Side-shifting hemicrania continua with aura (migraine with aura with autonomic symptoms responsive to indomethacin?)

Atypical features of hemicrania continua (HC), including both visual aura and side shifting, have been reported previously. However, auras and variable unilaterality have never been reported together in HC. We report two patients with side-shifting HC with aura. These patients' symptoms are unilateral headaches, visual aura, autonomic features, throbbing pain, nausea and photo/phonophobia. One could speculate that the unilaterality and/or the autonomic symptom modules are indomethacin responsive. The patients can also be classified as chronic migraine with aura, with autonomic symptoms, responsive to indomethacin. Neither migraine subtype nor side-shifting HC with aura is included in the current International Headache Society (IHS) classification, so these patients are not classifiable. Side-shifting HC with aura implies the need to revisit the traditional IHS categorization of headaches into unique diagnostic groups. The modular headache theory may be a tool for the understanding of these rare and complex cases.     

Investigation of communication ski lls with older population with dementia

INTRODUCTIONItisreported７０％－９０％patientsshowdementiapsychologyandbehaviorinpatientswithagingdementia（AD），whicharethemaincausesofhospitalization．OtherscannotunderstandADpatientswhoalsocannotunderstandtheotherpersonsaffectingqualityofnurs－ing．So，tocomprehendcommunicationskills，tosupportthemmenallyareveryimportantforimprovementofADpatients＇qualityoflife．NURSINGAPPROACHESThegentleattitudetoremovebewildering：ADpatientswereverysensitivetoothersattitude，emoticattitude…     

Do people with cancer comply with oral chemotherapy treatments?

Many people with cancer have oral medication as part or all of their regime. This medication is primarily self administered in the community. This mini-review aimed to determine the level of compliance of adult cancer patients with oral chemotherapy and to assess the quality of the available evidence. Searches were undertaken using three electronic databases (Medline, Embase, CINAHL) for studies which evaluated the compliance of adult cancer patients with oral anti-neoplastic agents through self-report, pill counts, drug/metabolite levels or microelectronic monitoring system (MEMS). Articles were selected if the follow-up was higher than 80% of patients. Six papers were identified for the review. The methodological quality of the studies was poor. The sample size of the majority of them was small and the method used to measure adherence was not entirely reliable. The results of these papers were varied and contradictory. A firm conclusion cannot be drawn because the studies present significant methodological flaws. The comparison of results between studies is difficult due to the lack of a gold-standard measure of adherence and a standardised definition of non-compliance. Further research in this area is needed. However it does appear that compliance is a problem in this patient group.     

Frozen with Fear? Attentional Mechanisms in Children with Selective Mutism

Cognitive Therapy and Research - Children with selective mutism (SM) are consistently unable to speak in certain social situations. Due to an overlap between SM and social anxiety disorder (SAD) in...     

What do patients with chronic rhinitis do with their disease?

There are numerous patients suffering from chronic rhinitis. What kind of doctors do they consult? What are their symptoms? What kind of examinations do they do? What kind of medication do they use? Are they ever treated surgically? The objective of this study was to give answers to such questions. This is a study of 269 patients suffering from chronic rhinitis aged from 3 to 72 years. Of the 269 patients, 198 had already visited another physician before consulting us. The most common symptom was nasal obstruction. The most commonly used oral medication was antihistamines, whereas the most commonly used topical medication was sympathomimetic agents. Additionally, 2.2% of them had used natural herbs intranasally, herbs they had collected by themselves and not sold in drugstores. The operation most commonly performed was polypectomy. Sufferers from rhinitis most commonly consult general practitioners. The percentage of patients using alternative medication is limited in comparison with other studies.     

Patients with pelvic fracture: what factors are associated with mortality?

Background

Pelvic fracture is one of the major injuries that lead to death in patients who sustain high-impact injuries such as road traffic accidents and falls from height.

Aims

This study aims to look at the epidemiology and the significant predictors of mortality in victims with pelvic fracture presenting to the emergency department (ED) of an urban Asian city.

Methods

This was a retrospective data analysis of all trauma patients with pelvic fracture who were treated at the ED of an urban adult hospital in Singapore from April 2001 to December 2004. Student’s t-test and χ² test were used in statistical analysis where appropriate.

