The alcohol withdrawal syndrome

The alcohol withdrawal syndrome (AWS) is a set of signs and symptoms that typically develops in alcohol-dependent people within 6–24 h of their last drink. It may occur unintentionally if abstinence is enforced by illness or injury, or deliberately if the person voluntarily stops drinking because of an alcohol-related illness, or as a prelude to becoming and remaining abstinent. The signs and symptoms of the syndrome (panel) are largely, but not exclusively, those of autonomic hyperactivity, the reverse of the effects of alcohol intoxication. They represent a homoeostatic readjustment of the central nervous system (CNS) to the neuroadaptation that occurs with prolonged alcohol intoxication.1 RC Turner, PR Lichstein and JG Peden et al., Alcohol withdrawal syndromes: a review of pathophysiology, clinical presentation and treatment, J Gen Intern Med 4 (1989), pp. 432–444. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (39)1 They vary in severity from mild to severe.1

Helminth parasite communities of the water-rat, Hydromys chrysogaster, from Queensland

The helminth fauna from 124 water-rats, Hydromys chrysogaster, collected from 33 localities in Queensland was analysed. A total of 45 species of helminths was found, comprising 2 acanthocephalans, 2 cestodes, 13 nematodes and 28 trematodes. The helminth community of the water-rats in the region north of latitude 18 degrees (far north) was different from that of water-rats south of 18 degrees (central); Sorensen's Index 45.8% similarity, whereas Holmes and Podesta's Index gave 32.1% similarity. Comparisons with data from water-rats from southern and Tasmanian regions showed that they were different from each other and from both Queensland regions. The helminth communities were characterised by high diversity, dominated by trematodes in the central and Tasmanian regions, but with nematodes becoming more prominent in the far northern and southern regions. No core or secondary species were found in the Queensland helminth communities, the southern community was suggestive of a bimodal distribution and the Tasmanian had two core species. A checklist of helminth species occurring in water-rats from eastern Australia is provided.

Endometrial leukemia inhibitory factor as a predictor of pregnancy after in vitro fertilization

Objective: To determine whether there is an association between endometrial expression of leukemia inhibitory factor (LIF) in the luteal phase of the menstrual cycle preceding in vitro fertilization (IVF) and treatment outcome. Methods: Biopsy specimens from the endometria of 52 women in the luteal. phase were immunostained against LIF Embryo culture and transfer were done according to standard procedures. Results: Clinical pregnancy occurred in 39% of the women following IVF, and strong endometrial immunohistochemical staining for LIF was associated with pregnancy (P=0.01). The women with a strong LIF expression had a 6.4-fold higher chance of becoming pregnant than those with weaker intensities (P=0.005). Conclusion: Endometrial expression of LIF during the luteal phase can be used as a predictor of IVF success. (C) 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Alcohol consumption in homicide victims in the city of Sao Paulo

Aims To assess the association between alcohol use and victimization by homicide in individuals autopsied at the Institute of Legal Medicine in Sao Paulo, Brazil. Design Cross-sectional study. Setting Excessive consumption of alcohol is a serious public health issue and a major factor in triggering violent situations, which suggests a strong association between alcohol ingestion and becoming a victim of homicide. Participants Data from 2042 victims of homicides in 2005 were obtained from medical examiner reports. Measurements The victim`s gender, age, ethnicity and blood alcohol concentration (BAC) were collected. The method of death and homicide circumstances, as well as the date, time and place of death were also studied. Findings Alcohol was detected in blood samples of 43% of the victims, and mean BAC levels were 1.55 +/- 0.86 g/l. The prevalence of positive BAC levels was higher among men (44.1%) than women (26.6%), P < 0.01. Firearms caused most of the deaths (78.6%), and alcohol consumption was greater among victims of homicide by sharp weapons (P < 0.01). A greater proportion of victims with positive BAC were killed at weekends compared to weekdays (56.4 and 38.5%, respectively; P < 0.01), and the correlation between homicide rates and the average BAC for the central area of the city was positive (r(s) = 0.90; P < 0.01). Conclusions These results highlight alcohol as a contributing factor for homicide victimization in the greatest urban center in South America, supporting public strategies and future research aiming to prevent homicides and violence related to alcohol consumption.

