Post-traumatic mutism in children: clinical characteristics, pattern of recovery and clinicopathological correlations.

Among the numerous clinical syndromes observed after severe traumatic head injury, post-traumatic mutism is a disorder rarely reported in adults and not studied in any detail in children. We report seven children between the ages of 3 1/2 and 14 years who sustained severe head injury and developed post-traumatic mutism. We aim to give a precise clinical characterization of this disorder, discuss differential diagnosis and correlations with brain imaging and suggest its probable neurological substrate. After a coma lasting from 5 to 25 days, the seven patients who suffered from post-traumatic mutism went through a period of total absence of verbal production lasting from 5 to 94 days, associated with the recovery of non-verbal communication skills and emotional vocalization. During the first days after the recovery of speech, all patients were able to produce correct small sentences with a hypophonic and monotonous voice, moderate dysarthria, word finding difficulties but no signs of aphasia, and preserved oral comprehension. The neurological signs in the acute phase (III nerve paresis in three of seven patients, signs of autonomic dysfunctions in five of seven patients), the results of the brain imaging and the experimental animal data all suggest the involvement of mesencephalic structures as playing a key role in the aetiology of post-traumatic mutism.

Parasite and egg burden, hepatic collagen and histologic pattern of liver granulomas in selection III high and low antibody responder mice infected with Schistosoma mansoni

Selection III mice have particular immunological characteristics: they are high (H III) or low (L III) antibody producer animals, yet both lines display similar T cell responses and macrophage activities. We submittedthese mice to infection with Schistosoma mansoni to assess in vivo parasite and egg burden, hepatic collagen and cellular composition of granulomas in both lines. Titration of anti-Schistosoma IgG by ELISA showed remarkably higher values inH III line, at both studied periods (8th and 12th weeks post-infection). Nevertheless, the number of adult worms recovered from the portal system was similar inboth lines, being not associated with anti-Schistosoma antibody levels. There isan increase in hepatic collagen from the 8th to the 12th weeks post-infection, which is paralleled by an increase in the number of eggs in the liver. This association apparently occurs at the same radio in H III and L III animals. The most important difference found between the two lines was the outstanding contrast interms of volume and eosinophil counts in the granulomas, with lesions from H IIImice clearly being larger and containing more of these cells than LIII lesions.

Daily pattern of flight activity of Aedes albifasciatus in Central Argentina

Aedes albifasciatus is an important common mosquito in Central Argentina. Its a confirmed vector of the Western Equine Encephalitis and is responsible for loss of milk production in dairy cattle during peak populations. This paper reports the flight activity pattern of Ae. albifasciatus for different seasons, in the southern coast of the Mar Chiquita Lake (Central Argentina). Data were collected by sampling two sites between 1992 and 1993 with CDC traps and human-bait captures. Adult mosquito population density, estimated by CDC trapping and human-bait, were highly correlated. However, when compared to other species, the proportion of Ae. albifasciatus was higher in human-bait collections. Adult female populations were active only when temperature were higher than 6§C. Two daily biting peaks were observed (dusk and dawn) during the spring, summer and autumn, and only one peak during winter (around 15:00 pm). Adult abundance was significantly correlated (R²= 0.71; p<0.01) with temperature and illumination.

Effect of diets high or low in unavailable and slowly digestible carbohydrates on the pattern of 24-h substrate oxidation and feelings of hunger in humans.

BACKGROUND: The pattern of substrate utilization with diets containing a high or a low proportion of unavailable and slowly digestible carbohydrates may constitute an important factor in the control, time course, and onset of hunger in humans. OBJECTIVE: We tested the hypothesis that isoenergetic diets differing only in their content of unavailable carbohydrates would result in different time courses of total, endogenous, and exogenous carbohydrate oxidation rates. DESIGN: Two diets with either a high (H diet) or a low (L diet) content of unavailable carbohydrates were fed to 14 healthy subjects studied during two 24-h periods in a metabolic chamber. Substrate utilization was assessed by whole-body indirect calorimetry. In a subgroup of 8 subjects, endogenous and exogenous carbohydrate oxidation were assessed by prelabeling the body glycogen stores with [(13)C]carbohydrate. Subjective feelings of hunger were estimated with use of visual analogue scales. RESULTS: Total energy expenditure and substrate oxidation did not differ significantly between the 2 diets. However, there was a significant effect of diet (P: = 0.03) on the carbohydrate oxidation pattern: the H diet elicited a lower and delayed rise of postprandial carbohydrate oxidation and was associated with lower hunger feelings than was the L diet. The differences in hunger scores between the 2 diets were significantly associated with the differences in the pattern of carbohydrate oxidation among diets (r = -0.67, P: = 0. 006). Exogenous and endogenous carbohydrate oxidation were not significantly influenced by diet. CONCLUSIONS: The pattern of carbohydrate utilization is involved in the modulation of hunger feelings. The greater suppression of hunger after the H diet than after the L diet may be helpful, at least over the short term, in individuals attempting to better control their food intake.

