Severe dysphagia associated with major tranquillizer treatment.

A 56 year old patient with psychiatric complications of systemic lupus erythematosus developed severe dysphagia complicated by weight loss and aspiration. Following investigation it was concluded that the addition of haloperidol to her treatment was the major precipitating cause and withdrawal of the drug was followed by an objective improvement in swallowing. Patients taking major transquillizers may be at increased risk of severe dysphagia; regular observation of swallowing is suggested as a useful addition to the clinical examination of these patients.     

Removable prosthodontics: A survey of practices and attitudes among South Australian dentists

All dentists registered in South Australia were surveyed in July 1993 in relation to removable prosthodontics. The replies indicated that removable prosthodontics constituted a significant part of most dental practices. Most dentists felt that removable prosthodontics should be an essential part of the undergraduate curriculum. They felt that more expertise is now required to manage the treatment of the ageing population with either their first or replacement removable prostheses. The majority of dentists felt that their own undergraduate training had equipped them well to manage removable prosthodontic treatment for their patients; however, many helpful suggestions were made on areas that they thought required more emphasis.     

Malaria in the African highlands: past, present and future.

Many of the first European settlers in Africa sought refuge from the heat and diseases of the plains by moving to the cool and salubrious highlands. Although many of the highlands were originally malaria free, there has been a progressive rise in the incidence of the disease over the last 50 years, largely as a consequence of agroforestry development, and it has been exacerbated by scarce health resources. In these areas of fringe transmission where the malaria pattern is unstable, epidemics may be precipitated by relatively subtle climatic changes. Since there is little immunity against the disease in these communities, outbreaks can be devastating, resulting in a substantial increase in morbidity and death among both children and adults. We present here the results obtained using a mathematical model designed to identify these epidemic-prone regions in the African highlands and the differences expected to occur as a result of projected global climate change. These highlands should be recognized as an area of special concern. We further recommend that a regional modelling approach should be adopted to assess the extent and severity of this problem and help improve disease surveillance and the quality of health care delivered in this unstable ecosystem.     

Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: The risedronate and alendronate (REAL) cohort study

Introduction Randomized clinical trials have shown that risedronate and alendronate reduce fractures among women with osteoporosis. The aim of this observational study was to observe, in clinical practice, the incidence of hip and nonvertebral fractures among women in the year following initiation of once-a-week dosing of either risedronate or alendronate. Methods Using records of health service utilization from July 2002 through September 2004, we created two cohorts: women (ages 65 and over) receiving risedronate (n = 12,215) or alendronate (n = 21,615). Cox proportional hazard modeling was used to compare the annual incidence of nonvertebral fractures and of hip fractures between cohorts, adjusting for potential differences in risk factors for fractures. Results There were 507 nonvertebral fractures and 109 hip fractures. Through one year of therapy, the incidence of nonvertebral fractures in the risedronate cohort (2.0%) was 18% lower (95% CI 2% – 32%) than in the alendronate cohort (2.3%). The incidence of hip fractures in the risedronate cohort (0.4%) was 43% lower (95% CI 13% – 63%) than in the alendronate cohort (0.6%). These results were consistent across a number of sensitivity analyses. Conclusion Patients receiving risedronate have lower rates of hip and nonvertebral fractures during their first year of therapy than patients receiving alendronate. This work was presented in part at the 28th annual meeting of the American Society for Bone and Mineral Research, Philadelphia, PA; September 15–19, 2006.     

Disposition of bupropion in healthy volunteers and subjects with alcoholic liver disease

Bupropion hydrochloride is a new monocyclic antidepressant. In humans, its disposition results in the formation of three major metabolites: the morpholinol metabolite, the erythroamino alcohol, and the threoamino alcohol metabolite. Bupropion's disposition was monitored following a single oral 200 mg dose in eight healthy volunteers and eight age- (44.5 +/- 8.4 years) and weight- (77.4 +/- 6.7 kg) matched volunteers with alcoholic liver disease. This latter group is of interest because the incidence of depression is more frequent in alcoholics than in the general population, and the liver is the major route of elimination for cyclic antidepressants. The mean elimination half-life of the morpholinol metabolite was significantly prolonged in subjects with alcoholic liver disease (32.2 +/- 13.5 vs. 21.1 +/- 4.9 hours (p less than 0.05), while the differences in bupropion (17.3 +/- 8.6 hours vs. 16.5 +/- 10.4 hours for healthy subjects and subjects with alcoholic liver disease, respectively), erythroamino alcohol (26.1 +/- 13.3 hours vs. 29.8 +/- 6.9 hours for healthy subjects and subjects with alcoholic liver disease, respectively), and threoamino alcohol (25.5 +/- 8.6 hours vs. 23.4 +/- 10.7 hours for healthy subjects and subjects with alcoholic liver disease, respectively) were minimal. Mean area under the plasma concentration time curves for bupropion and metabolites were increased in subjects with alcoholic liver disease; however, clear differences between means of these small groups did not emerge, probably due to the increased variability of bupropion pharmacokinetics in these subjects. As a therapeutic agent for the treatment of depression in chronic alcoholics who may consume alcohol in combination with their antidepressant therapy, the lack of sedation with bupropion could be advantageous.(ABSTRACT TRUNCATED AT 250 WORDS)