Pemphigus vulgaris

Pemphigus vulgaris is a chronic autoimmune mucocutaneous disease that initially manifests in the form of intraoral lesions, which spread to other mucous membranes and the skin. The etiology of pemphigus vulgaris is still unknown, although the disease has attracted considerable interest. The pemphigus group of disease is characterized by the production of autoantibodies against intercellular substances and is thus classified as autoimmune diseases. Most patients are initially misdiagnosed and improperly treated for months or even years. Dental professionals must be sufficiently familiar with the clinical manifestations of pemphigus vulgaris to ensure early diagnosis and treatment, since this in turn determines the prognosis and course of the disease. This article presents a case report with unknown etiology along with an overview of the disease.     

Impact of community-based immunization services

The knowledge, attitude and practice of mothers toward childhood immunization was surveyed in 2 neighborhoods in greater Bombay, India. The areas were a slum of 75,000 called Malavani, and a nearby area called Kharodi. Measles and triple (DPT or DPV) vaccines were available at local health centers, 1.5 km away at the most; oral polio vaccines were given by field workers to the Malavani community to children in their homes, but only in the center for those in Kharodi. BCG tuberculosis vaccinations were available to all, but from a center 5 km away. Malavani mothers had significantly better knowledge of triple and measles vaccines, but knowledge about BCG was similar in the 2 groups. Slightly more women from Kharodi expressed negative attitudes toward immunization. Coverage of children, established from clinic records, was significantly better in the Malavani area: 91% vs. 58% for polio; 71% vs 61% for BCG (n.s.); 85% vs. 55% for triple vaccine; and 21% vs 1% for measles. Evidently, visitation by field teams with polio vaccinations affected mothers' knowledge and practice for other immunizations available only at the center.     

Delirium in the postoperative cardiac patient: a review

BACKGROUND AND AIM OF REVIEW: Cardiac surgery is increasingly common and relatively safe, but there are frequent reports of neuropsychiatric sequelae occurring in the postoperative period. One of the most common neuropsychiatric presentations of cardiac surgery is delirium, also called postcardiotomy delirium (PCD). Despite the vast numbers of cardiac surgeries performed today, there is a paucity of data on risk factors and management options of PCD available to the clinician. This review aims to summarize available information, increase clinicians' awareness of PCD and suggest effective management of this illness. METHODS: Our literature search was completed using the databases Medline and CINAHL; it was limited to human and English language studies from 1964 to the present. Search terms included "delirium," "agitation," "postoperative," "cardiac," "neuropsychiatric," "neuroleptics," "psychosis," "surgery," "treatment," "postcardiotomy," and "pharmacotherapy." RESULTS: Our review of the literature revealed several risk factors for PCD, as well as various options for its pharmacological management. CONCLUSIONS: A multifactorial model should be applied when considering risk stratification for and prevention of delirium postoperatively. Pharmacologically, conventional antipsychotic agents, such as haloperidol, have long been used to manage delirium. In light of haloperidol's side effects, particularly those applicable to the cardiac patient, further research is required into the role of second generation antipsychotics. These agents are common in clinical use, and may be the preferred medications.     

Treatment of agitation following traumatic brain injury: a review of the literature

Agitation, restlessness, and aggression are frequent neurobehavioural sequelae in the early stages of recovery from traumatic brain injury (TBI). These behavioural symptoms disrupt patient care and impede rehabilitation efforts. We review the current literature (1985 onwards) examining the pharmacological management of post-TBI agitation in both acute and post-acute conditions. This article will assess the evidence for the use of selected alkylphenols, benzodiazepines, estrogens, antiandrogens, neuroleptics/antipsychotics, antidepressants, anti-Parkinsonian agents, antipsychotics, anticonvulsants, lithium carbonate, buspirone, beta-blockers, and psychostimulants in agitated TBI survivors. Review of the literature suggests that there is limited evidence to accurately guide clinicians in the management of this patient population.