Seizure disorders among relatives of Kenyan children with severe falciparum malaria

PURPOSE

The cause of seizures in children with falciparum malaria is unclear. In malaria endemic areas, children who develop severe falciparum malaria with seizures may have a genetically higher risk of epilepsy or febrile seizures. We used the history of seizures in relatives of children previously admitted with malaria to determine if there is evidence for a familial predisposition of seizures in children admitted with malaria and seizures or cerebral malaria.

METHODS

Family history of seizures were obtained from the parents/guardians of 81 children (35 children previously admitted with severe malaria and 46 children matched for age who had not been admitted with severe malaria). Data were collected on frequency, duration, age of onset, presence of fever and causes of seizures.

RESULTS

The prevalence of seizures in the relatives of children not admitted with severe malaria was 4.3%, of whom 2.2% had a history of seizures compatible with febrile seizures, and 1.1% with epilepsy. Overall the odds ratio (OR) for relations of children admitted with malaria, to have a seizure disorder was 1.41 [95% confidence interval (CI) 1.06-1.88]. There was a significant risk of the relatives dying if they had epilepsy [relative risk 1.88 (95% CI 1.11-3.19)], but not for other seizure disorders (i.e. febrile, single or unclassifiable seizures).

CONCLUSION

Relatives of children admitted with severe falciparum malaria are more likely to have a seizure disorder compared with controls, but it is unclear if this is because of a genetic propensity or caused by exogenous factors such as malaria.

Formative evaluation of a multimedia program for patients about the side effects of cancer treatment

Formative evaluation of multimedia programs can prevent costly and time-consuming revisions and result in more effective programs. Yet systematic formative evaluation is seldom conducted. This paper reviews the basic principles of formative evaluation and describes how we applied those principles to the formative evaluation of a multimedia program for patients about the side effects of cancer treatment. It discusses the challenges of developing multimedia programs for patients and provides guidance to other health professionals interested in developing programs on other topics.

Short-term stability of NEO-PI-R personality trait scores in opioid-dependent outpatients

The present study examined the short-term stability of personality trait scores from the Revised NEO Personality Inventory (NEO-PI-R) among 230 opioid-dependent outpatients. The NEO-PI-R is a 240-item empirically developed measure of the five-factor model of personality (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness). Participants completed the NEO-PI-R at admission and again approximately 19 weeks later. Results indicated fair to good stability for all NEO-PI-R factor domain scores, with coefficients ranging from .68 to .74. Stability of NEO-PI-R scores was decreased among potentially invalid response patterns but was not significantly affected by drug-positive versus drug-negative status at follow-up.

Influence of antisocial personality subtypes on drug abuse treatment response

This methodological study examined the impact of antisocial personality disorder (APD) and other psychiatric comorbidity on drug use and treatment retention in 513 new admissions to methadone maintenance treatment. Patients were classified into one of four groups: APD ONLY, APD plus other psychiatric disorder (APD MIXED), other psychiatric disorder, and no psychiatric disorder. Patients completed research assessments and were then followed for 1 year of treatment. Patients with APD had longer histories of heroin and cocaine use than non-APD patients and were more likely to meet criteria for cocaine dependence. Distinct clinical profiles emerged that differentiated APD ONLY from APD MIXED. APD ONLY patients exhibited higher rates of cocaine and heroin use, whereas those with APD MIXED exhibited higher rates of benzodiazepine use. Self-report measures supported urinalysis results, but group differences did not affect treatment retention. These differences in clinical profiles should be considered when evaluating treatment performance in substance abusers with APD.

Evaluation of a treatment-appropriate cognitive intervention for challenging alcohol outcome expectancies

The current study evaluated an alcohol expectancy challenge (EC) that did not require alcohol administration and could therefore be implemented in a treatment setting. Participants in the treatment group directly challenged alcohol expectancies endorsed on an expectancy questionnaire. A total of 62 male and female undergraduates completed the study (32 control participants, 30 EC participants). Self-report questionnaires were collected pre- and post-intervention, and alcohol logs were kept during the study. The EC resulted in significant reductions in alcohol expectancies across multiple expectancy dimensions. Although the analysis for alcohol consumption was not significant, there was a trend toward better outcomes for male participants in the EC condition. In contrast to study hypotheses, women in the EC condition increased their alcohol consumption from pre to post-test to a greater degree than did control participants.

The feasibility of a kinematic measure of lip closure during meaningful speech

PURPOSE

Assessment of dysarthria has traditionally been based on perceptual methods. The purpose of this study was to examine the feasibility of using 2D kinematic analysis to measure lip closure during normal speech.

