A comparison of self-reported risk and protective factors and the death implicit association test in the prediction of future suicide attempts in adolescent emergency department patients.

BACKGROUND: Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings. METHODS: A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics. RESULTS: A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84-0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85-0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52-0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55-0.79). CONCLUSIONS: In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.

Reinforcing mitochondrial functions in aging brain: An insight into Parkinson's disease therapeutics.

Mitochondria, the powerhouse of the neural cells in the brain, are also the seat of certain essential gene signaling pathways that control neuronal functions. Deterioration of mitochondrial functions has been widely reported in normal aging as well as in a spectrum of age-associated neurological diseases, including Parkinson's disease (PD). Evidences accumulated in the recent past provide not only advanced information on the causes of mitochondrial bioenergetics defects and redox imbalance in PD brains, but also much insight into mitochondrial biogenesis, quality control of mitochondrial proteins, and genes, which regulate intra- and extra-mitochondrial signaling that control the general health of neural cells. The mitochondrial quality control machinery is affected in aging and especially in PD, thus affecting intraneuronal protein transport and degradation, which are primarily responsible for accumulation of misfolded proteins and mitochondrial damage in sporadic as well as familial PD. Essentially we considered in the first half of this review, mitochondria-based targets such as mitochondrial oxidative stress and mitochondrial quality control pathways in PD, relevance of mitochondrial DNA mutations, mitophagy, mitochondrial proteases, mitochondrial flux, and finally mitochondria-based therapies possible for PD. Therapeutic aspects are considered in the later half and mitochondria-targeted antioxidant therapy, mitophagy enhancers, mitochondrial biogenesis boasters, mitochondrial dynamics modulators, and gene-based therapeutic approaches are discussed. The present review is a critical assessment of this information to distinguish some exemplary mitochondrial therapeutic targets, and provides a utilitarian perception of some avenues for therapeutic designs on identified mitochondrial targets for PD, a very incapacitating disorder of the geriatric population, world over.

Quantitative SPECT imaging and biodistribution point to molecular weight independent tumor uptake for some long-circulating polymer nanocarriers.

Polymeric nanocarriers are promising entities for cancer diagnosis and therapy. The aim of such nanocarriers is to selectively accumulate in cancerous tissue that is difficult to visualize or treat. The passive accumulation of a nanocarrier in a tumor through extravasation is often attributed to the enhanced permeation and retention (EPR) effect and the size and shape of the nanocarrier. However, the tumor microenvironment is very heterogeneous and the intratumoral pressure is usually high, leading to different opinions about how the EPR of nanocarriers through the irregular vasculature of a tumor leads to accumulation. In order to investigate this topic, we studied methods for the determination of pharmacokinetic parameters, biodistribution and the tumor uptake of nanocarriers. More specifically, we used non-invasive quantitative Single-Photon Emission Computed Tomography/Computed Tomography (qSPECT/CT) imaging of hyperbranched polyglycerols (HPGs) to explore the specific biodistribution and tumor uptake of six model nanocarriers in Rag2m mice. We were interested to see if a distinct molecular weight (MW) of nanocarriers (HPG 25, 50, 100, 200, 300, 500 kDa) is favoured by the tumor. To trace the model nanocarriers, HPGs were covalently linked to the strong chelator desferrioxamine (DFO), and radiolabeled with the gamma emitter 67Ga (EC = 100%, E γ = 185 keV (21.4%), 300 keV (16.6%), half-life = 3.26 d). Without the need for blood collection, but instead using qSPECT/CT imaging inside the heart, the blood circulation half-lives of the 67Ga labeled HPGs were determined and increased from 9.9 ± 2.9 to 47.8 ± 7.9 hours with increasing polymer MW. Total tumor accumulation correlated positively with the circulation time of the HPGs. Comparing the tumor-to-blood ratio dynamically revealed how blood and tumor concentrations of the nanocarrier change over time and when equilibrium is reached. The time of equilibrium is size-dependent and increases with molecular weight. Furthermore, the data indicate that for larger MWs, nanocarrier uptake and retention by the tumor is size independent. Further studies are necessary to advance our understanding of the interplay between MW and nanoparticle accumulation in tumors.

