Do You Understand Me? An Aphasia Assessment Case Study in a Non-Native English Speaker

Objective

We report on the assessment of a non-native, English speaking patient who presented for a comprehensive neuropsychological evaluation following an infarct with associated language deficits. Challenges in assessment and interpretation given language and cultural barriers are discussed.

Case Description

The patient presented for an evaluation of cognitive and emotional difficulties following a left internal carotid artery infarct. Brain MRI revealed multiple acute infarcts in the left hemisphere, including the left occipital, medial aspect of the left temporal, left frontal, and left parietal lobes. While the patient had lived in the U.S. for 30 years and spoke English fluently for work, he primarily spoke his native language (Tamil). Given the lack of medically certified interpreters in the region along with a lack of culturally sensitive tests, the patient was evaluated in English using English-based tests and norms.

Diagnostic Impressions and Outcomes

Results were suggestive of a transcortical sensory aphasia. Language comprehension deficits were observed in both oral and written formats, while simple oral expression and repetition remained intact. The lack of normative data that matched the patient’s demographic background in addition to the lack of available samples regarding the patient’s English language functioning prior to the stroke made assessing the severity of deficits challenging. The family’s cultural norms and the patient’s unawareness of his deficits may have resulted in underreporting of the patient’s symptoms to providers. These factors further complicated the selection of appropriate recommendations for short- versus long-term disability.

Discussion

Specific challenges included an inability to assess the patient in his native language while using culturally-sensitive measures; thus, shedding light on the current clinical need for increasing competency in the assessment of non-native English-speaking patients. Further directions and opportunities are discussed.

Modifications in rat testicular morphology and increases in IFN-gamma serum levels by the oral administration of subtoxic doses of mercuric chloride

Mercury induces structural and functional damage in several organs, however the effects of subtoxic doses of the metal on the male reproductive system are not well defined. In order to analyze testicular and epididymal morphological alterations and changes in IL-4 or IFN-gamma serum levels, adult male Sprague-Dawley rats received 0.01, 0.05 or 0.1 microg/ml of mercuric chloride (HgCl(2)) in deionized water for 1 to 7 months by oral route. Controls received deionized water alone. Twenty rats, separated in four groups of five animals each, were used per time of exposure. Progressive degenerative lesions consisting of lack of germ cell cohesion and desquamation, arrest at spermatocyte stage and hypospermatogenesis were observed in seminiferous epithelium by light and electron microscopy. Leydig cells showed cytoplasmic vacuolation and nuclear signs of cell death. Loss of peritubular cell aggregation was evidenced in the epididymis. Mercury accumulation was detected in both organs by mass spectroscopy. Rats showed enhanced IFN-gamma serum levels as compared to controls but only reached significance after 7 months of mercury administration. Subtoxic doses of inorganic mercury could lead to reproductive and immunological alterations. The results demonstrate that sublethal concentrations of mercuric chloride are enough to induce morphological and ultrastructural modifications in male reproductive organs. These contribute to functional alterations of spermatogenesis with arrest at spermatocyte stage, hypospermatogenesis and possibly impaired steroidogenesis which together could affect male fertility.

Epidemiological study of paracoccidioidomycosis and histoplasmosis in a suburb of San Félix city, Bolívar state, Venezuela

Epidemiologic studies of deep mycosis have been scarce in Bolivar state, where paracoccidioidomycosis and histoplasmosis are considered as endemic diseases. The aim of this study was to determine paracoccidioidomycosis and histoplasmosis prevalences in people from a suburb of San Féix, Bolívar state, Venezuela. Three-hundred volunteers agreed to participate in this study and they were inoculated with paracoccidioidine and histoplasmine. Identification and epidemiologic data were registered. Reading of skin tests after 24 hours was performed in 275 persons. Paracoccidioidine test was positive in 10.2% (n=28). A higher percentage of positive reactions in the age group of 40-50 years old (n=10; 35.7%) was observed. Bricklayers, farmers and miners were positive in 27.3% (3 out of 11), a higher percentage than in people with other occupations. Histoplasmine test was positive in 7.6% of cases (n=21). The higher percentage of reactivity was observed in the age group of 40-50 years old (n=9; 42.9%). There was a direct proportional relationship between staying time in the locality and H. capsulatum infection mainly in persons staying in the area for more than 30 years (p < 0.05). These results showed low prevalences of P. brasiliensis and H. capsulatum infection in this area.

