Leucoencefalopatía tóxica fatal: tres casos asociados al consumo de pasta base de cocaína / Fatal toxic leukoencephalopathy associated with consumption of pasta base of cocaine: Report of three cases

The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.

[Fatal toxic leukoencephalopathy associated with consumption of pasta base of cocaine: Report of three cases]. / Leucoencefalopatía tóxica fatal: tres casos asociados al consumo de pasta base de cocaína.

The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.

Association between perceived health status and satisfaction with quality of care: evidence from users of primary health care in Oman.

OBJECTIVE: Our aim was to assess the influence of perceived health status, as measured by SF-12, on the client's views of service quality. METHODS: A structured interview of patients was carried out in six primary health care centres in Adh Dhahira region health authority in the Sultanate of Oman. A total of 1226 patients aged 15 and over attending the different health care services within the health centres took part in the study. The main outcome measures were patients' satisfaction with the different aspects of health care and their perceived physical and mental health status. RESULTS: When adjusted for the relevant background factors such as age and gender, poor perceived health status has been found to predict less positive judgements of various aspects of health care quality. Poor mental health status, for example, predicts less positive judgements of aspects that are linked to the accessibility of the service and interpersonal aspects of care such as the working hours of the centre, GP's attitude and time spent with the GP (P < 0.05, <0.05 and <0.01, respectively). Poor physical health status, on the other hand, predicts less positive judgements of aspects such as cleanliness of the building, confidentiality of consultation with the GP, explanation about the visit to the antenatal clinic and standard of antenatal clinic in general (P < 0.05, <0.05, <0.05 and <0.05, respectively). CONCLUSION: Users' perceived health status has to be evaluated concurrently with assessing satisfaction with the quality of health care services. This would provide more valid results with regard to the patients' views on their level of satisfaction with health care quality.

Determinants of users' satisfaction with primary health care settings and services in Saudi Arabia.

OBJECTIVE: To identify the components of primary health care that cause most concern to service users and to identify socio-demographic and other factors associated with satisfaction among the users of primary health care centres. DESIGN: Interviews conducted by well-trained interviewers with a random sample of heads of households. The questionnaires were composed of questions that measure the extent of satisfaction with settings and services in the primary health care centres using a 5-point rating scale from very satisfied to very dissatisfied. SETTING: The community of Qateef, eastern Saudi Arabia. STUDY PARTICIPANTS: A sample of 802 households representing 838 families was chosen randomly from the housing lists of the primary health care centres in Qateef. There were 40 vacant houses and nine refusals. Thus the number of heads of households actually interviewed was 789. RESULTS: Waiting area structure, confidentiality measures and environmental structure were the areas that caused most concern to service users. The factors that showed the greatest association with satisfaction were the type of the primary health care centre building (purpose-built or rented), literacy status of the household head (literate or illiterate), the extent of the primary health care centre utilization (regular or infrequent). Surprisingly, age showed no association when other characteristics of the respondents were adjusted for, and sex was less important than in other studies. CONCLUSION: How regular the respondent was in using his or her primary health care centre was more predictive in deciding the extent of satisfaction with the various components in the study than the other variables. Socio-demographic factors played minor roles in deciding the extent of satisfaction, although each had a deciding role with one or more, but not all, components.

Enamel defects in the deciduous dentition as a potential predictor of defects in the permanent dentition of 8- and 9-year-old children in fluoridated Cheshire, England.

It is claimed that dental fluorosis in both deciduous and permanent teeth is increasing in fluoridated and non-fluoridated communities. What is unclear is whether fluoride-induced enamel opacities in the deciduous dentition are associated with the subsequent appearance of enamel defects in the permanent dentition. The aim of this study was to establish whether a relationship existed between the presence of diffuse enamel defects on the deciduous molars and permanent incisors of schoolchildren who were lifetime residents in an optimally fluoridated community in Cheshire, England. The dentitions of eight-and nine-year-old children were examined by two examiners, each unaware of the findings of the other. There was a significant increased risk of diffuse enamel defects in the permanent incisors for those children who presented with diffuse defects on their first deciduous molars (Relative Risk, 1.45; 95% confidence interval, 1.05 to 2.0) or second deciduous molars (Relative Risk, 1.86; 95% confidence interval, 1.36 to 2.54). In light of these findings, it is worth considering the potential of the presence of enamel defects in deciduous molars in children aged 1 to 3 years as a predictor of the future appearance of similar lesions in their permanent incisors.

Trends in the organization of cervical cancer screening.

Cervical cytological screening has been available in the UK for several decades, but has not achieved a significant reduction in the incidence of and mortality from cervical cancer. In this paper we describe past problems of cervical screening, discuss the impact of recent innovations to computerize call and recall, and suggest further improvements for the future.

Computer-managed call and recall for cervical screening: a typology of reasons for non-attendance.

Three pilot studies looked at women who had not attended for cervical screening following a computer-generated invitation to a health authority clinic. From these a typology of reasons for non-attendance for computer-managed screening has been developed, specifying inaccessibility, ineligibility, unsuitability, failure of communications, misclassification and refusal because of practical problems, inappropriate beliefs or attitudinal barriers. Underlying the typology are issues connected with the inaccuracy of the database, service organization and provision, and the characteristics of the women themselves.

Cervical screening: what are the communication problems?

Computer-managed call and recall schemes offer the opportunity for effective cervical screening. However, such schemes involve several different agencies, often independent of one another. As a result, problems of communication can arise. This paper discusses potential areas of difficulty and presents some suggestions for improvement.

