Holmes' tremor following midbrain Toxoplasma abscess: clinical features and treatment of a case

The label Holmes' tremor defines a rare symptomatic movement disorder frequently occurring with midbrain damage. It appears at rest and worsens adopting a posture and on attempting movements. We describe the case of a patient with Holmes' tremor due to a presumed Toxoplasma abscess of the midbrain. The positive response to a combined therapy with levodopa and isoniazid is also reported.     

Depression in adult Nigerians: Results from the Nigerian Survey of Mental Health and Well-being

BackgroundCommunity-based studies of the rates and profile of depression among Africans are still sparse.MethodsAs part of the World Mental Health Surveys initiative, a clustered multi-stage sampling of households in 21 of Nigeria's 36 states (representing 57% of the national population) was implemented to select adults aged 18 years and over (N = 6752) for face-to-face interviews using the Composite International Diagnostic Interview (CIDI 3.0). Diagnosis of major depressive episode (MDE) was based on the criteria of the Diagnostic and Statistical Manual, 4th edition.ResultsLifetime and 12-month estimates of MDE were 3.1% (standard error 0.3) and 1.1% (s.e. 0.1), receptively. Increasing age was associated with higher estimates of positive responses to stem (screen) questions for depression and of lifetime disorders among stem-positive respondents. The mean age of onset was about 29.2 years. The median (inter quantile range, IQR) duration of an episode among lifetime cases was 1.0 (2.0–2.4) year and the median (IQR) number of lifetime episodes was 1.5 (2.0–2.8). MDE was highly comorbid with anxiety disorders, musculoskeletal conditions, chronic pain and ulcer. The odds ratio of lifetime suicide attempt among persons with lifetime MDE was 11.6 (95% confidence interval, 3.9–34.9). Over 25% of 12-month cases were rated as severely disabled in the performance of usual roles. Only 16.9% (s.e. 5.0) of 12-month cases had received any treatment.LimitationsAll data were based on self-reports.ConclusionMDE, defined according to DSM-IV, is a risk factor for mental and physical comorbidity as well as disability in Nigerians. Age-related telescoping or denial may partly explain the low rates in this young population.     

Parental Mental Disorders and Suicidal Behavior in the Nigerian Survey of Mental Health and Well-Being

The objective of this study was to determine which parental mental disorders predict offspring suicidal behavior in a general adult population sample of a sub-Saharan African country. The World Health Organization Composite International Diagnostic Interview, version 3 was used to assess respondents' suicidal behaviors as well as psychopathology in their parents. The effects of parental disorders in predicting offspring suicide ideation and attempts were examined in a series of bivariate and multivariate models. Sections on suicidality were administered to the entire sample (n = 6752), but associations with parental psychopathology were examined in a subsample of respondents (n = 2143). Lifetime prevalence (95% confidence interval) of suicide ideation, plans, and attempts was 3.2% (1.4–6.5), 1.0% (0.4–7.5), and 0.7% (0.5–1.0) respectively. Parental panic disorder and substance abuse were associated with suicide ideation in offspring, but only parental panic disorder was linked to suicide attempts. Parental panic disorder predicted the onset and persistence of suicide ideation and attempts and also which persons with suicide ideation go on to make a suicide attempt. This study further affirms findings from previous studies of the role of disorders characterized by anxiety and impulse control in suicide attempts and as being a probable link in the transmission of suicidal behavior to offspring.     

