Unnoticed post-void residual urine volume in people with moderate to severe intellectual disabilities: prevalence and risk factors

Background   Increased post-void residual urine volume (PVR) is often seen in geriatric populations. People with intellectual disabilities (ID) have risk factors in common with these populations.
Aims   To investigate in adults with ID:

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  Feasibility of portable ultrasound bladder scanning;
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  Prevalence of PVR; and
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  Relations with proposed risk factors for PVR.

Methods   In a cross-sectional design, PVR was measured using ultrasound scanning in 346 adults with moderate to severe ID aged 18–82 years. Relationship between increased PVR and the following risk factors was assessed: age, level of ID, gender, ambulancy, medication, chronic illnesses, incontinence and profound multiple disabilities (PMD). Acceptation of scanning and manageability were noted.
Results   Feasibility: All participants were cooperatively undergoing the ultrasound scan and all outcomes were sufficiently interpretable. Prevalence: PVR ≥ 150 mL was newly identified in 30/346 persons (8.7%, 95% confidence interval 5.92–12.14). Associations: Higher age ( P  = 0.001), laxative use ( P  = 0.001), chronic illnesses other than epilepsy ( P  = 0.005), profound ID ( P  = 0.008), incontinence ( P  = 0.048) and immobility ( P  = 0.005) are determinants that were associated with urinary retention.
Conclusions   The bladder ultrasound scan is a feasible method to identify increased PVR in adults with more severe levels of ID. The prevalence of PVR in adults is similar to prevalences found in the geriatric general population.     

Imaging characteristics following 90yttrium microsphere treatment for unresectable liver cancer

Selective internal radiation therapy (SIRT) with (90)yttrium microspheres - also known as radioembolisation - is a relatively new interventional radiology technique offering symptomatic and survival advantages for patients with unresectable liver cancer. However, in delivering both beta-particle brachytherapy and embolisation of tumour vasculature, SIRT produces biological sequelae and imaging characteristics distinct from other treatment modalities. Current CT interpretation criteria consistently under-report pathological responses to radioembolisation, diminishing both the prognosis and subsequent treatment choices for responding patients. However, newer criteria incorporating both tumour dimensions and enhancement characteristics improve the correlation with histopathology and provide substantially earlier confirmation of response. CT following radioembolisation may also identify parenchymal features that are often benign but may be mistaken for tumour progression. This review outlines imaging criteria specific to SIRT, including assessment of tumour response and interpretation of both lesion and parenchymal characteristics. The adjunctive role of additional modalities such as positron emission tomography is also addressed.     

Home-care utilization within the year of death: trends, predictors and changes in access equity during a period of health policy reform in British Columbia, Canada

Healthcare policy reforms enacted through the 1990s explicitly endorsed expanded community care and enhanced equitable access to care. We examine end-of-life home-care service utilization during this time period. We are interested in trends in and predictors of utilization influencing receipt of service or total service use. This is a population-based, retrospective study of home-care utilization by adults 50 years of age and older in British Columbia, Canada, who died in the last 6 months of each year from 1991 to 2000 ( n  = 98 327). Data were drawn from the British Columbia Linked Health Data resource; we examined both receipt and extent of care, using logistic and standard regression models. Independent variables included year of death, age, gender, area of residence and income quintile. Year of death was not significantly associated with receipt of home care in general. However, the odds of receiving home support services declined significantly over time, while annual home support hours increased. In contrast, receipt of home nursing increased, while annual home nursing visits did not change. Social factors frequently emerged as significant predictors of both receipt and extent of care. However, we found only limited evidence for interactions between these factors and year of death acting as determinants of receipt or extent of service. Results suggest that end-of-life home care services did not expand, but instead were reallocated and intensified over the 1990s. As well, there was little evidence to suggest enhanced equity in access to care.     

Benzo[a]pyrene-7,8-dihydrodiol promotes checkpoint activation and G2/M arrest in human bronchoalveolar carcinoma H358 cells

Polycyclic aromatic hydrocarbons (PAHs) are potent carcinogens that require metabolic activation inside cells. The proximate carcinogens PAH-diols can be converted to o-quinones by aldo-keto reductases (AKRs) or to diol-epoxides by cytochrome P450 (P450) enzymes. We assessed the effect of benzo[a]pyrene-7,8-dihydrodiol (BPD) on proliferation in p53-null bronchoalveolar carcinoma H358 cells. BPD treatment led to a significant inhibition of proliferation and arrest in G2/M in H358 cells. The relative contribution of the AKR and P450 pathways to cell cycle arrest was assessed. Overexpression of AKR1A1 did not affect cell proliferation or cell cycle progression, and benzo[a]pyrene-7,8-dione did not cause any noticeable effect on cell growth, suggesting that AKR1A1 metabolic products were not involved in the antiproliferative effect of BPD. On the other hand, blockade of P450 induction or inhibition of P450 activity greatly impaired the effect of BPD. Moreover, P450 induction by 2,3,7,8-tetrachlorodibenzo-p-dioxin significantly enhanced the antiproliferative effect of BPD. Mechanistic studies revealed that BPD caused a DNA damage response, Chk1 activation, and accumulation of phospho-Cdc2 (Tyr15) in H358 cells, effects that were impaired by an ataxia-telangectasia mutated (ATM)/ATM-related (ATR) inhibitor. Similar results were observed in human bronchoepithelial BEAS-2B cells, arguing for analogous mechanisms in tumorigenic and immortalized nontumorigenic cells lacking functional p53. Our data suggest that a p53-independent pathway operates in lung epithelial cells in response to BPD that involves P450 induction and subsequent activation of the ATR/ATM/Chk1 damage check-point pathway and cell cycle arrest in G2/M.     

