Deliberate foreign body ingestion in patients with underlying mental illness: A retrospective multicentre study.

OBJECTIVE: Deliberate foreign body ingestion (DFBI) is characterised by recurrent presentations among patients with mental health conditions, intellectual disabilities and in prisoners. We aimed to profile the characteristics and evaluate the care of such patients in this study. METHODS: Adult patients with an endoscopic record of attempted foreign body retrieval between January 2013 and September 2020 were identified at three Australian hospitals. Those with a documented mental health diagnosis were included and their standard medical records reviewed. Presentation history, demographics, comorbidities and endoscopic findings were recorded and described. RESULTS: A total of 166 admissions were accounted for by 35 patients, 2/3 of which had borderline personality disorder (BPD). Repetitive presentations occurred in more than half of the cohort. There was an increased trend of hospital admissions throughout the years. At least half of the cohort had a documented mental health review during their admission. An average of 3.3 (2.9) foreign bodies were ingested per single episode. Endoscopic intervention was performed in 76.5% of incidents. The combined Length of stay for all patients was 680 days. CONCLUSION: Deliberate foreign body ingestion in mental health patients is a common, recurring and challenging problem that is increasing in frequency and requires collaborative research to further guide holistic management.

Stannsoporfin with phototherapy to treat hyperbilirubinemia in newborn hemolytic disease.

OBJECTIVE: To evaluate the efficacy and safety of tin mesoporphyrin (SnMP) in neonates with hyperbilirubinemia (HB) due to hemolysis. STUDY DESIGN: This multicenter, placebo-controlled phase 2b study (NCT01887327) randomized newborns (35-42 weeks) with hemolysis started on phototherapy (PT) to placebo (Ctrl), SnMP 3.0 mg/kg, or SnMP 4.5 mg/kg given once IM within 30 min of initiation of PT. RESULTS: In all, 91 patients were randomized (Ctrl: n = 30; 3 mg/kg SnMP: n = 30; 4.5 mg/kg SnMP: n = 31). At 48 h TSB significantly increased in Ctrl by 17.5% (95% CI 5.6-30.7; p = 0.004) and significantly decreased by -13% (95% CI -21.7 to -3.2; p = 0.013) in the 3.0 mg/kg and by -10.5% (95% CI -19.4 to -0.6; p = 0.041) in the 4.5 mg/kg group. Decreases in SnMP groups were significant (p < 0.0001) vs Ctrl. CONCLUSION: SnMP with PT significantly reduced TSB by 48 h. SnMP may be useful as a treatment for HB in neonates with hemolysis.

The action of dietary phytochemicals quercetin, catechin, resveratrol and naringenin on estrogen-mediated gene expression.

Hepatic expression of apolipoprotein (apo) II is in part modulated by estrogen-mediated stabilization of its mRNA. This stabilization is due to the estrogen-regulated mRNA stabilizing factor (E-RmRNASF) expressed in the liver in response to estrogen (Ratnasabapathy, 1995, Cell. Mol. Biol. Res, 41: 583-594). E-RmRNASF protects the RNA from targeted endonucleolytic degradation. The hepatic expression of E-RmRNASF is modulated by certain estrogenic and antiestrogenic nonsteroidal environmental xenobiotics (Ratnasabapathy et al. 1997, Biochem. Pharmacol., 53: 1425-1434). To determine whether dietary phytochemicals purported to prevent hormone-dependent breast and prostate cancers, and atherosclerosis, acted via the estrogen-cell-signaling pathway, roosters were administered increasing doses up to 1 mmole/kg of resveratrol, quercetin, catechin or naringenin parenterally and tested for hepatic expression of E-RmRNASF. Besides estrogen, the expression of E-RmRNASF in the liver was stimulated by resveratrol and catechin, indicating these agents to be estrogenic. A lack of E-RmRNASF expression was seen with the roosters treated with the vehicle, naringenin or quercetin. To determine whether the agents exerted partial agonistic or antagonistic effects, roosters were administered combinations of estrogen and increasing doses of the above phytochemicals. Resveratrol showed agonistic activity at all concentrations (10-1000 micromol/kg) tested. Catechin showed partial agonistic activity, while quercetin and naringenin appeared to be antagonistic.

A role for Pax6 in the normal development of dorsal thalamus and its cortical connections.

