A study of self poisoning with oral salbutamol--laboratory and clinical features

A review of 35 patients > 60 years of age with odontoid fractures showed that a type II injury (Anderson and D'Alonso) was the most common fracture pattern (82% of cases). On the basis of mechanism of injury and sex incidence, we deduced that osteopenia is a contributory factor in the occurrence of odontoid fractures. A fall in a domestic setting was the cause in 53%. The peg was posteriorly displaced in 88% of type II fractures, and primary union occurred in 23%. The incidence of concomitant spinal cord injury with type II fractures was higher in older patients than it was in those < 60 years of age. The outcome for these patients was largely determined by their neurological status at presentation. Myelopathy as a late complication of nonunion was not observed in nine patients with an average follow-up of 21 months. The data suggest that vigorous attempts to secure both primary union and a sound arthrodesis for non-union are questionable in the elderly except in unusual circumstances.     

An examination of the accident and emergency management of deliberate self harm

This article explores the relationship between selected socio-economic factors and health knowledge of children in Bangladesh. Data was generated from a representative sample survey of 2520 children aged 11-12 y and resident throughout the country. A total of six health knowledge items, all of which are very relevant to Bangladesh, were assessed in this study. Both bivariate and multivariate analysis were used for this purpose. Analysis revealed that the urban/rural residence of the child, the length of the child's schooling in years, the parental level of education and the economic status of the household was associated with the level of health knowledge of the children. To achieve the required improvement in health knowledge of Bangladeshi children this study concluded that adequate schooling of all children must be ensured by removing social barriers to this. Greater educational investment as well as quality education related to everyday life should be provided in rural areas.     

A survey of deliberate self harm services in New Zealand: shouldn't we be doing better?

AIMS: Deliberate self harm is important because it is common, it is associated with suicide and it provides a window of opportunity to provide help to people who do not access the usual mental health services. This survey aimed to describe the management and provision of services in New Zealand public general hospitals for people who deliberately harm themselves. METHODS: A questionnaire asking about deliberate self harm was sent to all 23 CHE's in New Zealand. RESULTS: Nineteen CHE's returned the questionnaire. There was widespread differences in the provision of services and the management of deliberate self harm. For example some admitted nearly everyone who presented whilst others only admitted 20%. Only two CHE's said they kept any computerised records of this population and only six had a psychiatrist responsible for the deliberate self harm service. CONCLUSIONS: Provision for the general hospital management of deliberate self harm is unplanned and disorganised. There should be centrally funded units which monitor deliberate self harm; standards for management of deliberate self harm in the general hospital should be produced; purchasers should use these standards in contracts with providers to insist on better care of this group of patients.     

Methanol poisoning: a review and case study of four patients from central Australia

Methanol intoxication, a rare and potentially lethal form of poisoning, usually results from ingestion and occasionally inhalation of methanol. Initial symptoms of blurred vision, elongated anion gap and metabolic acidosis are typically delayed and may not at first be recognised as methanol-related complaints. Once diagnosed, treatment must be prompt and definitive. As well as general supportive care, ethanol infusion, dialysis and alkalinization from the mainstays of treatment. The cases described in this paper are compared to previous reports from other countries worldwide and contrast the variance in outcome often seen in methanol poisoning. The paper describes two tragic deaths and two lucky survivors, all of whom had consumed a cocktail of methanol and other alcoholic beverages at the same party. The ICU nurse's role in managing the methanol-intoxicated patient relies on that person's sound knowledge of the unusual biochemical reactions occurring in the body and the need to institute definitive and supportive measures to help both patient and family recover.     

1,000 forensic outpatients: a descriptive study

The case notes and court reports of 1,000 consecutive outpatient referrals to a regional forensic outpatient service were studied retrospectively. Socio-demographic, psychiatric and forensic information was collected. The sample was predominantly male, Caucasian and relatively young in comparison with a general psychiatric population. The commonest source of referral was from defense solicitors and the commonest reason for referral was for a court report. A wide range of diagnoses and offences were noted. A number of differences were found in the frequency of gender, ethnicity and diagnosis according to the source of, and reason for, referral.     

Psychological adjustment in adults with cancer: The self as mediator.

