Electromyographic and affective responses of episodic tension-type headache patients and headache-free controls during stressful task performance

Thirty-four subjects meeting diagnostic criteria for episodic tension-type headache and 42 who rarely experienced headaches participated in two laboratory sessions in which cephalic electromyographic (EMG) activity, electrodermal activity, heart rate, and finger temperature were recorded. Subjects performed relaxation, choice reaction time, psychomotor tracking, voluntary muscle contraction, and cold pressor tasks. Headache subjects showed significantly greater EMG activity than controls during baseline and stressful task performance. During relaxation, both groups reduced EMG activity from baseline levels, and there was no significant difference in EMG level between the groups during relaxation. Headache subjects reported higher levels of subjective anxiety, depression, anger, and stress than controls. Headache subjects also reported higher levels of pain than controls, and headache subjects reported greater pain during stressful task performance relative to baseline and recovery periods.This research was supported by NIH Grant R01-NS-25114.     

Altered NMDA glutamate receptor antagonist response in recovering ethanol-dependent patients.

Ethanol is an antagonist of the N-methyl-D-aspartate (NMDA) glutamate receptor. Ethanol dependence upregulates NMDA receptors and contributes to crosstolerance with selective NMDA receptor antagonists in animals. This study evaluated whether recovering ethanol-dependent patients show evidence of a reduced level of response to the effects of the NMDA receptor antagonist, ketamine. In this double-blind study, 34 recently detoxified alcohol-dependent patients and 26 healthy comparison subjects completed 3 test days involving a 40-min infusion of saline, ketamine 0.1 mg/kg, or ketamine 0.5 mg/kg in a randomized order. Recovering ethanol-dependent patients showed reduced perceptual alterations, dysphoric mood, and impairments in executive cognitive functions during ketamine infusion relative to the healthy comparison group. No attenuation of ketamine-induced amnestic effects, euphoria, or activation was observed. The alterations in NMDA receptor function observed in recovering ethanol-dependent patients may have important implications for ethanol tolerance, ethanol dependence, and the treatment of alcoholism.     

Diagnostic specificity and familiality of early versus late evoked potentials to auditory paired stimuli across the schizophrenia‐bipolar psychosis spectrum

Disrupted sensory processing is a core feature of psychotic disorders. Auditory paired stimuli (PS) evoke a complex neural response, but it is uncertain which aspects reflect shared and/or distinct liability for the most common severe psychoses, schizophrenia (SZ) and psychotic bipolar disorder (BDP). Evoked time‐voltage/time‐frequency domain responses quantified with EEG during a typical PS paradigm (S1‐S2) were compared among proband groups (SZ [n = 232], BDP [181]), their relatives (SZrel [259], BDPrel [220]), and healthy participants (H [228]). Early S1‐evoked responses were reduced in SZ and BDP, while later/S2 abnormalities showed SZ/SZrel and BDP/BDPrel specificity. Relatives' effects were absent/small despite significant familiality of the entire auditorineural response. This pattern suggests general and divergent biological pathways associated with psychosis, yet may reflect complications with conditioning solely on clinical phenomenology.     

The impact of clinical pharmacist and ID intervention in rationalization of antimicrobial use

What is known and objective

There is little research on the impact of implementing and monitoring antimicrobial policy in Saudi hospitals. The purpose of this study is to measure the impact of the clinical pharmacist (CP) and infectious disease consultant (ID) interventions on the use of three antimicrobials (caspofungin, imipenem, meropenem) in hospitalized patients in the King Abdullah Medical City hospital.

Methods

The study was carried out in the King Abdullah Medical City, in Mekkah, Saudi Arabia. The hospital is a tertiary center that provides CCU, CSICU, Cardiac, Hematology, ICU, Medical, Neuroscience, Oncology, and specialized surgery services. The use of three antimicrobials (caspofungin, imipenem, meropenem) was reviewed by the clinical pharmacist for four periods, pre and post implementation of policy. Relevant data were collected in four periods. In the first period, before policy implementation, data were collected retrospectively to be used as baseline status reference, and in the three remaining periods that followed data were collected prospectively, and compared to baseline data, to evaluate the role of clinical pharmacist and ID interventions in optimizing antimicrobial therapy.

