Clinical evaluation and management of a 45-year-old man with confusion, psychosis, agitation, stereotyped behavior, and impaired speech.

Our patient Mr. A is a mentally and physically disabled gentleman. He was first diagnosed with bipolar disorder as a teenager. He incurred a lumbar spinal injury due to a motor vehicle incident in his 20s which led to weakness, numbness, and frequent infection over both of his lower extremities. He also developed alcohol addiction over the course of his life. Mr. A presented to our facility with complicated neuropsychiatric symptoms. By adopting various clinical strategies, we were able to control his symptoms of agitation, self-harm, mood swings, and stereotyped behavior. However, we were not able to improve his neurocognitive functioning or speech impairment which seemed to become severe and irreversible in a period of a few months. We felt disappointed and perplexed by the mixed treatment responses. To understand Mr. A's clinical presentation, various laboratory tests and imaging studies were performed. Different psychotropic medications were used to manage his symptoms. Gradually, we felt that we were able to understand this case better clinically and etiologically. His bipolar disorder, alcohol addiction, and physical injury had likely all contributed to his neuropsychiatric symptoms, directly or indirectly. It is highly possible that an alcohol-related progressive dementia along with his chronic bipolar disorder played a key role in the progression of his brain neurodegeneration. Also, Wernicke-Korsakoff syndrome could reasonably be considered having developed during his clinical course. Moreover, the fluctuation of the patient's neuropsychiatric symptoms we observed during his hospitalization reflects the increased vulnerability of the human brain under sustained neurodegeneration.

Minimum standards for continence care in the UK.

AIM: This paper reports on the publication of a joint statement on minimum standards for continence care in the UK. METHODS: A multidisciplinary working party were tasked with creating standards for both training and education in continence care, as well as explicit standards for a framework of service delivery. This was done through a process of extensive consultation with relevant professional bodies. RESULTS: The standards suggest a modular structure to continence training, including basic, male, female, catheter care etc. Discussions on service provision cover primary care through to expert tertiary centres. CONCLUSIONS: This is the first attempt to standardise continence care and training for all health care professionals nationally. The document is available on the United Kingdom Continence Society website www.ukcs.uk.net.

Tacrolimus-induced paranoid delusions and fugue-like state.

We report the case of a 43 year old male with no prior psychiatric history with apparent tacrolimus-induced psychosis. Previous reports have identified other neurotoxic adverse effects due to tacrolimus, however, to our knowledge, there are few reports that describe psychosis induced by the immunosuppressant drug. Although psychosis may be a rare adverse effect, it can have significant impact on the long-term prognosis and treatment in transplant recipients. It is imperative to quickly identify patients who develop a mental status change while on tacrolimus and to work with the appropriate transplant team in managing these patients. Treatment usually calls for prompt discontinuation of tacrolimus, substituting with another immunosuppressant, and possible use of antipsychotics.

Minimum standards for urodynamic practice in the UK.

AIM: This paper reports on the recent publication and wide distribution of a joint statement on minimum standards for urodynamic practice in the UK. METHODS: A multidisciplinary working party were tasked with creating standards for both training and certification in urodynamics, as well as explicit standards for a framework of service delivery. This was done through a process of extensive consultation with relevant professional bodies. RESULTS: The standards suggest a modular structure to urodynamics training, and make recommendations on minimum workload for individuals and departments, the need for multidisciplinary team working and for regular audit. CONCLUSIONS: This is the first attempt to standardise urodynamics practice nationally. The document is available on the United Kingdom Continence Society websitewww.ukcs.uk.net.

The effect of a multicomponent professional development training on the beliefs and behaviors of community health educators concerning food irradiation.

Beliefs have a significant effect on the health behaviors of individuals and educators; however, they can be difficult to change. The purpose of this study was to determine if exposing community health educators, specifically family and consumer sciences county extension educators, to a multicomponent professional development training on food irradiation could change their beliefs and behaviors. This study compared the food irradiation beliefs and educational programming of educators who participated in a professional development training with those who did not. Results indicated that the training significantly improved the food irradiation beliefs of participants. In addition, the number of participants who provided food irradiation education significantly improved compared with educators who had not attended the training. These results suggest that this type of professional development training format can significantly affect beliefs and could increase the amount of food irradiation information available to consumers through community health educators.

Evaluation of an ex vivo murine local lymph node assay: multiple endpoint comparison.

