一例47岁精神状态改变合并急性肾衰的病例分析

病例介绍患者,男,47岁,由于精神状态改变合并急性肾衰于6月初的一天早上10点送入我院急诊科。该患者在前一天晚上8点与家人共进晚餐时出现行为异常,餐后又开车外出。根据其妻子的描述,当晚回到家时,患者说话含糊不清并出现嗜睡。到晚9点出现呕吐并且昏睡。凌晨3点其妻子叫他无反应,遂拨打急诊中心电话,将患者送至当地医院急诊科。该患者最近没有发热、患病以及抑郁症状。曾患有肠易激综合征(服用了阿托品与地芬诺酯治疗)、慢性背部疼痛和焦虑,对青霉素过敏,没有个人或者家族重要疾病史。患者有吸烟和酗酒史,但近年无饮酒,其妻子确认其没有使…     

Bioactive Compounds in the Ethanol Extract of Marine Sponge Stylissa carteri Demonstrates Potential Anti-Cancer Activity in Breast Cancer Cells

Objective: Despite advanced treatment options available, drug resistance develops in breast cancer (BC) patientsrequiring novel effective drugs. Stylissa carteri, a marine sponge predominantly living in Indonesia territories, hasnot been extensively studied as anti-cancer. Therefore, this study targeted to assess the anti-tumor activity of theethanol extract of S. carteri in BC cells. Methods: S. carteri was collected from Pramuka Island, at Kepulauan SeribuNational Park, Jakarta, Indonesia and extracted using ethanol. Different BC cells including MDA MB 231, MDAMB 468, SKBR3, HCC-1954 and MCF-7 cells were treated with this extract for cytotoxic analysis using MTT assay.Spheroid growth assay and apoptosis assay were conducted in HCC-1954 cells. In addition, cell migration analysis andsynergistic activity with doxorubicin or paclitaxel were conducted in MDA MB 231 cells. This extract was subjectedalso for GC-MS analysis. Results: The results show that ethanol extract of S. carteri demonstrated a cytotoxic activityin BC cells. The IC50 of this extract was lower 15 μg/ml in MDA MB 231, MDA MB 468, SKBR3, and HCC-1954cells. Moreover, this extract inhibited spheroids growth and induced apoptosis in HCC-1954 cells. It inhibited cellmigration and demonstrated a synergistic activity with doxorubicin or paclitaxel on triggering cell death in MDA MB231 cells. Furthermore, GC-MS analysis indicated that this extract contained 1,2-Benzenediol, Dibutyl phthalate and9,12-Octadecadienoic acid, ethyl ester. Conclusion: Our preliminary data indicate a potential anti-tumor activity ofethanol extract of S. carteri in breast cancer cells.     

Prevalence and treatment of Pediculus humanus capitis with 1% permethrin and 0.4% d-phenothrin in Turkey

Pediculosis humanus capitis (head lice) is an important public health problem among school children. In our study, 20,612 schoolchildren (10,367 boys, 10,245 girls) were examined for Pediculus humanus capitis in 36 elementary schools between December 1996 and February 1998 in Ankara, Turkey. The prevalence of pediculosis capitis infestation was found to be 3.4% (701/20,612). Of these, 382 students were treated with application of 1% permethrin cream rinse, and 184 students with 0.4% d-phenothrin shampoo. On day 14 of the controlled trial, the success rates were 93.7% in the 1% permethrin cream rinse group and 75.5% in the 0.4% d-phenothrin shampoo group. The 1% permethrin cream rinse was also significantly more active in pediculicidal efficacy when compared to the 0.4% d-phenothrin shampoo (p<0.001). As a result, these findings demonstrate that pediculosis capitis still remains a widespread health problem.     

