumma, 11 of lichen scrofulosorum, 6 of tuberculosis verrucosa cutis and 2 of erythema induratum of Bazin were observed in our department. All patients were aged between 18 months and 69 years, and 49 were paediatric cases. Forty-five were HIV positive. Conclusion: The number of CT cases observed in the period of 34 months indicates a high incidence of the disease in the region also in the paediatric age. CT is still underdiagnosed due to the low number of dermatologists as well as the poor life conditions of the population and the traditional belief in magic medicine. The current study may therefore provide some indication about the epidemiology of CT in Ethiopia.
Dimensions of Psychosis in Patients with Bipolar Mania as Measured by the Positive and Negative Syndrome Scale
Authors: Lindenmayer Jean-Pierre , Bossie Cynthia A. , Kujawa Mary , Zhu Young , Canuso Carla M.
Published: April 2008

Background: Psychosis is present in 50% or more of patients with bipolar mania and is commonly evaluated in clinical research by means of the Positive and Negative Syndrome Scale (PANSS). The aim of the present analysis was to investigate the psychotic dimensions of bipolar disorder and its contributing symptoms based on a factor analysis of baseline PANSS scores and to compare them with those identified in studies of patients with schizophrenia and bipolar disorder. Sampling and Methods: Baseline data were analyzed from two 3-week, double-blind, placebo-controlled studies of risperidone monotherapy for acute mania associated with bipolar I disorder (n = 535). Inclusion criteria were a DSM-IV diagnosis of bipolar I disorder with manic features, with or without psychotic features, age ≧18 years, and mean baseline Young Mania Rating Scale scores ≧20. A principal component analysis of the 30 PANSS item scores of the 535 patients with a diagnosis of a manic episode at baseline was conducted. Results: Five factors were extracted by the analysis: anxiety (13.4% of the variance), negative symptoms (12.3%), depression (10.5%), excitement (10.3%), and positive symptoms (8.7%). Similar factors, in particular the negative, excitement, and positive factors, have been identified in patients with schizophrenia. There was an absence of a cognitive factor supporting the notion that bipolar patients may present fewer cognitive symptoms. Conclusion: The results of the present analysis and those of other studies indicate similarities in psychotic symptom domains, as measured by the PANSS, in patients with bipolar mania and schizophrenia. Future analyses will address the effects of treatment on the identified factors.
Unrestored Dentin Caries and Deep Dentin Restorations in Swedish Adolescents
Authors: Ridell K. , Olsson H. , Mejàre I.
Published: April 2008

The objectives of this longitudinal study were to assess: (a) the prevalence of unrestored dentin caries among 15-year-olds, (b) the proportion of these lesions that had progressed to deep dentin lesions (inner half of dentin) since the immediately preceding examination at the age of 14 and (c) the frequency of deep restorations (extending into the inner half of the dentin). The sample consisted of all 15-year-olds (n = 2,487) born in 1990 and included in the Public Dental Service in Malmö, Sweden. Bitewing radiographs taken during 2005–2007 and the immediately preceding radiographs were analysed and scored by two examiners. The main radiographic scores were: sound; radiolucency in the outer or inner half of dentin; restored surface. The results showed that 22% of the individuals had 1 or more dentin lesions left unrestored from the time of the examination at the age of 14 until the next recall examination at the age of 15. During the observation period (median time 1.2 years), 9% of the unrestored outer dentin lesions progressed to deep dentin lesions. The majority of these (93%) were in molars. One or more deep restorations were found in 22% of the 15-year-olds; the majority involved occlusal surfaces of first molars. In conclusion, unrestored dentin lesions were common in 15-year-olds. Progression to deep dentin lesions occurred in 9% of these lesions and was most common in first molars. Occlusal surfaces of first molars had the highest frequency of deep restorations.
The Anticariogenic Effect of Sugar-Free Gum Containing CPP-ACP Nanocomplexes on Approximal Caries Determined Using Digital Bitewing Radiography
Authors: Morgan M.V. , Adams G.G. , Bailey D.L. , Tsao C.E. , Fischman S.L. , Reynolds E.C.
Published: April 2008

