Alteration of nociceptive integration in the spinal cord of a rat model of Parkinson's disease

Background : Pain is a major non motor symptom that contributes to impaired quality of life in PD. However, its mechanism is unknown. Objectives and Methods : We sought to identify the pain phenotypes and parallel changes in spinal integration of peripheral stimuli in a rat model of PD induced by lesions of SN dopamine neurons, using behavioral plantar and von Frey tests as well as electrophysiology of the dorsal horn. Results : We show that dopamine depletion by 6‐OHDA induced hypersensitivity to mechanical and thermal stimuli. These abnormal behaviors were paralleled by increased neuronal responses and hyperexcitability of wide dynamic range neurons of lamina V of the dorsal horn of the spinal cord in response to electrical stimulation of the sciatic nerve in the 6‐OHDA model as compared to sham rats. Conclusions : These results provide evidence for alteration of nociceptive integration in the spinal dorsal horn neurons in 6‐OHDA rats that can reflect changes in pain behavior. © 2018 International Parkinson and Movement Disorder Society     

Assessing utility and completeness of information transmission during emergency department transfers

Background

The transfer of patients from community emergency departments to tertiary care centers is a daily occurrence in the practice of emergency medicine, but the completeness of medical data in the transfer documentation is a relatively unstudied area. The goal of this study was to evaluate the completeness of information transmitted in the transfer documentation between transferring and accepting institutions and its perceived value at the receiving tertiary center on medical management.

Methods

Prospective, observational, and convenience sample survey study at a tertiary referral center in Boston, MA.

Results

A total of 100 surveys were completed during the 2-month study period. The presence of the radiology report and the provider note was most important in physician assessment of utility of the transfer packet for subsequent care of patients, yet these were the most commonly missing items (31.1% and 21% respectively). Other common missing data were medication administration records, nursing notes, and laboratory results.

Conclusions

Medical data is absent in 15–31% of patients transferred from a community ED to a tertiary center. Provider notes and radiology reports were assessed as having the most utility to the receiving physicians.

     

Effects of reduction in dose and discontinuation of hydrochlorothiazide in patients with controlled essential hypertension

We studied the effects of a reduction in dose of hydrochlorothiazide from 50 to 25 mg/d, and its discontinuation for up to 22 months in 36 well-controlled hypertensive patients. Hydrochlorothiazide was discontinued if the diastolic blood pressure remained less than or equal to 94 mm Hg after a 6-month period on the lower dose of hydrochlorothiazide. No other changes were made in medications or diet. Sitting systolic blood pressure rose from 135 +/- 15 mm Hg to 140 +/- 14 mm Hg on reduction of the hydrochlorothiazide dose and rose still further to 145 +/- 20 mm Hg on discontinuation. Even greater increases in standing blood pressure were observed. There were no significant effects on the diastolic blood pressure with reduction of dose or discontinuation of hydrochlorothiazide. A significant decrease in the serum uric acid and a rise in serum potassium occurred. There were no changes in serum glucose or lipids on reduction in the dose of hydrochlorothiazide; whereas, with discontinuation, the serum lipids and hemoglobin A1C fell significantly. These results suggest that the benefits of a reduced dose of hydrochlorothiazide may not be as great as considered heretofore.     

Methicillin-resistant Staphylococcus aureus: A public health issue with economic consequences