Results

The study included 179 consecutive patients. Sixty-four percent of patients were males, and 71% of patients were in the 20–49-year-old age group. Road traffic accidents and falls from height were the two most common mechanisms of injury. Mortality rate was 37%. Pelvic fracture severity, shock and coma at presentation, and the presence of concurrent head and chest injuries were associated with increased mortality. Gender, other mechanisms of injury and other concomitant injuries were not associated with increased mortality.

Conclusions

The mortality rate of trauma patients with pelvic fracture continues to be high. In such patients, predictors of mortality are the severity of the pelvic fracture, the presence of coma, shock, and head and chest injuries.     

Gait changes with walking devices in persons with Parkinson’s disease

Purpose: To study immediate gait changes in persons with PD when walking with different assistive walking devices. Methods: Ten individuals with idiopathic PD participated in the study. Gait parameters were recorded while walking with a cane and a wheeled walker, and were compared to a free walk without a walking device. Results: Persons with PD walked with slower gait speed when using a cane and a wheeled walker compared to walking without any device (p?=?0.007, p?=?0.002, respectively). Stride length reduced significantly when walking with a wheeled walker (p?=?0.001). Walking with the assistive devices did not affect cadence, double support phase, heel to heel base of support, stride time, and stance period. Conclusion: Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker. The results may lead to more cautious clinical practice in gait rehabilitation using ambulatory assisted devices.

Implications for Rehabilitation

• Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker.

• Clinicians should be cognizant of these modifications during gait rehabilitation using ambulatory assisted devices.

     

Do Patients with Acute Myocardial Infarction Benefit from Treatment with Clopidogrel?

Clopidogrel (Plavix), a platelet aggregation inhibitor, has been shown to be effective in certain patients undergoing percutaneous coronary interventions, but its use in patients with acute myocardial infarction who receive a fibrinolytic strategy instead has been controversial. The aim of the Evidence-Based Medicine (EBM) Section is to bring the readership clinically relevant and practical evidence-based medicine principles and topic reviews. This EBM – Therapy review focuses on a relatively new therapy option for Emergency Department patients with acute myocardial infarction.     

What's wrong with me? Coming to terms with same sex attraction

Many, if not all, young people question what is wrong with them when they begin to realise that they are attracted to people of the same sex. This can be because of feelings of confusion, guilt and shame, which can develop in reaction to the society in which they live; feelings that are often mirrored by the families of the young people concerned. This article explains the theories behind sexuality to help nurses provide unprejudiced, appropriate support and information to children and young people seeking help.     

Interactions of β-Lactamases with Sanfetrinem (GV 104326) Compared to Those with Imipenem and with Oral β-Lactams