Perioperative visual loss: a rare complication of general surgery

BACKGROUND: Perioperative visual loss (PVL) refers to the loss of vision following surgery performed at distance from the visual pathways. An ischemic optic neuropathy (ION) is the most frequent clinical presentation of PVL, and can be bilateral. PATIENTS AND METHODS: A retrospective chart review of 11 consecutive patients with PVL examined between 2002 and 2007 was undertaken. RESULTS: An ION was found in all 11 cases: 8 were anterior (AION) and 3 were posterior (PION). Visual loss was bilateral in 9 patients. Mean visual acuity (VA) was 0.2 on the Snellen chart (0.74 LogMAR). Most frequently an arcuate/altitudinal visual field defect was present. PVL followed orthopedic (6), spinal (1), cardiac (2) and vascular (2) procedures. The average delay between surgery and visual loss was 32 hours (range: 0-96 hours). Average lowest perioperative hemoglobin level was 75 g/L. Average follow-up time was 14.7 months. VA improved by at least 2 Snellen lines in 5/20 eyes (25 %). CONCLUSIONS: PVL is a rare but dreadful complication of surgery, and is usually associated with severe anemia. Like other causes of ION, there is no specific therapy. Prompt correction of the anemia might decrease the rate of this complication

Evaluation of pilot initiatives undertaken in the North Eastern and South Eastern Health Boards on the provision of General Practitioner out-of-hours services in those areas

To assess the efficiency and effectiveness of the management, administrative and support structures for the General Practitioner out-of-hours pilot projects in the North Eastern and South Eastern Health Boards having regard to value for money and service enhancement considerations Download the Report here

Oviposition activity and seasonal pattern of a population of Aedes (Stegomyia) aegypti (L.) (Diptera: Culicidae) in subtropical Argentina

Monthly oviposition activity and the seasonal density pattern of Aedes aegypti were studied using larvitraps and ovitraps during a research carried out by the Public Health Ministry of Salta Province, in Tartagal, Aguaray and Salvador Mazza cities, in subtropical Argentina. The A. aegypti population was active in both dry and wet seasons with a peak in March, accordant with the heaviest rainfall. From May to November, the immature population level remained low, but increased in December. Ae. aegypti oviposition activity increased during the fall and summer, when the relative humidity was 60% or higher. Eggs were found in large numbers of ovitraps during all seasons but few eggs were observed in each one during winter. The occurrence and the number of eggs laid were variable when both seasons and cities were compared. The reduction of the population during the winter months was related to the low in the relative humidity of the atmosphere. Significant differences were detected between oviposition occurrences in Tartagal and Aguaray and Salvador Mazza cities, but no differences in the number of eggs were observed. Two factors characterize the seasonal distribution pattern of Ae. aegypti in subtropical Argentina, the absence of a break during winter and an oviposition activity concomitant of the high relative humidity of the atmosphere.

Acute Gastroenteritis in Ireland, North and South - A Study of General Practitioners

The principal aim of this study was to describe general practitioners management of patients with acute infectious gastroenteritis

Seasonal pattern of abundance of Aedes aegypti (Diptera: Culicidae) in Buenos Aires city, Argentina

In Buenos Aires, the most crowded city of Argentina, there is a potential risk of dengue virus transmission by the mosquito Aedes aegypti during late summer. The temporal patterns of oviposition activity and abundance of breeding sites of this vector were studied in two cemeteries of the city. Between September 1998 and August 1999, we examined 142 ovitraps weekly and a total of 18,010 water-filled containers. Both study areas showed remarkable differences in the percentages of positive ovitraps (19% vs 8%) and breeding sites (18% vs 1%), but similar temporal abundance patterns. The percentage of breeding sites was higher in summer and autumn than in spring and winter, and the percentage of positive ovitraps was higher in summer than in the other three seasons. Immatures were recorded from the first week of October to the second week of July, and oviposition activity from the third week of October until the end of April. In both cemeteries and with both methodologies the highest infestation levels were registered in March (ovitraps: 41.8% and 20.6%, breeding sites: 39.2% and 3.4%). These highest abundances took place after several months with mean temperatures above 20ºC and accumulated rainfalls above 150 mm. A sharp decline in oviposition activity was observed when monthly mean temperature decreased to 16.5ºC, and no eggs were found below 14.8ºC. Seasonal fluctuation of Ae. aegypti abundances in mid-latitudes like Buenos Aires would allow reduction of the egg mosquito population through the elimination of containers during the coldest months, which are free of adults.

