How to spot depressed patients in your practice

The relationships between clozapine dosages, plasma concentrations, and clinical responses in Chinese schizophrenics were studied. Fourteen treatment-refractory schizophrenic patients were treated with clozapine for 12 weeks. Patients were assessed before and after 6 and 12 weeks of treatment using the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI), and the Simpson-Angus Scale for Extrapyramidal Side Effect. Plasma clozapine concentrations were determined by high-performance liquid chromatography. Ten patients (71.4%) responded after 12 weeks of treatment. Although the mean daily dosage at week 12 (373 +/- 90 mg/day) was lower than that reported in American trials (444 mg/day), the mean plasma clozapine concentration attained (1,078 +/- 385 ng/ml) was higher. This higher concentration may be due to the lower body wight and the preponderance of women among our patients, absence of smoking and alcohol use, and/or ethnic difference between Chinese and non-Chinese. There was wide interindividual variation in the plasma clozapine concentrations. Compared with other studies, the plasma clozapine concentrations and the response rate were higher. Although the sample size was small, the findings are suggestive of pharmacokinetic and pharmacodynamic ethnic differences in Chinese with clozapine therapy.     

How infants perceive a simple causal event.

Four experiments examined 10-mo-old infants' causal event perception. Exp 1 replicated previous studies except that the specific objects used as agent and recipient varied from trial to trial. Under these conditions infants did not process the causality. Instead they keyed on specific temporal and spatial differences among the events. Exp 2 showed that infants notice a change in the particular agent performing either a causal or noncausal action. Exp 3 showed that infants do not notice a change in the type of action done to a particular recipient. Exp 4 demonstrated that infants do not pay attention to the object used as a recipient. As a whole, the results indicate that 10-mo-old infants perceive the causality of simple events by associating a specific agent with the causal action. These results provide more support for an information-processing view than for the view that infants have a causal module. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How do 4-day-old infants categorize multisyllabic utterances?

Three experiments, using the high-amplitude sucking procedure, tested whether 4-day-old infants discriminate multisyllabic utterances on the basis of number of syllables or number of phonemes. Exp 1 showed that infants discriminate 2 large sets of phonetically variable utterances composed of 2- vs 3-CV (consonant–vowel) syllables. Exp 2 was run to assess whether infants discriminated the 2 sets on the basis of duration differences between the 2- and 3-CV stimuli. Results indicate that reducing the duration differences does not affect infants' discrimination. Finally, Exp 3 investigated whether infants discriminate 4- vs 6-phoneme bisyllabic utterances. The results provide no evidence that infants are sensitive to such a change in number of phonemic constituents. Although not decisive, these results appear to be congruent with the hypothesis that infants perceptually structure complex speech inputs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Topically applied thiabendazole in the treatment of scabies

Forty patients were treated for scabies with a 10% suspension of thiabendazole applied externally. Thirty-two patients (80%) had a satisfactory response to one course of therapy, while a second course was necessary in six (15%). Two patients (5%) required intralesional injections of triamcinolone diacetate because of persistent scabious nodules.     

Treatment of drug resistant scabies]

The theory that narcotic-induced protracted biological changes are responsible for relapse of opiate-reinforced behavior was examined in the rat. Groups of rats were conditioned to prefer a distinctive environment by pairing it with morphine doses from 1-200 mg/kg, and were retested for persistence of this preference after a 3-week abstinence period. They were then observed for protracted signs such as sensitivity to naloxone, tolerance to morphine analgesia, hyperaggression, or changes in endocrine activity. Acquisition and relapse of the preference, as well as long-term tolerance, were dose related. None of the purported protracted signs showed any consistent relationship to the tendency to relapse. However, relapse correlated significantly with original acquisition scores in all relapsing groups. The results suggest that original conditioning factors, rather than protracted changes, are responsible for the observed relapse.     