Histoplasmine and paracoccidiodine epidemiological study in Upata, Bolívar state, Venezuela

OBJECTIVE

To determine the prevalence of histoplasmosis and paracoccidiomycosis in Upata, a city in Bolivar state, Venezuela.

METHODS

Cutaneous tests on 397 volunteers, 204 with histoplasmine and 193 with paracoccidioidine. Epidemiological data were collected in a protocol sheet. Readings were performed at 24 and 48 h post-injection, by the same observer, and a positive reaction was defined as hardened papule of 5 mm or more.

RESULTS

Histoplasmine tests were positive in 19.6% and 34.0% at 24 and 48 h after antigens injection with a significant increase of reactivity (P=0.0019). Paracoccidiodine tests were positive in 11.3% and 19.7% at 24 and 48 h respectively and this difference was also significant (P=0.004). Risk factors which could explain these levels of reactivity could not be clearly identified. Cultures and animal inoculation from soil samples for fungus isolation were negative.

CONCLUSIONS

Paracoccidioidomycoses and histoplasmosis are endemic in Upata.

The novel human gene aprataxin is directly involved in DNA single-strand-break repair

The cells of an ataxia-oculomotor apraxia type 1 (AOA1) patient, homozygous for a new aprataxin mutation (T739C), were treated with camptothecin, an inhibitor of DNA topoisomerase I which induces DNA single-strand breaks. DNA damage was evaluated by cytogenetic analysis of chromosomal aberrations. The results obtained showed marked and dose-related increases in induced chromosomal aberrations in the patient and her heterozygous mother compared to the intrafamilial wild-type control. The alkaline comet assay confirmed this pattern. Moreover, the AOA1 cells did not show hypersensitivity to ionizing radiation, i.e. X-rays. These findings clearly indicate the direct involvement of aprataxin in the DNA single-strand-break repair machinery.

Potassium bromate but not X-rays cause unexpectedly elevated levels of DNA breakage similar to those induced by ultraviolet light in Cockayne syndrome (CS-B) fibroblasts

It has been previously reported that the elevated accumulation of repair incision intermediates in cells from patients with combined characteristics of xeroderma pigmentosum complementation group D (XP-D) and Cockayne syndrome (CS) XP-D/CS fibroblasts following UV irradiation is caused by an "uncontrolled" incision of undamaged genomic DNA induced by UV-DNA-lesions which apparently are not removed. This could be an explanation for the extreme sensitivity of these cells to UV light. In the present study, we confirm the immediate DNA breakage following UV irradiation also for CS group B (CS-B) fibroblasts by DNA migration in the "comet assay" and extend these findings to other lesions such as 8-oxodeoxyguanosine (8-oxodG), selectively induced by KBrO3 treatment. In contrast, X-ray exposure does not induce differential DNA breakage. This indicates that additional lesions other than the UV-induced photoproducts (cyclobutane pyrimidine dimers, CPD, and 6-pyrimidine-4-pyrimidone products, 6-4 PP), such as 8-oxodG, specifically induced by KBrO3, are likely to trigger "uncontrolled" DNA breakage in the undamaged genomic DNA in the CS-B fibroblasts, thus accounting for some of the clinical features of these patients.