Well you can come in but i'm not having it. The role of the health visitor in computer-managed cervical screening.

Health visitors called on women who had not attended for a cervical smear test, following an invitation via a computer-managed scheme. Reasons for non-attendance were identified and the study showed that health visitors can be successful in encouraging some non-attenders to be screened. However, there are problems involved in undertaking such a role, which must be acknowledged if the health visitors's time is to be used effectively.

Reasons for non-attendance for computer-managed cervical screening: pilot interviews.

A pilot interview study looked at reasons why women did not attend a clinic following an invitation for a cervical smear test offered via a computer-managed scheme. Three broad issues were identified. First, the inaccuracy of the computer database (the FPC register) meant some women were inaccessible because they no longer lived at the address recorded. Other women were ineligible or unsuitable within the criteria of the scheme but had been sent invitations inappropriately because their screening records were incomplete or out of date. Second, aspects of service organisation and provision led to misclassification of some attenders as non-attenders and to various failures of communication such as non-receipt of the invitation or health education leaflet or unsuccessful attempts to rearrange appointments. In addition, the appointment or venue offered could be unsatisfactory. The third issue concerned the characteristics of the women which sometimes interacted with practical problems connected with service provision. Other women believed the test to be inappropriate for themselves while some were deterred by the prospect of the test itself. In general, embarrassment was pervasive and reflected in preferences for different types of service provision. Women who had neither attended nor been otherwise tested were particularly likely to express feelings of fear and fatalism. General attitudes to the test were favourable but this was not always applied personally. A typology of reasons for non-attendance for computer-managed cervical screening is presented.

Health education in a computer-managed cervical screening programme.

In designing health education material for a cervical screening programme, attention needs to be given to those features identified by research as influencing women's use of screening services. These include not only women's attitudes and beliefs about cervical screening, but also organisational and administrative barriers that can deter women from attending for a smear test. Health information may be presented through a variety of media and at different stages in the cervical screening decision-making process. This paper describes the specific health education used in a computer-managed scheme and how it was modified in the light of findings from research which monitored and evaluated the scheme.

Pregnancy following induced abortion: maternal morbidity, congenital abnormalities and neonatal death. Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists Joint Study.

In a prospective cohort study of the long-term sequelae of induced abortion, a comparison is made between a group of 6418 women who had an induced abortion (cases) and a control group of 8059 women recruited with an unplanned pregnancy which was not terminated with an induced abortion (controls). The present paper reports on 729 cases and 1754 controls who had a post-recruitment pregnancy. In general, prior induced abortion had no material effect on the rate of pregnancy-related morbidity, nor on the rate of congenital abnormalities and neonatal death in the offspring. There was, however, a significant difference in two specific conditions. In the post-index pregnancy in the cases there was an increased relative risk (RR 2.26) of the occurrence of urinary tract infection and a decreased risk (RR 0.25) of pregnancy-related anaemia.

PIP: The long-term sequelae of induced abortion were investigated in a prospective cohort study involving 6418 women who had an induced abortion and 8059 controls recruited with an unplanned pregnancy that was not termined through abortion. This article reports on the 729 cases and 1754 controls who had a post-recruitment pregnancy. In general, prior induced abortion had no significant effect on the rate of pregnancy-related morbidity, nor on the rate of congenital abnormalities and neonatal death in the offspring. However, in cases there was an increased risk of urinary tract infection (relative risk, 2.26) and a decreased risk of anemia (relative risk, 0.25). The prospective design of the present studyminimized the problems of unreliable recall of previous induced abortion and the under-reporting of early pregnancy complications. Although 11% of cases had a post-index pregnancy at the time of data analysis compared with 22% of controls, there is no reason to believe that this difference should affect any complication rates of the post-index pregnancy, especially since the rates were adjusted for variables such as age, smoking, parity, and previous mental illness. To determine whether induced abortion reduces the complication rate in the next pregnancy to the same extent as a full-term pregnancy, a further comparison was carried out in which the induced abortion of cases was counted as a full-term pregnancy. The significantly increased relative risk of 1.62 in the cases suggests that induced abortion does not offer the protection of a full-term pregnancy.

Hypothesis: common bacterial toxins are a possible cause of the sudden infant death syndrome.

It is hypothesised that common toxins produced by bacteria growing in the respiratory tract following a viral infection are a cause of SIDS. This hypothesis is consistent with evidence that viral infections pre-dispose to SIDS, minimal morphological change at autopsy, maximum incidence during sleep and the age incidence of this disease. We present evidence of nasopharyngeal bacterial overgrowth in victims of SIDS and have developed a mathematical model based on the hypothesis which closely predicts the age distribution. The model predicts other age distribution patterns for less common toxins and these may apply to other diseases of childhood. The hypothesis can be tested and if sustained would offer hope of prevention.

Breast self-examination: how committed are women? How committed are we?

Breast self-examination (BSE), increasingly promoted as a good health habit, is gaining recognition by surgeons as a significant factor in tumour size and staging at diagnosis. Clinically-based reports leave unanswered important behavioural questions and pay scant attention to the quality of the teaching or of the practice of BSE. This paper argues that if BSE is to be used as the coarse-screening modality of which it seems to be capable, we must apply to it the same criteria as to other screening modalities. Since BSE ipso facto must be undertaken by the women herself, it is a screening in which subject behaviour is crucial. Promotion of BSE requires not only behaviour change but also maintenance and support. Behavioural aspects are discussed in relation to a recent major study of the teaching and practice of BSE.