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become endemic worldwide in hospitals, and community-associated MRSA is spreading into the community at large. OBJECTIVES: To estimate the current cost of MRSA in Canada and to assess the magnitude of this public health issue. METHODS: An extensive review of the literature was conducted to gather epidemiology, health care resource utilization and cost data for MRSA in Canadian settings. The current MRSA burden was estimated using available cost data and the most recent epidemiology data. RESULTS: The rate of MRSA in Canadian hospitals increased from 0.46 to 5.90 per 1000 admissions between 1995 and 2004, while community-associated MRSA continued to spread into the community. Patients harbouring MRSA required prolonged hospitalization (average 26 days of isolation per patient), special control measures, expensive treatments and extensive surveillance. Total cost per infected MRSA patient averaged $12,216, with hospitalization being the major cost driver (81%), followed by barrier precautions (13%), antimicrobial therapy (4%) and laboratory investigations (2%). The most recent epidemiological data, combined with available cost data, suggest that direct health care cost attributable to MRSA in Canada, including cost for management of MRSA-infected and-colonized patients and MRSA infrastructure, averaged $82 million in 2004 and could reach $129 million in 2010. CONCLUSION: MRSA is a costly public health issue that needs to be tackled if the growing burden of this disease in Canadian hospitals and in the community is to be limited.     

2-Hour cytomegalovirus pp65 antigenemia assay for rapid quantitation of cytomegalovirus in blood samples

Of 109 blood samples tested for cytomegalovirus (CMV) antigenemia, 18 (16.5%) were positive. CMV Brite detected 13 and CMV Brite Turbo detected 16 of the 18 positives. There was no significant difference in the number of positive cells detected per sample. The seven discrepant samples contained a median of only one positive cell.     

Vasopressin in the treatment of milrinone-induced hypotension in severe heart failure

The use of phosphodiesterase inhibitors such as milrinone in the treatment of severe heart failure is frequently restricted because they cause vasodilation and hypotension. In patients with decompensated heart failure with hypotension after treatment with milrinone, low doses of vasopressin restored blood pressure without inhibiting the inotropic effect of milrinone.     

Speech acts and the pragmatic deficits of autism

In a videotaped free-play session with a parent, autistic children were compared with mental-age matched Developmental Language Delay (DLD) children and with normally developing (ND) 2-year-olds in the use of communicative acts by parent and child. Groups were matched for language level. Autistic children had more incidents of no responses, produced less affirming, turn-taking vocalization, and gesture, and were less likely to initiate communication than other children. Parent groups differed only in a greater amount of initiating and use of imperatives by parents of autistic children. Few relations between parent behaviors and child behaviors were found. Nonresponses by all children were concentrated subsequent to parent imperatives and questions, but no group differences were found in the distribution of nonresponses to various parent communicative acts. Results are interpreted to support the hypothesis that autistic children's language can serve a number of useful functions but that their pattern of language functions differs from that of nonautistic language-impaired children and much younger normal children of similar language level.     

Estrogenic properties of raloxifene,but not tamoxifen,on D2 and D3 dopamine receptors in the rat forebrain

The present study investigated the estrogenic specificity of the modulation of dopamine D(2) and D(3) receptors by comparing the effects of estradiol with tamoxifen or raloxifene. These compounds have estrogenic and/or antiestrogenic activity depending on the target tissue. Two weeks after ovariectomy of female rats, we observed a 60% decrease in the uterine weight, which was prevented by a replacement therapy of 2 weeks with 17beta-estradiol. A tamoxifen or raloxifene treatment of 2 weeks increased uterine weights by 35 and 15%, respectively, but significantly less than estradiol treatment. Ovariectomy decreased dopamine D(2) receptor specific binding (20%) in the dorsolateral part of the anterior striatum and these receptors were left unchanged in the other parts of the striatum as well as in the olfactory tubercle and the nucleus accumbens. 17beta-Estradiol and raloxifene, but not tamoxifen treatment prevented this decrease. Ovariectomy left dopamine D(3) receptor specific binding unchanged. However, estradiol and raloxifene treatment decreased dopamine D(3) receptor binding in the islands of Calleja, the core and shell of the nucleus accumbens and the dorsal part of the anterior striatum, compared with ovariectomized rats. Our results show that raloxifene, but not tamoxifen, has an agonist estrogenic activity on dopamine receptors. Furthermore, estradiol and raloxifene have opposite effects on specific binding to dopamine D(2) and D(3) receptors.