Improvement in inner ear blood flow by nitric oxide following experimentally induced cochlear thrombosis in anesthetized guinea pigs

The nitric oxide (NO) donor sodium nitroprusside (SNP) applied to the round window membrane has recently been found to increase cochlear blood flow (CoBF) in normal guinea pigs and in normal and presbyacusic mice. This study examined the effect of topical applications of SNP on experimentally impaired CoBF in anesthetized guinea pigs. Small (3 μl) portions of 3% SNP were applied to the round window niche of both normal and thrombosed cochleas. Local vascular impairment was produced by ferromagnetic thrombosis of cochlear blood vessels and the microcirculation measured using laser Doppler flowmetry. Ferromagnetic thrombosis resulted in a mean decrease of CoBF to 52% of baseline. There was a clear improvement in mean CoBF to 84% of baseline by the topical application of SNP that depended on the degree of ischemic damage produced. Under neuroleptanalgesia and ketamine-xylazine anesthesia, significant increases in CoBF were measured in normal ears as well as in the thrombosed ones. However, several SNP applications were needed to improve the impaired CoBF, while a single portion was sufficient in the normal cochlea to cause a drastic increase in mean CoBF to 234% of baseline. In urethane-anesthetized animals, no flow increase was found despite repeated drug administration. Careful evaluation of the laser Doppler signals was necessary to accurately determine the concentrations of the moving blood cells and their mean velocities. Received: 8 August 1997 / Accepted: 11 February 1998     

Treatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review

Aim

To identify the treatments and interventions available and their impact on people living with schizophrenia in Sub‐Saharan Africa.

Background

Help‐seeking behaviour and the choice of treatment are largely influenced by socio‐cultural factors and beliefs about the causes of mental illness. This review addresses the gap in knowledge regarding the treatment options available to people living with schizophrenia in Sub‐Saharan Africa.

Design

Adapted realist literature review.

Data sources

Electronic databases searched in June 2016 included PubMed, EMBASE, PsycINFO, ProQuest and CINAHL.

Review methods

The adapted realist review approach used to synthesize the published research involved identifying the review aim, searching and selecting relevant studies, extracting, iteratively analysing and synthesizing relevant data and reporting results.

Results

Forty studies from eight countries were reviewed. Most people were treated by both faith/traditional healers and modern psychiatry. Common treatments included antipsychotics, electroconvulsive therapy and psychosocial interventions. Few treatment options were available outside major centres, there was poor adherence to medication and families reported a high level of burden associated with caring for a relative.

Limitations

Major limitations of this review were the lack of studies, variable quality and low level of evidence available from most countries from Sub‐Saharan Africa and lack of generalizability.

Conclusion

People living with schizophrenia in Sub‐Saharan Africa were treated by faith, traditional healers and modern psychiatry, if at all. Further research is needed to better understand the local situation and the implications for caring for people from this region.

Implications for nursing and health policy

Mental health services in Sub‐Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence‐based, person‐centred and culturally relevant mental health services within the primary care context.