Investigated whether discrepancies between actual and ideal self-conceptions influence adjustment and mediate the effects of disease-related health problems on psychological well-being, in a cross-sectional study of 108 cancer patients (aged 26–86 yrs). Ss who had more symptoms and worse functional health and perceived their cancer as a chronic rather than an acute disease had higher levels of self-discrepancies and poorer adjustment. Self-discrepancy was a significant mediator of the effects of perceived health status on purpose in life, positive relations with others, and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measles in pregnancy: a descriptive study of 58 cases

OBJECTIVE: To describe the effects of measles in pregnancy using a large case series. METHODS: Pregnant women with measles were identified by county health department records, and their hospital and clinic records were reviewed. When available, records for the infants of case patients were also reviewed. RESULTS: Fifty-eight pregnant women with measles were identified. Thirty-five (60%) were hospitalized for measles, 15 (26%) were diagnosed with pneumonia, and two (3%) died of measles complications. Excluding three induced abortions, 18 pregnancies (31%) ended prematurely; five were spontaneous abortions and 13 were preterm deliveries. All but two of the 18 pregnancies that terminated early did so within 14 days of rash onset. Two term infants were born with minor congenital anomalies, but their mothers had measles late in the third trimester. No newborns were diagnosed with congenital measles. CONCLUSIONS: The incidence of death and other complications from measles during pregnancy may be higher than expected for age-comparable, nonpregnant women. Measles in pregnancy may lead to high rates of fetal loss and prematurity, especially in the first 2 weeks after the onset of rash.     

Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients

We examined the frequency of associated chondral and ligament lesions in distal fractures of the radius in young adults (men 20-60 years, women 20-50 years). Fifty initially displaced fractures were examined arthroscopically. Chondral lesions were found in 16 patients (32%). All patients but one were found to have a ligamentous injury in the wrist. No major instability was found. The most frequent ligament tear was the triangular fibrocartilage complex in 39 cases (78%), with a statistical correlation to ulnar styloid fractures. The scapholunate ligament was partially or totally torn in 27 cases (54%). No correlation was found between specific fracture type and pattern of ligament injury. Chondral and ligamentous lesions were frequent and may explain poor outcomes after seemingly well-healed distal fractures of the radius. The ligament lesions should also be kept in mind when early mobilization of the distal fracture of the radius is considered.     

A study of deliberate self-poisoning in patients with adjustment disorders

A sample of 140 patients (34 men and 106 women), hospitalized for deliberate self-poisoning in a toxicological clinic, was evaluated clinically and by P?ldinger's risk list for assessment of suicidality. All subjects met the criteria of DSM-IV adjustment disorder with no additional Axis I and Axis II comorbidity. 18% of the patients had a chronic adjustment disorder. The most common problems on Axis IV were those with the primary support group (especially in women). Occupational and economic problems were more frequent in men than in women. Most of the studied subjects undertook the suicidal attempt impulsively. Suicidal thoughts after deliberate self-poisoning persist in only 11% of the patients. The suicidal risk measured by P?ldinger's risk list for assessment of suicidality was negligible in 4/5 of the cases. The suicidal risk was higher in patients with chronic adjustment disorder and in patients with previous suicide attempts. The most represented age group - from 15 to 19 years old showed the highest suicidal risk. In women the suicidal risk increased with age. Women with impulsive suicide attempt showed a lower suicidal risk than women with a non-impulsive suicide attempt. A cathartic and abreactive effect of the suicide attempt was detected, but this effect only partially accounts for the relatively low percentage of suicidal thoughts after the suicidal act and the insignificant suicidal risk in 4/5 of the studied subjects.     

A four year prospective study of age-related cognitive change in adults with Down's syndrome

BACKGROUND: While neuropathological studies indicate a high risk for Alzheimer's disease in adults with Down's syndrome, neuropsychological studies suggest a lower prevalence of dementia. In this study, cognitive deterioration in adults with Down's syndrome was examined prospectively over 4 years to establish rates and profiles of cognitive deterioration. METHODS: Fifty-seven people with Down's syndrome aged 30 years or older were assessed using a battery of neuropsychological tests on five occasions across 50 months. Assessments of domains of cognitive function known to change with the onset of Alzheimer related dementia were employed. These included tests of learning, memory, orientation, agnosia, apraxia and aphasia. The individual growth trajectory methodology was used to analyse change over time. RESULTS: Severe cognitive deterioration, such as acquired, apraxia and agnosia, was evident in 28.3% of those aged over 30 and a higher prevalence of these impairments was associated with older age. The rate of cognitive deterioration also increased with age and degree of pre-existing cognitive impairment. Additionally, deterioration in memory, learning and orientation preceded the acquisition of aphasia, agnosia and apraxia. CONCLUSIONS: The prevalence of cognitive impairments consistent with the presence of Alzheimer's disease is lower than that suggested by neuropathological studies. The pattern of the acquisition of cognitive impairments in adults with Down's syndrome is similar to that seen in individuals with Alzheimer's disease who do not have Down's syndrome.     