Results and discussion

Caspofungin duration of therapy was not affected significantly by the intervention. Statistically significant reduction in antimicrobial therapy duration was observed in imipenem (37%) and meropenem (37%) from baseline, which indicate a better control on antimicrobial use and reduction in antimicrobial resistance.

What is new and conclusion

The impact of the clinical pharmacist and ID interventions, in reducing antimicrobial therapy duration using imipenem and meropenem, is clear from the result presented above. However, lack of restriction and follow up in the antimicrobial policy in case of negative culture makes antimicrobial use uncontrollable in these cases. Establishing good and accepted policy may help reduce consumption and total cost of therapy.     

Development and in vivo evaluation of chitosan nanoparticles for the oral delivery of albumin

Albumin is used as a plasma expander in critically ill patients and for several other clinical applications mainly via intravenous infusion. Oral administration of albumin can improve patient compliance although limited oral bioavailability of proteins is still a major challenge. Although nanomaterials have been extensively utilized for improving oral delivery of proteins, albumin has been utilized only as either a model drug or as a carrier for drug delivery. In the current study, for the first time, chitosan nanoparticles have been developed and extensively optimized to improve oral bioavailability of albumin as a therapeutic protein. Several characterizations have been performed for the albumin-loaded nanoparticles (e.g. drug encapsulation efficiency, DSC, FTIR, particle size, zeta potential, morphology, release kinetics, and enzymatic stability). Nanosized spherical particles were prepared and demonstrated high stability over three months either in a powdered form or as suspensions. Sustained release of albumin over time and high enzymatic stability as compared to the free albumin were observed. In vivo, higher serum concentrations of albumin in normal rabbits and cirrhotic rats were attained following oral and intraperitoneal administrations of the albumin-loaded nanoparticles as compared to the free albumin. The nanoparticles developed in the current study might provide efficient nanovehicles for oral administration of therapeutic albumin.     

Normative data for the unquantified EEG: examination of adequacy for neuropsychiatric research

Visual inspection of the unquantified electroencephalogram (EEG) remains the sole technique to confidently detect epileptiform discharges. Usefulness of this procedure in psychiatric research is hampered by reported prevalence of abnormalities in normal adults ranging from 4% to 57.5%. In this study, we examined the criteria used in available literature for selecting healthy individuals. Medline, PsychInfo, and textbook chapters were the primary sources for data. Analysis was restricted to studies examining the visual inspection of the EEG in humans. Thirty-eight articles met search criteria. Seven criteria for choosing healthy comparison subjects were used as the bases for this review. The majority of studies met no criteria, one criterion or two criteria. We conclude that the boundaries for normal unquantified EEG are poorly defined.     

Sensory gating deficits during the mid-latency phase of information processing in medicated schizophrenia patients

Sensory gating during preattentive phases of information processing has been extensively examined. Sensory gating processes that occur during subsequent phases of information processing have not been fully examined. The relationship between P50 sensory gating and schizophrenia symptoms remains underspecified and the clinical correlates of N100 and P200 gating are yet to be examined. Sensory gating indices derived from the mid-latency auditory evoked responses during preattentive (P50) and attentive (N100, P200) phases of information processing were collected from schizophrenia patients who were stable and mainly being treated with atypical antipsychotic medications (n=23) and age- and gender-matched healthy control subjects (n=23). Schizophrenia patients had demonstrable habituation or sensory gating difficulties throughout the mid-latency range of information processing. Moreover, we found no correlations between P50-derived sensory gating indices and the amplitude or latency of the more attention-related P300 evoked response. A number of N100 and P200 gating measures correlated with P300 variables. Finally, we found no correlations between sensory gating indices and schizophrenia symptoms clusters. These results suggest that sensory gating is a pervasive abnormality in schizophrenia patients that is not limited to the preattentive phase of information processing. Furthermore, the data suggest that N100 and P200 gating indices may influence subsequent information processing.     