The local lymph node assay (LLNA) is used to assess the skin sensitization potential of chemicals. In the standard assay, mice are treated topically on the dorsum of both ears with test substance for 3 days. Following 2 days of rest, the initiation of the hypersensitivity response is evaluated by injecting (3)H-thymidine into a tail vein, and then measuring the levels of radioisotope incorporated into the DNA of lymph node cells draining the ears. In the current study, BALB/c mice were treated with the contact sensitizers hexylcinnamic aldehyde (HCA) and oxazolone, and the nonsensitizer methyl salicylate. The proliferative response of lymph node cells was evaluated in an ex vivo assay, in which isolated cells were cultured in vitro with (3)H-thymidine. Treatment of mice with HCA at 5-50% resulted in concentration-related increases in (3)H-thymidine incorporation, with stimulation indices ranging from 3 to 14. Low animal-to-animal variability was seen in three replicate assays testing HCA at 25%. As anticipated, the proliferative response induced by the potent sensitizer oxazolone at 0.25% was greater than HCA at all concentrations tested. Stimulation indices of 1.5 and 3 were seen in two independent experiments with methyl salicylate. These equivocal findings were likely due to the irritancy properties of the compound. Importantly, measuring ex vivo (3)H-thymidine incorporation was more sensitive than evaluating lymph node weight and cellularity, and in vitro bromodeoxyuridine incorporation. Furthermore, the results of the ex vivo LLNA were comparable to the standard assay. This study provided evidence that supports the use of an ex vivo LLNA for hazard assessment of contact hypersensitivity.

Determining the food irradiation beliefs of community nutrition educators: do beliefs influence educational outreach?

OBJECTIVE: To develop an instrument to measure the food irradiation beliefs of community nutrition educators and to determine the influence of those beliefs on food irradiation educational outreach. DESIGN: Survey development, cross-sectional telephone survey. SETTING: Cooperative Extension Program. PARTICIPANTS: All Family and Consumer Sciences (FCS) county extension agents serving in the most populated counties in Texas (n = 134, response rate = 99%). These participants may not be representative of all FCS extension agents. VARIABLES MEASURED: Food irradiation beliefs and educational outreach as well as selected demographic variables. ANALYSIS: To determine validity and reliability of the instrument, factor analysis and Cronbach's alpha were conducted, respectively. To determine if food irradiation beliefs influenced food irradiation educational outreach, logistic and multiple regression analyses were conducted, with significance set at P < .05. RESULTS: The instrument had adequate reliability; two belief scales were identified through factor analysis, referred to as Safety Beliefs and Understanding Beliefs. Additionally, regression analysis suggested that educators' beliefs about food irradiation influenced the amount of food irradiation education they provided. CONCLUSIONS AND IMPLICATIONS: Results suggest that educators' beliefs about the safety and their understanding of food irradiation are predictors of the educational outreach they provide about it, indicating the potential value of professional development regarding food irradiation.

Induction of apoptosis by cationic amphiphilic drugs amiodarone and imipramine.

Phospholipidosis is the excessive accumulation of intracellular phospholipids in cell lysosomes. Drugs that induce this disease often share common physiochemical properties and are collectively classified as cationic amphiphilic drugs (CADs). Although the cause of phospholipidosis and morphologic appearance of affected lysosomes have been studied extensively, less is known about the physiologic effects of the condition. In the current study, U-937 cells were incubated with the CADs amiodarone (2.5-10 microg/mL) and imipramine (2.5-20 microg/mL). Treatment of U-937 cells with these compounds for 96 h resulted in concentration-related increases in phospholipids, as assessed by flow cytometry using the fluorophore nile red. These results were verified by measuring the concentrations of choline-derived phospholipids, which were significantly increased in drug-treated cells. Cell number in amiodarone (10 microg/mL) and imipramine (20 microg/mL) cultures following the 96-h incubation period were markedly reduced compared to control cultures. These observations suggested that accumulation of cellular phospholipids could inhibit cell proliferation. Flow cytometric analysis revealed a decrease in the percentage of cells in the S-phase of the cell cycle following drug treatment, yet DNA replication still occurred in a significant portion of cells. Interestingly, amiodarone and imipramine induced apoptosis in U-937 cells as shown by annexin V-FITC staining and DNA fragmentation. Enzymatic assays demonstrated that amiodarone and imipramine induced the activity of caspases 2 and 3. These results suggest that disruption of cell lysosomes in U-937 cells following accumulation of phospholipids does not cause a cell cycle arrest but instead induces apoptosis by activation of caspase pathways.