A Study to Examine the Attitudes of General Practitioners Towards Drug Users in the North East Region of Ireland

The research examines general practitioners attitudes and how these effect the management of drug misusers within their practice. The methodology is quantitative in approach. The instrument used is a structured postal questionnaire. Participants include all general practitioners within the North East region of Ireland. Anonymity and confidentiality of all respondents are guaranteed. Data was collected over a six week period, under the following headings - attitudes and beliefs, factors influencing treatment, treatment options, training and demographics. Attitudes and beliefs towards drug users were measured using a five point Likert scale ranging from strongly agrees to strongly disagree. The data was analysed with the aid of a computer package, SPSS allowing descriptive statistics to be presented. Results indicate that the majority of respondents are male. There appears to be sympathy towards drug users and that treatment approaches should be holistic. However, there appears to be a major lack of confidence in treating and managing drug misusers. Patient, social and practice factors all influence the decision to the drug misuser. Treatment options are varied, ranging from methadone maintenance to referral for residential treatment. However, a number of respondents offer no treatment for drug misusers. General practitioners do not feel adequately trained in treating and/or managing this client group. Results indicate that improved communication, ongoing education and more research is needed in this area.This resource was contributed by The National Documentation Centre on Drug Use.

A Study on the Feasibility of the Inclusion of General Practitioners and Prisons in the National Drug Treatment Reporting System: Plan for the Implementation of the NDTRS in Prison and GP Services

The Drug Misuse Research Division of the Health Research Board operates the National Drug Treatment Reporting System (NDTRS). The system is used to provide epidemiological information on treated problem drug misuse in Ireland and informs policy makers, researchers and the general public. The NDTRS collates data from participating treatment centres in all Health Board areas, however a gap in information exists in that drug misusers in treatment units within prisons and those treated by General Practitioners are not included. This study aims to determine the feasibility of including these two groups to increase coverage of the NDTRS and outlines preliminary steps for their inclusion.This resource was contributed by The National Documentation Centre on Drug Use.

Dispersal pattern of the sand fly Lutzomyia neivai (Diptera: Psychodidae) in a cutaneous leishmaniasis endemic rural area in Southeastern Brazil

The dispersal pattern of the sand fly Lutzomyia neivai was studied through mark-release-recapture experiments in an American cutaneous leishmaniasis endemic rural area in Southeastern Brazil. Over 6500 specimens were marked with fluorescent powder and released in forest edge and peridomicile habitats from August to November 1999, February and April 2000. Recapture attempts were made using Shannon and CDC traps up to eight successive nights after releases. A total of 493 (7.58%) specimens were recaptured. The number of recaptured males and females of L. neivai in CDC traps was not affected by the distance between the trap and the release points. Approximately 90% of males and females recaptured in CDC traps were caught up to 70 m from the release points. The maximum female flight range recorded was 128 m. The average flight range per day was less than 60 m for males and females. Of the flies released in forest edge, approximately 16% of the recaptured females were caught in Shannon traps in the peridomicile habitat. The results indicate that the movements of L. neivai are spatially focal and the possibility of dispersion from forest to peridomicile habitat may be an important way of contracting leishmaniasis in dwellings.

Comparative transcriptomics of rice reveals an ancient pattern of response to microbial colonization.

Glomalean fungi induce and colonize symbiotic tissue called arbuscular mycorrhiza on the roots of most land plants. Other fungi also colonize plants but cause disease not symbiosis. Whole-transcriptome analysis using a custom-designed Affymetrix Gene-Chip and confirmation with real-time RT-PCR revealed 224 genes affected during arbuscular mycorrhizal symbiosis. We compared these transcription profiles with those from rice roots that were colonized by pathogens (Magnaporthe grisea and Fusarium moniliforme). Over 40% of genes showed differential regulation caused by both the symbiotic and at least one of the pathogenic interactions. A set of genes was similarly expressed in all three associations, revealing a conserved response to fungal colonization. The responses that were shared between pathogen and symbiont infection may play a role in compatibility. Likewise, the responses that are different may cause disease. Some of the genes that respond to mycorrhizal colonization may be involved in the uptake of phosphate. Indeed, phosphate addition mimicked the effect of mycorrhiza on 8% of the tested genes. We found that 34% of the mycorrhiza-associated rice genes were also associated with mycorrhiza in dicots, revealing a conserved pattern of response between the two angiosperm classes.