The changing role of the state hospital director: Restructuring the top management team

This article analyzes turnover in the position of state hospital director. It examines the relationship between role structure, job stress and burnout. Based on this analysis, recommendations are made for the restructuring of a top management team. Buffalo Psychiatric Center, a 750-bed facility operated by the New York State Office of Mental Health, provides the setting for this case study.Diane M. Pinchoff, M.A., is Associate Director of the Buffalo Psychiatric Center, 400 Forest Avenue, Buffalo, N.Y. 14213. Mahmud Mirza, M.D., is Director of the Buffalo Psychiatric Center. Reprint requests should be directed to Diane M. Pinchoff at the above address.     

Association of T102C polymorphism of the 5-HT2A receptor gene with pyschiatric status in fibromyalgia syndrome

Serotonin (5-HT) is a key neurotransmitter in the central nervous system. It is suggested that serotonergic dysfunction may be involved in the pathophysiology of fibromyalgia syndrome (FS). In this study, we aimed to investigate T102C polymorphism of the 5-HT2A receptor gene in FS. Fifty-eight patients with FS and 58 unrelated healthy volunteer controls were included in the study. In both groups, the C/C, C/T, and T/T genotypes of the 5-HT gene were represented in 31% (22.4% in controls), 50% (53.4%), and 19% (24.1%), respectively. The 5-HT2A receptor gene polymorphism results were not significantly different between patients and controls (chi squared test, P>0.05). There was a significant correlation between patients with the T/T genotype and the subgroup according to the SCL-90-R test, (analysis of variance, P<0.05). We also saw that patients with the T/T genotype had the lowest pain threshold. CONCLUSION. T102C polymorphism of the 5-HT2A receptor gene is not associated with the etiology of FS. Our results also indicate that the T/T genotype may be responsible for psychiatric symptoms of FS.     

Knowledge, attitude and preventive practices of women for breast cancer in the educational institutions of Lahore, Pakistan

Breast cancer incidence rates, pattern of presentation and survival rates vary worldwide. High incidence, advanced stage disease presentation and low survival rates have been reported from Pakistan. Lack of awareness and screening facilities along with poor socioeconomic status are the main causes. A survey based upon multiple choice questionnaires was conducted during an awareness campaign in women educational institutions of Lahore, to assess the baseline knowledge, attitude towards breast self examination (BSE), clinical breast examination (CBE) and source of information used by them. 1155 filled questionnaires were analyzed by SPSS version 12. The majority (83.7%) of the respondents were <30 years old, 60% had >10 and 31.5% had <14 years of education. Only 27% had "good" while 14% had "poor" and 59% had "fair" knowledge scores about breast cancer. Television was the most commonly cited source of information but was associated with lower knowledge score. The knowledge scores and practice of BSE had a positive association with education level. The respondents had better knowledge of life time risk and association of early diagnosis with better chances of cure, but worse knowledge of risk factors as compared to women in educational institutions of other countries. Generally the respondents of present study had low level of knowledge of breast cancer. Properly designed awareness campaign on television and in educational institutions can be effective to raise the knowledge level, the best long term strategy for this purpose.     

Short-term tranexamic acid treatment in aneurysmal subarachnoid hemorrhage

Antifibrinolytic treatment for 4 weeks after a subarachnoid hemorrhage has been shown to have no effect on outcome since a reduction in the rate of rebleeding was offset by an increase in ischemic events. To determine if a shorter course (4 days) of antifibrinolytic treatment before the expected onset of ischemic complications might reduce the rate of rebleeding yet avoid ischemic complications, we prospectively studied a series of 119 patients with subarachnoid hemorrhage; 479 patients with subarachnoid hemorrhage from our previous randomized double-blind study (238 treated with placebo, 241 with long-term tranexamic acid) served as historical control groups. At 3 months' follow-up, the outcome of patients treated with short-term tranexamic acid was not different from that of patients treated with long-term tranexamic acid. The rate of rebleeding (24 of 119, 20%) was near that with placebo (56 of 238, 24%). In contrast, the rate of cerebral infarction (33 of 119, 28%) was almost identical to that after long-term tranexamic acid (59 of 241, 24%), although mortality from cerebral infarction was reduced. Compared with historical control groups, treatment with tranexamic acid for 4 days fails to reduce the incidence of rebleeding but still increases the rate of cerebral infarction.