Quality of life in schizophrenia: a multicenter, randomized, naturalistic, controlled trial comparing olanzapine to first-generation antipsychotics

OBJECTIVE: To assess the effectiveness of olanzapine for treating schizophrenia and to assess if olanzapine promotes a better quality of life than first-generation antipsychotics (FGAs). METHOD: Multicenter, naturalistic, randomized controlled study, comparing olanzapine with FGAs, at hospitalization and during a 9-month follow-up. Outcome assessors were blind to the allocated drug. The dose of antipsychotic was determined by doctors according to their clinical practice routines. Data collection was performed from April 1999 to August 2001. RESULTS: 197 patients with DSM-IV-diagnosed schizophrenia were allocated to olanzapine (N = 104) and FGA (N = 93). Patients taking olanzapine showed greater improvements in Positive and Negative Syndrome Scale (PANSS) negative symptoms (mean difference = 2.3, 95% CI = 0.6 to 4.1) and general psychopathology (mean difference = 4.0, 95% CI = 0.8 to 7.2) sub-scales and fewer incidences of tardive dyskinesia (RR = 2.4, 95% CI = 1.4 to 4.2, p < .0001). Olanzapine was also associated with greater improvement in a number of health-related quality-of-life outcomes on the Medical Outcomes Study 36-item Short-Form Health Survey, including physical functioning (mean difference = 6.6, 95% CI = 1.2 to 11.9), physical role limitations (mean difference = 13.7, 95% CI = 3.0 to 24.3), and emotional role limitations (mean difference = 12.1, 95% CI = 0.7 to 23.5). Patients taking olanzapine gained significantly more weight during the trial than patients taking FGAs, with a correspondent endpoint increase in the body mass index (BMI) of 28.7 versus 25.3 (p < .001). CONCLUSION: Compared with FGAs, olanzapine has advantages in terms of improvements of negative symptoms and quality of life. It is also associated with fewer incidences of tardive dyskinesia and greater increases in weight and BMI. These findings are highlighted by the naturalistic approach adopted in this trial.     

Percutaneous management of penetrating aortic ulcer

Penetrating aortic ulcer is a variant of classic aortic dissection having distinct histopathological characteristics. If not appropriately treated, it evolves to combined morbidity and mortality rates as high as those of classic dissection. This condition, therefore, warrants special attention with accurate diagnosis and treatment. Percutaneous management using endoprosthesis is the method of choice, since the patients are usually elderly and have comorbidities that would increase the complication rates of traditional surgery. A 78-year-old woman complaining of thoracic pain was admitted to the hospital; her pain had been radiating to the interscapular and left lumbar regions for four months. Upon diagnostic investigation, a penetrating aortic ulcer was found, and after being successfully treated percutaneously with stent implantation, the patient became asymptomatic and is under outpatient follow-up.     

The Minimal Approach: An Innovation in Facial Cosmetic Procedures

Plastic surgery is a rapidly growing field, particularly the use of less invasive procedures such as biodegradable dermal fillers and botulinum toxin. Aging is a complex process involving two important factors: volume loss throughout the face, and repetitive muscle movements that cause wrinkles and folds. Dermal fillers work by providing support for facial structures, whereas botulinum toxin reduces the mimetic effects. In combination, these products can be used effectively to reshape and rejuvenate the face and neck. Dermal fillers can be used throughout the face to raise the eyebrows, fill the tear trough, reshape the nose, lift the nose tip, fill nasolabial folds and oral comissures, fill the cheeks, raise the cheekbones, reshape the jaw line, and rejuvenate the neck area. This minimal approach offers a faster, less painful, and less costly alternative or complement to surgical facelifts. A variety of biodegradable injectable products are currently available, the most common of which are collagen- or hyaluronic acid–based. Using these products in combination takes advantage of their hydrophobic and hydrophilic properties and can provide better and longer-lasting results. The addition of botulinum toxin can further extend the duration of results by reducing the mimetic stress that can break down the polymers. With regular maintenance treatments, the minimal approach using dermal fillers and botulinum toxin can give patients a whole new look with a fast and relatively painless lunchtime procedure.     

Validation of a health survey questionnaire focusing on risk factors for coronary artery disease in a group of public employees in Juiz de Fora, Minas Gerais State, Brazil

The validity of a health survey questionnaire used in a family health promotion program to identify individuals at risk of developing coronary artery disease (CAD) was studied in a random sample of 297 State public employees in Juiz de Fora, Minas Gerais State, Brazil. The sample was stratified by sex, and subjects were 40 years of age or older. Results obtained in interviews were compared to laboratory and clinical data. We assessed the questionnaire's sensitivity, specificity, and positive and negative predictive values in relation to questions about current or previous history of diabetes, hypertension, smoking, and high cholesterol. Among individuals with at least one altered clinical or laboratory test, 81% (total sensitivity) were identified by the referred risk inquiry when reporting at least one risk factor. Sheffield and New Zealand tables were used to determine the individuals with increased risk of developing CAD and to assess if they would also be identified by the health survey questionnaire. The sensitivity for identifying this subgroup was 100%.     

