Psychosocial support for war-traumatized child and adolescent refugees: evaluation of a short-term treatment program

OBJECTIVE: The purpose of this study was to evaluate a newly designed psychosocial treatment program for war traumatized child and adolescent refugees. The program was designed to reduce emotional distress and improve psychosocial functioning. METHOD: Ten young Kosovan refugees (mean age 13.3 years) residing in Germany participated in the manual based intervention program. This multimodal program consists of individual, family and group sessions using a psychoeducational approach beside trauma and grief focusing activities, creative techniques and relaxation. Kind and severity of traumatic experiences were gathered by interviewing the child and their caretakers using the Harvard Trauma Questionnaire (HTQ). Psychiatric diagnoses (Schedule for Affective Disorders and Schizophrenia for School-Age Children, K-SADS) were assessed prior to the intervention. Post-traumatic symptomatology (HTQ), emotional problems (Diagnostic System for Psychological Disorders, DYSIPS) and the overall psychosocial functioning (Child Global Assessment Scale, CGAS) were assessed before and after the 12-week intervention. RESULTS: Following the intervention the degree of overall psychosocial functioning increased substantially in 9 of 10 participants. Furthermore, post-traumatic, anxiety and depressive symptoms were reduced significantly. The rate of post-traumatic stress disorder (PTSD) diagnoses fell from 60% to 30%. The number of patients with PTSD and a high rate of comorbid symptoms (depression and anxiety) as well as a history of severe traumatization remained at 30%. CONCLUSIONS: This study suggests that the psychosocial treatment program specified for war traumatized adolescents may be useful for the relief of psychiatric sequelae and for an improvement in overall psychosocial functions, but not for the subgroup of severely traumatized patients with complex psychiatric disturbances.     

Post-stroke dementia is associated with alpha(1)-antichymotrypsin polymorphism

BACKGROUND AND PURPOSE: Alpha-1-antichymotrypsin (ACT) is an acute phase protein involved in inflammatory reaction, promoting the assembly of beta amyloid protein into filaments and contributing to its resistance to proteolytic digestion. The aim of our study was to determine ACT signal peptide polymorphism (A/T) as a possible risk factor for post-stroke dementia (PSD). METHODS: 142 consecutive ischemic stroke patients and 188 controls were included in this study. Pre-stroke dementia (PRESD) was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). The diagnosis of the post-stroke dementia (PSD) was established according to DSM-IV criteria. The ACT gene (A/T) polymorphism was determined by PCR-RFLR. RESULTS: Both ACT-TT genotype and T-allele were significantly more prevalent in patients with PSD than in non-demented stroke patients, controls or patients with PRESD. After adjustment for age, gender, and vascular risk factors, both the ACT-TT genotype and T-allele remained independently associated with PSD. CONCLUSION: Our findings suggest that ACT polymorphism (A/T) is a risk factor for PSD.     

Effect of pregnancy on diabetic vascular complications

OBJECTIVES: There are still controversies referring to pregnancy influence on the development of vascular complications in type 1 diabetes. MATERIALS AND METHODS: 227 diabetic women were taken into the study (109 who gave at least one birth (GB) and 118, who never were pregnant (NB)). All of patients started to be diabetic before the 15 years of age. We compared the development of vascular complications (VC) (hypertension-RR, proteinuria (P), retinopathy (R) and the age of patients, HbA1C, serum creatinine (Cr), creatinine clearance (CrCl) between the GB and NB groups. We also compared the development of VC in relation to risk factors (RF): HbA1c and duration of diabetes. RESULTS: Women who gave birth were significantly older and developed diabetes earlier than childless women. We didn't find any significant difference in duration of diabetes, HbA1c, mean blood pressure (BP), Cr and CrCl between these two groups. In the GB group in comparison to NB we noticed higher frequency of RR (11.1% vs 6.8%, OR 1.7), proliferative retinopathy (9% vs 6.8%, OR 1.4) and laser therapy (5.5% vs 3.4%, OR 1.6). In the next step we analyzed the development of VC in relation to risk factors: duration of diabetes (less or more than 20 years) and HbA1c levels (below and above 8.0%). Patients, who developed diabetes before 20 years of age were significantly older (36.3 vs 31.2 years p < 0.001), duration of diabetes in this group was longer (26 vs 14 years p < 0.001), Cr was higher (0.9 mg/dl vs 0.8 mg/dl p < 0.05)and CrCl was lower (73 mg/ml vs 86 mg/ml p < 0.05). In this group the frequency of proteinuria as well as retinopathy were higher (18.2% vs 7.9%, OR 2.59) (52% vs 9.2%, OR 10.6).We didn't find the difference in HbA1c concentration between the groups with different duration of diabetes. Higher HbA1c presented no relation to the age of patients, but correlated with lower frequency of patients without retinopathy (60.3% vs 66% OR 0.68). In this group laser therapy had to be performed more frequent (6.8% vs 1.8% OR 6.1). CONCLUSIONS: Pregnancy in diabetic patients with good metabolic control doesn't seem to be a risk factor for developing vascular complications. These complications are still strongly correlated with duration of diabetes.     

Pharmacokinetics of amphotericin B lipid complex in critically ill patients on continuous veno-venous haemofiltration

Pharmacokinetics of amphotericin B lipid complex (ABLC) was determined in two critically ill patients requiring continuous veno-venous haemofiltration (CVVH) because of acute renal failure. ABLC was administered at a mean daily dose of 4.94 mg/kg for suspected invasive mycosis. Mean C(max) was 0.56 microg/ml, the mean AUC(0-24 h) was 7.46 mgh/l, V(ss) 9.13 l/kg, and t(1/2) was 13.21 h. The haemofilter clearance accounted about 20% of the total ABLC clearance. In one patient sampling was repeated after CVVH had been discontinued. The concentration-time profiles were very similar on and off haemofiltration. Data on our two patients suggest, that pharmacokinetics of ABLC is not significantly affected by CVVH and that ABLC can be administered at the standard doses during CVVH.     