METHOD

Retroflective markers (4 mm diameter) were placed on the midline of each lip of three healthy male, caucasian volunteers aged 69 years who repeated the sentence 'My mother made me an apple and blackberry pie' six times. Videorecordings were analysed using the Ariel Performance Analysis System to calculate the distance between the lips before, during and after the sentence.

RESULTS

The graphs produced from the data objectively measured the distance between the lips and identified the eight bilabial sounds. However, in spite of stringent study criteria to minimize differences linked to age, gender and race, differences were found between participants.

CONCLUSION

Kinematic 2D analysis may have potential for the objective measurement of lip closure in dysarthria in the context of meaningful speech. These results justify further pilot work to explore: the possible variability within defined populations; and the usefulness of 2D kinematic analysis in the measurement of disordered lip closure in dysarthria.

Gender differences related to heterosexual condom use: the influence of negotiation styles

The present study had three primary goals. The first was to identify gender differences related to negotiation styles associated with condom use. We hypothesized that women would report engaging in more negotiation behaviors associated with condom use than men. The second goal was to determine whether the relationships between intentions to use condoms and past condom use for women and men were moderated by negotiation behaviors. The third goal was to examine gender differences in responses to an open-ended question inquiring why participants did not use condoms. Male and female college students (N = 219) anonymously completed a series of measures. The results indicated that women and men have unique roles in the negotiation process; women play a more active role in negotiation of condom use, while men play a more reactive role. The relationship between intentions to use condoms and past condom use increased for men when their partners were more active in the process of deciding whether to use condoms. Responses to the open-ended item revealed that women identified perceptions of low risk as the most common reason for not using condoms, while men identified the inconvenience or unavailability of condoms as the most common reason. The implications of these results are discussed as they relate to health efforts to increase condom use.

Effects of priming positive and negative outcomes on drinking responses

The purpose of this investigation was to study the effects of priming positive and negative expectancy outcomes on the drinking responses of college students. Men and women (N = 64) were randomly assigned to 1 of 3 priming conditions: a positive expectancy outcome condition, a negative expectancy outcome condition, and a neutral (control) condition. Participants were exposed to a series of semantic primes corresponding to their condition and then asked to complete a beer taste-rating task. Planned comparisons revealed that the average ratio of beer consumed to body weight in the positive condition was significantly greater than the average ratio in the neutral condition, and the average ratio of beer consumed to body weight was significantly less in the negative condition than the average ratio in the neutral condition. These findings are discussed as they relate to cognitive models of alcohol use.

Self-esteem, gender, and alcohol use: relationships with HIV risk perception and behaviors in college students

The present study examined the confluence of alcohol use and self-esteem on risky sexual behavior and perceptions of risk for female and male college students. It was predicted that higher levels of self-esteem, female gender, and lower alcohol consumption would be associated with greater condom use and lower perceptions of risk for self and partner. Results indicated that for low drinking students, those with high self-esteem reported greater condom use. In addition, low rates of alcohol use were associated with greater frequency of past condom use. Women and students low in self-esteem indicated greater perceptions of risk for themselves and their partners. These findings are discussed in terms of their implications for developing interventions aimed at reducing risky sexual behavior.

Delayed paraplegia following spinal anaesthesia. Spinal subdural haematoma following dural puncture with a 25 G pencil point needle at T12-L1 in a patient taking aspirin

We report an extremely rare complication of regional anaesthesia, a spinal subdural haematoma, which resulted in permanent neurological damage occurring 8 days after dural puncture at T12-L1. Although spinal subdural haematoma following spinal anaesthesia and lumbar puncture has been described before, this is the first report of this complication occurring after dural puncture using a 25 G atraumatic pencil point (Whitacre) needle. Contributory factors might have been the perioperative intermittent low dose aspirin therapy and the fact that spinal anaesthesia was performed at the T12-L1 level.

Intubation with propofol: evaluation of pre-treatment with alfentanil or lignocaine

The effect of lignocaine or alfentanil pre-treatment on conditions at orotracheal intubation following induction with propofol, but without the use of muscle relaxants, were compared in a prospective, controlled, double-blind study. Forty five healthy patients undergoing elective surgery were randomly allocated to receive either 0.9% saline (control), alfentanil 20 micrograms/kg-1, or lignocaine 1.5 mg kg-1 prior to induction with propofol 2.5 mg kg-1. Ease of intubation was scored on a four point scale from 'excellent' = 1 to 'not possible' = 4. Alfentanil pre-treatment allowed intubation in 93% of patients compared to 60% in each of the groups pre-treated with lignocaine or saline. Intubation scores of 1 or 2 were obtained in 14 out of 15 patients (93%) in the alfentanil group and this was significantly better than the lignocaine group (33%) or control group (20%). No difference was detected between the scores of the latter two groups.

