Delirium during the course of electroconvulsive therapy in a patient on lithium carbonate treatment

Objective

The safety of concurrent mood stabilizers during the course of electroconvulsive therapy (ECT) is yet to be clearly established. Delirium with concurrent administration of ECT and lithium carbonate is described in this case report.

Methods

A 30-year-old male with a past history of significant head injury developed delirium during the course of bitemporal ECT.

Results

The clinical picture and the details of the cognitive impairment have been discussed in the report with a focus on relationship between the lithium carbonate administration and the concurrent ECT.

Conclusion

Patients with preexisting organic brain damage could be prone to develop the cognitive adverse effect while on a combination of lithium and ECT. Possible interactions between lithium and ECT need further systematic evaluation.     

Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy‐Induced Nausea and Vomiting in Children With Cancer

This clinical practice guideline provides an approach to the treatment of breakthrough chemotherapy‐induced nausea and vomiting (CINV) and the prevention of refractory CINV in children. It was developed by an international, interprofessional panel and is based on systematic literature reviews. Evidence‐based interventions for the treatment of breakthrough and prophylaxis of refractory CINV are recommended. Gaps in the evidence used to support the recommendations made in this clinical practice guideline were identified. The contribution of these recommendations to breakthrough and refractory CINV control in children requires prospective evaluation.     

Psychische Gesundheit von übergewichtigen und adipösen Jugendlichen unter Berücksichtigung von Sozialstatus und Schulbildung

Background

International studies showed that overweight and obese adolescents are more likely to have mental health problems compared to normal weight peers.

Objectives

This study analyses the relation between overweight/obesity and mental health problems among adolescents in Germany as well as potential modifying factors of this relation.

Materials and Methods

Data base was a subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, n?=?6,813, 11–17 years) which was conducted by the Robert Koch Institute from May 2003 to May 2006. Body height and weight were measured in a standardised manner and body mass index (BMI) was calculated. Indications of mental health problems and strengths were collected with the Strengths and Difficulties Questionnaire (SDQ) in the following areas: emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial behaviour. Socio-economic status (SES) and education are analysed as modifying variables. Prevalence and odds ratios with 95?% confidence intervals were calculated by binary logistic regression.

Results

Obese boys and overweight and obese girls showed more indications of mental health problems compared to normal weight peers. The most common problem areas were conduct problems and peer relationship problems. Obese girls were also more likely to show indications of emotional symptoms compared to normal weight girls. The age stratified analysis showed that the differences in the occourrence of mental health problems between normal weight and obese boys as well as between normal weight and overweight/obese girls are more pronounced aged 11 to 13 years than aged 14 to 17 years. The results on the impact of SES and education showed that in girls, SES had a modyfying impact on the relation between overweight/obesity and mental health problems in favour of the high SES group. In boys, SES only had a modifying impact on the relation between overweight and mental health problems, but here in favour of the low SES group. Only in girls education had a modifying impact on the relation between obesity and mental health problems in favour of the low education group.

Conclusion

In adolescence, overweight and especially obesity go along with a higher risk for mental health problems. In the context of prevention measures and care services for overweight and obesity at a young age, psychosocial aspects should be considered.     

Sinus node dysfunction during long-term lithium treatment.

BACKGROUND AND OBJECTIVE--Lithium has occasionally been reported to cause symptomatic sinus node bradyarrhythmias. The prevalence and mechanism of these arrhythmias during long-term treatment are unknown. The aims of this study were (a) to evaluate the systemic effects of lithium treatment on cardiac conduction in individuals who were free from cardiovascular disorders; (b) to assess the prevalence of lithium treatment in a group of patients with pacemakers; and (c) to evaluate the interaction between the parasympathetic limb of the autonomous nervous system and the sinus node cells during long-term lithium treatment. PATIENTS AND METHODS--45 patients who had been treated with lithium for > 12 months were investigated in a long-term electrocardiography study. Only patients without cardiovascular disease, or concomitant chronotropic medication, or metabolic disorders known to cause rhythm disturbances were included. An age-stratified population was used as a reference group. 21 patients also underwent analysis of carotid sinus pressure and sinus cycle length before and after atropine to clarify whether neural mechanisms were involved. The prevalence of lithium treated patients was determined in 650 patients with pacemakers. RESULTS--(a) Signs of moderate sinus node dysfunction (sinus arrest > 1.5 s, minimum heart rate < 50 beats/min) were found in 56% and 78% respectively in the lithium-treated group compared with 30% and 30% respectively in the reference group (p < 0.01). Severe sinus node dysfunction was equally common in both groups. (b) The prevalence of chronic lithium treatment in the pacemaker population was 0.46%. (c) Sinus cycle variations were abnormal in the basal state in three (14%) patients and in 11 (52%) patients after atropine despite signs of intact and normal parasympathetic innervation. CONCLUSIONS--Depressed sinus node function was significantly more common in a lithium-treated population than in an age-stratified reference group. Clinically significant dysfunction, however, was uncommon. The effect of lithium on the sinus node seemed to be intrinsic and was not caused by increased parasympathetic tone.     

