Institutionalising senile dementia in 19th‐century Britain

This article explains how old, poor people living with dementia came to be institutionalised in 19th‐century Britain (with a focus on London), and how they were responded to by the people who ran those institutions. The institutions in question are lunatic asylums, workhouses and charitable homes. Old people with dementia were admitted to lunatic asylums, workhouses and charitable homes, but were not welcome there. Using the records of Hanwell lunatic asylum, published texts of psychiatric theory, and the administrative records that all of these institutions generated at local and national levels, this article argues that ‘the senile’ were a perpetual classificatory residuum in the bureaucracy of 19th‐century health and welfare. They were too weak and unresponsive to adhere to the norms of the asylum regime, yet too challenging in their behaviour to conform to that of the workhouse, or the charitable home. Across all of these institutions, old people with dementia were represented as an intractable burden, many decades before the ‘ageing society’ became a demographic reality.     

Pharmacogenetics of neurological and psychiatric diseases at older age: has the time come?

Introduction: In recent years, a number of pharmacological approaches for treating neuropsychiatric conditions at older age have proven to be inadequate. The resulting increased prevalence of therapeutic failures (TF) and a worsening of clinical symptoms often linked to adverse reactions (ADRs), are perhaps among the major causes of the increasing rate of hospitalizations and institutionalizations observed in these patients.

Areas covered: This review underlines the importance of pharmacogenetic data to fingerprint the pharmacological treatment of neuropsychiatric late-life conditions throughout the analysis of metabolizing enzymes and transporters of psychotropic drugs, mainly those of the cytochrome P450 (CYP) family. Pharmacodynamic response measures as treatment effects mediated through targets (i.e., receptors in the brain) may also contribute to this image.

Expert opinion: CYP genetics is the basis of a continuum on which environmental and physiological factors act, modeling the phenotype observed in clinical practice with advancing age. Furthermore, other specific polymorphic genes influence drug response through differential effects of their functional genetic variants. The known genotypes associated with an altered metabolizer status and drug transporters may help clinical decision-making to avoid concomitant treatments, reduce therapeutic attempts and increase drug safety in neuropsychiatric conditions in older age, after controlling for other clinical variables.     

The theatrical dimension of suicide]

"Theatrical" is a term that in psychiatry mostly has a discredited connotation and that is often disparaged. This work means to assign to suicide's and attempted suicide's "theatrical dimension", a different side, showing theatricality as a very important communicative, creative and vital force.     

Extraction of bioactive compounds from buriti (Mauritia flexuosa L.) fruit by eco-friendly solvents: Chemical and functional characterization

Buriti (Mauritia flexuosa L.) is a palm tree found in several regions of Latin America. Buriti fruit is a rich source of bioactive compounds such as carotenoids and phenolic compounds. Thus, the aim of this study was to extract bioactive compounds from buriti fruit by ethanol and a supramolecular solvent system (SUPRAS) formed by octanoic acid aggregates. The extracts were evaluated for total carotenoids, β-carotene, phenolic compounds and antioxidant capacity. Additionally, SUPRAS extracts were characterized for antibacterial activity and modulating effect. The extraction of β-carotene with SUPRAS showed a yield of 5.82 ± 0.05 mg/g for the peel and 26.7 ± 0.02 mg/g for the pulp. In relation to total phenolic compounds, the yields were 32.1 ± 1.2 μg GAE/g for the peel and 24.53 ± 4.9 μg GAE/g for the pulp. The presence of gallic acid, quercetin and catechin stand out regarding the phenolics identified. The extracts showed antioxidant activity, with an emphasis on the extracts obtained by SUPRAS, which presented EC₅₀ (concentration required to obtain a 50% antioxidant effect) for the ABTS radical sequestration of 3.00 μg/mL for the peel and 0.84 μg/mL for the pulp. When combined with norfloxacin and gentamicin antibiotics, the extracts also showed a synergistic action against multi-resistant strains of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Thus, the extraction of bioactive compounds from buriti fruit using a safe, biocompatible, biodegradable and environmentally friendly solvent such as SUPRAS represents potential for developing new pharmaceuticals, cosmetics and functional foods.     

Viral hepatitis and hepatocellular carcinoma: From molecular pathways to the role of clinical surveillance and antiviral treatment

Hepatocellular carcinoma (HCC) is a global health challenge. Due to the high prevalence in low-income countries, hepatitis B virus (HBV) and hepatitis C virus infections remain the main risk factors for HCC occurrence, despite the increasing frequencies of non-viral etiologies. In addition, hepatitis D virus coinfection increases the oncogenic risk in patients with HBV infection. The molecular processes underlying HCC development are complex and various, either independent from liver disease etiology or etiology-related. The reciprocal interlinkage among non-viral and viral risk factors, the damaged cellular microenvironment, the dysregulation of the immune system and the alteration of gut-liver-axis are known to participate in liver cancer induction and progression. Oncogenic mechanisms and pathways change throughout the natural history of viral hepatitis with the worsening of liver fibrosis. The high risk of cancer incidence in chronic viral hepatitis infected patients compared to other liver disease etiologies makes it necessary to implement a proper surveillance, both through clinical-biochemical scores and periodic ultrasound assessment. This review aims to outline viral and microenvironmental factors contributing to HCC occurrence in patients with chronic viral hepatitis and to point out the importance of surveillance programs recommended by international guidelines to promote early diagnosis of HCC.     

