Erythema multiforme due to griseofulvin

Three patients are reported who developed erythema multiforme during treatment with griseofulvin. To our knowledge there have been no previously documented reports of this drug causing erythema multiforme in either the English or American literature.     

Monophasic Versus Biphasic Cardiac Stimulation: Mechanism of Decreased Energy Requirements

The purpose of the present study was to examine the effects of monophasic and biphasic stimulation under conditions of full and incomplete repolarization in an in vivo dog model and in an in vitro rabbit ventricular single cell model. Strength-interval curves were constructed with monophasic cathodal stimulation and biphasic subthreshold anodal followed by cathodal stimulation in dogs prior to and late after left anterior descending coronary artery occlusion. At the monophasic absolute refractory period plus 10 msec, less cathodal current was required for biphasic compared to monophasic stimulation (P = 0.04). Moreover, the biphasic absolute ventricular refractory period (116 +/- 8 msec) was significantly shorter than the monophasic absolute ventricular refractory period (136 +/- 15 msec) (P less than 0.02). At coupling intervals greater than 30 msec after the monophasic absolute ventricular refractory period, there was no distinction between monophasic and biphasic stimuli. Similarly enhanced excitability was observed with biphasic stimuli in infarcted hearts. Voltage clamp measurements mimicking conditions of the in vivo studies demonstrated that when repolarization is incomplete, a hyperpolarizing prepulse reactivates additional sodium current resulting in enhanced excitability. In conclusion, biphasic stimulation consisting of a hyperpolarizing anodal prepulse followed by a cathodal pulse decreases the current required for excitation compared to cathodal monophasic stimulation in a critical zone near the ventricular absolute refractory period.     

The Behavioural Status Index: therapeutic assessment of risk, insight, communication and social skills

An overview is given of the Behavioural Status Index (BSI), a developing classification instrument offering practical approaches to assessment and therapy surrounding social 'risk'. The approach hypothesizes that social 'risk' presented by a patient tends to correlate inversely with his/her degree of personal insight and capacity to perform well in key communicative and social skills, though no causal claims are made. Evidence exists to suggest that personal insight and communicative and social skills deserve serious consideration in a therapeutic approach to violent and dangerous behaviours. 'Risky' behaviours, as operationalized in the 'risk' subscale of the BSI, insight into the self and its activities, and communicative and social skills, may provide three critical foci for treatment planning in high security psychiatric care. A hypothetical linked factorial structure is proposed.     

Double-blind cross-over trial comparing beclomethasone dipropionate and terfenadine in perennial rhinitis

Eighteen patients with perennial rhinitis were evaluated in this double-blind cross-over trial comparing beclomethasone dipropionate (BDP) aqueous nasal spray with terfenadine tablets. Both treatments were effective in reducing symptom scores but BDP was significantly better than terfenadine in relieving running nose and sneezing ( P <0.05). BDP also had a greater effect on reducing nasal inflammation than terfenadine. Although the clinicians and patients assessed both therapies to be equieffective, significantly more patients preferred the BDP treatment ( P <0.003). Overall, BDP therapy proved more beneficial than terfenadine therapy in this small group of perennial rhinitis sufferers.     

Mutations in Conserved Amino Acids in the KCNQ1 Channel and Risk of Cardiac Events in Type-1 Long-QT Syndrome