The transcription factor Pax6 is widely expressed throughout the developing nervous system, including most alar regions of the newly formed murine diencephalon. Later in embryogenesis its diencephalic expression becomes more restricted. It persists in the developing anterior thalamus (conventionally termed "ventral" thalamus) and pretectum but is downregulated in the body of the posterior (dorsal) thalamus. At the time of this downregulation, the dorsal thalamus forms its major axonal efferent pathway via the ventral telencephalon to the cerebral cortex. This pathway is absent in mice lacking functional Pax6 (small eye homozygotes: Sey/Sey). We tested whether the mechanism underlying this defect includes abnormalities of the dorsal thalamus itself. We exploited a new transgenic mouse ubiquitously expressing green fluorescent protein tagged with tau, in which axonal tracts are clearly visible, and co-cultured dorsal thalamic explants from Pax6(+/+ )or Pax6(Sey/Sey )embryos carrying the transgene with wild-type tissues from other regions of the forebrain. Whereas Pax6(+/+ )thalamic explants produced strong innervation of wild-type ventral telencephalic explants in a pattern that mimicked the thalamocortical tract in vivo, Pax6(Sey)(/Sey) explants did not, indicating a defect in the ability of mutant dorsal thalamic cells to respond to signals normally present in ventral telencephalon. Pax6(Sey)(/Sey) embryos also showed early alterations in the expression of regulatory genes in the region destined to become dorsal thalamus. Whereas in normal mice Nkx2.2 and Lim1/Lhx1 are expressed ventral to this region, in the mutants their expression domains are throughout it, suggesting that a primary action of Pax6 is to generate correct dorsoventral patterning in the diencephalon. Our results suggest that normal thalamocortical development requires the actions of Pax6 within the dorsal thalamus itself.

Critical care nurses' perceptions of family needs as met.

In this descriptive, exploratory study, nurses' perceptions of family needs as met during the critical care experiences of an adult member were correlated to the families' perception of those same needs as being met. The population consisted of 45 family members in a large county hospital designated as a Level 3 trauma center. Family members of adult patients and registered nurses who were assigned to care for them completed a three-part instrument, which consisted of the Demographics Data Questionnaire, the Critical Care Family Needs Inventory (CCFNI), and the Needs Met Inventory (NMI). Data were analyzed using descriptive and inferential statistics. The top 10 needs perceived by the family members and registered nurses were reported in order of importance during the first 18-24 hours on the CCFNI and NMI. Data were analyzed on all 45 need statements to determine the top 10 needs perceived as important on the CCFNI and perceived as being met on the NMI. A one-way analysis of variance (ANOVA) test was performed on the data and yielded significant differences on three of the items. Linear regression was performed using t test which supported a significant difference on five statements based on critical care nursing years of experiences in critical care. Self-reported or open-ended comments from the family members and nurses were presented.

Descriptive profile of tuberculin skin testing programs and laboratory-acquired tuberculosis infections in public health laboratories.

The increase in numbers of cases of tuberculosis in the United States has placed greater demands on mycobacteriology laboratory workers to produce rapid and accurate results. The greater number of specimens generated by the increased emphasis on detecting the disease has placed these workers at greater risk of laboratory-acquired infection. We surveyed 56 state and territorial public health laboratories to determine the status of existing tuberculin skin testing (TST) programs and to evaluate the frequency of probable laboratory-acquired tuberculosis for each responding mycobacteriology laboratory. Probable laboratory-acquired infections were determined by each laboratory's evaluation of occupational positions, duties, and employee histories and review of medical records. Two-step TST for new employees was routinely practiced in only 33% of responding laboratories, and mycobacteriology laboratorians were found to be most frequently screened when they were compared to employees of other departments. Of 49 (88%) responding laboratories, 13 reported that 21 employees were TST converters from 1990 to 1994. Seven of these 21 employees were documented to have laboratory-acquired infections based on evaluations by their respective laboratories. Based on Centers for Disease Control and Prevention guidelines, converters are categorized on the basis of both a change in the size of the zone of induration and the age of the person being tested. By the definitions in the guidelines, 14 mycobacteriologists were identified as recent converters, 7 of whom were > or = 35 years of age and 4 of whom were exposed in the laboratory within a 2-year period. Inadequate isolation procedures, the high volume of specimen handling, and faulty ventilation accounted for these laboratory-associated infections. These results suggest that more frequent periodic evaluations based on documented TST conversions for workers in mycobacterial laboratories should be performed, since this population is at increased risk of becoming infected with Mycobacterium tuberculosis. Although general assessments are necessary to accurately and effectively evaluate the risk of tuberculosis transmission, they are especially important for those working in high-risk areas within a public health laboratory.

Selection of imagery in the relief of chronic and acute clinical pain.

This study examined the effects of pleasant imagery and type of pleasant imagery on the relief of acute and chronic pain. Two images were used in alternation, both selected from five images generated by the patient. The first image was the one most preferred by the patient; the second was the one determined by the experimenter to represent the most successful mastery of developmental stages according to the schemata outlined by Erickson (International Encyclopedia of Social Sciences, Vol. 9, McMillan, 1968). It was hypothesized that an image associated with successful phases of life would be less likely to provoke anxiety disruptive of the relaxation procedure and thus be more effective in the relief of pain. Both images were successful in reducing reported pain relief over a three-day period, but as predicted, the developmentally-selected image was more effective. The general effectiveness of these images held only for patients with acute pain.