Demographic and clinical profile of oral squamous cell carcinoma patients: a retrospective study.

BACKGROUND: Oral cancers are one of the ten leading cancers in the world. However, in India, it is one of the most common cancer and constitutes a major public health problem. AIM: The purpose of this study was to evaluate, retrospectively, the epidemiologic profile of patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: OSCC cases were retrospectively analyzed from January 2008 to September 2010 for age, gender, occupation, duration of the symptoms, habits (tobacco and alcohol consumption), site of primary tumor, and TNM staging, and the findings were formulated to chart the trends in central India population. RESULTS: Male to female ratio was 4.18:1. Mean age was 49.73 years. The most common site of presentation of tumor was in mandibular alveolus region. Tobacco chewing was the major cause for the development of OSCC. Maximum number of patients, i.e., 201 (68.14%) were presented within 6 months of onset of symptoms. Majority of patients were presented in Stage III (82.37%). Correlation between the two variables, i.e., site to habits, staging to site involved, staging to duration of the disease, staging to habits, and staging to age of the patient, were found to be statistically nonsignificant (P>0.05). CONCLUSIONS: The aim of the study was the demographic description of oral squamous cell carcinoma. Most of the cases report at advanced stages of the disease which often leads to delay in the management coupled with the fact that health care centers are burdened with long waiting lists. Strategies to overcome the present situation must be undertaken by oral health programs for the early diagnosis and prevention and management and follow up of oral cancer.

CBVT analysis of canal configuration of the mesio-buccal root of maxillary first permanent molar teeth: An in vitro study.

CONTEXT: For successful endodontic treatment, it's imperative to locate and obturate all root canals. As concluded by Ingle, the major cause for failure of root canal therapy is in ability to recognize all theexisting canals and subsequent failure in their obturation. AIM: To analyze the canal configuration of the mesio-buccal root of maxillary first permanent molar teeth. MATERIALS AND METHODS: A total of 30 recently extracted human permanent maxillary first molars were collected and stored in a container with 5% Sodium Chloride solution for four days. Teeth with open apices, external resorption, improperly formed roots and teeth with previous restorations were excluded. Using the dental modeling wax, teeth were arranged in a 'U' shaped arch with roots embedded inside the wax and occlusal surface remaining free. 10 teeth were arranged in each arch and three such sample plates were prepared. Flat surface of the base encasing enabled the plate to be mounted on flat plastic bite plate. With bite plate roughly centered in the focal trough area Axial, Coronal and Sagittal section Cone-Beam Computed Tomography (CBCT) images were taken with Kodak 9000 Extra-oral Imaging System. Images displayed on a monitor were inspected by two endodontists using Kodak Dental Imaging Software 3D Module V2.2. STATISTICAL ANALYSIS: When the data was observed, it was found that 24 teeth out of total 30 teeth examined showed some variation (i.e. possible additional canal) along the length of the mesio-buccal root canal. Out of these 24 teeth, 13 showed presence of additional canal at coronal third, 7 showed presence of additional canal at middle third and four showed presence of additional canal in apical third level. Percentage analysis was done as there was no group comparison to be done. RESULTS: Cone-Beam Volumetric Tomography (CBVT) evaluation positively identified the variations in mesio-buccal canal in 80% of samples. Out of these, 54.16% were in coronal 3(rd), 29.16% in middle 3(rd) and 16.66% were in apical 3(rd). CONCLUSION: Within the limitations of this study, it can be concluded that- (1) more than half of maxillary first molars have four canals and (2) most of the additional canals were located in the MBR and CBVT is a good diagnostic tool to help diagnose these additional canals. Further investigations using larger sample sizes would be helpful.

Screening for carbon monoxide in children.

