[Cultural diversity in mental health care]. / Culturele diversiteit in de geestelijke gezondheidszorg.

Background  Of the total Dutch population, 25.7% has a migration background. The countries of origin, migration motives and time in the Netherlands are very diverse. Aim  To provide an overview of the cultural diversity within the psychiatry of different groups of people with a migration background, and to address the challenges and mental health care to these groups and the position of transcultural psychiatry in the Netherlands. Method  Based on integration of a narrative literature review (without a systematic search), own experiences and a fictitious case, we discuss the most important groups. This concerns the so-called guest workers as a specific group of first-generation migrants, second-generation migrants with their specific problems, and finally refugees and undocumented migrants with an accumulation of risk-increasing factors. Results  In addition to predisposition and migration factors, insufficient understanding of cultural context contributes to the psychiatric problems of first- and second-generation migrants. Refugees and undocumented migrants also have limited access to care. There is a reimbursement system in the Netherlands for undocumented migrants, through which they can also rely on care. By understanding cultural backgrounds, professionals can further improve their skills and communication in the field of intercultural psychiatry. Conclusion  Cultural diversity of patient groups demands additional attention to diagnosis and therapy.

Association between serum uric acid and bone health in adolescents.

Previous studies are suggestive of the protective role of uric acid on bone in the middle-aged and elderly. Whether this association exists in younger individuals has not been examined. This investigation showed a significant positive association between serum uric acid and bone parameters among Iranian adolescents. INTRODUCTION: Uric acid (UA) might be linked to bone health, but it is unclear whether its effects on bone are limited to certain population subgroups. This study is aimed at investigating the correlation between serum uric acid levels and bone mineral density (BMD) in Iranian adolescents. METHODS: This cross-sectional study was conducted on 413 (221 girls and 192 boys) Iranian adolescents aged 9-19 years. An analysis of anthropometric, biochemical parameters and bone density was performed on the participants. Measurements included serum uric acid, calcium, phosphorus, alkaline phosphatase, albumin, and vitamin D. They were divided according to their serum UA into the low UA group who had UA ≤ 6 mg/dL and the high UA group with UA > 6 mg/dL. BMD and bone mineral content (BMC) were measured in the total body, lumbar spine, and left femoral neck, using dual energy X-ray absorptiometry (DXA), and bone mineral apparent density (BMAD) was calculated. RESULTS: A Pearson correlation analysis revealed a significant correlation between UA and bone parameters. In multiple regression analyses adjusted for potential confounders, serum UA was proven to be associated with BMD and BMC at all sites. There was no association between UA, serum calcium, and vitamin D concentrations. CONCLUSION: Our study, as the first research on adolescents, demonstrated a higher bone density in those who had higher UA levels.

Effects of selenium and vitamin C on the serum level of antithyroid peroxidase antibody in patients with autoimmune thyroiditis.

PURPOSE: Selenium (Se), an essential trace element, has been implicated in pathogenesis of autoimmune thyroiditis (AIT). Most studies attributed the immune modulating effects of Se to its antioxidant properties. However, there is insufficient evidence to support the use of selenium supplementation or other antioxidants in patients with AIT. This clinical trial was designed to investigate the impact of Se and vitamin C supplementation on antithyroid peroxidase antibody (TPO-Ab) level in patients with AIT. METHODS: One hundred and two subjects aged 15-78 years were randomized into three groups. Group one (GI) (n = 38) was treated with 200 µg/day sodium selenite, group two (GII) (n = 36) received 500 mg vitamin C/day, and group three (GIII) (n = 28) received placebo over a 3-month period. Thyroid stimulating hormone (TSH), TPO-Ab, antithyroglobulin antibody (Tg-Ab) and Se concentrations were once measured before treatment and at the end of the study. RESULTS: After 3 months, TPO-Ab concentrations decreased within Se and vitamin C-treated groups, but did not change in the placebo subjects. In this regard, there was no significant difference between the groups. We also did not find any statistically significant difference in TSH and Tg-Ab levels within and between the groups. At the end of the study, Se level was significantly higher in GI compared with GII and GIII. CONCLUSION: Our findings supported the hypothesis of antioxidant beneficial effects of Se in AIT. However, it was not superior to vitamin C, regarding its effects on thyroid-specific antibodies.

The influence of interferon-γ on cardiac and renal histopathological changes induced by carbamazepine.

BACKGROUND: Carbamazepine (CBZ) is used for the treatment of epileptic seizures. This study was designed to evaluate the effect of Interferon-gamma on the fetal heart and kidney histopathological changes of CBZ-treated pregnant mice. METHODS: Twenty pregnant mice were divided into four groups. The control group received distilled water. The second group received 240 mg/kg of CBZ by gastric gavage. The third group received intraperitoneal injection (IP) of IFN-γ. The fourth group received IP injection of IFN-γ with 240 mg/kg CBZ by gavage. The fetuses were delivered by hysterectomy on the 18th day of gestation. RESULTS: The mean weight, crown-rump length, the total volume of the heart and kidney of the fetuses in the CBZ-treated group were significantly reduced when compared with the control, INF-γ and CBZ + INF-γ groups (p < 0.05). INF-γ prevented histopathological changes when used with CBZ (p < 0.05). CONCLUSION: CBZ induced structural changes in the fetal tissues of the pregnant mice. However, IFN-γ could reduce these changes (Tab. 1, Fig. 4, Ref. 26).