Diclofenac Potassium Restores Objective and Subjective Measures of Sleep Quality in Women with Primary Dysmenorrhea

Study Objectives:

Primary dysmenorrhea is a common gynecological disorder that disrupts daytime functioning and nighttime sleep quality. We determined the effectiveness of diclofenac potassium, compared to placebo, in alleviating nighttime pain and restoring sleep architecture in women with primary dysmenorrhea.

Design:

Randomized, double-blind, crossover study

Setting:

Sleep laboratory

Participants:

Ten healthy women (21 ± 1 years) with a history of primary dysmenorrhea.

Interventions:

Placebo or diclofenac potassium (150 mg per day) for menstrual pain.

Measurements and results:

We assessed objective measures of sleep (polysomnography) and subjective measures of sleep quality, mood, and intensity of menstrual pain. Compared to a pain-free phase of the menstrual cycle (mid-follicular), women receiving placebo for their menstrual pain had a poorer mood (P < 0.01), decreased sleep efficiency (P < 0.05), less REM sleep (P < 0.05), more stage 1 sleep (P < 0.01), and more sleep stage changes per hour of sleep during the night. Administration of diclofenac potassium compared to placebo not only attenuated the women''s menstrual pain (P < 0.05), but also increased sleep efficiency (P < 0.05) and percentage of REM sleep (P < 0.01), decreased percentage of stage 1 sleep (P < 0.05) and number of sleep stage changes per hour of sleep (P < 0.05), and improved subjective ratings of sleep quality and morning vigilance (P < 0.05).

Conclusion:

Diclofenac potassium effectively attenuates nighttime dysmenorrheic pain and restores subjective and objective measures of sleep quality to values recorded in a pain-free phase of the menstrual cycle.

Citation:

Iacovides S; Avidon I; Bentley A; Baker FC. Diclofenac potassium restores objective and subjective measures of sleep quality in women with primary dysmenorrhea. SLEEP 2009;32(8):1019-1026.     

Contrast enhancing spots as a new pattern of late onset pseudoprogression in glioma patients

Journal of Neuro-Oncology - Magnet resonance imaging (MRI) of gliomas is assessed by Response Assessment in Neuro-Oncology Criteria (RANO), which define new contrast-enhancing lesions as a sign for...     

Diagnostic performance of computed tomography coronary angiography to detect and exclude left main and/or three-vessel coronary artery disease

Objectives

To determine the diagnostic performance of CT coronary angiography (CTCA) in detecting and excluding left main (LM) and/or three-vessel CAD (“high-risk” CAD) in symptomatic patients and to compare its discriminatory value with the Duke risk score and calcium score.

Materials and methods

Between 2004 and 2011, a total of 1,159 symptomatic patients (61?±?11 years, 31 % women) with stable angina, without prior revascularisation underwent both invasive coronary angiography (ICA) and CTCA. All patients gave written informed consent for the additional CTCA. High-risk CAD was defined as LM and/or three-vessel obstructive CAD (≥50 % diameter stenosis).

Results

A total of 197 (17 %) patients had high-risk CAD as determined by ICA. The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of CTCA were 95 % (95 % CI 91–97 %), 83 % (80–85 %), 53 % (48–58 %), 99 % (98–99 %), 5.47 and 0.06, respectively. CTCA provided incremental value (AUC 0.90, P?<?0.001) in the discrimination of high-risk CAD compared with the Duke risk score and calcium score.

Conclusions

CTCA accurately excludes high-risk CAD in symptomatic patients. The detection of high-risk CAD is suboptimal owing to the high percentage (47 %) of overestimation of high-risk CAD. CTCA provides incremental value in the discrimination of high-risk CAD compared with the Duke risk score and calcium score.

Key Points

? Computed tomography coronary angiography (CTCA) accurately excludes high-risk coronary artery disease. ? CTCA overestimates high-risk coronary artery disease in 47?%. ? CTCA discriminates high-risk CAD better than clinical evaluation and coronary calcification.     

Case report: Treatment failure using propanolol for treatment of focal subglottic hemangioma

Subglottic hemangioma is a rare, potentially life threatening tumor of infancy which poses serious treatment challenges. A number of medical and surgical therapies over the years have met with variable success, and are associated with numerous potential morbidities. A potential windfall in the management of infantile hemangiomas has arisen with the recent identification of propanolol as a highly efficacious and relatively safe new treatment modality. At least five reports in the literature have described the rapid, successful treatment of airway hemangiomas with oral propanolol. We describe the first reported treatment failure with propanolol for subglottic hemangioma in an infant who initially responded dramatically to the medication.