Methazolamide-Induced Delirium

A 74-year-old man became delirious 2 days after beginning oral therapy with methazolamide. The delirium was manifested by intermittent psychosis, incontinence of bowel and bladder, lethargy, and disorientation. These symptoms continued for 25 days despite many changes in his drug regimen, and complete laboratory, urologic, and neurologic work-ups. The symptoms resolved completely within 1 week of discontinuing methazolamide. This is the first case reported of delirium associated with methazolamide not accompanied by a metabolic imbalance.     

A critical reflection on the personal impact of managerial hegemony within nurse education

This paper, written by two male nurse teachers, describes and analyses their experience of working in a nurse education culture permeated by the philosophy of business management The introduction of business management practices to nurse education is discussed as a reflection of the current political hegemony of market forces and individualism The authors discuss the implications for nurse teachers of being continually exposed to these politically motivated forces which increasingly provide the paradigm for service developments within the United Kingdom health services In discussing the impact of this exposure it is argued that at the personal level individual teachers are experiencing a degree of apathy and personal dissonance which undermines their professional value system, resulting in emotional distress and a crisis of identity It provides a critical reflection on the way organizational dynamics and power relations influence the subjective sense-making of individuals The authors use a multiplicity of perspectives, including those provided by individual psychology, power relations, feminism and personhood, to argue for the need to develop an alternative paradigm which is characterized by the valuing of individual persons, empathic sensitivity and the fostering of creativity been important to us from a personal and professional     

Effect of chronic ethanol administration on the uptake and degradation of asialoglycoproteins by the perfused rat liver

We have shown previously reduced binding, internalization, degradation and receptor-ligand dissociation during receptor-mediated endocytosis (RME) of 125I-asialoorosomucoid (ASOR) by hepatocytes isolated from rats fed ethanol for 4-6 weeks. In the present study, we investigated the effect of ethanol feeding on RME by using the intact perfused liver as a model. Male, Sprague-Dawley rats were fed a liquid diet containing either ethanol (36% of calories) or isocaloric carbohydrate. Receptor-mediated endocytosis of 125I-ASOR was then examined over a time course of perfusion. In all cases, clearance of the labeled glycoprotein was followed by a slower but steady appearance of acid-soluble products in the medium. Ethanol-fed animals had a significantly (P less than 0.01) slower rate of clearance of the labeled ligand from the circulating perfusate than did control animals. Impairment of ASOR surface binding and degradation in ethanol-fed animals was also demonstrated in this model. When we examined the subcellular distribution of labeled ligand after various times of perfusion, we found that in control livers, a shift of radiolabeled ligand from the subcellular fractions containing endosomes and plasma membranes to fractions containing lysosomes occurred, while significantly less ligand was shifted to the lysosomes of ethanol-treated rats. These results show that ethanol administration inhibits RME of ASOR in the isolated perfused liver model, thus confirming our earlier reported defects in isolated hepatocytes. In addition, transport of ligand along the intracellular RME pathway was also shown to be altered by ethanol treatment as indicated by the impaired movement of ASOR from the endosomal to the lysosomal compartment.