[Evaluation of family training effect on salivary cortisol and behavioral symptoms in children and adolescents with disruptive behavior disorder]

Association between biological factors and disruptive behaviors in children and adolescents is important to investigate. Antisocial, aggressive and delinquent behaviors in adults often begin early in life. Basal cortisol is a valuable biological characteristic of children with disruptive behavior disorder [DBD]. In this study the effect of family training on basal salivary cortisol in children with DBD was investigated. This is a clinical trial study. Basal salivary cortisol levels were studied in 19 children between 8-13 years old with DBD, before and 2 months after treatment [family training]. The disruptive behavior of the child was assessed with child behavior checklist [CBCL]. Before and after treatment cortisol levels and score of behavior were compared. Data was analyzed using descriptive statistics, paired T test and pearson correlation. Salivary cortisol before family training was 7.9 +/- 4.6 nmol/L and after that was 10.46 +/- 3.84 nmol/L which was significantly different [p<0.001]. Behavior score before treatment was 72.05 +/- 10.10 and after that was 49.361 +/- 1.89 that was also significantly different [p<0.0001]. Children with lower basal salivary cortisol had a better response to intervention. Parent training is an effective method for behavioral modification in DBD. Salivary cortisol can be considered as a predictive factor for severity of disruptive behavior, also the response to parent training in children with DBD

Blind extrathoracic subclavian venipuncture for temporary pacing lead insertion: a 4 year experience in 760 patients

Seven hundred and sixty patients admitted in Cardiology Dept. Mayo Hospital, Lahore from Feb.1994 to Jan 1998 were inserted temporary pacing lead for different indications. Modification of the percutaneous technique for extrathoracic subclavian venipuncture proposed by Magney and colleagues for permanent pacing lead placement was used. Before puncturing bony landmarks were marked on the skin according to Magney's description to identify the needle entry point. Then the venipuncture was accomplished by inserting the needle through a standard infraclavicular land mark. 760 patients were approached with this technique with in a span period of four years. This technique was successful in 684 [90%] cases with first puncture, additional 35 [5%] with second attempt, while additional 14 [2%] patients required multiple attempts or the change of the site. In rest 3% the procedure was completed using other routes. Patients were followed till the removal of temporary pacing wire or implantation with permanent pacing system. In the present study the blind approach to the extrathoracic portion of the subclavian vein proved to be safe and effective for pacing lead insertion. Further observations are required to establish whether this method decreases the complication rate