A flexible zirconium oxide based-ceramic membrane as a separator for lithium-ion batteries

A flexible and thermally stable zirconium oxide (ZrO₂)-based porous ceramic membrane (PCM) was prepared with PVdF–HFP as binder.

Sisal-derived activated carbons for cost-effective lithium–sulfur batteries

Elemental sulfur was successfully impregnated in an activated carbon (AC) matrix obtained from sisal fibers.

The role of transporter ectodomains in drug recognition and binding: phlorizin and the sodium–glucose cotransporter

This article reviews the role of segments of SLCs located outside the plasma membrane bilayer (ectodomains) using the inhibition of SGLTs (SLC5 family) by the aromatic glucoside phlorizin as a model system.

Metal organic framework-laden composite polymer electrolytes for efficient and durable all-solid-state-lithium batteries

A copper benzene dicarboxylate metal organic framework (Cu-BDC MOF) was synthesized and successfully incorporated in a poly(ethylene oxide) (PEO) and lithium bis(trifluoromethanesulfonylimide) (LiTFSI) complex.

Natural, biodegradable and flexible egg shell membranes as separators for lithium-ion batteries

Flexible egg shell membranes (ESM) were obtained from chicken eggs after treatment with hydrochloric acid.

Association of oral candidal carriage with dental caries in children

INTRODUCTION

Oral candidiasis is one of the most common opportunistic oral fungal infections. Oral candidal carriage in schoolchildren is a subject of increasing interest worldwide and has recently been associated with increased caries incidence in children.

AIMS

This study was carried out to identify association between oral candidal carriage in children and dental caries.

SUBJECTS AND METHODS

One hundred subjects with an age range between 6 and 12 years were included in this study. The subjects were distributed equally into two groups, i.e., study (caries-positive) and control (caries-free) groups. Oral hygiene index and DMFT/dmft scores were recorded for each subject. Sampling for Candida was carried out using intraoral swabs and concentrated oral rinse. Sabouraud dextrose agar containing 0.1 mg/ml of chloramphenicol was used as the primary culture medium. Candida was identified by employing API-20C AUX and germ tube formation tests.

RESULTS

The subjects in the caries-positive group showed a high frequency of oral candidal carriage compared to the caries-free subjects and the results were statistically very significant (p < 0.01). The odds ratio was 67.37, implying a high caries risk with positive oral candidal carriage (95% CI 14-323).

DISCUSSION

The findings of this study underscore the possible association of Candida with dental caries.

CONCLUSIONS

The occurrence of dental caries in children with mixed dentition is positively correlated with the frequency of oral candidal carriage.

Movement and mood disorder in two brothers with Gaucher disease

Gaucher disease (GD) is a lysosomal storage disorder with a wide spectrum of phenotypic presentations. We report the case histories of two adult brothers with GD who developed both parkinsonism and psychiatric symptoms. Direct sequencing and real-time polymerase chain reaction were used to establish that the patients were homozygous for mutation L444P. While parkinsonism has been described previously in GD, these patients had atypical features, including a complicated mood disorder. The comorbidity of GD and a mood disorder is a new finding, as psychiatric manifestations of GD have been described rarely. The etiology of the mental illness could be related to the processes contributing to the development of parkinsonism.

Tardive Priapism Associated with Clozapine

A man affected by schizoaffective disorder and alcohol abuse presented priapism after eleven years of clozapine treatment. After surgical intervention and resolution of priapism, he continued clozapine treatment at the same dose without problems. Clozapine withdrawal is not mandatory in patients who develop priapism in the course of treatment.

[A case of pervasive developmental disorder with chromosomal translocation (X; 4) (p11; q13)]

INTRODUCTION

Chromosomal aberrations, with or without congenital physical abnormalities, have been frequently found associated with neuropsychiatric disorders, including mental retardation, psychosis, autism, and criminal behaviour. The meaning of the association frequently remains unclear. However, consistent findings of association between specific chromosomal abnormalities and clinical phenotype may provide evidence of a causal relationship and shed light on the pathogenesis of obscure disorders.