This study investigated, using digital bitewing radiography, the progression and regression of approximal caries in adolescent subjects chewing a sugar-free gum containing 54 mg CPP-ACP relative to the identical gum without CPP-ACP. 2,720 subjects from 29 schools were randomly assigned to one of the two gums and were instructed to chew their assigned gum for 3 × 10 min/day, with one session supervised on school days, over the 24-month study period. Standardized digital bitewing radiographs were taken at the baseline and 24-month clinical examinations for each subject. The radiographs, scored by a single examiner, were assessed for approximal surface dental caries at both the enamel and dentine level. Surface level transitions were scored using a transition matrix. Caries progression or regression was analysed using proportional-odds ordered logistic regression modelling of the transition scores at the tooth surface level. There was a statistically significant difference in the frequency distributions of the transition scores between the two gum groups (OR = 0.82, p = 0.03). For subjects chewing the CPP-ACP gum the odds of a surface experiencing caries progression were 18% less than those of a surface experiencing caries progression for subjects chewing the control gum. In conclusion, the 54 mg CPP-ACP sugar-free gum significantly slowed progression and enhanced regression of approximal caries relative to a control sugar-free gum in a 24-month clinical trial.
Risk Factors for Alzheimer Dementia in a Community-Based Birth Cohort at the Age of 75 Years
Authors: Fischer Peter , Zehetmayer Sonja , Jungwirth Susanne , Weissgram Silvia , Krampla Wolfgang , Hinterberger Margarete , Torma Sabine , Rainer Michael , Huber Klaus , Hoenigschnabl Selma , Gelpi Ellen , Bauer Kurt , Leitha Thomas , Bauer Peter , Tragl Karl-Heinz
Published: April 2008

Background: Few prospective community-based cohort studies have so far concentrated specifically on the risk factors for Alzheimer dementia (AD) with onset after the age of 75 years. Methods: We prospectively investigated a birth cohort of 585 nondemented inhabitants in the area on the East bank of the river Danube who were born between 1925 and 1926. They were investigated at the age of 75 years and followed up after 30 months. The follow-up was possible with 488 probands; 36 died, and 61 refused to participate. Results: In multivariate analysis an elevated risk for late-onset AD could be found for (1) history of depressive episodes (OR = 2.09; 95% CI = 1.25–3.48); (2) the Ε4 allele of the APOE gene (OR = 1.86; 95% CI = 1.08–3.23); (3) lower serum level of folate (OR = 0.92; 95% CI = 0.87–0.98); (4) no chronic use of nonsteroidal anti-inflammatory drugs (OR = 0.40; 95% CI = 0.20–0.81), and (5) lower education (OR = 1.43; 95% CI = 1.03–2.00). Conclusions: Five risk factors for late-onset AD could be confirmed, which might be targets for preventive strategies.
Upregulation of Rat Renal Cortical Organic Anion Transporter (OAT1 and OAT3) Expression in Response to Ischemia/Reperfusion Injury
Authors: Zhang Rui , Yang Xiao , Li Jun , Wu Jun , Peng Wen-Xing , Dong Xiu-Qing , Zhou Shu-Feng , Yu Xue-Qing
Published: April 2008

Background/Aims: Renal organic anion transporters (OAT1 and OAT3) localized in the basolateral membrane mediate the uptake of organic anions from the blood into proximal tubules. This study aimed to examine the effects of renal ischemia/reperfusion injury (IRI) on the expression of cortical renal OAT1 and OAT3 and the functional impact. Methods: Male rats underwent a right nephrectomy and clamping of the left renal pedicle for 50 min or sham operation, followed by reperfusion for 1, 2, 4 and 6 days. The expression of OAT1 and OAT3 was detected by RT-PCR, immunohistochemistry and Western blot analysis. Na+-K+-ATPase activity was also estimated. Results: The renal clearance of para-aminohippurate was significantly decreased on day 1 in IRI rats compared with sham-operated rats and returned to normal when the tubular injury recovered. There were significant increases in the mRNA and protein levels of OAT1 and OAT3 in renal cortex homogenates and basolateral membranes on day 1 after IRI, while on days 2 and 4 after IRI, the renal expression of OAT1 and OAT3 decreased gradually but was still significantly higher than that of the sham-operated rats. The Na+-K+-ATPase activity in renal cortex homogenates decreased significantly on day 1 after IRI but gradually increased on days 2, 4 and 6. Conclusions: Renal para-aminohippurate clearance was depressed in response to IRI; however, the expressions of renal cortex OAT1 and OAT3 were significantly elevated in the early stage of IRI which may have substantial impact on renal excretion of some drugs and toxic compounds.
The Effect of Zinc Supplements in Cystic Fibrosis Patients
Authors: Van Biervliet S. , Vande Velde S. , Van Biervliet J.P. , Robberecht E.
Published: April 2008

