Household Transmission of Vibrio cholerae in Bangladesh.

BACKGROUND: Vibrio cholerae infections cluster in households. This study's objective was to quantify the relative contribution of direct, within-household exposure (for example, via contamination of household food, water, or surfaces) to endemic cholera transmission. Quantifying the relative contribution of direct exposure is important for planning effective prevention and control measures. METHODOLOGY/PRINCIPAL FINDINGS: Symptom histories and multiple blood and fecal specimens were prospectively collected from household members of hospital-ascertained cholera cases in Bangladesh from 2001-2006. We estimated the probabilities of cholera transmission through 1) direct exposure within the household and 2) contact with community-based sources of infection. The natural history of cholera infection and covariate effects on transmission were considered. Significant direct transmission (p-value<0.0001) occurred among 1414 members of 364 households. Fecal shedding of O1 El Tor Ogawa was associated with a 4.9% (95% confidence interval: 0.9%-22.8%) risk of infection among household contacts through direct exposure during an 11-day infectious period (mean length). The estimated 11-day risk of O1 El Tor Ogawa infection through exposure to community-based sources was 2.5% (0.8%-8.0%). The corresponding estimated risks for O1 El Tor Inaba and O139 infection were 3.7% (0.7%-16.6%) and 8.2% (2.1%-27.1%) through direct exposure, and 3.4% (1.7%-6.7%) and 2.0% (0.5%-7.3%) through community-based exposure. Children under 5 years-old were at elevated risk of infection. Limitations of the study may have led to an underestimation of the true risk of cholera infection. For instance, available covariate data may have incompletely characterized levels of pre-existing immunity to cholera infection. Transmission via direct exposure occurring outside of the household was not considered. CONCLUSIONS: Direct exposure contributes substantially to endemic transmission of symptomatic cholera in an urban setting. We provide the first estimate of the transmissibility of endemic cholera within prospectively-followed members of households. The role of direct transmission must be considered when planning cholera control activities.

[Bariatric surgery - significance, risks, long term consequences]. / Adipositaschirurgie- Stellenwert, Risiken und Folgen.

In recent years the number of bariatric surgery has markedly increased in industrial nations. Surgery provides a more rapid decrease of body weight than conservative approach. However a long term conservative follow up therapy is mandatory to stabilize reduced weight. Due to increasing knowledge from long term follow up of surgically treated obese patients there is a growing body of evidence that frequently there is necessity of reoperations and of substitution both of trace elementsand of minerals or vitamins due to their hampered enteral resorption. Additionally therapy of surgery induced endocrine alterations not seldom is necessary.These insights are of outstanding importance because meanwhile an enlargement of the indications for bariatric surgery as a therapeutic option for metabolic disorders is being discussed. This review refers to the recent internationally published papers concerning consequences of bariatric surgery.

[Therapy for obesity--conservative and/or surgical?]. / Adipositastherapie--konservativ und/oder chirurgisch?

On comparing surgical and conservative approaches in therapy for obesity it is accepted that there is a more rapid decline in body weight after surgery than by conservative measures. In contrast to widespread convictions, it has been shown that even in extreme obesity (BMI>60 kg/m²) both a meaningful and a long-lasting reduction of body weight is possible by conservative approach. There is an increasing body of evidence that bariatric surgery, especially malabsorptive and combined forms, causes endocrine disturbances and both vitamin and micronutrient deficiencies. Furthermore, alterations in drug pharmacokinetics are possible. Even bariatric surgeons have stated that surgery neither removes the chronic disease obesity nor is its final therapy.

Experimental evidence for neutral community dynamics governing an insect assemblage.

The high levels of species diversity observed within many biological communities are captivating, yet the mechanisms that may maintain such diversity remain elusive. Many of the phenotypic differences observed among species cause interspecific tradeoffs that ultimately act to maintain diversity through niche-based coexistence. In contrast, neutral community theory argues that phenotypic differences among species do not contribute to maintaining species diversity because species are ecologically equivalent. Here we provide experimental and observational field evidence that two phylogenetically very distant Enallagma species appear to be ecologically equivalent to one another. Experimental abundance manipulations showed that each species gains no demographic advantage at low relative abundance, whereas manipulations of total Enallagma abundance resulted in large increases in per capita mortality and large decreases in growth for both species. Moreover, demographic rates and relative abundances of multiple Enallagma species were uncorrelated with major environmental gradients in an observational study of 20 natural lakes. These are the expected patterns if species are ecologically equivalent. However, these results do not imply that all damselflies in these lakes are ecologically identical. Previous experimental results have demonstrated the operation of strong coexistence mechanisms maintaining Enallagma and its sister-genus Ischnura in these littoral food webs. Combined with a simple theoretical model we present, these results taken together show how both neutral and niche dynamics can jointly structure communities.

