Aggressive behavior following traumatic brain injury: how common is common?

OBJECTIVE: To assess the prevalence and predictors of aggressive behavior among traumatic brain injury (TBI) survivors at 6, 24, and 60 months postdischarge. DESIGN: Mixed cross-sectional and longitudinal data from a 5-year follow-up study of discharged TBI patients analyzed retrospectively. SETTING: A specialized Brain Injury Rehabilitation Service of a tertiary referral hospital. PATIENTS: Two hundred twenty-eight (228) patients with moderate to severe TBI. MAIN OUTCOME MEASURES: The Overt Aggression Scale; injury-related variables (in particular, Glasgow Coma and Outcome scales and posttraumatic amnesia duration); and a battery of postdischarge questionnaires (Beck Depression Inventory, Trauma Complaints List, General Health Questionnaire, etc). RESULTS: At any given follow-up period, 25% of the participants were classified as aggressive. Aggression, where present, was consistently associated with depression, concurrent traumatic complaints, younger age at injury, and low satisfaction with life rather than with injury, demographic, or premorbid characteristics. Depression was the factor that was most significantly associated with aggressive behavior at all times postinjury, followed by a younger age at the time of injury. CONCLUSIONS: Aggression is a common, fluctuating, and long-term problem following TBI. The underlying association between aggression and psychosocial variables lends support to the provision of ongoing outreach services and psychological and behavioral interventions for all affected TBI survivors.     

Susceptibility of Streptococcus pneumoniae to penicillin, azithromycin and telithromycin (PROTEKT 1999-2003)

Isolates of Streptococcus pneumoniae collected over the first 4 years of the PROTEKT study were tested for susceptibility to penicillin, azithromycin and telithromycin. A total of 20 750 isolates were collected from 39 countries. Penicillin non-susceptibility rates were stable over the study period; overall, 21.8% of isolates were resistant. Azithromycin resistance increased from 31.0% in Year 1 to 36.3% in Year 4. Resistance rates for penicillin and azithromycin varied between countries and were highest in France, Spain, South Africa, USA and the Far East. Multidrug resistance in S. pneumoniae did not change significantly over the 4 years, with an overall rate of 38.6%. Telithromycin retained good activity against S. pneumoniae (0.1% of isolates resistant), including multidrug-resistant isolates.     

Heart rate reduces when stroke patients are touched . . . And??

McFadden KL, Hernández TD. Cardiovascular benefits of acupressure (Jin Shin) following stroke. Complement Ther Med 2010; 18: 42–8.     

The impact of progesterone on memory consolidation of threatening images in women

Recent findings suggest that consolidation of emotional memories is influenced by menstrual phase in women. In contrast to other phases, in the mid-luteal phase when progesterone levels are elevated, cortisol levels are increased and correlated with emotional memory. This study examined the impact of progesterone on cortisol and memory consolidation of threatening stimuli under stressful conditions. Thirty women were recruited for the high progesterone group (in the mid-luteal phase) and 26 for the low progesterone group (in non-luteal phases of the menstrual cycle). Women were shown a series of 20 neutral or threatening images followed immediately by either a stressor (cold pressor task) or control condition. Participants returned two days later for a surprise free recall test of the images and salivary cortisol responses were monitored. High progesterone levels were associated with higher baseline and stress-evoked cortisol levels, and enhanced memory of negative images when stress was received. A positive correlation was found between stress-induced cortisol levels and memory recall of threatening images. These findings suggest that progesterone mediates cortisol responses to stress and subsequently predicts memory recall for emotionally arousing stimuli.     

Managing community acquired pneumonia in the elderly – the next generation of pharmacotherapy on the horizon

Introduction: Community acquired pneumonia (CAP) is associated with high rates of morbidity and mortality, especially among the elderly. Antibiotic treatment for CAP in the elderly is particularly challenging for many reasons, including compliance issues, immunosuppression, polypharmacy and antimicrobial resistance. There are few available antibiotics that are able to address these concerns.

Areas covered: After a systematic review of the current literature, we describe seven novel antibiotics that are currently in advanced stages of development (phase 3 and beyond) and show promise for the treatment of CAP in those over the age of 65. These antibiotics are: Solithromycin, Pristinamycin, Nemonaxacin, Lefamulin, Omadacycline, Ceftobiprole and Delafloxacin. Using a novel conceptual framework designed by the present authors, known as the ‘San Antonio NIPS model’, we evaluate their strengths and weaknesses based on their ability to address the unique challenges that face the elderly.

Expert opinion: All seven antibiotics have potential value for effective utilization in the elderly, but to varying degrees based on their NIPS model score. The goal of this model is to reorganize a clinician’s focus on antibiotic choices in the elderly and bring attention to a seldom discussed topic that may potentially become a health-care crisis in the next decade.     

盐酸帕罗西汀治疗胃肠疾病433例分析

常见胃肠疾病的临床症状常是非特异性及多样性,其中或多或少受到精神因素的影响［１］。为探索针对调整神经功能失调药物在治疗胃肠疾病中的作用,自１９９７年５月至１９９８年７月,我们在常规药物治疗的基础上加用盐酸帕罗西汀（赛乐特）治疗常见胃肠疾病４３３例,疗效满意,现报告如下。材料与方法一、研究对象４３３例胃肠疾病均依据临床表现、内镜、实验室及影象学检查明确诊断,其表１　主要胃肠道症状及治疗效果（例）恶心呕吐腹痛腹胀暖气大便次数及习惯改变吞咽障碍或吞咽不协调病例数１５６１２８８２４３１０有效数１３２１１…     

Severe congenital absence of skin in a preterm infant

A severe case of aplasia cutis congenita in a preterm infant is described. Although major problems with thermoregulation and fluid balance were anticipated, these parameters were relatively easy to control once the patient was stabilized. Meticulous skin care and rapid formation of a membranous-like fibrous tissue layer covering the denuded areas probably played an important role in minimizing excessive fluid and heat loss. The prognosis in aplasia cutis congenita is determined by the underlying associated anomalies, the severity of skin lesions and, in our case, the maturity of the infant who died from complications of prematurity.     

Neonatal Marfan syndrome: A case report

A case of neonatal Marfan syndrome is presented. The patient was noted to have cardiomegaly and tricuspid regurgitation on antenatal ultrasound scan. She was born with long, slender fingers and toes, an aged appearance and non-paralytic hypotonia. Echocardiogram revealed a dilated right atrium, right ventricle, dysplastic tricuspid valve and severe tricuspid regurgitation. She subsequently died of severe heart failure. Post-mortem examination showed the pathological features of lobar emphysema and cystic medial necrosis of the aorta. These features supported the diagnosis of neonatal Marfan syndrome. Nucleotide sequencing showed substitution of G by A at codon 1032 in exon 25 located in the long arm of chromosome 15. This resulted in the substitution of a cysteine by a tyrosine. A de novo mutation is suggested by the absence of affected family members.