Severe hepatotoxicity associated with bromfenac sodium

Subacute hepatitis and liver failure occurred in a 40-yr-old woman following a 1-month course of treatment with the nonsteroidal anti-inflammatory drug bromfenac. Serologies for hepatitis A, B, and C were negative, as were antinuclear antibodies and ceruloplasmin. A transjugular liver biopsy demonstrated submassive hepatic necrosis. The clinical course was complicated by encephalopathy, fluid retention, and spontaneous bacterial peritonitis, prompting consideration for liver transplantation. With supportive measures, jaundice and fluid retention resolved over a 3-month period. We conclude that prolonged use of bromfenac was the etiological agent in this case, and that this drug can cause severe hepatotoxicity resulting in liver failure.     

Negative ANA-IIF in SLE patients: what is beyond?

Clinical Rheumatology - The antinuclear antibody (ANA) test has high sensitivity in diagnosing and classifying systemic lupus erythematosus (SLE). To describe the immunological pattern of SLE...     

Reduced intensity is preferred over myeloablative conditioning allogeneic HCT in chronic lymphocytic leukemia whenever indicated: A systematic review/meta-analysis

Despite availability of new and more effective therapies for chronic lymphocytic leukemia, presently this disease remains incurable unless eligible patients are offered an allogeneic hematopoietic cell transplant. Recent published clinical practice recommendations on behalf of the American Society for Blood and Marrow Transplantation relegated the role of for allogeneic hematopoietic cell transplantation to later stages of the disease. To our knowledge, no randomized controlled trial has been performed to date comparing myeloablative versus reduced intensity conditioning regimens in chronic lymphocytic leukemia patients eligible for the procedure. We performed a systematic review/meta-analysis to assess the efficacy of allogeneic hematopoietic cell transplantation when using myeloablative or reduced intensity conditioning regimens. We report the results in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Based on lower non-relapse mortality and slightly better overall survival rates, reduced intensity conditioning regimens appear to be the most desirable choice whenever the procedure is indicated for this disease. It appears highly unlikely that a RCT will be ever performed comparing reduced intensity vs. myeloablative allogeneic hematopoietic cell transplantation in chronic lymphocytic leukemia. In the absence of such a study, results of this systematic review/meta-analysis represent the best available evidence supporting this recommendation whenever indicated in patients with chronic lymphocytic leukemia.     

Jordanian undergraduate nursing students' perceptions of effective clinical teachers

Clinical teaching is a dynamic process that occurs in a variety of sociocultural contexts. The quality of student-teacher interaction in the clinical field can either facilitate or hinder the students' learning in the clinical area. This paper presents the results of a study to explore Jordanian undergraduate nursing students' perceptions of effective clinical teacher characteristics. The results showed that overall, the nursing students rated the professional competence of the clinical teacher as the most important characteristic, which when compared to the Western population was different. When male and female nursing students' perceptions were compared, no significant differences were found. However, responses of nursing students from the three academic years differed significantly in that second-year students rated the clinical teachers' relationship with students as most important and fourth-year students rated personal qualities of the clinical teachers as most important. The results were significant in that they were congruent with the students' level of education and most importantly, their cultural beliefs and values about education.     

Immediate bonding to bleached enamel

This research sought to determine the shear bond strength, degree of resin infiltration and failure mode when organic solvent-based adhesives (acetone or ethanol) were used in immediate bonding to enamel bleached with 10% carbamide peroxide or 38% hydrogen peroxide systems. Seventy-two non-carious bovine incisors were randomly assigned to three groups of 24 specimens each-control group (deionized water), 38% hydrogen peroxide bleach group and 10% carbamide peroxide bleach group. Each group was further subdivided into two subgroups of 12 specimens each according to the adhesive system used to bond the resin composite to enamel surfaces. The two adhesive systems used were Single Bond, an ethanol-based adhesive, and One Step, an acetone-based adhesive. The shear bond strengths of 38% hydrogen peroxide and 10% carbamide peroxide were significantly lower compared to the non-bleached controls. Fractography revealed an adhesive failure mode in all specimens. Qualitative comparisons of resin tags present in the bleached and unbleached specimens using scanning electron microscopy (SEM) revealed few, thin and fragmented resin tags when 38% hydrogen peroxide and 10% carbamide peroxide were used.     

Comparison of microwave-polymerized denture base resins

Three denture base resins, two designed for microwave polymerization and one for host-water-bath-processing, were compared. Results indicated that all four tested thicknesses (3, 6, 11.6, and 17.7 mm) of the water-bath-polymerized samples and one of the microwave-polymerized resins were porosity-free. When the water-bath-polymerized material was microwave processed, porosity was found when resin thickness exceeded 3 mm. When one resin designed for microwave polymerization was irradiated using the high-wattage (513 W), shorter cycle (4 minutes 52 seconds), porosity also occurred when the thickness exceeded 3 mm. Porosity did not occur until there was 9 mm of thickness when the lower-wattage (75.9 W), longer cycle (15 minutes 26 seconds) was used. No significant differences in transverse strength or hardness were noted between the materials.     

Diagnostic yield of early morning urine samples in the diagnosis of tuberculosis

Sir, Early morning urine (EMU) samples are sent in significant numbersfrom patients suspected of having tuberculosis (TB), despiteevidence that the diagnostic yield is very low.¹ We assessedthe diagnostic yield of EMUs and calculated the associated workload,by retrospectively analysing data from our institution fromJanuary 2000 to June 2004. All patients with     

Schizophrenia,Subjectivity, and Mindreading

A number of recent articles, many appearing in Schizophrenia Bulletin, signal a renewed interest in phenomenological approaches to our understanding of schizophrenia. These approaches conceptualize schizophrenia as a disorder of altered self-awareness and decreased prereflective social attunement, which may manifest as an impaired understanding of self, others, and the physical world. Phenomenological approaches to psychopathology are sometimes construed as being incompatible with the reductionistic methodology of contemporary neuroscience. In this article, we re-examine findings from the phenomenological investigation of schizophrenia in light of an influential neurocomputational account of mindreading, which postulates that understanding of others is subserved by coherent internal self-models. We argue that the phenomenological approach to schizophrenia is not incompatible with a neurocomputational account of mindreading, and that the 2 approaches should instead be viewed as existing in a relationship of mutual constraint and enlightenment. Our hypothesis, while speculative, is an attempt to marry the phenomenological and neuronal realities of schizophrenia. Furthermore, it has implications for psychotherapeutic interventions and future research.Key words: phenomenology, Bayesian inference, predictive coding, self-disorder