[Assessment of additional health care needs of persons with restricted competence in daily life: problems and possible solutions]. / Sozialmedizinische Erfassung des zusätzlichen Pflegebedarfs von Personen mit eingeschränkter Alltagskompetenz: Probleme und Lösungsmöglichkeiten1.

A brief general view was given on the public German care insurance. Stressing somatic care, persons with restricted competence for daily life activities are recorded insufficiently. An instrument for documentation of those restrictions was presented.

[Unconventional treatment methods in multiple sclerosis and their expert assessment]. / Unkonventionelle Behandlungsverfahren bei Multipler Sklerose und ihre Begutachtung.

Unorthodox therapies are used also by MS-patients very frequently. Not all procedures are harmless affecting only the purse. The medical expert working within the German health care system will also be called for questions of compensation of costs. A survey of some paradigmatic unorthodox treatments is given. While the law and the jurisdiction concerning the public health insurance fund pronounce clear standards in respect to the demands on the efficacy shown by modern (biomathematic) methods, it is essentially a more difficult task to bring the jurisdiction of the Federal Supreme Court (BGH) in harmony with basic requirements of a rational and scientific medicine. The interindividual and intraindividual course of MS is most variable, therefore it is very difficult to make a distinction between natural course and effects of a therapy in a single case while the only possibility to estimate individual therapeutic chance is a statistic evidence of efficacy in general.

Preliminary experiences and results with the Munich version of the Andreasen Scale. Assessment of productive and negative symptoms in chronic schizophrenic patients.

The Andreasen Scale (SANS), an instrument for evaluating negative symptoms in schizophrenic patients, was translated at the Psychiatric Hospital of Munich and tested on 35 chronic schizophrenic inpatients at the Regensburg State Mental Hospital. In addition, psychopathology was evaluated with the BPRS, sociodemographic data were collected, and cognitive performance was evaluated by the MMS. Also, VBR was determined on the basis of CAT scans. Our results suggest that the SANS is a reliable instrument for measuring negative symptoms; however, the symptom complexes are affected by age, duration of illness and hospitalization, thus making a clear distinction between negative symptoms per se and the effects of hospitalization questionable.

Psychomotor disturbances in psychiatric patients as a possible basis for new attempts at differential diagnosis and therapy. II. Cross validation study on schizophrenic patients: persistence of a "psychotic motor syndrome" as possible evidence of an independent biological marker syndrome for schizophrenia.

This study investigates the existence and course of psychomotor symptoms in schizophrenic patients (n = 57, both treated and untreated with antipsychotic drugs) as compared to 25 healthy controls. Previous psychometric studies had suggested the existence of a "psychotic motor syndrome" (PMS) both in (untreated) schizophrenic and endogenous depressed patients, consisting of disturbances of lip and tongue movements, fine and gross movements of the dominant right hand and impaired complex motor coordination of the extremities. We confirmed the existence of the PMS in this study. There was no correlation of the PMS with the psychopathological status of the patients, or with extrapyramidal side-effects of the drugs used, perhaps indicating an independent "basic syndrome" ("Basisstörung"). Factorial analyses revealed similar structures both in schizophrenic and healthy persons; the differences in motor performance may be due to an impairment of the first factor "general motor ability" in schizophrenic patients. The PMS did not disappear parallel to the psychopathological improvement of the patients, nor in the symptom-free remission interval. The role of the PMS as possible independent biological marker syndrome for schizophrenia can consequently be further supported, with its implications towards the differential diagnostic and therapeutical values of this syndrome.

Music psychopathology. III. Musical expression and psychiatric disease.

Musical expression of the instrumental playing of 61 mentally ill patients and 29 controls recorded several times was assessed by means of a short polarity profile. The performances were reversibly impaired in correlation with the psychopathology. Musical expression followed a systematic variation according to nosological classification. Endogenous-depressive patients could be clearly distinguished from neurotic-depressive patients due to weakened motoric qualities in their playing. In schizophrenia, motoricity did not seem to be so much involved, although the performances were altered in the dimension of musical logic and order. Maniform syndromes had the least effect on musical expression.

No correlation between neuroleptic-induced increase of beta-endorphin serum level and therapeutic efficacy in schizophrenia.

In 23 acute, unmedicated, schizophrenic patients, psychotic behaviour and beta-endorphin serum level were measured before and during four weeks of neuroleptic therapy. Prior to drug treatment, beta-endorphin level of all patients was within the normal range. Neuroleptic therapy induced marked elevations of beta-endorphin in eight subjects; statistical analysis revealed a slight but significant increase for the whole group. This endocrine effect was not correlated with therapeutic efficacy of neuroleptic treatment.

The effect of fluperlapine in acute psychotic patients.