Epidemiological survey of histoplasmine and paracoccidioidine skin reactivity in an agricultural area in Bolívar state, Venezuela

Paracoccidiodomycosis and histoplasmosis are endemic diseases in the south of Venezuela, representing a public health problem. Prevalence of Paracoccidiodes brasiliensis and Histoplasma capsulatum infections were estimated in Monte Ralo, a rural community area of Bolivar state using paracoccidiodine and histoplasmine skin tests. Paracoccidiodine was intradermically injected to 173 persons and readings were made at 24 and 48 h afterwards to 167 persons (97.85%). Reaction was positive in 8.5% (n = 14) at 24 h post-injection and 13.2% (n = 20) at 48 h. Farmers showed the higher percentage of positivity at 24 and 48 h. One hundred-seventy five persons were intradermically injected with histoplasmine but 167 and 157 of them attended for reading of the dermal reaction at 24 and 48 h post-injection respectively. Tests were positive in 25.7% (n = 43) at 24 h and 42.7% (n = 67) at 48 h. Further studies are needed in surrounding places to delimit the endemic area of these mycosis in the Bolivar state. However, epidemiological vigilance of PCM and H should be considered by local health authorities.

X-ray-induced chromosome aberrations in human lymphocytes in vitro are potentiated under simulated microgravity conditions (Clinostat)

The influence of simulated microgravity weightlessness on the outcome of radiation-induced chromosomal aberrations was investigated using the clinostat as a tool to simulate weightlessness conditions. Treatments were performed in the G0 phase of human lymphocytes with 1.5 Gy of X-rays alone or in combination with the DNA synthesis inhibitor of 1-beta-D-arabinofuranosylcytosine (ara-C) to check also for possible specific radiation-induced DNA repair processes impairment (excision repair caused by base damage) under microgravity conditions. The results obtained, which confirmed previous findings, showed significantly higher increases of aberrant cells and hence total number of aberrations compared to the parallel treatments performed 'on ground'. For what concern ara-C its contribution in terms of potentiation in the induction of aberrant cells was equivalent in absolute terms under simulated microgravity conditions and 'on ground' indicating that excision repair caused by base damage and inhibited by ara-C is not affected by simulated microgravity. A possible explanation for this outcome could quote two major factors: i) Enhanced probability that under simulated microgravity conditions the reactive DSB are spatially brought together to better interact, hence increasing the probability of mis-rejoining. ii) Alternatively chromatin structure could be modified under simulated microgravity conditions generating different quality and quantities of DNA lesions compared to treatments performed 'on ground'.

Anxiety sensitivity: relations to psychopathy, DSM-IV personality disorder features, and personality traits

Relatively few data are available concerning the relations between anxiety sensitivity (AS) and both abnormal and normal personality traits. In particular, little is known about the associations between AS and personality disorders, although Shostak and Peterson [Behav. Res. Ther. 28 (1990) 513.] hypothesized that AS would be negatively correlated with antisocial personality disorder (ASPD) and perhaps related conditions (e.g., psychopathy). We examined the relations between AS, as assessed by the AS Index (ASI), and measures of psychopathy/ASPD, personality disorder features. and personality traits in a sample of 104 undergraduates. The ASI was not significantly associated with global measures of psychopathy or ASPD, although it was negatively correlated in some cases with the core affective deficits of psychopathy. In addition, the ASI was positively correlated with features of several Clusters B (e.g., borderline) and C (e.g., dependent) personality disorders and with features of passive-aggressive personality disorder. In addition, the ASI was positively associated with measures of several normal-range personality traits, including trait anxiety, alienation, well being, Negative Emotionality, and Constraint. Some, although not all, of the abnormal and normal personality correlates of the ASI were attributable to the variance shared by the ASI with trait anxiety measures. Implications and limitations of the present findings for the correlates and etiology of AS are outlined.

Higher than normal plasma interleukin-6 concentrations in cancer patients with depression: preliminary findings

OBJECTIVE

This study investigated whether cancer patients with and without major depression exhibit immune system abnormalities similar to those reported in medically healthy, depressed subjects without cancer.

