Factors Influencing Community-Based Rehabilitation for Persons with Co-Occurring Psychiatric and Substance Abuse Disorders

This pilot study describes factors influencing rehabilitation in a community-based program for individuals with co-occurring psychiatric and substance abuse disorders. Findings indicate that individuals who had been in the program for more than six months had fewer absences and were more likely to adhere to program requirements. Psychiatric symptom relapse occurred in fewer than one-half of participants and was associated with program absence, medication nonadherence, substance abuse, and hospitalization. Family problems were associated with psychiatric symptom and substance abuse relapse as well as hospitalization. Findings suggest the need to identify specific reasons for nonadherence to treatment during the first six months of enrollment. Further study is needed to identify interventions to assist individuals with recovery early in the program, especially in regard to coping with family problems and psychiatric symptoms and substance abuse relapse.     

Differences between chronic schizophrenic patients in the hospital and in the community.

Clinical differences between stable, chronic schizophrenic patients with long stays in the hospital and schizophrenic patients living in the community were investigated. Patients were matched for age, gender, and diagnosis. Hospitalized patients had more severe thought disorder and negative symptoms, and those in the community had a significantly higher incidence of depression and anxiety. The community-based patients were also receiving higher doses of neuroleptic drugs and had a higher incidence and severity of extra-pyramidal side effects. Results suggest that living in the community, despite its obvious benefits, may have its price in terms of the distressing effects of affective symptoms and neuroleptic side effects.     

N-acetyl-L-tryptophan,a substance-P receptor antagonist attenuates aluminum-induced spatial memory deficit in rats

Neuroinflammation plays an important role in the pathophysiology of Alzheimer’s disease. Neurokinin substance P is a key mediator which modulates neuroinflammation through neurokinin receptor. Involvement of substance P in Alzheimer’s disease is still plausible and various controversies exist in this hypothesis. Preventing the deleterious effects of substance P using N-acetyl-L-tryptophan, a substance P antagonist could be a promising therapeutic strategy. This study was aimed to evaluate the effect of N-acetyl-L-tryptophan on aluminum induced spatial memory alterations in rats. Memory impairment was induced using aluminum chloride (AlCl₃) at a dose of 10?mg/kg for 42 d. After induction of dementia, rats were exposed to 30 and 50?mg/kg of N-acetyl-L-tryptophan for 28 d. Spatial memory alterations were measured using Morris water maze. Acetylcholinesterase activity and antioxidant enzyme glutathione level were assessed in hippocampus, frontal cortex and striatum. The higher dose of N-acetyl-L-tryptophan (50?mg/kg) significantly improved the aluminum induced memory alterations. N-acetyl-L-tryptophan exposure resulted in significant increase in acetylcholinesterase activity and glutathione level in hippocampus. The neuroprotective effect of N-acetyl-L-tryptophan could be due to its ability to block substance P mediated neuroinflammation, reduction in oxidative stress and anti-apoptotic properties. To conclude, N-acetyl-L-tryptophan may be considered as a novel neuroprotective therapy in Alzheimer’s disease.     

Inner ear damage following electric current and lightning injury: a literature review

Audiovestibular sequelae of electrical injury, due to lightning or electric current, are probably much more common than indicated in literature. The aim of the study was to review the impact of electrical injury on the cochleovestibular system. Studies were identified through Medline, Embase, CINAHL and eMedicine databases. Medical Subject Headings used were ‘electrical injury’, ‘lightning’, ‘deafness’ and ‘vertigo’. All prospective and retrospective studies, case series and case reports of patients with cochlear or vestibular damage due to lightning or electrical current injury were included. Studies limited to external and middle ear injuries were excluded. Thirty-five articles met the inclusion criteria. Fifteen reported audiovestibular damage following electric current injury (domestic or industrial); a further 15 reported lightning injuries and five concerned pathophysiology and management. There were no histological studies of electrical current injury to the human audiovestibular system. The commonest acoustic insult after lightning injury is conductive hearing loss secondary to tympanic membrane rupture and the most frequent vestibular symptom is transient vertigo. Electrical current injuries predominantly cause pure sensorineural hearing loss and may significantly increase a patient’s lifetime risk of vertigo. Theories for cochleovestibular damage in electrical injury include disruption of inner ear anatomy, electrical conductance, hypoxia, vascular effects and stress response hypothesis. The pathophysiology of cochleovestibular damage following electrical injury is unresolved. The mechanism of injury following lightning strike is likely to be quite different from that following domestic or industrial electrical injury. The formulation of an audiovestibular management protocol for patients who have suffered electrical injuries and systematic reporting of all such events is recommended.     

