Frequent users of an acute psychiatric inpatient unit: A 5-year retospective study

Introduction

A small subset of patients with above average admissions to psychiatric inpatient units is recognized in clinical practice. These frequent users tend to be younger and to have a diagnosis of schizophrenia or affective disorder. Social conditions and the severity of the illness seem to be associated with this increased number of admissions.

Aims/Objectives

To study demographic and clinical characteristics of frequent and non-frequent users of a psychiatric inpatient unit.

Methods

Retrospective data of all the patients admitted to a psychiatric inpatient unit from January 2004 to December 2008 were reviewed. Frequent-users were defined as patients with 3 or more admissions over that period of time, and non-frequent users as those with less than 3 admissions. The two groups were compared in terms of age, gender, ethnicity, psychiatric diagnosis and compulsory admissions

Results

In a total of 2018 admissions and 1348 patients, the frequent-user group represented 10.2% (n = 137) of the patients and 28.9%(n = 584) of the admissions. Frequent-users were significantly younger (39.5 vs. 44.5 years, p = .001), more frequently black (22.6 vs. 19.4%, p < .001) and compulsorily admitted (27.7 vs. 14%, p < .001) than non-frequent users. Patients with bipolar disorder (p = .001), schizophrenia (p = .003) belonged significantly more to frequent-users group, while unipolar depressive patients (p = .016) and other diagnosis (p = .011) was more significantly represented in the non-frequent users group. Frequency of admission did not differ with gender.

Conclusions

The results concerning age and psychiatric diagnosis are consistent with previous studies. Compulsory admissions and black ethnicity were significantly higher among frequent- users.

Fragmentation pathways of H+(H2O)2 after extreme ultraviolet photoionization

Photofragmentation of the protonated water dimer H+(H2O)_{2}, a fundamental system both in aqueous solutions and gas-phase water clusters, has been studied at 13.8 nm using the Free Electron Laser FLASH in Hamburg. In a crossed-beam experiment using time-resolved, single-molecule fragment imaging, the two-body breakup into H2O++H3O+ was found as a prominent fragmentation channel with a kinetic energy release of up to 10 eV. This channel was observed with at least a similar yield as events with stronger fragmentation, producing protons together with neutral fragments and showing an absolute cross section of (0.5 ± 0.2) × 10(-18) cm2.

Antiviral activity of apricitabine in treatment-experienced HIV-1-infected patients with M184V who are failing combination therapy

OBJECTIVES

Apricitabine (ATC) is a novel deoxycytidine analogue nucleoside reverse transcriptase inhibitor (NRTI) with significant antiviral activity in vitro, including activity against HIV-1 with reverse transcriptase mutations that confer resistance to other NRTIs. ATC has shown promising antiviral activity and good tolerability when given as monotherapy for 10 days in treatment-naïve HIV-1-infected patients.

METHODS

In this Phase II randomized, double-blind study, 51 treatment-experienced HIV-1-infected patients with the reverse transcriptase mutation M184V who were failing therapy which included lamivudine (3TC) were randomized to receive twice-daily 600 mg ATC, 800 mg ATC or 150 mg 3TC for 21 days. Patients remained on their existing background regimen until day 21, when background therapy could be optimized according to genotype at screening.

RESULTS

At day 21, the mean change in viral load was -0.71 and -0.90 log(10) HIV-1 RNA copies/mL in the 600 and 800 mg ATC groups, respectively, compared with a -0.03 log(10) change in the 3TC group. In patients with at least three thymidine analogue mutations (TAMs) at baseline, greater reductions in viral load were observed in the 800 mg ATC group at day 21 than in the 600 mg ATC group. Few genotypic changes were detected at day 21 [two patients (600 mg ATC) lost and three patients (800 mg ATC) gained a TAM] and all patients with detectable virus retained the M184V mutation. The safety profiles of the two ATC doses were similar to that of 3TC.

CONCLUSIONS

Over the 21-day treatment period, ATC showed promising antiviral activity and was well tolerated in treatment-experienced patients with M184V, with or without additional TAMs.