Sanfetrinem is a trinem β-lactam which can be administered orally as a hexatil ester. We examined whether its β-lactamase interactions resembled those of the available carbapenems, i.e., stable to AmpC and extended-spectrum β-lactamases but labile to class B and functional group 2f enzymes. The comparator drugs were imipenem, oral cephalosporins, and amoxicillin. MICs were determined for β-lactamase expression variants, and hydrolysis was examined directly with representative enzymes. Sanfetrinem was a weak inducer of AmpC β-lactamases below the MIC and had slight lability, with a k_cat of 0.00033 s⁻¹ for the Enterobacter cloacae enzyme. Its MICs for AmpC-derepressed E. cloacae and Citrobacter freundii were 4 to 8 μg/ml, compared with MICs of 0.12 to 2 μg/ml for AmpC-inducible and -basal strains; MICs for AmpC-derepressed Serratia marcescens and Morganella morganii were not raised. Cefixime and cefpodoxime were more labile than sanfetrinem to the E. cloacae AmpC enzyme, and AmpC-derepressed mutants showed much greater resistance; imipenem was more stable and retained full activity against derepressed mutants. Like imipenem, sanfetrinem was stable to TEM-1 and TEM-10 enzymes and retained full activity against isolates and transconjugants with various extended-spectrum TEM and SHV enzymes, whereas these organisms were resistant to cefixime and cefpodoxime. Sanfetrinem, like imipenem and cefixime but unlike cefpodoxime, also retained activity against Proteus vulgaris and Klebsiella oxytoca strains that hyperproduced potent chromosomal class A β-lactamases. Functional group 2f enzymes, including Sme-1, NMC-A, and an unnamed enzyme from Acinetobacter spp., increased the sanfetrinem MICs by up to 64-fold. These enzymes also compromised the activities of imipenem and amoxicillin but not those of the cephalosporins. The hydrolysis of sanfetrinem was examined with a purified Sme-1 enzyme, and biphasic kinetics were found. Finally, zinc β-lactamases, including IMP-1 and the L1 enzyme of Stenotrophomonas maltophilia, conferred resistance to sanfetrinem and all other β-lactams tested, and hydrolysis was confirmed with the IMP-1 enzyme. We conclude that sanfetrinem has β-lactamase interactions similar to those of the available carbapenems except that it is a weaker inducer of AmpC types, with some tendency to select derepressed mutants, unlike imipenem and meropenem.Carbapenems evade many β-lactamases that compromise other β-lactams: in particular, imipenem, meropenem, and biapenem are stable to extended-spectrum β-lactamases (ESBLs) (3, 16), and the AmpC β-lactamases only confer resistance when they are hyperproduced in exceptionally impermeable strains (5, 16). Nevertheless, β-lactamase-mediated resistance to carbapenems does occur, and this is mostly caused by zinc (class B) enzymes. Such β-lactamases are chromosomal in Stenotrophomonas maltophilia, Flavobacterium odoratum, some Aeromonas spp., and in a few Bacteroides fragilis isolates (10, 17, 29); additionally, a carbapenem-hydrolyzing zinc β-lactamase, IMP-1, has become plasmid mediated in Japan, where it has spread in Pseudomonas aeruginosa, Serratia marcescens, and Klebsiella spp. (24, 32). Carbapenem-hydrolyzing activity also occurs in three closely related class A enzymes (Sme-1, NMC-A, and IMI-1) (23, 30, 36), which were recorded as chromosomal in tiny numbers of S. marcescens and Enterobacter cloacae isolates, most of which were collected before carbapenems entered clinical use. Finally, carbapenem resistance is emerging in Acinetobacter spp., where it is most often mediated by functional group 2f β-lactamases (1, 26) but where it is occasionally mediated by zinc-dependent enzymes (27) or β-lactamase-independent mechanisms (33).Trinems (previously tribactams) have a carbapenem-related structure but with a cyclohexane ring attached across carbons 1 and 2 (Fig. ​(Fig.1).1). Sanfetrinem, which is the first member of the family to be developed, can be administered orally as a hexatil ester. In the present study we have compared its β-lactamase interactions with those of imipenem and various oral β-lactams. Open in a separate windowFIG. 1Structure of sanfetrinem.     

Are satisfaction with and self-management of personal assistance services associated with the life satisfaction of persons with physical disabilities??

Purpose.?To examine the relationships between satisfaction with and self-management of personal assistance services ((PAS)) and the quality of life ((QoL)) of persons with disabilities. To test the postulate that consumer-directed PAS can fulfil the human need for control and contribute to a satisfactory life.

Method.?A survey compared the perspectives of persons using consumer-directed PAS versus those using agency-directed. A Personal Data Form obtained demographics and PAS characteristics. The Quality of Life Inventory measured life satisfaction. A PAS questionnaire measured perceptions about the management of, desire for control of, and satisfaction with PAS. Data were analysed using SPSS®? 14.

Results.?Significant relationships were found between QoL and satisfaction with PAS ((p < 0.001)) and between perceived control of PAS and satisfaction with PAS ((p < 0.001)). Significant group differences were also found. Consumer-directed participants reported higher satisfaction with their PAS ((p < 0.01)), greater control over services ((p < 0.001)) and greater QoL than agency-directed participants, ((p == 0.001)).

Conclusions.?The relationships found between self-management, PAS satisfaction, and QoL support the value of consumer-directed programmes. Rehabilitation professionals can use this knowledge to develop, implement and research practises that enable self-management.     

The treatment of different postlaminec-tomy with incision accompanied with po-stoperative exercises on 870 patients with prolapse of lumber intervertebral disc

BACKGROUND: There are many operative ways for curing prolapse of lumbar interventebral disc. We should pay attention to decreasing operative trauma when choosing operative style, keeping structure of posterior gray column of spinal cord at the most to sustain stability of spine and avoiding losing excessively the mechanical function of lumbar vertebrae. It is especially important of early postoperative subjective rehabilitation training for operative effect