Attack of the scabies: what to do when an outbreak occurs

Scabies remains a significant source of morbidity in nursing home residents because of its highly contagious nature. It is characterized by severe pruritus and papules, pustules, burrows, nodules, and occasionally urticarial lesions. Lesions are commonly found on the wrists, finger webs, antecubital fossae, axillae, areolae, periumbilical region, lower abdomen, genitals, and buttocks. Diagnosis is based on the history, physical examination, and demonstration of mites, eggs, or scybala on microscopic examination. Several topical scabicides are available, but permethrin cream appears to be less toxic and more effective in cases that are resistant to other agents. Successful management requires evaluation of individuals with close patient contact.     

Parasitological and clinical studies on human scabies in Cairo

This study is a parasitological and clinical study on human scabies. This study was carried out on 100 patients attending the Dermatology Outpatient Clinic at Ain Shams University Hospitals, including 54 males and 46 females. All patients were subjected to detailed history taking, complete dermatological examination including Skin Scraping Test and Burrow Ink Test. Younger patients attended the dermatology clinic earlier than older patients, who usually delayed their visits until complications occurred. Scratching, erythematous papules and secondary infected lesions were the commonest lesions. The hands, wrist and external genitalia were the most frequently affected sites while the feet, ankles, knees and back were the least affected. Burrows could only be detected in 40% of patients. The most frequent sites were the web spaces, external genitalia, and finger sides. Burrow Ink Test was positive among 85% of patients with burrows while mites could be identified by Skin Scraping Test in 55% of patients. The most frequent clinical manifestations in the parasitologically positive patients were itching, burrows, and papules, and the most frequent sites were the web spaces, and the finger sides. Multiple sites affection was the characteristic feature among the preschool age children who represented 14% of cases.     

Lice and scabies. Myths and reality

Scabies mites are only distantly related to human lice. Nevertheless, the two groups have much in common as regards to structure and life-style. These similarities result from the two groups using parallel adaptations in order to solve some of the problems of being parasites. Understanding these adaptations may help us give better advice.     

The importance of eyes: How infants interpret adult looking behavior.

Two studies assessed the gaze following of 12-, 14-, and 18-month-old infants. The experimental manipulation was whether an adult could see the targets. In Experiment 1, the adult turned to targets with either open or closed eyes. Infants at all ages looked at the adult's target more in the open- versus closed-eyes condition. In Experiment 2, an inanimate occluder, a blindfold, was compared with a headband control. Infants 14- and 18-months-old looked more at the adult's target in the headband condition. Infants were not simply responding to adult head turning, which was controlled, but were sensitive to the status of the adult's eyes. In the 2nd year, infants interpreted adult looking as object-directed--an act connecting the gazer and the object. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Make the first move: How infants learn about self-propelled objects.

In 3 experiments, the author investigated 16- to 20-month-old infants' attention to dynamic and static parts in learning about self-propelled objects. In Experiment 1, infants were habituated to simple noncausal events in which a geometric figure with a single moving part started to move without physical contact from an identical geometric figure that possessed a single static part. Infants were then tested with an event in which the parts of the objects were switched. In Experiments 2 and 3, infants were habituated and tested with identical events except that the part possessed by each object during habitation was switched relative to the first experiment. Results of the experiments revealed that 16-month-olds failed to encode the relation between an object's part and its onset of motion, 18-month-olds were unconstrained in the relations involving self-propulsion that they would encode, and 20-month-olds were constrained in the relations they would encode. The results are discussed with regard to the developmental trajectory of learning about motion properties and the mechanism involved in early concept acquisition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

谈营销创新

市场经济时代,企业营销形态、营销战略、营销模式、营销思维不断创新,努力提高企业市场应变能力和竞争力,将使企业在激烈的市场竞争中立于不败之地。     

Intervention programs for premature infants. How and do they affect development?

Over the past 30 years, a variety of intervention programs for the enhancement of the neurodevelopmental status of premature infants have been implemented with confusing outcomes. In addition, diametrically different forms of therapy that rest on contrasting theories have led, paradoxically, to similar results. This article systematically examines and analyses the various modes of therapy and their underlying theoretical mechanisms. Skin-to-skin contact (kangaroo care) is suggested as the intervention that most logically meshes the premature infant's need to develop state regulation while facilitating sequential sensory development and promoting mother-infant attachment.     