Virological and clinico-pathological features of orf virus infection in experimentally infected rabbits and mice

Many aspects of the biology of orf virus (ORFV) infection remain poorly understood and attempts to establish animal models have yielded conflicting and non-reproducible results. We herein describe the characterization of ORFV infection and disease in rabbits and mice. A protocol of intradermal inoculation was employed to inoculate 10(8.5)TCID₅₀/mL of ORFV strain IA-82 in the skin of ears, of the back and labial commissures. All inoculated rabbits presented a clinical course characterized by erythema, macules, papules/vesicles or pustules that eventually dried originating scabs. Local signs started around days 3 and 4 post-inoculation (pi) and lasted 3-10 days. Virus was recovered from lesions between days 2 and 14pi. Histological examination of lesions revealed focal proliferative dermatitis with ballooning degeneration and eosinophilic intracytoplasmic inclusion bodies in keratinocytes, histological hallmarks of contagious ecthyma in sheep. A similar, albeit milder clinical course occurred in 5/10 inoculated mice; virus was recovered from lesions from three animals. Inoculated lambs - used as controls - developed severe lesions of contagious ecthyma. VN tests performed at day 28pi failed to detect neutralizing antibodies in all inoculated animals. In contrast, convalescent rabbit sera were positive by ELISA at dilutions from 100 to 400. These results show that rabbits are susceptible to ORFV infection and thus may be used to study selected aspects of ORFV biology.

Physiological characterisation of the efflux pump system of antibiotic-susceptible and multidrug-resistant Enterobacter aerogenes

Enterobacter aerogenes predominates amongst Enterobacteriaceae species that are increasingly reported as producers of extended-spectrum beta-lactamases. Although this mechanism of resistance to beta-lactams is important, other mechanisms bestowing a multidrug-resistant (MDR) phenotype in this species are now well documented. Amongst these mechanisms is the overexpression of efflux pumps that extrude structurally unrelated antibiotics prior to their reaching their targets. Interestingly, although knowledge of the genetic background behind efflux pumps is rapidly advancing, few studies assess the physiological nature of the overall efflux pump system of this, or for that matter any other, bacterium. The study reported here evaluates physiologically the efflux pump system of an E. aerogenes ATCC reference as well as two strains whose MDR phenotypes are mediated by overexpressed efflux pumps. The activities of the efflux pumps in these strains are modulated by pH and glucose, although the effects of the latter are essentially restricted to pH 8, suggesting the presence of two general efflux pump systems, i.e. proton-motive force-dependent and ABC transporter types, respectively.

Effects of aerobic conditioning on salivary IgA and plasma IgA, IgG and IgM in older men and women

As people age, they experience a decline in immune responses. Unusually heavy acute or chronic exercise could increase the risk of upper respiratory tract infection (URTI) whereas regular moderate physical activity may reduce URTI symptomatology. The purpose of the present study was to determine whether an aerobic exercise program would promote chronic adaptations in plasma IgA, IgG and IgM, and salivary IgA (Sal-IgA) in both elderly women and men. Forty-three independently living men and women, aged between 65 and 96 years, were randomly assigned to an aerobic exercising or a control group. Each participant underwent three evaluations (pre, post at 16 weeks and follow-up at 32 weeks). The aerobic exercise group increased resting plasma IgA concentration from 1.08 g. L (-1)+/-0.50 g. L (-1) to 2.29 g. L (-1)+/-0.93 g. L (-1), whereas salivary IgA concentration was unchanged. The control group maintained the plasma IgA values but experienced a decrease in Sal-IgA. The IgG and IgM plasma concentrations increased in both groups, however, only the exercise group maintained higher values in the final follow-up evaluation. Regular aerobic exercise may be effective in promoting IgA immunity and protecting against the deterioration in Sal-IgA values observed in the control group. No gender differences in the immunoglobulin responses to aerobic training were observed.

Targeting human macrophages for enhanced killing of intracellular XDR-TB and MDR-TB

Although many compounds have been described to inhibit the replication of drug-susceptible and drug-resistant strains of Mycobacterium tuberculosis, most of these studies only evaluate their in vitro activity. There is a lack of studies that show whether any of these agents can kill these organisms at the site where they normally reside post infection, namely, the macrophage of the lung parenchyma. It is the aim of this mini-review to identify agents that have been shown to enhance the killing of intracellular drug-susceptible, multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) strains by non-killing macrophages. Because these agents appear to promote their activity by affecting the transport of K(+) and Ca(2+) from the phagolysosome containing the bacteria, and thereby promoting its acidification and activation of hydrolases that will eventually kill the organism, the authors suggest that compounds that are known to affect the transport of K(+) and Ca(2+) should be considered for possible activity against intracellular MDR- and XDR-TB.