CASE-REPORT

Here, we present the case of a 28 year-old, Caucasian male affected by pervasive developmental disorder, associated with chromosomal translocation 46, XY, t (X; 4) (p11; q13), and abnormal facial features. A few days after birth, the patient was taken away from his parents and adopted for unknown reasons. No information is available about his biological relatives. Mild delay in the development of spoken language was reported. Since early childhood, the patient's behaviour was characterized by troublesome relationship with his parents and his fellows, and persistent violation of norms and rules at home and at school. Consequently, social and school functioning was poor. When he was eight, verbal and motor stereotypy appeared for the first time. As an adolescent, he was more and more aggressive. He exhibited countless episodes of rage and verbal and physical aggressiveness. After he had completed secondary school, his way of life was chaotic. He got into the habit of staying away from home, sleeping in the day and vagabonding at night. He began to abuse alcohol. Grandiosity and persecutory delusions became evident. He claimed to hate the Vatican, the Pope, and the Polish people and to be the Devil, the Antichrist. He feared that his food was poisoned by his mother and refused to eat at home any more. He loved to remain in a cage with two wild dogs, accumulating and keeping bottles full of his urine. He often engaged in violent fights in the street with tramps and foreigners. Finally, he was involuntary admitted to a psychiatric intensive care unit. He was hostile, uncooperative, and violent. Magnetic resonance imaging of brain was normal, Wechsler Adult Intelligence Scale IQ score was 96 (total), 108 (verbal), 80 (non verbal), and Standard Progressive Matrices score was 44/60, chromosomal examination [banding R (RBG)] revealed an apparently balanced translocation 46, XY, t (X; 4) (p11; q13). The patient was treated with risperidone (8 mg/day) and valproate (1500-2000 mg/day) with improvement. Psychotic symptoms, hostility and violence vanished. Amazingly, his behaviour and attitude became normal. Very early onset of symptoms, absence of negative signs, and dysmorphic features suggesting an underlying medical disease do not support the diagnosis of schizophrenia.

DISCUSSION

The diagnosis of pervasive developmental disorder, not otherwise specified, could be made, considering the delay in the development of spoken language, the large discordance between verbal and non verbal WAIS IQ score, the presence of stereotypy, abnormal facial features, and motor clumsiness. The late onset of symptoms precludes the diagnosis of autism, while the delay in language does not permit the diagnosis of Asperger's disorder. The lack of information on his biological relatives did not permit us to assess the presence of genetic, physical or mental abnormalities in his family. Therefore, the causal relationship between the chromosomal translocation and the psychiatric disorder is uncertain in this patient. Similar genetic abnormalities found in patients affected by neuropsychiatric disorders could confirm an etiological link.

Using a custom mega prosthesis to treat hydatidosis of bone: a report of 3 cases

Three cases of hydatidosis of bone with pathological fracture were treated by wide resection, custom mega prosthesis replacement, and chemotherapy. Two patients were females and one was male, with a mean age of 47 years (range, 38-55 years). Two of them had a pathological fracture of the proximal femur, and one had a pathological fracture of the distal femur. All patients were treated postoperatively with albendazole 400 mg, twice daily, for 12 weeks. During the mean follow-up period of 4.5 years, no recurrence of Echinococcal infection was noticed. The use of the custom mega prosthesis technique has not been reported elsewhere, and hydatid disease of the bone can now be considered an extended indication for custom mega prosthesis in addition to its application in surgery for tumours and massive trauma.

Novel antipsychotics and acute dystonic reactions

The growing use of atypical antipsychotics has led to a decrease of acute dystonic reactions (ADR). To evaluate the prevalence of ADR, we recorded all ADR occurring in a population of patients consecutively admitted to a psychiatric intensive care unit. Among 1337 cases treated with antipsychotics, we observed 41 cases (3.1%) affected by ADR. At discharge, mean chlorpromazine-equivalent daily dose was 465.8 (+/-421.5) mg, while 39 cases (3.0%), all treated with typical neuroleptics, received anticholinergics. During hospitalization, 15 cases received quetiapine, 19 sertindole, 95 olanzapine, 142 clozapine, 495 risperidone and 561 typical neuroleptics. Four ADR occurred among the cases treated with risperidone monotherapy, and 4 occurred in risperidone-treated patients after emergency parenteral treatment with typical neuroleptics. In these last 4 cases, temporal relationship suggested that typical neuroleptics had caused ADR. One ADR occurred in a patient treated with olanzapine and 1 ADR in a patient treated with quetiapine. Among cases assuming typical neuroleptics, 32 ADR occurred. The difference between typical and atypical neuroleptics is highly significant (chi2 = 27.756; d.f. = 1; p = 0.000). Atypical antipsychotics carry a minimal risk of ADR.

