Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised,controlled trial

Introduction  

Patients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness will reduce the development of new onset PTSD.     

LOCUS OF CONTROL AND SELF-ESTEEM AS STRESS-MODERATORS OR STRESS-MEDIATORS IN PARENTALLY BEREAVED CHILDREN

Parentally bereaved children's locus of control and self-esteem were examined as stress-moderators or stress-mediators of their internalizing and externalizing mental health problems. Seventy-six children ages 8 to 16 and their surviving parent were assessed 4 to 34 months after the death. Stress, locus of control, and self-esteem were measured by child report questionnaires. Internalizing and externalizing mental health problems were measured by child report on both questionnaires and a structured interview and by parent report questionnaires. The results revealed that self-esteem was a significant mediator of the relations between stress and both child and parent reports of internalizing problems but not externalizing problems. No significant mediation effects were found for locus of control. Neither locus of control nor self-esteem was a significant moderator of the relations between stress and children's internalizing and externalizing problems. Implications for understanding parentally bereaved children's mental health problems and for developing preventive interventions are discussed.     

Administration of β-glucan following Leishmania major infection suppresses disease progression in mice

Summary The potential of β-glucan (glucan) to suppress the progression of lesions caused by virulent strains of Leishmania major in genetically susceptible BALB/c mice when administered post challenge was evaluated. Glucan particles (glucan^p) prepared from Saccharomyces cerevisiae were injected i.v. at 7-day intervals starlins 7 days after parasite challenge. Four injections gave a more rapid and a higher extent of suppression than 1, 2 or 3 injections. Mice receiving only parasites, a glucose solution, starch particles or glucan^p by the i.p. route showed a progressive increase in footpad thickness and developed ulcerating lesions. An alkali solubilized glucan (glucan^as) was injected (50 μg, 200 μg and 400 μg/mousc) 4 times at 4 day intervals either i.v. or i.p. starling four days post parasite challenge. Glucan^as injection by either route blocked lesion development; the 50 μg treatment had already substantial effects and 400 μg in the i.p. route prevented even the initial stages of lesion formation. Touch prints from the lesion area and from the liver of mice receiving 200 μg glucan^as were amasiigote free. The anti Leishmania antibody litre of glucan^as treated mice was lower and their sera recognized fewer antigens than that of control Leishmania bearing mice.     

Dental pulp stem cells: what,where, how?

Introduction.  It is now accepted that progenitor/stem cells reside within the post-natal dental pulp. Studies have identified several niches of multipotent mesenchymal progenitor cells, known as dental pulp stem cells, which have a high proliferative potential for self-renewal. These progenitor stem cells are now recognized as being vital to the dentine regeneration process following injury. Understanding the nature of these progenitor/stem cell populations in the pulp is important in determining their potentialities and development of isolation or recruitment strategies for use in regeneration and tissue engineering. Characterization of these cells, and determination of their potentialities in terms of specificity of regenerative response, may help direct new clinical treatment modalities. Such novel treatments may involve controlled direct recruitment of the cells in situ and possible seeding of stem cells at sites of injury for regeneration or use of the stem cells with appropriate scaffolds for tissue engineering solutions. Such approaches may provide an innovative and novel biologically based new generation of clinical materials and/or treatments for dental disease.
Aim.  This study aimed to review the body of knowledge relating to stem cells and to consider the possibility of these cell populations, and related technology, in future clinical applications.     

Aggressive Basal Cell Carcinoma with Invasion of the Parotid Gland, Facial Nerve, and Temporal Bone

Aggressive variants of basal cell carcinoma (BCC), such as infiltrating, morpheaform, and basosquamous types, are associated with invasion of underlying tissues and are often difficult to treat.1 BCCs located in embryonic fusion planes, such as the periauricular region, are thought to exhibit deep extension and, subsequently, high recurrence rates, although this theory has been challenged and remains controversial.2-4 Despite the known features of aggressive BCC, parotid gland invasion and temporal bone and facial nerve involvement are rarely reported occurrences. We describe two patients with morpheaform BCC in the periauricular region demonstrating direct invasion of the parotid gland and concomitant facial nerve involvement. These patients require complex surgical management, as highlighted in this report.     