Wine wastes as carbon source for biological treatment of acid mine drainage

Possible use of wine wastes containing ethanol as carbon and energy source for sulphate-reducing bacteria (SRB) growth and activity in the treatment of acid mine drainage (AMD) is studied for the first time. The experiments were performed using anaerobic down-flow packed bed reactors in semi-continuous systems. The performance of two bioreactors fed with wine wastes or ethanol as carbon sources is compared in terms of sulphate reduction, metals removal and neutralization. The results show that efficient neutralization and high sulphate removal (>90%) were attained with the use of wine wastes as substrate allowing the production of effluents with concentrations below the required local legislation for irrigation waters. This is only possible provided that the AMD and wine wastes are contacted with calcite tailing, a waste material that neutralizes and provides buffer capacity to the medium. The removal of metals using wine wastes as carbon source was 61-91% for Fe and 97% for both Zn and Cu. The lower removal of iron, when wine waste is used instead of ethanol, may be due to the presence of iron-chelating compounds in the waste, which prevent the formation of iron sulphide, and partial unavailability of sulphide because of re-oxidation to elemental sulphur. However, that did not affect significantly the quality of the effluent for irrigation. This work demonstrates that wine wastes are a potential alternative to traditional SRB substrates. This finding has direct implication to sustainable operation of SRB bioreactors for AMD treatment.

Extreme ultraviolet laser excites atomic giant resonance

Exceptional behavior of light-matter interaction in the extreme ultraviolet is demonstrated. The photoionization of different rare gases was compared at the free-electron laser in Hamburg, FLASH, by applying ion spectroscopy at the wavelength of 13.7 nm and irradiance levels of thousands of terawatts per square centimeter. In the case of xenon, the degree of nonlinear photoionization was found to be significantly higher than for neon, argon, and krypton. This target specific behavior cannot be explained by the standard theories developed for optical strong-field phenomena. We suspect that the collective giant 4d resonance of xenon is the driving force behind the effect that arises in this spectral range.

Core-hole screening as a probe for a metal-to-nonmetal transition in lead clusters

Metal clusters serve as model systems to study basic problems of electronic correlation. Vacuum ultraviolet light from the free-electron laser FLASH ionizes 5d electrons from mass-separated negatively charged clusters, thus transiently leading to core-ionized neutral systems. Shielding of the core hole affects the electron binding energy. From the strong deviation from expectations of the metallic droplet and jellium models we conclude on reduced electronic shielding once the cluster size falls below about 20 atoms. This suggests a metal-to-nonmetal transition, in agreement with previous local density approximation calculations.

Coherent-pulse 2D crystallography using a free-electron laser x-ray source

Coherent diffractive imaging for the reconstruction of a two-dimensional (2D) finite crystal structure with a single pulse train of free-electron laser radiation at 7.97 nm wavelength is demonstrated. This measurement shows an advance on traditional coherent imaging techniques by applying it to a periodic structure. It is also significant that this approach paves the way for the imaging of the class of specimens which readily form 2D, but not three-dimensional crystals. We show that the structure is reconstructed to the detected resolution, given an adequate signal-to-noise ratio.

Sexual Dysfunction in Alcohoolism

The prevalence of sexual dysfunction in alcoholism is frequent and fluctuates between 3.2% and 64.4%, according different studies. The aim of this research is to study sexual dysfunction frequency in a sample of alcoholic patients who were undergoing treatment for this illness.

The study consists of an a questionnaire on sexual behaviour, with a sample of 80 individuals, 60 men and 20 women.

The authors conclude about the sexual dysfunction in different groups of alcoholic patients, in treatment in an inpatient and follow-up setting.

Influence of Different Primer Application Times On Bond Strength of Self-etching Adhesive Systems to Unground Enamel

An increase in application time of acid primer does not improve the bonding of self-etching adhesive systems to unground enamel.

Potent bactericidal action of a flavonoid fraction isolated from the stem bark of Butea frondosa

The flavonoid fraction isolated from the ethyl acetate fraction (BF-1) of Butea frondosa (L.) stem bark exhibited distinct antimicrobial activity when tested against 129 bacterial strains belonging to 9 different genera of both gram-positive and gram-negative types. Minimum inhibitory concentration (MIC) of the fraction BF-1 was determined following NCCLS guidelines using the agar dilution method. Twenty-four out of 36 strains of Staphylococcus aureus were inhibited by 50-200 mg/l of the fraction. This fraction also inhibited strains of Bacillus spp., Shigella spp., Salmonella spp. and even a few Pseudomonas at concentrations between 50-200 mg/l. Other bacteria including Escherichia coli, Vibrio cholerae and V. parahaemolyticus were moderately sensitive to BF-1. In the in vivo studies, this fraction offered significant protection to Swiss albino mice at a concentration of 80 microg/mouse (p<0.001) when they were challenged with 50 median lethal dose of Salmonella enteritidis NCTC 74. A fraction named BF-1 that was isolated from an ethyl acetate fraction of Butea frondosa provided protection against an infection from a Salmonella enteritidis NCTC strain.