The relation between scabies and hypersensitivity to antigens of house dust mites and storage mites

Twenty five non-atopic scabietic patients were examined to estimate their reaction to crude house dust mite Dermatophagoides farinae (D. farinae) and storage mite Tyrophagus putrescentia (T. putrescentiae) antigens. Skin prick testing (SPT) by extracts of both mites antigens showed significant higher positive results in scabietics when compared to non-scabietic control subjects. Moreover, 60% and 56% of scabietic patients showed positive levels of specific anti-D. farinae and T. putrescentia IgE respectively in comparison to 13.4% & 20% of control subjects. A significant difference has been obtained when the total number of positive results were compared to the total number of negative ones. The results revealed that there is an evidence of cross reactivity between Sarcoptes scabiei antigens and extracts of D. farinae and T. putrescentiae, and the hypersensitivity to house dust mite and storage mite antigens was significantly higher in scabietics than in controls. It could be concluded that there is some proof that other mites rather than Sarcoptes scabiei may have a role in the pathogenesis of scabies and the cross reactivity between S. scabiei and house dust mite and storage mite may explain the persistence of symptoms in some cases even after proper treatment of the disease.     

The metabolic response to operative stress in infants

The aim of this study was to characterize energy metabolism and substrate utilization in infants following an operation. Nineteen infants (weight 3.2 +/- 0.2 kg) who had an operation were studied. Anesthesia was standardized and operative stress score (OSS) was recorded. Five infants had a minor operation (OSS < 7), and 14 infants had a major operation (OSS > or = 7). Energy and nitrogen intake were constant during the 48-hour study period. Respiratory gas exchange was measured by indirect calorimetry preoperatively, and postoperatively for the first 12 hours continuously and at 24 hours, 48 hours, and 5 days. Urinary nitrogen excretion rate was measured for the first 48 hours following the operation. Physical activity was scored. Resting energy expenditure (REE) and nonprotein respiratory quotient (NPRQ) were calculated. REE increased postoperatively, peaking at 2 to 4 hours, and returned to baseline levels by 12 to 24 hours. Peak REE was significantly higher than baseline REE (P < .001). Substrate utilization was not altered by operation. The increase in REE was significantly greater in infants having a major operation than in infants having a minor operation (P < .05). Among infants having a major operation, the increase in REE was significantly greater in those infants more than 48 hours old, than in those infants less than 48 hours old (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Chronic exposure to environmental lead in Chilean infants

BACKGROUND: In Chile, there are several sources of environmental lead exposure. However, the few studies about lead levels in Chilean infants, do not allow to establish the prevalence of high lead levels in this population. AIM: To measure blood lead levels in nursing infants, living in rural and urban areas, from birth until two years of age. SUBJECTS AND METHODS: Newborns from public maternity hospitals in Santiago and a rural area were selected for the study. An umbilical cord blood sample was obtained at birth and venous blood samples thereafter, every 6 months until the age of 24 months. Lead levels were measured by atomic absorption spectrophotometry. Atmospheric lead was measured simultaneously every week in Santiago and the rural area. RESULTS: Three hundred twelve children from Santiago and 113 from the rural area completed the 24 months follow-up. The mean lead exposure for infants living in Santiago and in the rural area was 1.23 +/- 0.66 and 0.19 +/- 0.15 micrograms/m3 respectively (p < 0.001). Mean blood levels were always higher in infants from Santiago, compared to those from the rural area. At 24 months, 4.5% of children from Santiago and 0.7% of children from the rural area had blood lead levels over 10 micrograms/dl. Significant risk factors for high lead levels were recent painting of the house where the infant lives, eating soil, biting banisters and familiar labor exposure to lead. CONCLUSIONS: Infants living in an urban area and exposed to increased atmospheric lead levels have higher blood lead levels than infants living in a rural area.