Training in oncoplastic surgery: An international consensus. The 7th Portuguese Senology Congress, Vilamoura, 2009

Oncoplastic Breast Surgery (OPBS) is becoming an integral part of breast cancer management, but few surgeons have received formal training in these techniques. An International Symposium has recently debated the key issues which impact on training and specialisation in OPBS, as well as patient access to these procedures. The Symposium concluded that increasing the availability of OPBS is a major challenge, which demands much closer collaboration and cooperation between breast and plastic surgeons, backed up by new training schemes, new curricula and new guidelines. (C) 2010 Elsevier Ltd. All rights reserved.

Relationship Between Blood Pressure and Anthropometry in a Cohort of Brazilian Men: A Cross-Sectional Study

BACKGROUND Hypertension, a risk factor for cardiovascular diseases, and obesity are becoming a health problem in many developed and developing countries, as Brazil. Although hypertension and obesity are both closely associated, there is no universal anthropometric marker of this association. This is probably due to distinct population characteristics, and in the case of Brazil, the highly heterogeneous population. We evaluated which anthropometric measurement closely relates to high blood pressure in a sample of Brazilian factory workers. METHODS A cross-sectional study was designed. In this study, multiple logistic regression and receiver operating characteristics analysis were performed in order to obtain the precise relevance of each anthropometric measurement as a blood pressure marker. Nine hundred and thirteen men, 36 +/- 8 years-old, were submitted to a standardized questionnaire of demographic and risk factors knowledge, anthropometric and conventional blood pressure measurements were taken, and blood sample evaluations of glucose, total cholesterol, LDL-Cholesterol, and triglycerides were performed. RESULTS Overweightness or obesity was identified in 64, 11.1% were smokers and hypertension was detected in 29.2% of the participants. A linear correlation was significant (P < 0.001) between both the systolic and diastolic blood pressure and all anthropometric measurements, except for the systolic blood pressure and waist-to-hip ratio. Waist circumference (WC) was the only independent anthropometric measurement related to hypertension. Hypertensive patients presented all anthropometric measurements larger than normotensives. CONCLUSIONS Age and WC were the only independent predictors of hypertension, indicating that this simple measurement may be useful as a marker of hypertension in the Brazilian male, younger adult population. Am J Hypertens 2009; 22:980-984 (C) 2009 American Journal of Hypertension, Ltd.

Chagas disease

Chagas disease is a chronic, systemic, parasitic infection caused by the protozoan Trypanosoma cruzi, and was discovered in 1909. The disease affects about 8 million people in Latin America, of whom 30-40% either have or will develop cardiomyopathy, digestive megasyndromes, or both. In the past three decades, the control and management of Chagas disease has undergone several improvements. Large-scale vector control programmes and screening of blood donors have reduced disease incidence and prevalence. Although more effective trypanocidal drugs are needed, treatment with benznidazole (or nifurtimox) is reasonably safe and effective, and is now recommended for a widened range of patients. Improved models for risk stratification are available, and certain guided treatments could halt or reverse disease progression. By contrast, some challenges remain: Chagas disease is becoming an emerging health problem in non-endemic areas because of growing population movements; early detection and treatment of asymptomatic individuals are underused; and the potential benefits of novel therapies (eg, implantable cardioverter defibrillators) need assessment in prospective randomised trials.

Nanoscale Oxidative Patterning of Metallic Surfaces to Modulate Cell Activity and Fate

In the field of regenerative medicine, nanoscale physical cuing is clearly becoming a compelling determinant of cell behavior. Developing effective methods for making nanostructured surfaces with well-defined physicochemical properties is thus mandatory for the rational design of functional biomaterials. Here, we demonstrate the versatility of simple chemical oxidative patterning to create unique nanotopographical surfaces that influence the behavior of various cell types, modulate the expression of key determinants of cell activity, and offer the potential of harnessing the power of stem cells. These findings promise to lead to a new generation of improved metal implants with intelligent surfaces that can control biological response at the site of healing.

Compartmentalization of Ras proteins

The Ras GTPases operate as molecular switches that link extracellular stimuli with a diverse range of biological outcomes. Although many studies have concentrated on the protein-protein interactions within the complex signaling cascades regulated by Ras, it is becoming clear that the spatial orientation of different Ras isoforms within the plasma membrane is also critical for their function. H-Ras, N-Ras and K-Ras use different membrane anchors to attach to the plasma membrane. Recently it has been shown that these anchors also act as trafficking signals that direct palmitoylated H-Ras and N-Ras through the exocytic pathway to the cell surface but divert polybasic K-Ras around the Golgi to the plasma membrane via an as yet-unidentified-route. Once at the plasma membrane, H-Ras and :K-Ras operate in different microdomains. K-Ras is localized predominantly to the disordered plasma membrane, whereas H-Ras exists in a GTP-regulated equilibrium between disordered plasma membrane and cholesterol-rich lipid rafts. These observations provide a likely explanation for the increasing number of biological differences being identified between the otherwise highly homologous Ras isoforms and raise interesting questions about the role membrane microlocalization plays in determining the interactions of Ras with its effecters and exchange factors.