Exercise and diet interventions improve perceptions of self in middle-aged adults

The effect of a 1-year exercise and diet intervention program on global self-concept, perceptions of the body, physical competence, exercise mastery, social competence, social comfort, and fitness was examined with 208 healthy individuals (191 males, 17 females) aged 39-49 years (mean age 44.9) with elevated risk factors for cardiovascular disease. The relative utility of the skill development versus the self-enhancement model of the self-concept/behaviour relationship was tested. The participants were randomized into four groups: diet (n = 53), diet and exercise (n = 64), exercise (n = 48) and no active intervention (n = 43). Measurements were made by the Harter adult self perception profile (HASPP) and the self-perception in exercise questionnaire (SPEQ). Two-way ANOVA analyses revealed that exercise participation, with or without diet, enhanced self-perceptions of physical mastery and ability, body perception, fitness and social comfort. The unique contribution of diet indicated enhanced body perception. No effect was found of diet or exercise on global self-concept. Exercise participation had a positive effect on perceptions of the self, and the higher the compliance with the exercise program, the stronger were the effects on the self-perceptions. This supported the skill development model of the self-concept/behaviour relationship. As the pretest self-concept scores did not predict exercise compliance, the self-enhancement model of the self-concept/behaviour relationship was not supported.     

Placental pathology and antiphospholipid antibodies: a descriptive study

We described placental pathology in antiphospholipid antibody (APL) syndrome, APL and no history of recurrent pregnancy loss, and in treated and untreated pregnancies of APL syndrome. Thirty-nine pregnancies of 28 patients were studied: 23 placentas delivered from 23 women with APL (13 with APL syndrome and 10 with serological APL); 8 untreated miscarriages before APL diagnosis from 6 of the 13 patients with APL syndrome and 1 of 10 with serological APL; and 8 miscarriages by 5 additional women before APL syndrome diagnosis. Histopathology was reviewed by a pathologist blinded except to gestational age. Contingency tables and analysis of variance (ANOVA) considered p < 0.05 significant. Comparing the placentas delivered at > 18 weeks' gestation, excessive perivillous coagulation, avascular terminal villi, and chronic villitis/uteroplacental vasculitis tended to be more common in treated APL syndrome than serological APL cases (p = 0.07). Of the 16 miscarriages before diagnosis of APL, 11 were lost at < 18 weeks' gestation. None had pathology typical of APL, but 4 of 11 (36%) had chronic intervillositis. Five of 16 miscarriages before the diagnosis of APL were miscarried between 18-22 weeks. Three of 5 (60%) miscarried after 18 weeks had multifocal uteroplacental thromboses, compared to 6 of 13 (46%) treated pregnancies with APL syndrome and 0 of 10 cases with serological APL.     

Brachymesophalangia-V in five samples of children: a descriptive and methodological study

The occurrence of brachmesophalangia-V (BMP-V) in 2,012 individuals from five samples of children of different ethnic backgrounds was determined using two indices. Frequencies of BMP-V were analyzed for three variants: BMP-V alone, BMP-V with clinodactyly, and BMP-V with a cone-shaped epiphysis. The two indices used to identify BMP-V indicated highest relative frequencies among Mexican children, moderate frequencies among children of European ancestry (Pennsylvania White, Canadian, West German), and lower frequencies in Pennsylvania Black children. Index 1, based on the ratio of the width to the length of the fifth mid-phalanx, consistently produced higher frequencies than Index 2, based on the ratio of the length of the fifth to the length of the fourth mid-phalanges. Index 1 was also more selective of BMP-alone, while Index 2 selected primarily BMP-V with clinodactyly and/or cone-shaped epiphyses. The differences between indices were largely due to the fact that Index 1, which basically defines shape, selected both the shortest and/or widest mid-phalanges, while Index 2 related actual length differences. It is suggested that Index 2 provided a more suitable criterion of BMP-V in comparative studies, due to possible population differences in phalangeal shape.