Acute neuronal and vascular changes following unilateral cerebellar pedunculotomy in the neonatal rat

During development of the central nervous system (CNS) both deafferentation and axotomy induce increased neuronal death and result in a smaller brain with diminished function at maturity. Unilateral cerebellar pedunculotomy has been used as a model to study the relative importance of these 2 types of lesion on the survival of developing CNS neurons. Within the cerebellum, unilateral pedunculotomy causes deafferentation of the hemicerebellum and axotomy in the efferent pathway from the ipsilateral deep cerebellar nuclei. This results in a smaller hemicerebellum with normal cortical laminae but no extracerebellar outflow. In order to identify the sequence of events which leads to this altered structure and therefore to understand the relative importance of afferent versus target-derived trophic support, unilateral cerebellar pedunculotomy was performed on neonatal rat pups, aged between 1 and 3 days. The cerebella were analysed for histological and vascular changes after survival times of 0, 3, 6, 9, 12, 18, 21, 24 and 48 h. The results show that the effects of axotomy on the deep cerebellar nuclear neurons begin within 3 h of the lesion and apoptotic neuronal degeneration occurs within 48 h. However, the cerebellar cortical neurons continue to undergo normal histological development for at least 48 h after deafferentation. In addition, since ischaemia induces similar effects, a study of the vascular tree was made. The results indicate that the pedunculotomy does not alter the blood supply to the cerebellum, nor induce ischaemia of the cerebellar neurons. From this it may be hypothesised that target-derived trophic support is more crucial for the survival of immature neurons than is the trophic effect of afferent input.     

State Policymaking and Stated Reasons: Prenatal Care for Undocumented Immigrants in an Era of Abortion Restriction

Policy Points

• States can create policies that provide access to publicly funded prenatal care for undocumented immigrants that garner support from diverse political coalitions.
• Policymakers have used a wide range of moral and practical reasons to support the expansion of care to this population, which can be tailored to frame prenatal policies for different stakeholder groups.

ContextEven though nearly 6% of citizen babies born in the United States have at least one undocumented parent, undocumented immigrants are ineligible for most public health insurance. Prenatal care is a recommended health service that improves birth outcomes, and some states, including both traditionally “blue” and “red” states, have opted to provide publicly funded coverage for prenatal services for people who are otherwise ineligible due to immigration status. This article explores how courts and legislatures in three states have approached the question of publicly funded prenatal care for undocumented immigrants and its relationship to the abortion debate, with a particular focus on the moral and practical justifications that policymakers employ.MethodsWe employed a review and qualitative analysis of the documents that comprise the legislative histories of prenatal policies in three case states: California, New York, and Nebraska.FindingsThis review and analysis of policy documents identified moral reasons based on appeals to different conceptions of moral status, respect for autonomy, and justice, as well as prudential reasons that appealed to the health and economic benefits of prenatal care for US citizens and legal residents. We found that much of the variation in reasons supporting policies by state can be traced to the state''s position on the protection of reproductive rights and whether the policymakers in each state supported or opposed access to abortion. Interestingly, despite these differences, the states arrived at similar prenatal policies for immigrants.ConclusionsThere may be areas where policymakers with different political orientations can converge on health policies affecting access to care for undocumented immigrants. Future research should explore the reception of various message frames for expanding public health insurance coverage to immigrants in other contexts.     

The effect of bile acids on the growth and adherence of Helicobacter pylori

Bile reflux gastritis occurs in the absence of Helicobacter pylori (H. pylori). The aim of this study was to see if the bile acids cheno or ursodeoxycholic acid affected the growth or adherence of H. pylori in vitro. Twenty-seven strains growth were inhibited by 0.1% chenodeoxycholic acid whereas only 11 out of the 27 were inhibited by 0.1% ursodeoxycholic acid. Growth was totally inhibited by a combination of 0.05% chenodeoxycholic acid +0.05% ursodeoxycholic acid. Chenodeoxycholic acid was a more effective inhibitor of adherence in that the number inhibited and percentage inhibition were greater than with ursodeoxycholic acid. Bile salts might be useful in the treatment of H. pylori infection.