OBJECTIVE: Carbon monoxide (CO), a colorless, odorless gas, accounts for the majority of fatal poisonings in the United States. To date, few screening studies that evaluate pediatric exposure are available. The objectives of this study were to determine the value of a CO breath analyzer for detecting pediatric CO exposure and to identify potential CO sources. DESIGN: Prospective screening study. SETTING: Emergency department of an urban children's hospital. PATIENTS: A convenience random sample of 470 noncritically ill children, aged five to 20 years, who presented to a pediatric emergency department and could blow into a CO breath analyzer. INTERVENTION: After informed consent and demographic and clinical variables were ascertained, eligible patients blew into a CO breath analyzer. Those with breath CO levels > or = 9 ppm underwent confirmatory cooximetric analysis of capillary blood. Sources of CO exposure were determined by history and a home-site evaluation by the local gas company. Patients with carboxyhemoglobin (COHb) levels of more than 5% were given normobaric 100% oxygen until their COHb levels were less than 5%. RESULTS: 1.9% (9/470) of patients had elevated breath CO levels and COHb levels by cooximetry. Putative sources of CO exposure were active cigarette smoking for five patients and a faulty furnace in the home for one patient. On the basis of the history, we believe environmental tobacco smoke or automobile exhaust or both contributed to the elevated COHb levels in the other three patients. There was a good correlation between COHb by cooximetry and breath analysis (concordance correlation = 0.739) CONCLUSION: Breath analysis for CO is a convenient tool to estimate exposure and identify older children at risk.

Ossification of the ligamentum flavum causing thoracic myelopathy: a case report.

Ossification of the ligamentum flavum is a well reported clinicopathologic entity causing narrowing of the spinal canal and subsequent spinal cord compression. The patient described in this case report complained of 9 mo of middle and lower back pain, difficulty with balance, progressive gait disturbance, and recent onset of bladder retention. Magnetic resonance imaging and computed tomographic scan revealed a bone density mass at the T2-3 level causing 25% cord compression and edema. A decompressive laminectomy was performed at T-2. The etiology of the compression was found to be attributable to an ossified ligamentum flavum at the T-2 level, which was confirmed by histologic examination. His neurologic signs and symptoms and functional status markedly improved after surgery and subsequent comprehensive rehabilitation. The patient was able to ambulate independently with a walker as opposed to previously being wheelchair-bound. Prompt surgical intervention and appropriate rehabilitation management play a key role in improving the functional outcome of myelopathy caused by ossified ligamentum flavum. This article acquaints rehabilitation personnel with the clinical features, proposed etiologies, association with other diseases, work-up, treatment, and rehabilitation concerns of patients with myelopathy caused by ossified ligamentum flavum.

Insulin reverses haemodynamic changes and pulmonary oedema in children stung by the Indian red scorpion Mesobuthus tamulus concanesis, Pocock.

The efficacy of insulin administration in reversing haemodynamic changes in pulmonary oedema in victims of poisonous scorpion sting is assessed by a study based on animal experiments in which insulin administration reversed metabolic and electrocardiographic changes induced by scorpion envenomation. Six previously healthy children aged 18 months to 11 years were admitted to hospital five to 17 hours after scorpion sting. Frusemide for raised central venous pressure and pulmonary oedema, crystalloid infusion for reduced central venous pressure, and hydrocortisone and dopamine for hypotension were used as standard therapy. Insulin (0.3 units g-1 of glucose) was administered when the standard therapy failed to produce an improvement, and at the earliest sign of haemodynamic instability. Reversal of pulmonary oedema and haemodynamic changes, and attainment or normal respiratory rate, blood pressure and central venous pressure, were observed. It is concluded that insulin administration may be useful in reversing haemodynamic changes and pulmonary oedema in victims of scorpion stings.

Sources of lead exposure in urban slum school children.

A school based study was undertaken to trace various sources of lead exposure in urban slum children. Two cases with elevated venous blood lead (PbB) levels were detected and confirmed in 100 consecutive Bombay school children, referred to a hospital school clinic for clinical pallor. A common source of lead exposure in one suburb, was implied by the significantly higher PbB levels here. Systematic family and environmental studies identified the source was a nearby factory manufacturing lead storage batteries. Similar studies for the other index case traced the source to the dust produced by small scale foundries and secondary lead smelters. This study indicates that large scale screening studies are necessary to establish the magnitude and epidemiology of this problem in Bombay.