Ticks (Acari: Ixodidae) on wild marsh-deer (Blastocerus dichotomus) from Southeast Brazil: infestations before and after habitat loss

The lake from Porto-Primavera hydroelectric power station inundated an area of 2,200 km2 at the border of S?o Paulo and Mato-Grosso do Sul States, Brazil. Infestations by ticks were evaluated on 135 marsh deer, Blastocerus dichotomus (Illiger), captured before and after inundation. Ticks were collected for identification, and infestation level of animals was assessed by scoring. Deer were divided into four groups according to capture location and temporal relation to the inundation. Groups 1, 2, and 3 were captured before inundation. Group 4 was captured after inundation. Four tick species were found: Amblyomma cajennense (F.), Amblyomma triste Koch, Anocentor nitens (Neumann), and Boophilus microplus (Canestrini). Groups 1, 2, 3, and 4 had 30, 45, 100, and 96%, respectively, of animals carrying B. microplus ticks. A. triste was observed on 16, 22, 22, and 88% of animals from groups 1, 2, 3, and 4, respectively. A. nitens and A. cajennense were observed only on group 4, on 32 and 16% of the animals, respectively. Groups 1 and 2 had only 4.8 and 6.1% of animals with high infestation levels, respectively, and no ticks on 46.8% and 45.5% of the animals, respectively. Conversely, groups 3 and 4 lacked noninfested animals and had high infestation levels on 77.8 and 50% of deer, respectively. Marsh area shrinkage was blamed for higher infestation levels on deer from groups 3 and 4. The widespread presence of A. triste on marsh deer, a Neotropical tick species, raises the possibility of a natural host-parasite relationship.     

Inflammatory follicular cyst associated with an endodontically treated primary molar: a case report

This is a case study of an inflammatory follicular cyst associated with an endodontically treated deciduous molar with radiographic and microscopic diagnosis. This cystic lesion represents a typical follicular cyst that arose in association with periapical inflammation from a non-vital deciduous molar and involved the follicle of the unerupted successor premolar. This paper describes the case and discusses diagnosis, histogenesis, and controversies regarding terminology.     

Effects of a saccharin and cyclamate mixture on rat embryos

Sodium saccharin (NaS) and calcium cyclamate (CaC) are artificial sweeteners widely used in food and drink. To evaluate their toxicological effects on preimplantation mammalian embryos, pregnant rats were gavaged with 1.65 mg NaS/kg bw + 3.85 mg CaC/kg bw (DI) or 6.6 mg NaS/kg bw + 15.4 mg CaC/kg bw (D2) on days 1, 2, 3 and 4 of pregnancy (positive vaginal smear = day 1). The female rats were killed on day 5 of the pregnancy (GD 5), maternal organs weighed, and the blastocysts collected, counted and evaluated for gross morphology, cell number and mitotic index. There was no alteration in maternal organ weights, but there was an increase of the cell number/embryo in the dams treated with that NaS + CaC mixtures (D1 = 37.20 +/- 7.96; D2 = 37.26 +/- 10.90) compared to control group (32.24 +/- 6.73). Embryos whose dams were exposed to NaS + CaC may have adapted for implantation into the uterus but more studies are needed to demonstrate this mechanism of action.     

Evaluation of respiratory muscle strength and thoracic and abdominal amplitudes after a functional reeducation of breathing program for obese individuals

The purpose of this study was to assess the elements of respiratory mechanics in obese individuals with respect to respiratory muscle strength determined by maximum respiratory pressure (PImax and PEmax) and the amplitude of thoracoabdominal movements at the levels: axillary (AAX), xiphoid (AXf) and abdominal (AAb). Twenty nine patients (43 +/- 13 years) were divided in two groups: Experimental group (E) and Control group (C). All patients were submitted to an initial evaluation and determination of PImax, PEmax, AAx, AXiph and AAb. The E group was submitted to 18 sessions of a Functional Reeducation of Breathing Program that consisted of respiratory orientation, respiratory coordination exercise associated to trunk and limb movements and muscle relaxation two times a week during 9 weeks. Student t-test showed a significant increase in PImax, Axif and Aabd in the experimental group, but when authors compared the two groups, they did not find any statistical difference. The results showed that the Program increased the respiratory muscle strength and the amplitude of abdominal movements in obese patients.