METHOD

The study subjects consisted of patients diagnosed with pancreatic, esophageal, or breast cancer. Other groups consisted of subjects with major depression (without cancer) and healthy comparison subjects. Subjects' diagnoses were made with the Structured Clinical Interview for DSM-III-R. Severity of depression was measured with the Hamilton Depression Rating Scale. Plasma concentrations of interleukin-6 (IL-6) and postdexamethasone cortisol were measured.

RESULTS

Cancer patients with depression had markedly higher plasma concentrations of IL-6 than healthy comparison subjects and cancer patients without depression. Although significant correlations were found between Hamilton depression scale scores and plasma concentrations of postdexamethasone cortisol, no significant correlations were found between plasma IL-6 and postdexamethasone cortisol concentrations.

CONCLUSIONS

Higher than normal plasma IL-6 concentrations were associated with a diagnosis of major depression in cancer patients. IL-6 may contribute to sickness behavior that has overlapping symptoms with major depression.

Paroxetine for the prevention of depression induced by high-dose interferon alfa

BACKGROUND

Depression commonly complicates treatment with the cytokine interferon alfa-2b. Laboratory animals pretreated with antidepressants have less severe depression-like symptoms after the administration of a cytokine. We sought to determine whether a similar strategy would be effective in humans.

METHODS

In a double-blind study of 40 patients with malignant melanoma who were eligible for high-dose interferon alfa therapy, we randomly assigned 20 patients to receive the antidepressant paroxetine and 20 to receive placebo. The treatment was begun 2 weeks before the initiation of interferon alfa and continued for the first 12 weeks of interferon alfa therapy.

RESULTS

During the first 12 weeks of interferon alfa therapy, symptoms consistent with a diagnosis of major depression developed in 2 of 18 patients in the paroxetine group (11 percent) and 9 of 20 patients in the placebo group (45 percent) (relative risk, 0.24; 95 percent confidence interval, 0.08 to 0.93). Severe depression necessitated the discontinuation of interferon alfa before 12 weeks in 1 of the 20 patients in the paroxetine group (5 percent), as compared with 7 patients in the placebo group (35 percent) (relative risk, 0.14; 95 percent confidence interval, 0.05 to 0.85). The incidence of adverse events was similar in the two groups.

CONCLUSIONS

In patients with malignant melanoma, pretreatment with paroxetine appears to be an effective strategy for minimizing depression induced by interferon alfa.

Platelet reactivity in depressed patients treated with paroxetine: preliminary findings

BACKGROUND

Alterations in platelet reactivity have been previously posited to underlie the increased vulnerability of patients with depression to ischemic heart disease (IHD). The present study sought to determine whether the increased platelet reactivity associated with major depression is reduced after antidepressant treatment.

METHODS

Patients diagnosed as having DSM-IV major depression (n = 15) (mean age, 37 +/- 7 years; range, 23-48 years) and 12 normal comparison subjects (mean age, 36 +/- 7; range, 23-48 years) were recruited. None of the controls or depressed group had evidence of IHD; 10 of 15 patients who were depressed had 1 or more traditional IHD risk factors. In vivo platelet activation, secretion, and dose-response aggregation of the controls and patients was measured after overnight bedrest under basal conditions, and after a mild exercise challenge. After 6 weeks of open-label treatment with the selective serotonin reuptake inhibitor paroxetine (20 mg/d), the patients with depression were readmitted and procedures of the first General Clinical Research Center admission repeated.

RESULTS

In comparison with the control group, the depressed group exhibited greater procoagulant activity as detected by increased platelet binding of the monoclonal antibodies anti-ligand-induced binding site and GA6, and increased plasma concentrations of platelet factor 4 under basal conditions. After paroxetine treatment, the patients with depression exhibited significant reductions in all 3 parameters.

CONCLUSIONS

Normalization of platelet activation is associated with paroxetine treatment of patients with depression. Because this study design did not allow for the determination of whether this effect of paroxetine on platelet function is caused by a direct effect of the drug or placebo or, alternatively, because of recovery from depression, studies containing a placebo and/or psychotherapy treatment arm may resolve this issue.