Living with under-fives: a programme for parents with a mental illness

Parenthood is considered a major life role. Yet for people with a major mental illness, it is one that is fraught with difficulties and for which they receive the least support. Research on parenting and parenting programmes for people with a major mental illness is sparse and most of the papers presented do not provide a working model that can be easily replicated. This lack of support for parents or knowledge of working parenting programmes has often resulted in children being placed in care. Occupational therapists working in an Australian mental health service developed a two-stream programme which aimed to consolidate the parent/child relationship and enable the parents to develop effective parenting skills. This programme has a parents' educational stream and a stream with developmentally appropriate activities for the children. Observed outcomes have included the parents becoming more responsive to their children, increased treatment compliance, improved community access, and a decrease in the number of children in temporary foster care.

Concepts for critical appraisal of an original research paper.

With the ever-growing evidence base it is more difficult to keep abreast of relevant issues in health care. Studies are also becoming more complex in order to address specific research and clinical questions. Appropriate interpretation of these studies is paramount to a progressive practice in health care. This article presents an intellectual framework for the critical appraisal of an original research article. (author abstract)

Design of clinical pharmacology trials

1. There are a variety of methods that could be used to increase the efficiency of the design of experiments. However, it is only recently that such methods have been considered in the design of clinical pharmacology trials. 2. Two such methods, termed data-dependent (e.g. simulation) and data-independent (e.g. analytical evaluation of the information in a particular design), are becoming increasingly used as efficient methods for designing clinical trials. These two design methods have tended to be viewed as competitive, although a complementary role in design is proposed here. 3. The impetus for the use of these two methods has been the need for a more fully integrated approach to the drug development process that specifically allows for sequential development (i.e. where the results of early phase studies influence later-phase studies). 4. The present article briefly presents the background and theory that underpins both the data-dependent and -independent methods with the use of illustrative examples from the literature. In addition, the potential advantages and disadvantages of each method are discussed.

Issues in Australian Foreign Policy January to June 2001

The first half of 2001 saw traditional issues dominating the foreign policy agenda, with both Australia's relationship with the United States and the policy of Asian engagement still holding centre stage. But those old issues generated fresh anxieties. In the United States, the incoming Bush administration displayed a genuine radicalism in its approach to foreign policy, and that raised concerns in many Western capitals — including Canberra — about a new mood of unilateralism in Washington. At the same time, the emergence of the thesis that Australia was becoming a "branch office economy", where key decisions were taken in the capital markets of New York and London, made the government noticeably more cautious and selective in its endorsement of globalisation. Further, the issue of Asian engagement grew steadily more complex: Australian policy-makers searched unsuccessfully for a new focus for the policy of Asian engagement, as Japan's economy wallowed and Indonesia's democratic government tottered.

A new approach for detecting and mapping sewage impacts

Increased nitrogen loading has been implicated in eutrophication occurrences worldwide. Much of this loading is attributable to the growing human population along the world's coastlines. A significant component of this nitrogen input is from sewage effluent, and delineation of the distribution and biological impact of sewage-derived nitrogen is becoming increasingly important. Here, we show a technique that identifies the source, extent and fate of biologically available sewage nitrogen in coastal marine ecosystem. This method is based on the uptake of sewage nitrogen by marine plants and subsequent analysis of the sewage signature (elevated delta N-15) in plant tissues. Spatial analysis is used to create maps of delta N-15 and establish coefficient of variation estimates of the mapped values. We show elevated delta N-15 levels in marine plants near sewage outfalls in Moreton Bay, Australia, a semi-enclosed bay receiving multiple sewage inputs. These maps of sewage nitrogen distribution are being used to direct nutrient reduction strategies in the region and will assist in monitoring the effectiveness of environmental protection measures. (C) 2001 Elsevier Science Ltd. All rights reserved.

Presentations of physical illness in people with developmental disability: the example of gastro-oesophageal reflux

People with developmental disabilities are becoming an important part of the general practice population. Although they have a similar range of medical conditions to the general population, there are some important differences in prevalence, risk factors, presentation and management of particular conditions. We use gastro-oesophageal reflux to illustrate how developmental disability may affect the presentation, assessment and management of a common condition.