Dysphagia in children with severe generalized cerebral palsy and intellectual disability

This study assessed the clinical indicators and severity of dysphagia in a representative sample of children with severe generalized cerebral palsy and intellectual disability. A total of 166 children (85 males, 81 females) with Gross Motor Function Classification System Level IV or V and IQ<55 were recruited from 54 daycare centres. Mean age was 9 years 4 months (range 2 y 1 mo-19 y 1 mo). Clinically apparent presence and severity of dysphagia were assessed with a standardized mealtime observation, the Dysphagia Disorders Survey (DDS), and a dysphagia severity scale. Additional measures were parental report on feeding problems and mealtime duration. Of all 166 participating children, 1% had no dysphagia, 8% mild dysphagia, 76% moderate to severe dysphagia, and 15% profound dysphagia (receiving nil by mouth), resulting in a prevalence of dysphagia of 99%. Dysphagia was positively related to severity of motor impairment, and, surprisingly, to a higher weight for height. Low frequency of parent-reported feeding problems indicated that actual severity of dysphagia tended to be underestimated by parents. Proactive identification of dysphagia is warranted in this population, and feasible using a structured mealtime observation. Children with problems in the pharyngeal and esophageal phases, apparent on the DDS, should be referred for appropriate clinical evaluation of swallowing function.     

Phytomedicine Versus Gonorrhoea: The Bapedi Experience

Records regarding the phytomedicine employed by the Bapedi are almost non-existent. This is the first study of herbal remedies used by Bapedi traditional healers to treat gonorrhoea, of concern as it is a danger to reproductive health. A semi-structured questionnaire, centred on sexual health, was administered to 30 traditional healers in 15 local municipalities across the three districts of Limpopo Province during 2009/10. The questionnaire focussed on the use of plants for medicine as well their application in reproductive health management. This investigation found that the Bapedi employed no less than 18 different plant species, sometimes as multiple-plant extracts, but more often as single-plant extracts. The single most used species was Catharanthus roseus, which accounted for 60% of all reported cases, followed by Aloe marlothii subsp. marlothii (13.3%). Both these species occur abundantly throughout the province and are currently not threatened. This is the first record for the use of Callilepis salicifolia, Jatropha zeyheri and Cotyledon orbiculata to treat gonorrhoea by people of any culture.     

Feasibility of quantitative ultrasound measurement of the heel bone in people with intellectual disabilities

Low bone mineral density (BMD) and fractures are common in people with intellectual disabilities (ID). Reduced mobility in case of motor impairment and the use of anti-epileptic drugs contribute to the development of low BMD. Quantitative ultrasound (QUS) measurement of the heel bone is a non-invasive and radiation-free method for measuring bone status that can be used outside the hospital. QUS might be used for screening purposes to identify people with intellectual disability with poor bone status, who are in need of supplementary examination and treatment.To investigate feasibility of QUS in this group, QUS of the heel bone was performed on-site in 151 people with ID living in residential care.Measurements were successfully performed in at least one foot in 94.7%, were interpretable (resulting in a stiffness index) in 91.6%, and induced barely or no stress in 90.4% of the study population. Measurements generally took less than 10 min. In 93 persons bone status of both feet had been measured. The “mean percentage of the absolute difference” between outcomes of both feet was 15.5% (±15.3% SD, range 0–76.5%).Ultrasound measurement of the heel bone is a feasible and non-stressful method for measuring bone status in people with ID. Since the mean difference between outcomes of the left and right foot were large, measurement of both feet is recommended to prevent inaccurate interpretation.     

Reproducibility of antroduodenal motility during prolonged ambulatory recording

Ambulatory recording of antroduodenal manometry is a novel technique with several advantages over standard stationary manometry recording. Although the feasibility of this technique in clinical practice has been demonstrated, reproducibility of antroduodenal motility recorded by means of ambulatory manometry has not been investigated. To test whether antroduodenal motility recorded by ambulatory manometry is reproducible, we performed two 24-h ambulatory antroduodenal manometry recordings in 18 healthy subjects according to an identical protocol with a 1-week interval. Motility was recorded with a five-channel solid-state catheter. Postprandial motility was recorded after consumption of two test meals and interdigestive motility was recorded nocturnally. Postprandial antroduodenal motor characteristics were identical between the separate recordings. The number and duration of nocturnal cycles of the interdigestive migrating motor complex were also in the same range. Phase III characteristics in general were not different between the two recordings. Only minor alterations were observed in the duration of phase III motor fronts with duodenal onset and in the number of interdigestive cycles concluded by duodenal onset phase III. Parameters obtained by qualitative analysis were comparable between the two recordings. The antroduodenal motility pattern, when measured by ambulatory recording with solid state catheters under standardized conditions, is very reproducible.