Generators of the intracranial P50 response in auditory sensory gating

Clarification of the cortical mechanisms underlying auditory sensory gating may advance our understanding of brain dysfunctions associated with schizophrenia. To this end, data from nine epilepsy patients who participated in an auditory paired-click paradigm during pre-surgical evaluation and had grids of electrodes covering temporal and frontal lobe were analyzed. A distributed source localization approach was applied to the intracranial P50 response and the Gating Difference Wave obtained by subtracting the response to the second stimuli from the response to the first stimuli. Source reconstruction of the P50 showed that the main generators of the response were localized in the temporal lobes. The analysis also suggested that the maximum neuronal activity contributing to the amplitude reduction in the P50 time range (phenomenon of auditory sensory gating) is localized at the frontal lobe. Present findings suggest that while the temporal lobe is the main generator of the P50 component, the frontal lobe seems to be a substantial contributor to the process of sensory gating as observed from scalp recordings.     

Validation of an Egyptian Arabic Version of Skindex-16 and Quality of Life Measurement in Egyptian Patients with Skin Disease

Purpose

To translate and cross-culturally adapt the Skindex-16, a brief skin-disease-specific QoL questionnaire, into Arabic for Egyptians and to evaluate its measurement properties in Egyptian patients with skin disease.

Method

Translation and cultural adaption were performed following guidelines for cross-cultural adaption of health-related quality of life measures. Subsequently, Skindex-16 was administered to 500 consecutive dermatological patients and 500 healthy persons for verification of its reliability and validity. Next, we examined the effect of skin disorders on QoL as well as influences of age, sex, socioeconomic level, education, and use of medication on skin disease-related QoL.

Results

The instrument showed high internal consistency reliability and good construct and content validity. The quality of life was most deteriorated in the emotional domain followed by symptoms domain (mean percentage score 55.5 ± 23.1 and 31.7 ± 26.8 respectively), while functioning was the least affected domain (mean percentage score 29.1 ± 26.8). Higher total Skindex-16 scores were observed for patients with psoriasis, urticaria, acne, and atopic dermatitis than those with vitiligo and alopecia areata. Educational level, social class, medication use, and family history influenced the impact of skin disease on overall QoL.

Conclusion

The adapted Egyptian Arabic version of Skindex-16 is valid and reliable; it showed that skin problems had a clinically significant impact on QoL in Egyptian patients.

     

The Effects of Psychological Stress on Electromyographic Activity and Negative Affect in Ambulatory Tension-Type Headache Patients

Fourteen female dental hygiene students (seven with episodic tension-type headache and seven who rarely or never experienced headache) wore an ambulatory electromyographic recorder and completed hourly subjective ratings of pain and negative affective states for six days while they carried out their normal daily activities. Three of the days were designated as high stress days by virtue of the fact that the students were required to take a major course examination or undergo a clinical evaluation on that day. The remaining three days were designated as low stress days by virtue of the fact that no unusual demands were made on the students, and they simply attended lectures as usual. All students showed significantly greater levels of electromyographic activity on the high stress days compared to the low stress days, but there was not a statistically significant difference between the headache and control groups. Headache group subjects reported significantly higher levels of pain compared to the control group, but their pain ratings did not differ between high and low stress days. Subjective ratings of negative affective states (anxiety, anger, sadness, and frustration) were significantly greater on high stress days compared to low stress days. Headache group subjects also exhibited a tendency to report higher levels of negative affective states than did control group subjects, but only in the case of frustration was the .05 level of statistical significance achieved.