The ophthalmopathy of Graves' disease

Ophthalmopathy is an integral component of Graves' disease. It usually appears at the same time as hyperthyroidism, and is characterized by proptosis (exophthalmos), periorbital and conjunctival edema, eye muscle dysfunction, and on occasion corneal ulceration or optic neuropathy. Graves' ophthalmopathy, like Graves' hyperthyroidism, is an autoimmune disease, but the mechanisms that initiate and maintain it are not known. Most patients can be treated conservatively, but a few require anti-inflammatory or surgical therapy to relieve symptoms and preserve vision.

Cardiovascular changes at antagonism of atracurium. Effects of different doses of premixed neostigmine and glycopyrronium in a ratio of 5:1

The cardiovascular changes in the 10 minutes following antagonism of an atracurium-induced block were studied in 32 patients. A 5:1 ratio combination of either 15, 35, 55 or 75 micrograms/kg neostigmine, with a corresponding dose of 3, 7, 11, or 15 micrograms/kg of glycopyrronium was used for antagonism. The least change in heart rate was with neostigmine 15 micrograms/kg with an increase of more than 15 beats/minute found in only one patient. Antagonism with 35, 55 and 75 micrograms/kg neostigmine mixture produced the greatest increase in heart rate at one minute and this was significantly different from the effect of the 15 micrograms/kg dose. Twenty out of 24 patients given the larger doses had heart rate increases in excess of 15 beats/minute and in nine patients this ranged from 30 to 52 beats/minute, representing increases of 46-80% above baseline values. Arterial pressure increases after antagonism were statistically significant in all four groups, with no between-group difference; these were clinically unimportant. When antagonising an atracurium-induced block with clinically useful doses of neostigmine, the standard 5 : 1 ratio combination with glycopyrronium will result in an initial tachycardia.

Antagonism of atracurium with neostigmine. Effect of dose on speed of recovery

In 36 patients in whom anaesthesia was maintained with nitrous oxide and 0.5% isoflurane an atracurium-induced neuromuscular block was either allowed to recover spontaneously or antagonised with one of four doses of neostigmine (15 micrograms/kg, 35 micrograms/kg, 55 micrograms/kg or 75 micrograms/kg). The recovery times to a train-of-four ratio of 0.5, 0.75 and 0.9 were recorded. In patients given neostigmine, antagonism was at an average T1 of between 8.8% and 14.9%. There was no difference in the recovery times between the patients given neostigmine 35 micrograms/kg, 55 micrograms/kg or 75 micrograms/kg. Recovery after neostigmine 15 micrograms/kg was significantly slower than after the higher doses. One patient given neostigmine 75 micrograms/kg showed an unusual bimodal pattern of recovery. There appears to be no benefit in giving a larger dose than 35 micrograms/kg of neostogmine as a single bolus.

Resedation after bolus administration of midazolam to an infant and its reversal by flumazenil

A 4-month-old infant was sedated with bolus doses of midazolam, and after initial apparent complete arousal, became unresponsive and hypotonic. Administration of flumazenil enabled differentiation of a residual drug effect from an intracerebral event.

Contralateral tension pneumothorax during thoracotomy for lung resection

A patient underwent right thoracotomy and upper lobectomy for a mass found on routine chest radiography. He became profoundly cyanosed with a bradycardia and severe reduction in oxygen saturation at completion of surgery. The diagnosis of tension pneumothorax on the contralateral side to surgery was made and treatment instituted. The causes, treatment and implications of such an event during general anaesthesia for lung resection are discussed.

An evaluation of the incentive spirometer to improve lung function after cholecystectomy

Forty patients who underwent elective cholecystectomy were allocated randomly to one of two groups. Patients in one group used an incentive spirometer as part of their postoperative chest physiotherapy; those in the other received routine postoperative physiotherapy as dictated by their needs. Each group contained equal numbers of smokers and nonsmokers, and the data from each group were analysed separately. The use of the incentive spirometer did not confer any benefits as judged by clinical evidence of pulmonary complications, pulmonary function tests or length of hospital stay.