Frequency of delirium and subsyndromal delirium in an adult acute hospital population.

Background The frequency of full syndromal and subsyndromal delirium is understudied. Aims We conducted a point prevalence study in a general hospital. Method Possible delirium identified by testing for inattention was evaluated regarding delirium status (full/subsyndromal delirium) using categorical (Confusion Assessment Method (CAM), DSM-IV) and dimensional (Delirium Rating Scale-Revised-98 (DRS-R98) scores) methods. Results In total 162 of 311 patients (52%) screened positive for inattention. Delirium was diagnosed in 55 patients (17.7%) using DSM-IV, 52 (16.7%) using CAM and 58 (18.6%) using DRS-R98⩾12 with concordance for 38 (12.2%) individuals. Subsyndromal delirium was identified in 24 patients (7.7%) using a DRS-R98 score of 7-11 and 41 (13.2%) using 2/4 CAM criteria. Subsyndromal delirium with inattention (v. without) had greater disturbance of multiple delirium symptoms. Conclusions The point prevalence of delirium and subsyndromal delirium was 25%. There was modest concordance between DRS-R98, DSM-IV and CAM delirium diagnoses. Inattention should be central to subsyndromal delirium definitions.

Acute visual loss after initiation of antihypertensive therapy: case report.

We report the case of a 50-year-old man who reported sudden, painless loss of vision in his left eye after starting antihypertensive therapy. Potential causes of acute painless unilateral visual loss are discussed, as is the initial management of hypertension in asymptomatic patients.

Neuro-ophthalmic findings in progressive multifocal leukoencephalopathy.

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disorder of the central nervous system found in immunodeficient patients, most frequently now in those infected with HIV. It may represent the initial manifestation of HIV infection. Since the central visual pathways may be affected, a variety of neuro-ophthalmic signs and symptoms can manifest. We studied the clinical, radiographic and histopathological characteristics of patients with PML. METHODS: The charts of 13 patients in whom PML was diagnosed in the Neuro-AIDS clinic at the Montreal Neurological Institute between November 1987 and March 1995 were reviewed. The diagnosis of PML was established by characteristic clinical features together with typical computed tomographic or magnetic resonance imaging findings, such as nonenhancing low-density (on computed tomography) or hyperintense (on T2-weighted magnetic resonance imaging) white-matter lesions, without mass effect. Neuro-ophthalmic findings were based on clinical examination by an ophthalmologist, neuro-ophthalmologist or neurologist. Tissue for pathological examination was obtained by biopsy in one case and at postmortem study in a second case. RESULTS: The most common finding was homonymous hemianopia, in five patients (38%). Other features included nystagmus (in two patients), diplopia with cranial nerve palsy (in one) and cortical blindness (in one). One of the patients exhibited involvement of the brain stem, a site not usually affected by this demyelinating process. INTERPRETATION: The diagnosis of PML should be considered in immunocompromised patients with neuro-ophthalmic findings, particularly those with homonymous hemianopia.

Suffering, justice, and the politics of becoming.

To suffer is to undergo, to bear, to endure. Suffering exists on the underside of agency; it is as important to ethics as agency. The experience of suffering is never entirely captured by the ethical, political, medical and spiritual categories in which it is represented. Perhaps an engagement with suffering can open up hidden connections between these domains. After examining John Caputo and Friedrich Nietzsche comparatively on the relation between suffering and ethics, this essay explores the relation of the "politics of becoming" to suffering. The politics of becoming is a paradoxical process by which a new cultural identity is drawn into being and yet is irreducible to the energies and motives that spurred its initiators to action. To exemplify and think the politics of becoming is to call into question the sufficiency of existing paradigms of morality. A critical examination of the Rawlsian model of justice brings out, for example, the insufficiency of justice to the politics of becoming. It suggests the need, first, to pursue an "ethics of engagement" between several parties drawing upon a variety of sources of ethical inspiration and, second, to cultivate "critical responsiveness" to new social movements that struggle to place new identities onto the cultural register. If the latter movements sometimes modify general understandings of suffering, identity, justice and medical practice they also indicate the role cultural thinkers can play in re-examining periodically established codes of interaction between these domains.

Drug addiction, pregnancy, and childbirth: legal issues for the medical and social services communities.

There are many new legal issues emerging as a consequence of the large number of women who abuse drugs during pregnancy. As a result, the medical community has to take greater steps to advise women of the consequences of actions taken during pregnancy. Physicians and hospitals also must develop protocols for obtaining informed consent of a parent or legal guardian before drug tests are run on newborns and for reporting cases of infants born drug dependent. This article focuses on the conflicting interests and rights involved and offers some concrete ideas as to how these interests might be balanced.

Evaluating the use of occupational standards for controlling toxic air pollutants.

Currently, the U.S. Environmental Protection Agency has established air standards for relatively few chemicals. As a result, state agencies are faced with controlling air contaminants for a large number of chemicals posing potential public health threats. Use of occupational standards as a basis for deriving ambient air guidelines is a method used by states to control air toxics. This standard development approach is reviewed by considering the differences in the health basis and numerical values which often occur among the occupational standards set by OSHA, NIOSH and ACGIH. This study indicated that careful selection should be made of the most appropriate occupational standard to use to protect public health. A comparison is made of chemicals regulated by various state air toxic programs using occupational standards lowered by a safety factor to concentrations established by the U.S. EPA. It was found that the air guidelines vary, but the degree of stringency can be comparable.

Optic disc colobomas.

This paper describes optic disc colobomas in a father and his twin sons. Two of the six eyes had associated anterior colobomas (one of the iris and the other of the peripheral retina), and there was evidence of abnormal development of Bergmeister's papilla in the father's left eye.

Treatment of blepharitis and blepharoconjunctivitis: comparison of gentamicin-betamethasone, gentamicin alone and placebo.

At two university centres 46 patients presenting with symptomatic infective blepharitis or blepharoconjunctivitis participated in a double-blind study of a new antibiotic-steroid ointment containing gentamicin and betamethasone. There was no significant difference in response to 2 weeks of therapy between the patients treated with this ointment and those treated with either an ointment containing gentamicin alone or a placebo ointment. There was also no significant correlation between the clinical response and the results of the bacterial cultures of swabs obtained at the beginning and the end of the study. However, the patients treated with the placebo had a much higher rate of recurrence of their symptoms over a 6-week follow-up period. The patients who before treatment had associated rosacea, dry eyes and a long duration of symptoms showed a poor response to therapy.