Leishmaniasis among soldiers of stabilization forces in Iraq. Review article

The results of studies concerning the incidence of leishmaniasis among soldiers of Stabilization Forces serving in Iraq in the years from 2003 to March 2004 are presented in this article, in the light of a possibility of importation of this disease to the countries of their origin. Epidemiology, clinical picture, laboratory diagnosis, treatment and prevention of leishmaniasis are described. In mid-2004, more than 2400 Polish soldiers served in Iraq. By the end of June 2004 no case of leishmaniasis was diagnosed among them. Among American troops serving in Iraq, 653 cases of cutaneous and 2 cases of visceral leishmaniasis were reported by the end of March 2004. According to the U.S. sources, the number of infected American soldiers could have been higher, from 750 to 1250 or even more, what made up to nearly 1% of U.S. troops serving in Iraq in 2003-2004.     

Diagnostic value of the morphological ultrasound score system and the serum concentration of CA 125 in the diagnosis of malignant ovarian cancer

OBJECTIVES: The aim of this study was to estimate the diagnostic value of the morphological ultrasound score system and the serum concentration of CA 125 in the diagnosis of malignant ovarian masses. The aim was realized by the evaluation of the statistical coefficients like sensitivity, specificity, positive predictive value and negative predictive value in three groups tested by different methods (A--ultrasonography, B--serum concentration of CA 125, C--both methods). MATERIALS AND METHODS: We have analyzed 59 patients (17-77 years old)--mean 46.5 +/- 14.8 with ovarian malignant masses diagnosed in years 1999-2001. RESULTS: Merz morphological ultrasound score system revealed its sensitivity of 92.3%, specificity--87.9%, positive predictive value--85.7% and negative predictive value--93.7%. Statistical coefficients for serum Ca 125 marker concentration was not so attractive: sensitivity--57.7%, specificity--90.9%, positive predictive value--83.4% and negative predictive value--73.2%. Using both methods at the same time we obtained significantly different coefficients: sensitivity--96.2%, specificity--80.0%, positive predictive value--78.1% and negative predictive value--96.6%. CONCLUSIONS: Ultrasound assessment of ovarian morphology is very useful element in early detection of ovarian neoplasm. Serum CA 125 concentration assay is not a test verifying malignancy. Using both methods at the same time we increase its sensitivity and negative predictive value.     

Congenital diaphragmatic hernia--diagnostic and therapeutic procedures

Congenital diaphragmatic hernia (CDH) is connected with a high risk of neonatal mortality and morbidity, which are caused mostly by lung hypoplasia. Frequency of these congenital malformations is 1: 2000-3000 live birth. CDH can be isolated, but in as many as 23% of cases, it co-exists with other fetal anomalies. Moreover, in 12% of cases it may be connected with genetically determined syndromes. Ultrasonographic diagnostics, especially in isolated CDH cases, is very difficult so that pregnant women must very often be admitted to perinatal 3rd references center. The first symptom to suggest CDH is polyhydramnios appearing between the 2nd and 3rd trimester of pregnancy. Appropriate prenatal diagnosis, delivery at a specialized perinatal center, and well-prepared neonatal, anaesthesiological and surgical teams significantly improve the survival rate and increase the likelihood of the proper development of newborn infants. The aim of this paper is the presentation of the case of a newborn diagnosed with intrauterine CDH who, upon delivery at 34th week of gestation, was admitted to the Department of Child Surgery, and after surgical procedures, was discharged in a healthy condition.     

Quadriceps femoris torque and EMG activity in seated versus supine position

PURPOSE: To compare voluntary and electrically evoked knee extensor torque, surface electromyography (EMG), and activation level obtained under seated versus supine position, i.e., with shortened versus lengthened rectus femoris (RF) muscle. METHODS: The knee extensor torque obtained during maximal voluntary contractions (MVC) and after single and paired stimuli applied at rest was measured under seated (i.e., 90 degrees hip angle) and supine (i.e., 180 degrees hip angle) conditions. The associated EMG activity from biarticular RF and monoarticular vasti was also recorded, and activation level was estimated by means of the twitch interpolation technique. RESULTS: Knee extensor MVC was 10.6% higher in the seated compared with the supine position (P < 0.01). EMG normalized to the M-wave amplitude for respective muscles and for respective positions was significantly lower under supine conditions, and deficits averaged approximately 20% for vasti and approximately 41% for RF (P < 0.05). Similarly, activation level estimated in the supine position was approximately 4% lower than the seated counterpart. Relative MVC losses observed supinely were significantly correlated with the corresponding activation level deficits (P < 0.05). On the other hand, both single and paired stimuli resulted in higher torque amplitudes in the supine with respect to the seated position, and mean differences were comprised between 10% (single twitch, P < 0.05) and 20% (potentiated doublet, P < 0.001). RF M-wave amplitude recorded supinely was 19% higher than the seated counterpart (P < 0.01). CONCLUSION: The higher neural activation observed for the knee extensor muscles in the seated versus supine position, likely attributable to improved motor unit recruitment, may reflect a neurophysiological mechanism partly compensating the neuromuscular transmission-propagation impairment and/or mechanical disadvantage of shortened RF muscle.