Identification of dopamine D2 receptors in gill of Crassostrea virginica

The lateral epithelial cells of gill of Crassostrea virginica are innervated by dopamine and serotonin nerves that regulate the beating rate of their lateral cilia. Terminal release of dopamine slows down the beating rate of the cilia, while serotonin release increases the beating rate. Previously, we showed that the dopaminergic, but not the serotonergic, mechanism regulating the beating rate of the lateral cilia was disrupted by manganese treatments and that this disruption was occurring postsynaptically, at the level of the dopamine receptor or further downstream in the signal transduction pathway. In humans manganese toxicity causes Manganism, a neurological disorder with clinical symptoms similar to Parkinson s disease. In this study we utilized pharmacological agents and an immunohistofluorescence technique to characterize the dopamine receptor type present on the lateral ciliated cells of C. virginica gill. Agonists and antagonists to dopamine D1 or dopamine D2 receptors were applied to gill sections and beating rates of the lateral cilia were measured by stroboscopic microscopy. The D2 agonists and D2 antagonists were effective in mimicking or blocking, respectively, the inhibitory actions of dopamine on lateral cilia beating, while application of either D1 agonists or D1 antagonists had no significant effect. In other experiments we used an epilume fluorescence microscopic fitted with FITC filters to view gill sections treated with a primary antibody against D2 receptors and a FITC-linked secondary antibody. Control gill sections without primary antibody exposure were similarly treated and viewed. The D2 antibody treated sections showed bright fluorescent receptor-antibody complexes present at the lateral ciliated cells and other areas of gill, when compared to controls. The results of our immunofluorescence study identify the presence of D2-like receptors on the lateral ciliated cells of C. virginica gill and our pharmacological results indicate that D2-like receptors are the postsynaptic dopamine receptors involved in the cilio-inhibitory response of the lateral cilia. The results of this study, when combined with our previous work, further suggest that the mechanism of action that underlies the dopaminergic neurotoxicity of manganese in gill of C. virginica involves disruption of D2-like receptors. C. virginica continues to provide a simple yet good model with which to study the physiology of dopaminergic systems as well as the pharmacology of drugs affecting biogenic amines.     

Sickle Cell Trait and Development of Microvascular Complications in Diabetes Mellitus

Background and objectives: Many African Americans (AA) have both sickle cell trait (SCT) and diabetes mellitus. The objective of this study was to determine whether individuals with diabetes mellitus and SCT have higher rates of microvascular complications relative to those without SCT.Design, setting, participants, & measurements: This was a retrospective study comparing albuminuria, estimated GFR (eGFR), and microvascular complications in AA with diabetes on the basis of presence of SCT. The study included 821 outpatients who underwent hemoglobin A1c (HbA1c) testing, and presence of SCT was determined using the HbA1c assay. Medical record review and telephone interviews were performed for AA participants.Results: Data were obtained on 376 AA patients (110 with SCT, 245 with neither SCT nor hemoglobin C trait, and 21 with hemoglobin C trait) and 445 European Americans. The mean eGFR and urinary protein excretion were similar between the three AA subgroups. Analysis revealed that 36.3% of AA nontrait and 22.7% of AA SCT participants had retinopathy, peripheral vascular disease, or end-stage kidney disease (P = 0.01). After adjustment for diabetes duration, age, insulin use, and gender, differences in the prevalence of microvascular complications were not observed.Conclusions: SCT does not increase the risk of microvascular complications in AA with diabetes mellitus.Sickle cell trait (SCT) and diabetes mellitus (DM) are common conditions occurring together in more than 1 million individuals worldwide (1–3). Despite the many dually affected individuals, little information exists on whether SCT affects the course and development of complications in patients with DM.Because patients with SCT and DM are prone to papillary necrosis and hematuria (4), it is possible that pathophysiologic changes induced by SCT could potentiate the microvascular complications of DM. It is unknown whether individuals with SCT face increased risk for developing the microvascular complications associated with DM.Newer methods for measuring hemoglobin A1c (HbA1c) now quantify hemoglobin S (5–7). Most laboratories do not report this information. However, if obtained, individuals with SCT can readily be identified for research or clinical purposes.To better understand the interactions between HbA1c and SCT, we studied HbA1c measurements from outpatients at an academic medical center over an 8-month study period. Patients with SCT or hemoglobin C trait were identified based on results of the gas chromatography performed to measure HbA1c. Laboratory values in individuals with and without SCT were contrasted, and surveys were performed for the presence of end-organ damage. We also determined whether individuals with SCT were previously aware of this diagnosis.     

Short report: Diagnosis of tick-borne relapsing fever by the quantitative buffy coat fluorescence method.

The quantitative buffy coat (QBC) parasite detection method is a sensitive and specific tool for the diagnosis of malaria parasites. It is also useful for the diagnoses of other hemoparasites, including Trypanosoma, Babesia, and Leptospira. We report a case of relapsing fever diagnosed by this technique in a short-term traveler from Senegal. The diagnosis was confirmed by the standard Giemsa hemoscopy and by the identification of significant titers of antibodies to Borrelia spp. of tick-borne relapsing fevers by specific immunofluorescence and Western blot tests. The QBC technique seems to be useful in the diagnosis of tick-borne relapsing fever in blood samples and should be included in the management of fever in the traveler returning from tropical regions.