Changing the dehydrogenation pathway of LiBH4-MgH2via nanosized lithiated TiO2.

Nanosized lithiated titanium oxide (LixTiO2) noticeably improves the kinetic behaviour of 2LiBH4 + MgH2. The presence of LixTiO2 reduces the time required for the first dehydrogenation by suppressing the intermediate reaction to Li2B12H12, leading to direct MgB2 formation.

The impact of using different doses of progesterone on memory performance.

OBJECTIVE: Progesterone is a sex hormone and its receptors are expressed throughout the hippocampus. This study was aimed at evaluating the effects of different doses of progesterone on memory. METHODS: Male rats were arbitrarily assigned to nine groups, namely Group I: control, Group II: control-cannula, Group III received 0.5 µl of saline by cannula, Groups IV , V, VI, VII and VIII received progesterone in doses of 0.5, 1, 1.5, 2, and 3 µg/ 0.5 µl by cannula, respectively. Group IX received 0.5 µl almond oil by cannula. Memory performance was tested in form of passive avoidance task. RESULTS: Our results indicated that progesterone at doses of 1.5 and 2 µg (p < 0.05) significantly increased the memory performance while at a dose of 3 µg (p < 0.05), it significantly decreased memory as compared to the control group. CONCLUSION: The current study revealed that the influence of progesterone on memory is related to its dose (Fig. 1, Ref. 25).

A Computer-Aided Type-II Fuzzy Image Processing for Diagnosis of Meniscus Tear.

Meniscal tear is one of the prevalent knee disorders among young athletes and the aging population, and requires correct diagnosis and surgical intervention, if necessary. Not only the errors followed by human intervention but also the obstacles of manual meniscal tear detection highlight the need for automatic detection techniques. This paper presents a type-2 fuzzy expert system for meniscal tear diagnosis using PD magnetic resonance images (MRI). The scheme of the proposed type-2 fuzzy image processing model is composed of three distinct modules: Pre-processing, Segmentation, and Classification. λ-nhancement algorithm is used to perform the pre-processing step. For the segmentation step, first, Interval Type-2 Fuzzy C-Means (IT2FCM) is applied to the images, outputs of which are then employed by Interval Type-2 Possibilistic C-Means (IT2PCM) to perform post-processes. Second stage concludes with re-estimation of "η" value to enhance IT2PCM. Finally, a Perceptron neural network with two hidden layers is used for Classification stage. The results of the proposed type-2 expert system have been compared with a well-known segmentation algorithm, approving the superiority of the proposed system in meniscal tear recognition.

Antimicrobial Activity of the Essential Oil from the Leaves and Seeds of Coriandrum sativum toward Food-borne Pathogens.

The increasing incidence of drug-resistant pathogens and toxicity of existing antibacterial compounds has drawn attention toward the antimicrobial activity of natural products. The purpose of this study is to evaluate the antimicrobial activity of the essential oil of the leaves and seeds of Coriandrum sativum. The five strains of bacteria comprising Escherichia coli, Staphylococcus aureus, Yersinia enterocolitica, Salmonella enterica and Vibrio cholerae were used for the antibacterial tests. In this study, antimicrobial effects of the essential oil from the leaves and seeds of Coriandrum sativum are evaluated by determining the minimum inhibitory concentration (MIC), the inhibition zone and minimum bactericidal concentration (MBC). The essential oil from Coriandrum sativum was extracted by steam distillation. The results indicate that the antimicrobial activities against the five pathogens were in the range of 2.5- 320 µg/mL. Increase in essential oil concentration caused significant increase in inhibitory feature. The essential oil of the leaves and seeds of Coriandrum sativum showed antimicrobial activity against the food-borne pathogenic bacteria. Thus, its oil can be used as an alternative to synthetic food preservative without toxic effects. Also, it can be used in biotechnological fields as ingredients in antibiotics and the pharmaceutical industry. These results suggest that the essential oil of C sativum leaves and seeds may have potential use in pharmaceutical and food industries for preservatives or antimicrobial agents.

Synthesis and application of FePt/CNTs nanocomposite as a sensor and novel amide ligand as a mediator for simultaneous determination of glutathione, nicotinamide adenine dinucleotide and tryptophan.