Refining the phenotype of alpha-1a Tubulin (TUBA1A) mutation in patients with classical lissencephaly

Mutations in the alpha-1a Tubulin (TUBA1A) gene have recently been found to cause cortical malformations resemblant of classical lissencephaly but with a specific combination of features. To date, TUBA1A mutations have been described in five patients and three foetuses. Our aims were to establish how common TUBA1A mutations are in patients with lissencephaly and to contribute to defining the phenotype associated with TUBA1A mutation. We performed mutation analysis in the TUBA1A gene in 46 patients with classical lissencephaly. In 44 of the patients, mutations in the LIS1 and/or DCX genes had previously been excluded; in 2 patients, mutation analysis was only performed in TUBA1A based on magnetic resonance imaging (MRI) findings. We identified three new mutations and one recurrent mutation in five patients with variable patterns of lissencephaly on brain MRI. Four of the five patients had congenital microcephaly, and all had dysgenesis of the corpus callosum and cerebellar hypoplasia, and variable cortical malformations, including subtle subcortical band heterotopia and absence or hypoplasia of the anterior limb of the internal capsule. We estimate the frequency of mutation in TUBA1A gene in patients with classical lissencephaly to be approximately 4%, and although not as common as mutations in the LIS1 or DCX genes, mutation analysis in TUBA1A should be included in the molecular genetic diagnosis of classical lissencephaly, particularly in patients with the combination of features highlighted in this paper.

Promising therapy of XDR-TB/MDR-TB with thioridazine an inhibitor of bacterial efflux pumps

Global rates of pulmonary tuberculosis (TB) continue to increase. Moreover, resistance of the causative organism Mycobacterium tuberculosis to the two most effective anti-TB medications continue to rise. Now, multi-drug resistant TB (MDR-TB) has progressed to extensively drug resistant TB (XDR-TB) - a M. tuberculosis organism that is resistant to the most effective second line drugs available for the treatment of TB. This review provides detailed, significant evidence that supports the use of an old neuroleptic compound, thioridazine (TZ), for the management of MDR-TB and XDR-TB infections and which has been shown to inhibit efflux pumps of bacteria. The argument has been previously presented but no one seems to be listening - and the disease continues unabated when there is a very good probability that the suggested drug will prove to be effective. When the prognosis is poor, available therapy predictably ineffective and death is inevitable, compassionate therapy with TZ should be contemplated. The risks are small and the rewards great.

Effect of Pre-processing Controlled Atmosphere Storage on the Quality of Fresh-cut Galia Melons

The effects of controlled atmosphere (CA) storage of whole Galia melon on its physical, chemical, and sensory quality after minimal processing were evaluated. High quality fruits washed with 200 mg/L NaClO water solution were stored at 8 °C and 95% RH under CA of 4 kPa O2 + 15 kPa CO2 (T1), 4 kPa O 2 + 10 kPa CO2 (T2) and 21 kPa O2 + 0 kPa CO 2 (T3, air as control). Melons were removed from CA after 10 and 28 days, kept in air at 5 °C for 24 h and then minimally processed in a disinfected cold room at 5 °C. Trapezoidal sections were washed with 100 mg/L NaClO, rinsed and drained. Melon pieces were placed in polypropylene (PP) trays which were heat sealed with an oriented PP film of 35 μm thickness and stored at 5 °C. After 9 days the atmosphere within packages was dependent of pre-storage time, but very similar for the three pre-storage CA treatments: around 2 kPa O2 + 21 kPa CO2 for those stored 10 days and 3 kPa O2 + 31 kPa CO2 for those stored during 28 days. Overall quality of minimally processed Galia melon was affected by pre-processing conditions. Trapezoidal sections obtained from melons previously stored during 28 days at 8 °C under 4 kPa O2 + 15 kPa CO 2 and MAP stored for 7 days at 5 °C showed the highest firmness and the best sensory quality. However, for all the cases, microbial counts were over the legal limits. Alternative disinfection procedures should be developed to guarantee safety of the product.

The defensive strike of five species of lanceheads of the genus Bothrops (Viperidae)

We studied the defensive strike of one species of each of five recognized lineages within the genus Bothrops, namely, B. alternatus, B. jararaca, B. jararacussu, B. moojeni and B. pauloensis. The defensive strike of the studied species was in general similar to that of Crotalus viridis and C. atrox, but some important differences were observed. Bothrops alternatus and B. pauloensis struck preferentially from a tight body posture, whereas B. jararaca and B. moojeni from a loose body posture. Defensive strikes were either true or false (during the latter, the mouth remains closed or partially open). Almost all strikes were successful; only on a few occasions snakes missed their target (flawed strikes). Strike variables were very conservative among the five species, especially strike distance and height, and one possible explanation may be related to constraints imposed on strike variables as a way of increasing strike accuracy.