Asperger's disorder in the emergency psychiatric setting

Asperger's syndrome (AS) is a pervasive developmental disorder that may be unrecognized, especially if signs of other psychiatric disorders coexist. The objectives of this paper are: 1) to ascertain the prevalence of AS in the emergency psychiatric setting; and 2) to describe features of AS which may help to differentiate these patients from patients with psychotic disorders. Among 2500 patients admitted to a psychiatric intensive care unit, 5 (0.2%) received a diagnosis of AS, for the first time. Besides impairment of social interaction, common features were the following: male gender, left handedness, obsessive-compulsive symptoms, cognitive hyper-abilities, violent behavior, sense of humor, low WAIS total score, high WAIS verbal/performance score ratio, unusual, restricted interest and clumsiness. Comorbid schizophrenia is difficult to rule out in these patients. Psychotic symptoms should not be overvalued in making the diagnosis when specific features of AS are present.

Evaluation of efficacy and safety of nimesulide with betacyclodextrin vs nimesulide tablets in osteoarthritis

Efficacy and safety of nimesulide as well as favourable tolerability have been tested in osteoarthritis in short term study and post-marketing survey. Here is a report which shows the superiority of nimesulide complexed with betacyclodextrin vs ninesulide tablet in osteoarthritis in a long term study.

Neurocutaneous melanosis and psychosis: a case report

The paper describes a case of neurocutaneous melanosis (NM), with mental retardation, chronic psychosis, and epilepsy possibly due to a temporal focus. This is the first report of NM associated with a severe and chronic psychosis. It is likely that such an association has not previously been described because of the ominous prognosis of most cases of NM with early involvement of the central nervous system.

Second-generation antipsychotics in the emergency care setting. A prospective naturalistic study

The objective of this subject was to examine the impact of the replacement of standard neuroleptics with atypical antipsychotic agents in an intensive psychiatric care unit. A mirror-image study was conducted. Cases admitted in the first semester of the year (when most of patients were treated with standard neuroleptics) were compared to cases admitted in the second semester of the year, when atypical antipsychotic agents were routinely utilized as first line treatment of patients with psychotic signs. Cases admitted in the first semester received a significantly higher daily dosage of antipsychotic drugs and more frequently received anticholinergics. In the second semester, a significantly higher number of patients received anticonvulsants, in particular valproate and gabapentin. There was no significant difference between the two groups of cases in the number of patients treated with antipsychotics, benzodiazepines, lithium, and carbamazepine and in the mean daily dose of benzodiazepines, lithium, carbamazepine, or valproate on the first day of hospitalization, the day of evaluation, and on discharge. On discharge, similar percentages of patients went home, were transferred to other Psychiatric Intensive Care Units (PICUs) or to private clinics, or left our PICU against medical advice. The length of hospitalization was similar in the two groups. There was no significant difference in the rate of aggressive or violent behavior registered in the two groups of cases. The risk of increasing violence rates, lengthening hospitalization, and facilitating patients' non-compliance should not be major concerns for physicians prescribing second-generation antipsychotics in the emergency care setting. Since these drugs have been shown to have at least similar efficacy (or greater efficacy in the case of clozapine) in the treatment of psychotic disorders as typical neuroleptics and to have a better side-effects profile, they should become first line treatment for patients with psychotic signs admitted to emergency care psychiatric facilities.

Risperidone-induced absence of ejaculation

The absence of ejaculation in two patients treated with risperidone is described. This side-effect has rarely been reported. The mechanism responsible for ejaculation dysfunction in risperidone treated patients is unclear, but might be due to the alpha1-adrenergic antagonist action of the drug.

Malignant ovarian germ cell tumours -- a survival and prognostic analysis

The medical records and histopathology of all ovarian germ cell tumours (OGCT) in a tertiary centre between 1980 and 1996 were reviewed. Response, overall survival (OS), relapse-free survival (RFS) and prognostic factors were analysed. Sixty-seven patients with OGCT were identified and treated, including 33 dysgerminomas, 18 immature teratomas, 10 endodermal sinus tumours, and 6 mixed tumours. Fifty-three patients (79%) received conservative surgery, 24 (36%) had residual disease post-primary surgery, and 43 (64%) had chemotherapy. Complete response was achieved in 62 patients (93%), 4 out of 5 patients who relapsed were successfully salvaged; OS and RFS at 5 years were 89% and 76%, respectively. Advancing stage of disease was the only significant adverse prognostic factor (p = 0.0001 for OS, and 0.0003 for RFS at 5 years). Out of 44 women with the potential to conceive following treatment, there were 16 successful pregnancies. None of the children born subsequent to the chemotherapy were reported to have any congenital abnormalities. The review indicates a high cure rate in OGCT with combined surgery and chemotherapy and that conservative surgery and preservation of fertility are feasible.

Sixty percent salvage rate for germ-cell tumours using sequential m-BOP, surgery and ifosfamide-based chemotherapy

BACKGROUND

In germ-cell tumours (GCT), there is continuing controversy over the relative merits of dose dense therapy (increased frequency over a given time) versus vertical intensification (increased dose per fraction). The value of using a cisplatin-based dose dense approach in the salvage setting has not been documented and in addition the role of methotrexate remains uncertain. This paper reviews results from our investigations of these issues.