Aim: To study the effect of Zn supplements in cystic fibrosis (CF) on disease evolution. Methods: A retrospective study of all CF patients treated with Zn supplements (January 2002 to December 2004). Data from patient files for the year before and the first year of supplementation were compared. The controls were CF patients with normal serum Zn and without Zn supplementation. Results: 21 patients (7 females), median age 8.9 (interquartile range 13.1) years, received 5 mg/kg Zn sulfate/day (maximum 150 mg). The number of infections decreased from 3 (1.25) to 2 (2.0) (tied p < 0.02) and the forced expiratory volume in 1 s (FEV1) increased from 72.0 (38.4) to 76.5 (52)% (p < 0.02). Energy intake improved (92.3 (14.5) to 117.0 (28.5)%; tied p < 0.02), as did weight for height (W/H; 90 (9.4) to 94 (8.5)%; tied p = 0.043). In the CF control patients the number of infections (2.0 (2.0)), energy intake (116 (43.3)%) and nutritional status remained stable (W/H 99 (17.2)%), but pulmonary function decreased significantly (ΔFEV1 loss of 2.0 (8.0)%). There was a significantly different evolution for the change in forced vital capacity (p < 0.004) and ΔFEV1 (p < 0.001) between supplemented and control patients. Conclusions: Analysis of the clinical data on Zn supplementation in CF showed beneficial effects in Zn-deficient CF patients. These results must be confirmed in a prospective double-blind randomized control trial.
High Dosage of Ascorbic Acid and Alpha-Tocopherol Is Not Useful for Diminishing Oxidative Stress and DNA Damage in Healthy Elderly Adults
Authors: Retana-Ugalde Raquel , Casanueva Esther , Altamirano-Lozano Mario , González-Torres Cristina , Mendoza-Núñez Víctor Manuel
Published: April 2008

Aim: To determine the useful dosage of ascorbic acid and alpha-tocopherol against oxidative stress and DNA damage in the elderly. Methods: A double-blind controlled clinical assay carried out in a sample of 66 healthy subjects divided into three age-paired random groups with 22 subjects in each group. Group A received placebo and group B was administered 500 mg of ascorbic acid and 400 IU of alpha-tocopherol, whereas group C received 1,000 mg of ascorbic acid and 400 IU of alpha-tocopherol for a 6-month period. The following measurements were performed before and after the 6-month treatment period: thiobarbituric acid reactive substances (TBARS); total antioxidant status (TAS); superoxide dismutase (SOD), and glutation peroxidase (GPx) and DNA damage by comet assay. Results: After 6 months, group B subjects exhibited an increase in SOD and GPx enzyme levels; however, this was not statistically significant (p > 0.05). Likewise, TBARS and TAS concentrations remained unchanged (p > 0.05). In addition, in group C the decrease in TBARS and increase in SOD, GPx, and TAS were not statistically significant (p > 0.05). Similarly, average DNA migration showed no significant differences with high-dosage ascorbic acid and alpha-tocopherol. Conclusion: These findings suggest that administration of 1,000 mg of ascorbic acid plus 400 IU of alpha-tocopherol for 6 months is not useful for diminishing oxidative stress and DNA damage in healthy elderly adults.
Effects of a Multifaceted Psychiatric Intervention Targeted for the Complex Medically Ill: A Randomized Controlled Trial
Authors: Stiefel F. , Zdrojewski C. , Bel Hadj F. , Boffa D. , Dorogi Y. , So A. , Ruiz J. , de Jonge P.
Published: April 2008

Background: This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity. Methods: Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA1c levels (diabetic patients). Results: Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02). Conclusions: The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.
Who Counts? On Democracy, Power, and the Incalculable
Authors: Schmidt Dennis
Published: April 2008

The intention of this paper is to discuss the notion and word "democracy" as a Greek legacy and then to pose the question of the specific challenges to that conception of democracy presented by this historical present, which Heidegger characterizes as the Gestell. Questions concerning the sources of power, the relation of power to peoples and individuals, as well as the shift from power to violence are addressed. Plato, Aristotle, Pericles, Lincoln, Derrida, and Heidegger are the key figures in this discussion.