Neurocognition in bipolar disorders—A closer look at comorbidities and medications

The last decade has witnessed a growing interest in the neuropsychological study of bipolar disorder (BD). This chronic mood disorder is associated with persistent neurocognitive impairments even during periods of euthymia, particularly in the broad domains of attention, verbal memory and executive functions. More interestingly, cognitive dysfunction seems to predict a poorer functional outcome among BD patients and thus represents an important target for future therapies. The aetiology of cognitive dysfunction is probably multifactorial, including gene-environment interactions with potentially confounding variables as well. Drug-induced cognitive adverse effects represent an important and difficult to examine confounder. This review provides an overview of selected aspects of neurocognition in bipolar disorder with a focus on the relative contributions of medications as well as medical and psychiatric comorbid conditions to cognitive dysfunction. Finally, recommendations for future research in the field are provided including collaborative studies with larger samples, observational follow-up studies, as well as randomized clinical trials comparing head-to-head the neurocognitive impact of different medications.     

Magnetic resonance imaging of the kidney.

High tissue contrast, multiplanar image capabilities, and tissue characterization render MR into an ideal imaging modality for effective evaluation of a wide range of renal disorders. It provides high details of anatomy and can suggest the composition of lesions. Improvements of MRI technology during the last years have made MRI increasingly attractive for body imaging. Fast imaging sequences and parallel imaging techniques have proved to be useful in minimizing artifacts from respiratory motion and magnetic susceptibility differences providing superior imaging quality. Additionally, the use of renally eliminated paramagnetic contrast agents permits assessment of parenchymal perfusion and visualization of the excretion of the contrast medium providing information on renal function.     

The effect of ionizing radiation on the primate pancreas: An endocrine and morphologic study

In this study we evaluated the endocrine, biochemical, and haematological derangements as well as pancreatic and histological changes of the bone-marrow in the primate following external fractionated subtotal marrow irradiation without bonemarrow reconstitution. The irradiation was administered in preparation for pancreatic transplantation. Two groups of animals (ten in each group) received 800 rad (8 Gy) and 1,000 rad (10 Gy) respectively over 4 to 5 weeks. A maximum of 200 rads (2 Gy) were administered weekly as photons from a 6 MV linear accelerator. During irradiation the animals remained normoglycaemic in the presence of transiently elevated liver enzymes and serum amylase values, which returned to normal on completion of the irradiation. Insulin release was significantly reduced in both groups during irradiation and was associated with minimally decreased K-values in the presence of mild glucose intolerance. Pancreatic light morphologic changes included structural changes of both exocrine and endocrine elements and included necrosis of the islet cells and acinar tissue. Islet histology demonstrated striking cytocavitary network changes of alpha and beta cells, including degranulation, vacuolization, mitochondrial destruction, and an increase in lysosomes. A hypoplastic bonemarrow ranging from moderate to severe was observed in all irradiated recipients. Near total fractionated body irradiation in the primate is therefore associated with elevated liver enzymes, pancytopenia, transient hyperamylasaemia, hypoinsulinaemia, a varying degree of pancreatitis, and bonemarrow hypoplasia.     

A pharmacological analysis of food intake regulation in rats treated neonatally with monosodium L-glutamate (MSG)

Studies were conducted to examine deficits in food intake regulation in MSG-treated rats that result from known or suspected damage to neurotransmitter systems involved in feeding. Male rats were injected with either MSG (4 mg/g) or sodium chloride on postnatal days 2 and 4 (MSG-Lo) or postnatal days 2, 4, 6 and 8 (MSG-Hi). As adults, MSG-treated and control rats (n = 12/group) were examined for deficits in pharmacologically elicited feeding and other measures of food intake regulation. A second group of MSG-treated (n = 9/group) and control rats (n = 12) were used to measure basal blood pressure and nociceptive reactivity in adulthood. Organ weights, body weight and neuropeptide Y (NPY) content in brain regions were determined at the end of the study. MSG-Hi rats consumed significantly less food than controls during the dark part of the light cycle. Both MSG-Hi and MSG-Lo groups ate significantly less food than controls after a 48-hour fast. MSG-Hi and MSG-Lo rats consumed significantly less food than controls in response to 1.0 mg/kg morphine. MSG-Hi rats consumed significantly less food than controls during the dark phase and significantly more food than controls during the light phase in response to naloxone (1.0 mg/kg). MSG-Lo ate significantly more than controls in response to 0.1 mg/kg guanfacine. MSG-Hi and MSG-Lo showed a significant attenuation in diazepam-stimulated feeding when compared to controls. Blood pressure was significantly lower in both MSG-Hi and MSG-Lo rats compared to controls. Tail flick latencies were not altered by MSG-treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV infection due to a platelet transfusion after allogeneic bone marrow transplantation

