Carbamazepine poisoning: treatment with haemodialysis.

Sir, A 32-year-old woman was brought to the emergency room 28 h afteringesting an unknown amount of carbamazepine (probably 150–200tablets containing 200 mg each). She had been taking cabamazepine400 mg twice daily for the past 10 years for symptomatic epilepsyrelated to cerebral arterio-venous malformation. She was unconsciousbut responding to noxious stimuli. She had shallow irregularrespiration     

Post-tonsillectomy bleed: a delayed diagnosis of duodenal ulceration

Post-operative haemorrhage is one of the commonest complications of tonsillectomy. We report a case of a 36-year-old lady who presented with three haemorrhagic episodes following tonsillectomy. Although initially treated as secondary tonsillar haemorrhage, the actual cause of the bleeding was later identified to be a duodenal ulcer. The case is presented with a review of the literature.     

Emblica officinalis exerts wound healing action through up-regulation of collagen and extracellular signal-regulated kinases (ERK1/2)

During wound healing, the wound site is rich in oxidants, such as hydrogen peroxide, mostly contributed by neutrophils and macrophages. Ascorbic acid and tannins of low molecular weight, namely emblicanin A (2,3-di- O -galloyl-4,6-( S )-hexahydroxydiphenoyl-2-keto-glucono-δ-lactone) and emblicanin B (2,3,4,6-bis-( S )-hexahydroxydiphenoyl-2-keto-glucono-δ-lactone) present in Emblica officinalis (emblica), have been shown to exhibit a very strong antioxidant action. We proposed that addition of these antioxidants to the wound microenvironment would support the repair process. The present investigation was undertaken to determine the efficacy of emblica on dermal wound healing in vivo. Full-thickness excision wounds were made on the back of the rat and topical application of emblica accelerated wound contraction and closure. Emblica increased cellular proliferation and cross-linking of collagen at the wound site, as evidenced by an increase in the activity of extracellular signal-regulated kinase 1/2, along with an increase in DNA, type III collagen, acid-soluble collagen, aldehyde content, shrinkage temperature and tensile strength. Higher levels of tissue ascorbic acid, α-tocopherol, reduced glutathione, superoxide dismutase, catalase, and glutathione peroxidase support the fact that emblica application promotes antioxidant activity at the wound site. In summary, this study provides firm evidence to support that topical application of emblica represents a feasible and productive approach to support dermal wound healing.     

Noonan's syndrome with mental retardation presenting with an affective disorder--case report

A 30 year old Chinese lady initially thought to have Turner's Syndrome was rediagnosed as Noonan's Syndrome following admission to a psychiatric hospital for treatment of an Affective Disorder (Hypomania). The genetics and morphological features in Noonan's Syndrome are briefly discussed and the patient's psychiatric presentation is described.     

Depressive symptoms moderate the relationship between sleep quality and cognitive functions among the elderly

Objective: The co-occurrence of sleep problems, cognitive impairment, and depression among the elderly suggests that these three conditions are likely to be interrelated. Recent findings suggest that depressive symptoms moderate the relationship between sleep problems and cognitive impairment in elderly people but methodological problems have led to inconsistent conclusions. The present study aims to better understand the relationship between sleep quality, depressive symptoms, and cognitive function. Method: We administered the Repeatable Battery for the Assessment of Neuropsychological Status and self-report measures of sleep quality and depression to 380 elderly participants (M_age = 68 years, SD= 5.7). Bootstrapped moderation analyses were conducted to examine the role of depressive symptoms in the relationship between sleep and various aspects of cognitive function. Results: This moderation effect was significant in the domains of delayed memory (ΔR² = .01, F = 4.5, p = .04), language (ΔR² = .01, F = 4.6, p = .035), and general cognitive status (ΔR² = .01, F = 5.3, p = .02). However, unlike previous studies, higher sleep quality corresponded to better outcomes in delayed memory, language abilities, and general cognitive status in participants with low levels of depressive symptoms. No significant relationship between sleep quality and any cognitive function was observed among participants with high levels of depressive symptoms. Conclusions: Among individuals who reported low levels of depressive symptoms, sleep quality was positively related to cognitive performance in the domains of delayed recall, language, and general cognitive status. However, sleep quality was not significantly associated with cognitive abilities in these domains among participants with elevated levels of depressive symptoms; participants had relatively poor outcomes in these cognitive domains regardless of their sleep quality.     

Pruritus ani

INTRODUCTION

Pruritus ani is a common condition with many causes, predominately anorectal pathology. There are some new insights and therapies, but the most recommendations are based on low-level evidence.

PATIENTS AND METHODS

A literature search was carried out using Medline and the internet with the keywords ‘pruritus ani’ from 1950 to 2007.

RESULTS

A review of the evidence is presented and a management plan based on the elimination of irritants and scratching, general control measures and active treatment measures is offered.

CONCLUSIONS

Treatment of primary and secondary pruritus ani has a good prospect of regression of symptoms and skin changes.     

Predictive value of p53 and pRb expression in superficial bladder cancer patients treated with BCG and interferon-alpha

BACKGROUND: Nuclear p53 and retinoblastoma protein (pRb) were reported to be poor prognostic indicators for transitional cell carcinoma of the bladder. The authors sought to determine the prognostic value of nuclear p53 and pRb in superficial bladder transitional cell carcinoma patients who were treated with intravesical bacille Calmette-Guerin (BCG) or BCG with interferon-alpha (IFN-alpha). METHODS: A prospective histological review was performed for 80 superficial bladder transitional cell carcinoma patients who underwent postresection intravesical regimes of BCG (81 mg, n = 33 or 27 mg, n = 20) or BCG (27 mg) with IFN-alpha (n = 27), and followed for a mean of 4.5 years. Hematoxylin and eosin (H & E) and immunoperoxidase staining were performed on tissue sections. Nuclear p53 and pRb immunoreactivity were assessed semiquantitatively, by using a combination of staining extent and intensity, to categorize overexpression or underexpression. Data were analyzed by using chi-square analysis, multiple logistic regression, and Kaplan-Meier curves. RESULTS: pRb expression was not associated with patient outcome after BCG-alone therapy, but pRb underexpression was significantly associated with BCG nonresponse and tumor recurrence (P = .047) after BCG and IFN-alpha (BCG + IFN-alpha) therapy. Low-grade tumors were associated with pRb overexpression, with or without nuclear p53 underexpression (P = .019; P = .043, respectively). p53 expression alone or in combination with pRb expression had no significant relation with tumor response to BCG alone or BCG + IFN-alpha with respect to recurrence, progression, or cancer-specific death. CONCLUSIONS: Nuclear pRb underexpression may be predictive of nonresponse and cancer recurrence after intravesical BCG + IFN-alpha therapy. Nuclear p53 expression or its combination with pRb expression is not associated with post-BCG clinical outcome, so p53 expression or p53 with pRb expression should not be used to influence decisions concerning BCG-alone or BCG + IFN-alpha therapy.