Clinical efficacy and safety of teicoplanin in the treatment of gram-positive infections

Summary This study was an open efficacy and safety study of teicoplanin in hospitalized patients with gram-positive infections. 26 patients entered the study. Teicoplanin was administered by intravenous bolus injection at a dose of 200 mg or 400 mg every 24 h, and in all cases an initial loading dose of 400 mg was given. The mean duration of treatment was 9.4 days (range four to 20 days). The infections included 18 skin/soft tissue, four lower respiratory tract, two urinary tract and two joint/bone. Clinical cure and improvement occurred in 20 of the 26 patients. Only two adverse events (moderate diarrhoea and mild pain at injection site) related to teicoplanin occurred in one patient. It was concluded that teicoplanin was effective and well tolerated in the treatment of gram-positive infections.

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Klinische Wirksamkeit und Verträglichkeit von Teicoplanin in der Behandlung von grampositiven Infektionen

Zusammenfassung In einer offenen Studie wurde die klinische Wirksamkeit und Verträglichkeit von Teicoplanin bei 26 Patienten mit grampositiven Infektionen geprüft. Teicoplanin wurde mittels i.v. Bolusinjektion in der Dosierung von 200 mg oder 400 mg alle 24 Stunden verabreicht. In allen Fällen wurde eine Initialdosis von 400 mg gegeben. Die durchschnittliche Behandlungsdauer betrug 9,4 Tage (4–20 Tage). Folgende Infektionen wurden behandelt: 18 Haut/Weichteile, vier untere Atenwege, zwei Harnwege und zwei Knochen/Gelenke. Eine klinische Heilungs- und Besserungsrate wurde bei 20 der 26 Patienten erzielt. Nur zwei unerwünschte Arzneimittelwirkungen (mäßige Diarrhoe und leichter Schmerz an der Injektionsstelle) wurden bei einem Patienten beobachtet. Die Ergebnisse lassen darauf schließen, daß Teicoplanin in der Behandlung von grampositiven Infektionen wirksam und gut verträglich ist.

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Supported by Merrell Dow Pharma GmbH, Rüsselsheim, FR Germany.     

Alltagskompetenzen und Lernprozesse im höheren Lebensalter

This article deals with the study “Competencies in later life” (CiLL), a parallel study to the German program for the international assessment of adult competencies (PIAAC) survey which assesses the level and distribution of skills of the adult population in a representative study. Assuming the growing importance of learning and education in a society challenged by demographic changes, the first section of the paper outlines the qualitative research of learning activities of focus groups in the daily life of elderly people. The second section of the paper presents the survey design and exemplary findings of the quantitative CiLL study. Initial results show that basic skills of the elderly are highly influenced by personal and sociodemographic variables, particularly by educational background. The data available indicate that the participation of the elderly in adult education and the options available for competence development have to be increased.     

MELD at POD 1 as a predictor of outcome in liver allografts with peak AST >5000 U/l

Perioperative liver graft injury is associated with elevation of aminotransferases after orthotopic liver transplantation (OLT). Values above 5000 U/l usually are regarded as extreme liver graft injury (ELGI). Some patients and organs recover from this critical condition. The aim of the study was to evaluate factors contributing to graft and patient survival after ELGI. From chart review we identified 64 of 917 OLT adult patients (median age 54.2 years; 68.8% males) transplanted between 11/2003 and 02/2012, who presented ELGI after OLT. Donor and recipient factors were analyzed and correlated with the outcome by univariable and multivariable methods. Multivariable cox proportional hazards showed that recipient's BMI (P = 0.01), model for end stage liver disease (MELD) score before OLT (P = 0.02) and laboratory MELD score 24 h after OLT (P = 0.01) were independently associated with patient survival. 30‐days and 12‐months survival in patients with a postoperative laboratory MELD higher than 31 was 21.4%, while patients with a postoperative laboratory MELD lower than 31 displayed 30‐days and 12‐months survival rates of 80% and 71.8%, respectively (P < 0.001). Retransplantation in the setting of ELGI after OLT should be based on all available data. Utilization of the postoperative labMELD enables the transplant physician within 24 h after transplantation to identify necessity of retransplantation objectively.