Hereditary neuropathy with liability to pressure palsies

Journal of Neurology - Hereditary neuropathy with liability to pressure palsies (HNPP) is characterized by recurrent sensory and motor neuropathy in individual nerves starting in adolescence or...     

Interferon-beta in pediatric multiple sclerosis patients: safety in short-term prescription

None of the approved immunomodulatory drugs in adults Multiple Sclerosis (MS) patients have been officially approved for the pediatric patients and are currently used off-label in this population. In this study, we evaluated the effectiveness and tolerability of intramuscular interferon beta1-a (Avonex(?)) and subcutaneously injected interferon beta1-b (Betaferon(?)) in children with definite relapsing-remitting MS (RRMS). Thirteen patients aged younger than 16, who were recently diagnosed with definite RRMS according to the McDonald's criteria, were enrolled in this study. Six patients were treated with Avonex(?) 30 μg, intramuscularly every week, and seven patients were treated with Betaferon(?) 250 μg, subcutaneously every other day. All patients were treated with adult doses; initially interferon-beta was prescribed with half dose, and it was increased to full adult dose steadily. Eleven girls and two boys, mean (SD) age of 14.7 (1.9) years, were studied. Following nine months of using interferon-beta, nine patients (69.2%) had no relapses and the remaining four, experienced only one relapse. The mean EDSS score was decreased significantly after the study period. The present study provides reasonable data for the use of interferon-beta in Pediatric MS due to lack of short-term complications and safety. Studies with larger sample size and longer follow up duration are required to shed light on the long term impact of the interferon-beta therapy in children.     

The beneficial effects of protein tyrosine kinase inhibition on the circulatory failure induced by endotoxin in the rat

Implication of enhanced activity of tyrosine kinases has been established in the pathophysiology of many diseases associated with local (e.g., atherosclerosis) or systemic (e.g., septic shock) inflammation. The main objective of this study was to elucidate whether tyrosine kinase and nitric oxide were involved in endotoxin-induced impairment of vascular responses to sympathetic nerve stimulation (SNS) in rat isolated mesenteric bed. Therefore, the effects of genistein, an inhibitor of protein tyrosine kinase, and L-NAME (N-nitro-L-arginine methyl ester), an inhibitor of nitric oxide synthase, on endotoxin-induced shock were investigated in the thiopental-anesthetized rats. We also studied the effects of endotoxin on the vasoconstrictor responses to SNS in the rat isolated perfused mesenteric bed. Endotoxin injection (10 mg kg(-1), i.p.) produced a marked hypotension and a reduction of the pressor responses elicited by phenylephrine (0.1, 0.3, and 3 microg kg(-1), i.v.). Pretreatment of the rats with either genistein (10 mg kg(-1) i.p., 2 h before endotoxin injection), L-NAME (0.1 mg kg(-1), i.p., 30 min before endotoxin injection), or a combination of both attenuated the hypotension caused by endotoxin. SNS in the rat isolated perfused mesenteric bed caused a frequency-dependent vasoconstrictor response, which was abolished by tetrodotoxin (10(-7) M), prazoscin (10(-7) M), and guanethidine (10(-7)M). In mesenteric vascular beds removed from rats injected with endotoxin, the vasoconstrictor responses to SNS were markedly impaired. Although genistein and L-NAME pretreatment attenuated the vascular hyporeactivity to phenylephrine, they did not improve the impaired SNS response of the isolated vascular bed of endotoxin-treated animals. These results indicate that genistein and L-NAME pretreatment prevent the hypotension and the delayed hyporeactivity to phenylephrine induced by endotoxin, but they failed to restore the vascular hyporeactivity to SNS.     

Diversity and education of the nursing workforce 2006–2016

Background

The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor’s degree, and inter-professional education.

Raloxifene adjunctive therapy for postmenopausal women suffering from chronic schizophrenia: a randomized double-blind and placebo controlled trial

Background

Cumulative evidence from epidemiological, preclinical and clinical studies suggests estrogens may have psychoprotective effects in schizophrenic patients. Selective Estrogen Receptor Modulators could have therapeutic benefits in schizophrenia for both sexes without being hazardous to gynecological tissues or having feminizing effects. Few studies have been conducted regarding the effects of raloxifene on postmenopausal women suffering from schizophrenia. We conducted this placebo-controlled trial to compare the add-on effect of raloxifene to risperidone versus risperidone with placebo.

Methods

This was an 8-week, parallel-group, placebo-controlled trial undertaken at two universities affiliated psychiatric Hospitals in Iran. Forty-six postmenopausal women with the definite diagnosis of schizophrenia were enrolled in the study. Patients received risperidone (6 mg/day in 3 divided doses) combined with either placebo (N = 23) or 120 mg/day of raloxifene (N = 23) for 8 weeks. Patients were assessed by a psychiatrist at baseline and at 2 and 8 weeks after the start of medical therapy. Efficacy was defined as the change from baseline to endpoint in score on Positive and Negative Syndrome Scale (PANSS).

Results

For PANSS scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 1.77, p = 0.18]. For positive subscale scores, there was marginal significant interaction between intervention type and time [F (2, 47) = 2.93, p = 0.06] and there was substantial main effect for time [F (2, 47) = 24.39, p = 0.001] within both groups showing reduction in positive subscale scores across the three time periods. In addition, the main effect comparing two types of intervention was significant [F (1, 48) = 3.78, p = 0.02]. On the other hand, for negative subscale scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 1.43, p = 0.23]. For general subscale scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 0.03, p = 0.86].

Conclusions

According to our findings, raloxifene as an adjunctive treatment to risperidone was only superior in improvement of positive symptoms and it was not effective in treating negative and general psychopathology symptoms.

Trial registration

The trial was registered at the Iranian registry of clinical trials: IRCT201205131556N42     

Pseudoaneurysm of mitro-aortic intervalvular fibrosa during the course of mitral valve endocarditis with aorto-left ventricle outflow tract fistula

The mitro-aortic intervalvular fibrosa (MAIVF) connects the anterior mitral leaflet to the posterior portion of the aortic annulus.The pseudoaneurysm of MAIVF is one of the uncommon but catastrophic complications of native or prosthetic aortic valve endocarditis or chest trauma.We report a case of infective endocarditis of mitral valve complicated by development of pseudoaneurysm of MAIVF, and fistulous formation causing massive shunt flow from the ascending aorta above the non-coronary cusp to the left ventricle outflow tract.