Mental health status of Aboriginal and non-Aboriginal Australian prisoners

OBJECTIVE: To compare the mental health of Aboriginal and non-Aboriginal prisoners in New South Wales. METHODS: The sample consisted of a cross-sectional random sample of sentenced prisoners, and a consecutive sample of reception prisoners. The sample was drawn from 29 correctional centres (27 male, two female) across New South Wales. Overall, 1208 men (226 Aboriginal), and 262 women (51 Aboriginal) participated in the study. Mental illness was detected using the Composite International Diagnostic Interview (CIDI-A) and a number of other screening measures incorporated into the programme. RESULTS: No differences were detected in mental illness between Aboriginal and non-Aboriginal men, apart from depression, which was lower in the latter group. Aboriginal woman were more likely than non-Aboriginal women to screen positive for symptoms of psychosis in the prior 12 months and have a higher 1 month and 12 month prevalence of affective disorder; they also had higher psychological distress scores. Suicidal thoughts and attempts were the same in both groups. CONCLUSIONS: These findings confirm that the demand for mental health services in prisons is considerable, and that Aboriginal women are one of the most vulnerable groups. Services and programmes providing an alternative to incarceration are needed, as are culturally sensitive approaches to treatment.     

Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study

Although intradialytic parenteral nutrition (IDPN) is a method used widely to combat protein-calorie malnutrition in hemodialysis patients, its effect on survival has not been thoroughly studied. We conducted a prospective, randomized trial in which 186 malnourished hemodialysis patients received oral nutritional supplements with or without 1 year of IDPN. IDPN did not improve 2-year mortality (primary end point), hospitalization rate, Karnofsky score, body mass index, or laboratory markers of nutritional status. Instead, both groups demonstrated improvement in body mass index and the nutritional parameters serum albumin and prealbumin (P < 0.05). Multivariate analysis showed that an increase in prealbumin of >30 mg/L within 3 months, a marker of nutritional improvement, independently predicted a 54% decrease in 2-year mortality, as well as reduced hospitalizations and improved general well-being as measured by the Karnofsky score. Therefore, although we found no definite advantage of adding IDPN to oral nutritional supplementation, this is the first prospective study demonstrating that an improvement in prealbumin during nutritional therapy is associated with a decrease in morbidity and mortality in malnourished hemodialysis patients.     

Sensitization of tilt-table testing for syncope of unknown etiology: which drug to use?

OBJECTIVE: The sensitivity of tilt-table testing in the diagnosis of vasovagal syncope is between 30% and 50% only. The most common method currently used to improve the sensitivity of the test is the administration of isoproterenol i.v. However, this method is difficult to perform and time consuming. The objective of our study was to compare sublingual trinitrin administration to i.v. isoproterenol during tilt-table testing. METHODS: We analyzed the results of 257 consecutive patients referred for tilt testing. Patients who had a negative test received either a ten minutes infusion of i.v. isoproterenol at the dose of 4 mcg/kg/min, or 0.4 mg of trinitrin given sublingually. RESULTS: Two hundred (and) fifty-seven patients underwent tilt-table testing. In the first group (isoproterenol group), 42 patients (39%) had a spontaneous positive tilt test, compared to 45 patients (31%) in the trinitrin group (P = NS). After sensitization, 24 additional patients (22%) had a positive test in the isoproterenol group vs 55 patients (37%) in the trinitrin group (P = NS). The total number of positive tests was 66 (61%) in the isoproterenol group compared to 100 (68%) in the trinitrin group (P = NS). CONCLUSION: Sublingual trinitrin is at least as good as IV isoproterenol during tilt-table testing. Because trinitrin is simpler to use and because its administration is much faster than isoproterenol, it should be recommended as the drug of choice to improve the sensitivity of tilt-table testing.     

Wire-guided pancreatic pseudocyst drainage by using a modified needle knife and therapeutic echoendoscope

BACKGROUND: Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature. OBJECTIVE: A new drainage technique is described that uses a modified needle knife advanced over a guidewire positioned in the pseudocyst by EUS guidance. DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: Consecutive subjects from December 1, 2002, to January 10, 2005, with symptomatic pseudocysts in whom EUS-guided drainage was attempted. INTERVENTIONS: By using a therapeutic linear echoendoscope, a 19-gauge aspiration needle was inserted into the pseudocyst. A guidewire was placed through the needle, and a needle knife with the cutting wire protruding and bent was advanced over the guidewire to contact the stomach mucosa. The needle knife was then advanced by using electrocautery into the pseudocyst. The cystenterostomy was dilated by using a balloon over the guidewire. One to 4 stents were placed through the tract. MAIN OUTCOME MEASUREMENTS: Successful pseudocyst drainage. RESULTS: A total of 21 of 23 patients underwent technically successful pseudocyst drainage. One patient had self-limited hypotension during the procedure. Another patient had free intraperitoneal air after the procedure but correct stent placement. LIMITATIONS: Retrospective analysis, small sample size. CONCLUSIONS: In this preliminary experience, wire-guided pseudocyst drainage with a modified needle knife appears effective and safe while allowing for a more controlled pseudocyst puncture.     

Development of validated UV spectrophotometric method for <Emphasis Type="Italic">in vitro</Emphasis> analysis of sumatriptan in pharmaceutical preparations in comparison with HPLC

An accurate, simple reproducible and sensitive method for the determination of sumatriptan succinate was developed and validated. According to this, sumatriptan succinate was determined using a UV spectrophotometric (UVS) technique and the results were compared with the data of isocratic HPLC procedure on a Bondapack reversed-phase ODS or C18 Waters column (chemically bonded to Spherisorb⁽particles (5 μm), 4.6 mm × 25 cm,) under conditions of isocratic elution at a flow rate of 1.0 ml/min. The mobile phase composition was acetonitrile – buffer (420 : 580, v/v), pH 7.5. The buffer composition was dibutylamine, 85% phosphoric acid, and doubly distilled water (0.18 : 0.06 : 99.76, v/v), which was adjusted to pH 7.5 with 0.8 N sodium hydroxide solution. Both the proposed UVS procedure and HPLC with UV detection were carried out at 282 nm. The linear range of detection for sumatriptan succinate by means of both UVS and HPLC methods was between 21 and 39 μg/ml of sumatriptan. The UVS method is shown to be linear, reproducible, specific, sensitive and robust.     

The effect of verapamil on in vitro susceptibility of promastigote and amastigote stages of <Emphasis Type="Italic">Leishmania tropica</Emphasis> to meglumine antimoniate

Pentavalent antimonials are the standard treatment for cutaneous leishmaniasis (CL) with low efficacy and resistance is emerging. CL is increased significantly in respect to incidence rate and expanding to new foci. In the present study, the effect of verapamil on in vitro susceptibility of promastigote and amastigote stages of Leishmania tropica to meglumine antimoniate (MA, Glucantime) was evaluated using colorimetric assay (MTT) and in a macrophage model, respectively. Verapamil, as a calcium channel blocker, affects drug uptake by preventing of drug efflux from the cells. In promastigote form, several concentrations of MA with or without verapamil showed significant decrease (P < 0.05) in optical density. The overall mean IC₅₀ value with combination of MA plus verapamil (IC50 = 116.03 μg/ml) was significantly less than MA (IC50 = 225.14 μg/ml) alone (P < 0.05) for promastigote stage. Similarly, the amastigote stage was more susceptible to treatment with MA plus verapamil to that of MA alone (P < 0.05). Analysis of overall effect of different concentrations of MA alone, compared with combination of MA plus verapamil by mean infection rate of amastigotes in each macrophage showed a significant difference (P < 0.05).These findings indicated some degree of synergistic effects between MA and verapamil on in vitro susceptibility of L. tropica to MA. Further works are required to evaluate this synergistic effect on animal model or volunteer human subjects.     

Adenovirus infections in hospitalized patients in Israel: epidemiology and molecular characterization

Adenoviruses can cause a broad spectrum of clinical diseases, most of which are self-limited. However, adenovirus infection can occasionally result in severe or lethal infection. Fifty-five adenovirus serotypes are known today, and they are classified into 7 subgroups (subgroups A to G). Here we examined 282 samples derived from hospitalized patients in Israel (September 2006 to August 2008) who were diagnosed as suffering from adenovirus infections. We used a recently described PCR amplification method and subsequent sequencing to identify the adenovirus. In addition, we studied the medical charts of 106 hospitalized patients from Sheba Medical Center in Israel. The most prevalent adenovirus serotypes found were serotypes 1 (22.8%), 2 (19.2%), 7 (18%), and 3 (14%). In addition, we identified several serotypes that have not been identified previously in Israel. Overall, serotypes of subgroup B were found to be approximately 4 times more prevalent among immunocompromised children than among generally healthy children (52.6%; P < 0.007). The realization that the virus subtypes are different among healthy and immunocompromised patients may lead to more efficient treatment of adenovirus infections among immunocompromised children in the future.