PATIENTS AND METHODS

Between 1987 and 1996, 65 patients with relapsing or refractory germ-cell tumour received weekly m-BOP (methotrexate, bleomycin, vincristine and cisplatin) as salvage therapy. Residual masses were excised if possible and patients progressing after this received cisplatin and ifosfamide based chemotheraphy with or without high dose chemotherapy (HDCT) consolidation.

RESULTS

With a median follow-up of 33 months, 34% are progression free following m-BOP, 11% who had surgery for residual masses which showed viable cancers are progression free. A further 15% who progressed following m-BOP with or without surgery were rendered progression free by third-line therapy.

CONCLUSIONS

The use of m-BOP as second line therapy with deferment of cisplatin and ifosfamide based treatment to third line therapy with consolidation of third line responses with HDCT, leads to an overall progression-free survival of 60%. It does not appear that M-BOP prejudiced the response to third line therapy suggesting a lack of cross resistance. The potentially lower risk of leukaemia and infertility from m-BOP requires further evaluation.

Managing antipsychotic-induced acute and tardive dystonia

Antipsychotic-induced extrapyramidal adverse effects continue to be a serious problem in the treatment of psychotic disorders. While the pathophysiology of these adverse effects is not well understood, much recent research has focused on improving our ability to use available pharmacotherapy in the most effective and least toxic manner. Acute dystonic reactions only occur within the first days of antipsychotic treatment. They are often distressing and frightening for the patient and may even be dangerous. However, they can be effectively prevented or reversed with anticholinergics. Furthermore, the growing use of the new atypical antipsychotics will lead to a significant decrease in the rate of acute dystonic reactions. In contrast, tardive dystonia is a long-lasting menace in the course of antipsychotic treatment, for which there is no established therapy. Tardive dystonia is sometimes disabling or disfiguring and, like other tardive disorders, is potentially irreversible. Because, in most cases, patients need to continue taking the antipsychotic that has caused the adverse effect to prevent relapse of the mental illness, preventive measures are crucial. Antipsychotics should be prescribed only for patients affected by psychotic disorders, when definitely indicated and at the lowest effective dosage. The use of clozapine and other novel antipsychotic agents is also likely to represent an important step in the prevention and treatment of tardive dystonia. Compared with traditional antipsychotics, most of the new antipsychotics are characterised by a low acute extrapyramidal adverse effects liability and they also bring the hope of reducing the risk of tardive disorders. If tardive dystonia has occurred, switching to clozapine or another atypical antipsychotic and treatment with tetrabenazine, reserpine and botulinum toxin are possible options.

Diabetes insipidus and polydipsia in a patient with Asperger's disorder and an empty sella: a case report

The paper describes a patient with Asperger disorder, Neurogenic Diabetes Insipidus (NDI) and Primary Empty Sella (ES). His response to vasopressin treatment suggested a concomitant presence of primary polydipsia. This is the first reported case of an autistic spectrum disorder associated with NDI or ES. The implications of the observed co-occurrence of these relatively rare disorders are discussed in relation to diagnosis and pathogenesis.

Aggressive and violent behavior in a population of psychiatric inpatients

The aim of this observational study was to assess the rates of aggressive and violent behavior in patients admitted to an Italian emergency psychiatric unit and to explore possible risk factors for patient violence. In a population of 313 consecutive patients, we considered aggressive or violent behavior, rated according to a hierarchy from no aggressive behavior to serious physical violence. The results confirm that young age, psychotic symptoms, excitement, akathisia, and diagnosis of personality disorder are risk factors for violent behavior. The unique and major finding of the study is the low prevalence of aggressive and violent acts in this sample of patients, possibly related to their cultural background and to the system of psychiatric care. These data provide supportive evidence for the importance of sociocultural factors in the behavior of psychiatric patients and suggest the need to explore new strategies of prevention and treatment of patient aggression and violence. A non-restraint policy could be a critical factor in reducing violence among psychiatric inpatients.