Fluperlapine (NB 106 689), a dibenzazepine chemically and pharmacologically similar to clozapine, was investigated in 28 patients with regard to antipsychotic efficacy and occurrence of adverse effects. In an open early phase II study patients were given fluperlapine over a period of 26 days. The average daily dosage was 300 mg. Five patients had to be withdrawn from the trial during the first week due to side effects or therapeutic inefficacy, 23 patients were examined during the period planned. The substance proved to have fast-acting antipsychotic effect with few adverse effects and no extrapyramidal motor disturbances.

[Karl Kraus and psychiatry. An assay]. / Karl Kraus und die Psychiatrie. Ein Essay.

This essay deals with Karl Kraus' polemics against psychiatry; not only orthodox psychiatry but also psychoanalysis, which at that time was gaining in importance. The introduction is an appreciation of Kraus' significance for the German speaking civilization. Then the two cases, Louis von Sachsen and Prof. Beer, are discussed in relationship to Kraus' polemics against forensic psychiatry, for in these cases forensic psychiatry was in danger of losing its claim of being scientific and of becoming a supporter of the vested interests or an advocate of sexual repression. It is then attempted to show how aphorisms with universal validity arise out of topical polemics. Kraus' position in relation to Freud and his school is discussed. We try to demonstrate that the similarity in opinion that H. Marcuse assumed about the significance of a sexual economy can only be a superficial one, especially as it relates to sublimation as a mainspring of civilization. Also Kraus' critique of the inferiority complex is delved into. Concluding, we touch upon attempts at interpreting Kraus' work and personality from a psychoanalytical standpoint. Here the term 'narcissistic personality' is discussed.

[Norepinephrine turnover under neuroleptic treatment of schizophrenic syndromes (author's transl)]. / Noradrenalinstoffwechsel unter Neuroleptikabehandlung schizophrener Syndrome.

In 45 psychotic in-patients with the paranoid-hallucinatory syndrome, the psychopathology, the extrapyramidal motor disturbances and 3-methoxy-4-hydroxy-phenylethyleneglycol (MHPG) in CSF were investigated. A 15-day treatment with haloperidol induced significant increase of MHPG in CSF; after 10 days clozapine treatment MHPG was significantly reduced. 10 days later the normal values were reached again. The investigation of MHPG in CSF under treatment with neuroleptics showed no correlation between antipsychotic activity and the turnover of central norepinephrine.

Clinical and biochemical parameters during neuroleptic treatment. I. Investigations with haloperidol.

26 patients with a paranoid-hallucinatory syndrome were treated with a fixed daily dose of haloperidol. Psychopathological symptoms and parkinsonism were studied before and during the treatment. HVA and 5-HIAA concentrations in CSF were determined immediately before and after 5 or 15 days of treatment. After 5 days of treatment a slight effect was observed on psychotic symptoms and on the extrapyramidal motor system, as well as an elevation of HVA and 5-HIAA concentrations in CSF. After 15 days of treatment the extrapyramidal and antipsychotic effects were significant, but the rise of HVA was smaller than after 5 days of treatment; 5-HIAA remained unchanged. These different time courses of the neuroleptic effects on psychopathological symptoms, on extrapyramidal system and on monoamine metabolites concentration in CSF could be interpreted as a development of drug tolerance in relation to the biochemical parameters.

Clinical and biochemical parameters during neuroleptic treatment. II. Antipsychotic effect of haloperidol in patients with chronic organic brain damage.

The time-course of psychopathological symptoms, of extrapyramidal side effects, and of changes in cerebrospinal fluid (CSF) concentration of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were simultaneously studied during Haloperidol treatment of 14 psychotic patients with chronic organic brain damage. After 15 days of treatment significant antipsychotic effect was found, while Parkinsonism scores in clinical and experimental tests increased only slightly. CSF concentration of HVA increased significantly by 150% compared to the baseline value (p less than 0.05) and 5-HIAA remained unchanged. No correlation was found between the clinical and biochemical variables studied. The comparison of these results with those obtained in patients without brain damage suggests that different psychopathological and extrapyramidal responses to neuroleptics are not strictly associated with specific HVA changes in CSF.

Clinical and biochemical parameters during neuroleptic treatment. III. Primitive reflexes during neuroleptic treatment.

Palmomental reflex, glabellar reflex and oral responses were studied in the course of a treatment with Haloperidol in 14 psychotic patients with a chronic organic brain damage. An increase of the three responses was found; maximum intensity and frequency of the primitive reflexes were reached during the first 5 days of treatment. There was no correlation found between the intensity of primitive reflexes and changes of psychopathological symptoms, of extrapyramidal scores and of homovanillic acid (=HVA) and 5-hydroxyindoleacetic acid (5=5-HIAA) concentration in cerebrospinal fluid (=CSF). The presence of primitive responses is interpreted as a "decompensation phenomenon" induced by neuroleptics, probably in relation to an effect on the central nervous system (=CNS) dopamine receptors. It is suggested that the appearance of several definite, primitive reflexes during neuroleptic therapy may have some diagnostic and prognostic significance.