In this study, we report the synthesis and application of a FePt/CNTs nanocomposite as a highly sensitive sensor and novel amide ligand (9,10-dihydro-9,10-ethanoanthracene-11,12-dicarboximido)-4-ethylbenzene-1,2-diol as a mediator for the determination of glutathione (GSH), nicotinamide adenine dinucleotide (NADH) and tryptophan (Trp). The synthesized materials were characterized with different methods such as NMR, IR spectroscopy, TEM, XRD, FESEM, cyclic voltammetry, electrochemical impedance spectroscopy and square wave voltammetry (SWV). The modified electrode exhibited a potent and persistent electron mediating behavior followed by well-separated oxidation peaks of GSH, NADH and Trp. The peak currents were linearly dependent on GSH, NADH and Trp concentrations in the range of 0.08-220, 1.0-400 and 5.0-500 µmol L(-1), with detection limits of 0.05, 0.8 and 1.0 µmol L(-1), respectively. The modified electrode was used for the determination of these compounds in real samples.

Endogenous compounds labeled with radionuclides of short half-life-some perspectives.

In the article, the strategy and synthesis of some endogenous compounds labeled mainly with (11) C are presented. There are some examples illustrating how endogenous labeled compounds in connection with positron emission tomography have unique properties to describe various biological processes, and a few examples of the use of tracers labeled with (13) N and (15) O are also discussed. Labeled endogenous compounds may be an important asset to describe the conditions and the status of biological systems and might therefore be a key for the future search of individualized medicine.

Genetic variation in macrophage migration inhibitory factor associated with gestational diabetes mellitus and metabolic syndrome.

The aim of this study was to investigate the association of macrophage migration inhibitory factor (MIF) polymorphism rs1007888 with gestational diabetes mellitus (GDM), and its association with postpartum metabolic syndrome. In a case-control study, 147 GDM and 169 healthy pregnant patients were recruited. Blood sample was taken 2 times from all the participants; one at 24-28 weeks of gestation, second at 6-12 weeks of postpartum. Biochemical measurement and DNA extraction were performed. The PCR_SSP was performed for genotyping. The frequencies of AA, AG, and GG genotypes were 11.24% (19), 76.92% (130), and 11.83% (20) in healthy pregnancies and were 7.48% (11), 70.74% (104), and 21.76% (32) in GDM individuals. The distributions of MIF genotypes were significantly different in GDM and healthy subjects (p=0.04). Moreover, GG genotype had a significant association with pre-pregnancy obesity and family history of diabetes. In postpartum follow-up GG genotype was two-fold more frequent in women with metabolic syndrome (p=0.01, odds ratio=2.30, CI 95%; 1.23-4.30) and relative risk was equal 1.77 (CI 95%; 1.19-2.64). Our findings demonstrate an association between MIF polymorphism rs1007888 and susceptibility to GDM in pregnancy and metabolic syndrome development.

Fracture resistance of cuspal coverage of endodontically treated maxillary premolars with combined composite-amalgam compared to other techniques.

This in vitro study investigated the fracture resistance of teeth restored with combined composite-amalgam for cuspal coverage compared to direct coverage with composite (with or without an amalgam base) and composite onlay. Seventy-two intact maxillary premolars were randomly divided into six groups (n=12). The two control groups were G1, intact teeth (negative control), and G2, mesio-occlusodistal preparation only (positive control). Each of the four experimental groups used a different type of restoration for the prepared teeth: G3, direct composite cusp coverage; G4, composite onlay; G5, direct composite coverage with an amalgam base; and G6, combined composite-amalgam cuspal coverage. After thermocycling, fracture strength was tested. The data were analyzed with analysis of variance and the least significant differences post hoc tests (α=0.05). Mean fracture resistance in the six groups (in N) were G1, 1101 ±1 86; G2, 228 ± 38; G2, 699 ± 161; G4, 953 ± 185; G5, 859 ± 146; and G6, 772 ± 154. There were significant differences between G1 and all the other groups except for G4 and between G2 and all the other groups. Fracture strength in G3 also differed significantly compared to G4 and G5. The difference between G4 and G6 was statistically significant (p<0.05), but the difference between G3 and G6 was not (p>0.05).

Combination of bleach and flourescent microscopy: a milestone in the diagnosis of smear negative tuberculosis.

BACKGROUND: The reliability of direct smear microscopy for diagnosis of tuberculosis has frequently been questioned due to low sensitivity. Treatment of sputum with sodium hypochlorite (NaOCI) has been used to increase sensitivity in many settings. However, no study has established the effect of NaOCI on fluorescent microscopy. OBJECTIVE: To establish whether NaOCI concentration method enhances positivity of fluorescent microscopy smear negative sputum for diagnosis of tuberculosis. DESIGN: A prospective study. SETTING: Mbagathi District Hospital and Centre for Respiratory Diseases Research, Kenya Medical Research Institute. RESULTS: Forty five (22%) specimens were culture positive. Fluorescent microscopy sensitivity was 28.9% and 22.2% after centrifugation and sedimentation with 3.5% NaOCI, respectively (P > 0.05). