Functional neuroanatomy of subcomponent cognitive processes involved in verbal working memory

Recent research has used functional magnetic resonance imaging (fMRI) to examine brain regions related to specific subcomponent cognitive processes of verbal working memory, which include initial encoding of material, maintenance of the information over a brief delay interval, and later retrieval of the information. The present study examined each of these subcomponents in 14 healthy adults using a Sternberg verbal working memory task and fMRI. Group analysis revealed several brain regions active during all subcomponent processes, which included dorsolateral and ventrolateral prefrontal, parietal, hippocampal, and premotor cortex. Several other brain regions showed activation limited to specific subcomponent processes.     

Ondansetron for the Prevention of Postoperative Nausea and Vomiting: Which is the Best Dosage for Aesthetic Plastic Surgery?

Background Ondansetron has been used widely in plastic surgery to prevent postoperative nausea and vomiting. A literature search showed controversial dosages of this drug, and because of its short half-life, its use only before anesthetic induction could have a limited effect. The purpose of this study was to assess the efficacy of intravenous (IV) ondansetron (4 mg) for aesthetic plastic surgery performed with the patient under general anesthesia and the prophylaxis of postoperative nausea and vomiting (PONV) in two situations: (a) only before anesthetic induction and (b) before anesthetic induction and immediately before extubation.Methods Of the 60 patients who had general anesthesia for aesthetic plastic surgery, 30 received 4 mg of IV ondansetron before anesthetic induction (control group) and 30 received 4 mg of IV ondansetron before anesthetic induction plus 4 mg IV immediately before extubation (experimental group). The PONV was recorded in the postanesthetic care unit and in the hospital room.Results The total occurrence of PONV (n = 60) was 6.7%. In the postanesthetic care unit, one patient in the experimental group (3.3%) manifested this symptom. In the hospital room, two patients in the control group (6.7%) and one patient in the experimental group (3.3%) manifested PONV.Conclusion According to the findings, there was no statistical difference between the groups. However, the dosage used in the control group was effective and less expensive.     

Clinical and urodynamic evaluation after ureterocystoplasty and kidney transplantation

PURPOSE: We assessed clinical and surgical results in renal transplantation candidates with voiding dysfunction and end stage renal disease who underwent bladder augmentation. MATERIALS AND METHODS: We analyzed 8 patients 3 to 30 years old with dilated ureters, voiding dysfunction and end stage renal disease who underwent renal transplantation following bladder augmentation from 1995 to 2003. The etiology of bladder dysfunction was neurogenic bladder in 3 patients, posterior urethral valves in 3 and vesicoureteral reflux in 2. All cases were assessed by ultrasonography, voiding cystourethrography and urodynamic studies. RESULTS: Mean followup was 50 months (range 4 to 93). Previous urodynamic evaluation revealed a bladder capacity of 75 to 294 ml (mean +/- SD 167.38 +/- 77.32) and an intravesical pressure of 28 to 100 mm H2O (mean 51.25 +/- 22.17). Urodynamic study after augmentation and kidney transplantation showed a bladder capacity of 191 to 400 ml (mean 335.25 +/- 99.01) and an intravesical pressure of 15 to 35 mm H2O (mean 28 +/- 9.45). Mean serum creatinine was 1.65 mg/dl (range 0.8 to 2.5). All patients remained continent. Three patients with neurogenic bladder empty the bladder by clean intermittent catheterization and the others empty by the Valsalva maneuver. None of the grafts were lost and the most common complication was asymptomatic urinary tract infection. CONCLUSIONS: Bladder augmentation is a well-known procedure for low capacity and poorly compliant bladders even in candidates for a renal transplant. Ureterocystoplasty combines the benefits common to all enterocystoplasties without adding to complications or risks.     

Association between mortality from suicide in England and antidepressant prescribing: an ecological study

Background

There are multiple studies in different countries regarding the prevalence of vitamin D deficiency. These studies showed high prevalence of vitamin D deficiency in Asian countries. This study tries to elucidate the prevalence of vitamin D deficiency and its influencing factors in population of Tehran.

Methods

1210 subjects 20–64 years old were randomly selected. 25 (OH) D serum levels were measured. Duration of exposure to sunlight, the type of clothing and level of calcium intake and BMI were quantified based on a questionnaire.

Results

A high percentage of vitamin D deficiency was defined in the study population. Prevalence of severe, moderate and mild Vitamin D deficiency was 9.5%, 57.6% and 14.2% respectively. Vitamin D serum levels had no significant statistical relation with the duration of exposure to sunlight, kind of clothing and BMI. Calcium intake in the normal vitamin D group was significantly higher than the other groups (714.67 ± 330.8 mg/day vs 503.39 ± 303.1, 577.93 ± 304.9,595.84 ± 313.6). Vitamin D serum levels in young and middle aged females were significantly lower than the older group.

Conclusions

Vitamin D deficiency has a high prevalence in Tehran. In order to avoid complications of vitamin D deficiency, supplemental dietary intake seems essential.     

Following in the footsteps of smallpox: can we achieve the global eradication of measles?

Background  

Although an effective measles vaccine has been available for almost 40 years, in 2000 there were about 30 million measles infections worldwide and 777,000 measles-related deaths. The history of smallpox suggests that achieving measles eradication depends on several factors; the biological characteristics of the organism; vaccine technology; surveillance and laboratory identification; effective delivery of vaccination programmes and international commitment to eradication.     

A prospective comparative study on IVF outcomes with either purified FSH or human menopausal gonadotrophin in downregulated normogonadotrophic women

OBJECTIVE: In compare the use of purified follicle-stimulating hormone with that of a preparation containing follicle-stimulating hormone and luteinizing hormone in infertile females undergoing IVF. DESIGN: Open-labelled prospective controlled single-center study. SETTING: Nile Badrawy IVF unit. PARTICIPANTS: 153 infertile females undergoing their first cycle of IVF divided into 2 groups. Interventions: Ovarian stimulation was done with either highly purified FSH for group 1 (n = 75) or human menopausal gonadotrophin group 2 (n = 78) after pituitary desensitization commenced in the midluteal phase of the preceding cycle. Monitoring was performed by ultrasound transvaginal oocyte retrieval followed by IVF and transfer of three embryos. OUTCOMES: Number of oocytes >18 mm at day of hCG, fertilization rate, embryo transfer rate, clinical pregnancy rate and incidence of ovarian hyperstimulation syndrome. RESULTS: The response to ovarian hyperstimulation was similar in both groups. The number of follicles >18 mm achieved at day of hCG was 12.3 +/- 0.9 (mean +/- SEM) following stimulation with 38.3 +/- 0.9 ampoules of Fostimon The Menogon-treated group needed 39.1 +/- 0.8 ampoules to produce 11.6 +/- 0.7 follicles. Fertilization rate (2PN/cell) was 58.6 vs. 64.2% in the Fostimon and Menogon group, respectively (p > 0.05). The number of embryos transferred per woman was 3.1 +/- 0.1 in the Fostimon group and 3.6 +/- 0.1 in the Menogon group. The pregnancy rate per woman was 33.3 vs. 25.6% in the Fostimon- and Menogon-treated groups, respectively (p > 0.05). Miscarriage rate was 16 vs 20%, respectively. However, the incidence of multiple pregnancies was significantly higher in the Fostimon-treated group (32%) vs. 10% only in the Menogon-treated group (p < 0.01). CONCLUSION: Purified FSH yields similar clinical outcome to hMG in terms of oocytes retrieved and clinical pregnancies in a standard IVF regimen.     

Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy

Objectives:  Repetitive transcranial magnetic stimulation (rTMS) has been shown to improve depressive symptoms. We designed and carried out the following left prefrontal rTMS study to determine the safety, feasibility, and potential efficacy of using TMS to treat the depressive symptoms of bipolar affective disorder (BPAD).
Methods:  We recruited and enrolled 23 depressed BPAD patients (12 BPI depressed state, nine BPII depressed state, two BPI mixed state). Patients were randomly assigned to receive either daily left prefrontal rTMS (5 Hz, 110% motor threshold, 8 sec on, 22 sec off, over 20 min) or placebo each weekday morning for 2 weeks. Motor threshold and subjective rating scales were obtained daily, and blinded Hamilton Rating Scale for Depression (HRSD) and Young Mania Rating Scales (YMRS) were obtained weekly.
Results:  Stimulation was well tolerated with no significant adverse events and with no induction of mania. We failed to find a statistically significant difference between the two groups in the number of antidepressant responders (>50% decline in HRSD or HRSD <10 – 4 active and 4 sham) or the mean HRSD change from baseline over the 2 weeks ( t =−0.22, p=0.83). Active rTMS, compared with sham rTMS, produced a trend but not statistically significant greater improvement in daily subjective mood ratings post-treatment ( t =1.58, p=0.13). The motor threshold did not significantly change after 2 weeks of active treatment ( t =1.11, p=0.28).
Conclusions:  Daily left prefrontal rTMS appears safe in depressed BPAD subjects, and the risk of inducing mania in BPAD subjects on medications is small. We failed to find statistically significant TMS clinical antidepressant effects greater than sham. Further studies are needed to fully investigate the potential role, if any, of TMS in BPAD depression.