Background: Type-1 long-QT syndrome (LQT1) is caused by mutations in the KCNQ1 gene. The purpose of this study was to investigate whether KCNQ1 mutations in highly conserved amino acid residues within the voltage-gated potassium channel family are associated with an increased risk of cardiac events.
Methods and Results: The study population involved 492 LQT1 patients with 54 missense mutations in the transmembrane region of the KCNQ1 channel. The amino acid sequences of the transmembrane region of 38 human voltage-gated potassium channels were aligned. An adjusted Shannon entropy score for each amino acid residue was calculated ranging from 0 (no conservation) to 1.0 (full conservation). Cox analysis was used to identify independent factors associated with the first cardiac event (syncope, aborted cardiac arrest, or death). Patients were subcategorized into tertiles by their adjusted Shannon entropy scores. The lowest tertile (score 0–0.469; n = 146) was used as a reference group; patients with intermediate tertile scores (0.470–0.665; n = 150) had no increased risk of cardiac events (HR = 1.19, P = 0.42) or aborted cardiac arrest/sudden cardiac death (HR = 1.58, P = 0.26), and those with the highest tertile scores (>0.665; n = 196) showed significantly increased risk of cardiac events (HR = 3.32, P <0.001) and aborted cardiac arrest/sudden cardiac death (HR = 2.62, P = 0.04). The increased risk in patients with the highest conservation scores was independent of QTc, gender, age, and beta-blocker therapy.
Conclusions: Mutations in highly conserved amino acid residues in the KCNQ1 gene are associated with a significant risk of cardiac events independent of QTc, gender, and beta-blocker therapy.     

Societal determinants of cultural factors related to the dental health of a selected older black population

Societal and cultural factors influence the use of professional services by older black Americans. The objective of this study was to examine societal determinants that influence culturally learned behavior manifested by a selected group of older black Americans. A variation on the Health Belief Model was used as the primary tool of data collection with 122 black Americans age 55 to 97. The belief index was divided into four major categories: caries; perceived susceptibility to dental caries; perceived severity of dental caries; and perceived benefits of preventive action. Although evidence supported the relationship between economics and the utilization of dental services for this population, evidence also suggested that dental help-seeking behavior appears to be independent of income. The study suggests that a case can be made linking the health beliefs of this population with their dental practice. It is certain that the multifaceted nature of the sociocultural environment does have an impact on the dental health of this older black American population.     

CORNEAL GRAFT SURVIVAL: A RETROSPECTIVE AUSTRALIAN STUDY

Four hundred and forty-eight consecutive corneal grafts are analysed and their survival calculated usin the actuarial life-table method. Overall survival at two years is 81 ± 4% and at five years is 65 ± 5%. Within diagnostic subgroups keratoconus has the best prognosis. Previous graft failure and recipient corneal vascularization are shown to have a negative effect on graft survival. Sex of patient, urgency of operation and use of combined procedures do not affect survival and second regrafts fare no worse than first regraits. The use of the actuarial life-table method of analysing graft survival is discussed and its importance emphasized.     

Prognosis of Critically-ill Patients with Acute Renal Failure: APACHE II Score and Other Predictive Factors

The survival from acute renal failure requiring renal replacementtherapy was studied in 90 critically-ill patients admitted toan intensive care unit. Mean age (± SD) was 51 ±14.6 (range 17 to 81) years. Mechanical ventilation was requiredin 88 patients and 71 patients received total parenteral nutrition.Thirty-three per cent of patients left the intensive care unitalive and 24 per cent survived to leave hospital. Final survivalwas 20 per cent in medical patients (n= 49), 29 per cent insurgical patients (n= 38) and 100 per cent in obstetric patients(n= 3). Hypotension, requirement for inotropic support, oliguriaand sepsis were all associated with a poorer prognosis. Themode of renal replacement therapy did not affect survival, butadditional haemodialysis was required in 33 of 65 patients treatedby continuous arteriovenous haemofiltration but none of 22 treatedwith continuous arteriovenous haemodialysis (p < 0.001).APACHE II score was calculated for 87 patients. Mean APACHED score was 26.1 ± 6.9 (range 14 to 44). APACHE II scoreon admission predicted the likelihood of survival well. No patientswith a score of more than 40 survived, compared to 40 per centof those with scores of 10 to 19. Pre-existing organ insufficiencyor immunosuppression meriting a CHE score of 5 was associatedwith a very poor survival (1 of 30 patients). APACHE II scoreis a reliable indicator of severity of illness and likelihoodof survival in critically-ill patients with acute renal failure.The widespread adoption of APACHE II scoring for patients withacute renal failure requiring intensive care would facilitatemedical audit and comparison of studies from various centres.