Intracranial tumors in Kuwait: a 15-year survey

The dearth of literature on intracranial tumors (ICT) in Kuwait has necessitated this study whose objective is epidemiological. It is based on the records of the Department of Pathology, Al-Sabah Hospital, Kuwait, where virtually all brain biopsies in Kuwait were examined. Between 1995 and 2009, 439 males (53.41%) and 383 females (46.59%) had primary intracranial tumors (PICT). Most (69%) were younger than 50 years, with 16% children and adolescents and 4% elderly (≥70 years); meningioma (28%), pituitary adenoma (19%), glioblastoma (15%), astrocytoma (13%), and medulloblastoma (5%) were the most common. In childhood and adolescence, astrocytoma (35.34%) and medulloblastoma (22.56%) predominated. The mean age-adjusted incidence rate/100,000 was: PICT: 3.02; astrocytic tumors: 0.93; meningioma: 0.96; pituitary adenoma: 0.44; and medulloblastoma: 0.13. All showed a declining trend which was only statistically significant for medulloblastoma (P = 0.007). A modest correlation between the percentage of elderly in the general population and incidence rates was found (r = 0.411). Tumors with significant male preponderance were high-grade astrocytic tumors, silent pituitary adenoma (SA), and nerve sheath tumor. Meningioma had a female to male ratio of 2.24. The peak frequency for functional pituitary adenoma and females was in the age range of 20–29 years, while for SA and males it was 40–49 years. About 5% of ICT were metastatic, with cancers of breast (26%), lung (17%) and gastrointestinal (11%) origin as the most common. In conclusion, the epidemiology of PICT in Kuwait is characterized by low incidence rates and a distinct age distribution.     

Are there any changes in burden and management of communicable diseases in areas affected by Cyclone Nargis?

Background

This study aims to assess the situation of communicable diseases under national surveillance in the Cyclone Nargis-affected areas in Myanmar (Burma) before and after the incident.

Methods

Monthly data during 2007, 2008 and 2009 from the routine reporting system for disease surveillance of the Myanmar Ministry of Health (MMOH) were reviewed and compared with weekly reporting from the Early Warning and Rapid Response (EWAR) system. Data from some UN agencies, NGOs and Tri-Partite Core Group (TCG) periodic reviews were also extracted for comparisons with indicators from Sphere and the Inter-Agency Standing Committee.

Results

Compared to 2007 and 2009, large and atypical increases in diarrheal disease and especially dysentery cases occurred in 2008 following Cyclone Nargis. A seasonal increase in ARI reached levels higher than usual in the months of 2008 post-Nargis. The number of malaria cases post-Nargis also increased, but it was less clear if this reflected normal seasonal patterns or was specifically associated with the disaster event. There was no significant change in the occurrence of other communicable diseases in Nargis-affected areas. Except for a small decrease in mortality for diarrheal diseases and ARI in 2008 in Nargis-affected areas, population-based mortality rates for all other communicable diseases showed no significant change in 2008 in these areas, compared to 2007 and 2009. Tuberculosis control programs reached their targets of 70% case detection and 85% treatment success rates in 2007 and 2008. Vaccination coverage rates for DPT 3^rd dose and measles remained at high though measles coverage still did not reach the Sphere target of 95% even by 2009. Sanitary latrine coverage in the Nargis-affected area dropped sharply to 50% in the months of 2008 following the incident but then rose to 72% in 2009.

Conclusion

While the incidence of diarrhea, dysentery and ARI increased post-Nargis in areas affected by the incident, the incidence rate for other diseases and mortality rates did not increase, and normal disease patterns resumed by 2009. This suggests that health services as well as prevention and control measures provided to the Nargis-affected population mitigated what could have been a far more severe health impact.