A 30-yr-old man with chronic granulocytic leukaemia received a bone marrow transplant from his histocompatible sister in December 1982. His post-transplant course was complicated by Grade III graft-versus-host disease and multiple infectious episodes until his death from pneumonia on d + 190. He was later found to be seropositive for anti-HIV at the time of his death. Retrospective analysis of stored sera showed a transient period of seropositivity from d + 11 to d + 20 thought to reflect passive transfer of antibody from a blood product transfused prior to d + 11 when he was also exposed to infectious virus. He remained seronegative until d + 78 when anti-HIV was again found. Seropositivity persisted until his death and was attributed to endogenous antibody response. Although it is unclear whether his clinical course was due to AIDS, exposure of an immunosuppressed patient to HIV may be associated with more rapid development of clinical disease.     

Retrospective assessment of potential interaction between levofloxacin and warfarin

Objective There is currently a controversy regarding interactions between levofloxacin and warfarin. The aim of this study was to determine the clinical relevance of this interaction in our setting. Setting A university hospital in Barcelona, Spain. Methods We carried out a retrospective evaluation of all patients hospitalized in our hospital during the period 2000–2005, selecting all those concomitantly treated with levofloxacin and warfarin for the study. The following data were compiled: demographic information, concomitant medication, comorbid conditions, and relevant analytical parameters, particularly the international normalized ratio (INR), including values taken before, during, and after concomitant administration of the two study drugs. Patients for whom INR values during concomitant administration were not available were excluded. Differences in INR before and during the potential interaction, and before and after the interaction were analyzed with the Wilcoxon t test using SPSS (V12.0). In addition, patients were stratified according to presence or not of toxic habits (smoking/alcohol consumption) to investigate the possible impact of these factors on the interaction under study. Results Among the 30 patients identified, 9 were excluded because INR data during concomitant administration of warfarin and levofloxacin were not available. Statistical analysis demonstrated significant increase in INR (P = 0.001) following addition of levofloxacin to warfarin therapy. Conclusions. The results of this study reaffirm the hypothesis that concomitant administration of levofloxacin and warfarin leads to INR increase; hence close monitoring of INR is advisable when patients are prescribed this combination of drugs. This paper has not been submitted elsewhere in similar form, and all authors have contributed significantly to the publication. All authors are aware of the submission and agree with it.     

Variability of vitamin E in virgin olive oil by agronomical and genetic factors

In this work the effect of genetic and agronomic factors on virgin olive oil tocopherol content and composition has been studied. For genetic effect, olive oil from thirty olive cultivars has been analyzed; for agronomic factor evaluation, three olive cultivars have been monitored during fruit ripening for three consecutive crop years. Total tocopherol content has ranged between 84 and 463 mg/kg, α-tocopherol represented more than 95%, β-tocopherol was found at very low concentrations whereas γ-tocopherol varied from 1 to 29 mg/kg. Tocopherols in virgin olive oil have a significant genetic component. Variability by crop year was due to the rainfall levels, and oils from the drier crop year (1998/99) showed the highest tocopherol content. However, this effect was cultivar-dependent, with ‘Hojiblanca’ cultivar the most affected. In general, tocopherols decreased during the ripening process, and although γ-tocopherol showed an increase for the last harvesting dates, this trend was related to the chlorophyll losses in the oil.     

Necrotizing haemorrhagic pneumonia proves fatal in an immunocompetent child due to Panton–Valentine Leucocidin, toxic shock syndrome toxins 1 and 2 and enterotoxin C-producing Staphylococcus aureus

Panton–Valentine leucocidin (PVL) toxin-producing strains of Staphylococcus aureus ( S. aureus ) are associated with skin abscesses and furunculosis, with necrotizing pneumonia being a relatively rare problem. Here, we describe a fatal case of necrotizing pneumonia in a 14-year-old child who presented initially with sore throat and pyrexia. He deteriorated rapidly, developing hypotension, multiple organ failure and purpura fulminans. S. aureus was isolated from the tracheal aspirate, which was found to be positive for PVL, toxic shock syndrome toxins (TSST) 1 and 2 and staphylococcal enterotoxin C (SEC). It was postulated that purpura fulminans and toxic shock syndrome were a result of the abovementioned exotoxins.
Conclusion: This case highlights the emergence of PVL-positive community-acquired S. aureus infection and association of purpura fulminans with superantigens. Practitioners should be aware of this illness in order to initiate appropriate treatment.