The comparison of nail and serum trace elements in patients with epilepsy and healthy subjects

The objective of this prospective study was to determine the levels of manganese (Mn), copper (Cu), and zinc (Zn) levels in both nail and serum from patients with epilepsy. For this purpose, levels of these elements were measured in 31 patients with epilepsy and 19 healthy subjects. Element analyses were carried out by atomic absorption spectrophotometer (AAS). Increased Mn levels were detected in nail of patients with epilepsy compared to healthy controls (P<.008). The main nail Zn and Cu levels were found to be unchanged in epileptic patients compared to control subjects. There were no significant differences in serum Mn and Zn levels between epileptic patients and control subjects. However, there was a statistically significant increase in serum Cu levels in patients with epilepsy in comparison with control group (P<.009). Our results demonstrate that some trace element levels may vary in epileptic patients, and because of the more stable status, the analysis of these element levels in some tissues such as nail might be superior to serum analysis.     

Risperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ

OBJECTIVE: The aim of this study was to examine the safety and efficacy of risperidone, with or without concomitant psychostimulant use, in the treatment of children with conduct disorder (CD) or other disruptive behavior disorders [oppositional defiant disorder (ODD), disruptive behavior disorder-not otherwise specified (DBD-NOS)], and comorbid attention-deficit hyperactivity disorder (ADHD). METHODS: Data from two 6-week placebo-controlled trials assessing risperidone therapy in children with subaverage IQs and CD, ODD, DBD-NOS were combined, and patients with comorbid ADHD were selected for this post hoc analysis. Patients were grouped according to randomized drug therapy (risperidone or placebo), and then subgrouped according to their use of a concomitant psychostimulant. Safety outcomes included adverse events and weight change, while efficacy outcomes included changes in scores on disruptive behavior and hyperactivity-based subscales of two behavior-rating instruments (Nisonger Child Behavior Rating Form and the Aberrant Behavior Checklist). RESULTS: The analysis included 155 of 208 originally tested children divided into four sub-groups (35-43 patients each). There was no significant difference in the frequency of adverse events in patients who received risperidone alone and those who received risperidone plus a stimulant. The most common adverse events in risperidone-treated patients were somnolence, headache, dyspepsia, rhinitis, and vomiting. Within each randomized treatment group, actual weight gain was comparable, regardless of concomitant stimulant use. Risperidone-treated patients had clinically and statistically significant reductions in both disruptive behavior and hyperactivity subscale scores, compared to placebo, regardless of concomitant stimulant use. The addition of risperidone to a psychostimulant resulted in significantly better control of hyperactivity (p < 0.001) than was achieved with stimulant treatment alone, without causing an increase in adverse events. CONCLUSION: Risperidone was a safe and effective treatment, with or without a combined psychostimulant, for both disruptive behavior disorders and comorbid ADHD in children.     

Correlates of attempted suicide among young injection drug users in a multi-site cohort

The purpose of this study was to determine the prevalence and correlates of attempted suicide among young injection drug users (IDUs) from six study sites in five US cities. Two thousand two hundred and nineteen participants 15-30 years of age underwent interviewer-administered questionnaires relating to self-reported drug use, sociodemographics, suicidal ideation and attempts, and exposure to violence. The 6-month prevalence of suicidal ideation and attempts was 35.8% (n = 795) and 7% (n = 156), respectively. Compared to those not reporting a recent (past 6 months) suicide attempt, those attempting suicide were more likely to have a lifetime history of mental health facility admission or sexual abuse. Participants receiving drug treatment at the time of the baseline interview (53.2% versus 37.1%, odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.39, 2.67) were also more likely to report a recent attempt; as were those reporting a history of experiencing violence. These associations persisted after adjusting for age, sex, race/ethnicity, study site, and other significant covariates by multiple logistic regression. These data suggest that increased access to drug treatment, community mental health, and violence prevention programs may decrease suicidal behavior among young injection drug users.     

The use of RADAAR (ratio of rim area to disc area asymmetry) in detecting glaucoma and its severity

BACKGROUND: In a previous study it was shown that the asymmetry of rim area and disc area of fellow eyes expressed as a ratio (rim area to disc area asymmetry ratio [RADAAR]) was associated with the diagnosis of glaucoma in patients with highly asymmetric disease. Furthermore, this ratio was able to distinguish these patients from groups of glaucoma suspects and subjects without glaucoma. The purpose of this study was to investigate whether the RADAAR correlates with the diagnosis and severity of glaucoma in a large glaucomatous population. METHODS: We reviewed the records of 140 randomly selected patients with open-angle, normal-tension or pseudoexfoliative glaucoma evaluated at the glaucoma service of a tertiary care centre in Philadelphia between January 1996 and April 2000. Heidelberg Retina Tomograph (HRT) disc area, rim area, cup-to-disc area ratio, pattern-standard deviation and mean deviation as well as maximum intraocular pressure (IOP) were recorded. Disc staging and visual fields determined severity of glaucoma, and fellow eyes were classified as "better" or "worse." RESULTS: The RADAAR was significantly correlated with IOP (r = 0.23, p < 0.03), mean deviation (r = -0.22, p < 0.02), cup-to-disc area ratio (r = 0.19, p < 0.03) and disc stage of glaucomatous optic nerve damage (r = 0.17, p < 0.05) in "worse" eyes. RADAAR groups were also correlated with fellow-eye differences in mean deviation (p < 0.05) and cup-to-disc area ratio (p < 0.02). INTERPRETATION: The RADAAR, a new HRT-derived measure of asymmetry in fellow eyes, is associated with the diagnosis of glaucoma and its severity.     

Acid suppression therapy may not alter malignant progression in Barrett's metaplasia showing p53 protein accumulation

OBJECTIVES: Several previous studies have shown that malignant progression in Barrett's metaplasia (BM) occurs even in patients treated with fundoplication or acid suppression therapy (AST). The aim of this study was to test the hypothesis that AST may not alter malignant progression in BM if key genes involved in DNA repair and cell cycle control, particularly p53, are defective. METHODS: Initial and follow-up biopsies from 21 patients with BM treated with AST and observed for 1-13 yr were entered in the study. All biopsies were graded for dysplasia and evaluated for p53 protein accumulation and oxidative DNA damage by immunohiostochemistry, using antibodies to p53 and to 8-hydroxydeoxyguanosine, respectively. DNA ploidy was determined using image analysis. Statistical analysis was performed using Kaplan-Meier curves, log rank test, and multivariate regression. RESULTS: Patients with p53 positive initial biopsies were more likely to have progression in dysplasia grade (p = 0.022) and DNA ploidy status (p = 0.023) than those with p53 negative biopsies. In eight patients AST resulted in significant reduction in oxidative DNA damage in the five patients with p53-negative initial biopsies, but not the three with p53 positive ones (p = 0.0007). CONCLUSIONS: We conclude that failure of AST to alter malignant progression in BM may be due, at least in part, to defects in DNA repair and cell cycle control resulting from p53 gene mutation, present before AST treatment. Although AST may be effective in preventing further DNA damage, it is unlikely to alter progression in genetically unstable cells.