An overview of breast cancer

Breast cancer is a major health problem in many parts of the world. Its impact in Saudi Arabia will be more obvious when the national data is released from the National Cancer Registry (NCR) in the near future. It is the most common cancer referred to the King Faisal Specialist Hospital and Research Centre (KFSH&RC). This is a retrospective review of all female breast cancer cases treated at KFSH&RC over a 15-year period. Patients were divided into two groups at the time of their referral to KFSH&RC: metastatic and nonmetastatic. We describe the demographic data, cancer-related information and the treatments offered to all patients. Comparisons were made between Saudi and non-Saudi, and the Saudis were examined in relation to their region of referral and observed to see if any changes occurred during the study period. As well, we tried to compare our results with experience elsewhere. A total of 1584 female breast cancer patients were treated at KFSH&RC between 1975 and 1991. Early breast cancer (Stages I, II) represented 36%, while 64% presented with advanced or metastatic disease (Stages III, IV). The majority of patients were premenopausal (64%). For patients with Stages I-III (1005), mastectomy was performed in 85% and lymph node dissection in 93%. Only 30% had no pathologic lymph node involvement and in 49% of the patients, lymph node dissection was adequate (>/= 10 nodes removed). Estrogen and progesterone receptors were known in 30% of the patients. Sixty-two percent and 72% of patients referred from the central region and the northern region had Stages II and III, respectively. For the non-Saudis, we observed more premenopausal patients (76%) and fewer Stage III. At 15 years, the relapse-free survival in Stages I, II and III was 33%, 36% and 18%, and the overall survival was 80%, 64% and 45%, respectively. Breast cancer in this population affects younger patients (premenopausal) and a higher proportion present with metastatic or locally advanced disease. Management strategies should incorporate conservative surgery when appropriate, and adequate lymph node dissection. This should be coupled with increasing public awareness and education and institution of screening programs. Overall survival is clearly linked to the stage of the disease.

Tardive dystonia. Prevalence, risk factors and clinical features

In order to replicate the results of our previous study of tardive dystonia (TDt) and to enlarge the studied sample, we examined 154 consecutive psychiatric in-patients who had been exposed to neuroleptic drugs for a cumulative period of at least three months. The present study provides further data supporting a distinction between TDt and tardive dyskinesia (TDk). The patients with TDt tend to be younger, male, less exposed to neuroleptic drugs, and to have a more severe movement disorder. TDt appears to be the most frequent form of secondary dystonia, and there is evidence that its prevalence has so far been underestimated.

Frequency and distribution of 22,836 adult cancer cases referred to King Faisal Specialist Hospital and Research Centre

Since late 1975, the King Faisal Specialist Hospital and Research Centre (KFSH&RC), a tertiary-care hospital in Saudi Arabia, has continuously collected data on its experience in oncology. With 22,836 cancer cases as a base, covering the years between 1976 and 1993, it is intended to present the hospital data obtained in this referral center as a prelude to the release of statistics from the Saudi Arabia National Cancer Registry (NCR) established in 1994. It will be interesting to see whether the data collected in the largest cancer referral center in the Kingdom will be comparable with national data when this becomes available. Our intent is to identify trends of referral and any possible bias in the data when compared to the NCR statistics of 1994.

Severe barbiturate withdrawal syndrome in migrainous patients

Three patients who presented with grand mal seizures and an associated behavioral disorder were recognized as suffering from a severe butalbital withdrawal syndrome. All were migraineurs who had become dependent on barbiturates. We propose that the occurrence of seizures, psychotic behavior, or a recent personality change should be considered clues to possible barbiturate abuse in patients with migraine.

Neurological diagnoses in psychiatric patients. The uncertain boundaries between neurology and psychiatry

The study highlights the high prevalence of neurological diagnoses in a population of psychiatric in-patients admitted to 16 private clinics and 6 private institutes because of their mental and behavioral disorders. Neurological diseases affected 13.05% of acute and 68.09% of chronic psychiatric patients. These results emphasize the need for specific neurological competence in the treatment of many psychiatric patients and better integration between neurological and psychiatric departments. The close relationship between neurology and psychiatry, as well as the renaissance of neuropsychiatry are discussed.

Tardive dystonia. Prevalence, risk factors, and comparison with tardive dyskinesia in a population of 200 acute psychiatric inpatients

In a population of 200 consecutive inpatients with a history of at least 3 months' total cumulative neuroleptic exposure, the prevalence of tardive dystonia (TDt) was 4%, higher than previously reported. The prevalence of tardive dyskinesia (TDk) was 22%. Patients with TDt did not differ in demographic or clinical variables from nondyskinetic patients. In comparison with patients with TDk, patients with TDt were significantly younger, had a more severe movement disorder, and had received neuroleptics for the first time fewer years before. Patients with TDk were significantly older than patients without tardive disorders, both when they were examined and when they had started their first neuroleptic treatment. Furthermore, they had started their first neuroleptic treatment more years before. These results support the distinction between TDt and TDk, and suggest that the previously reported prevalence of TDt might have been underestimated.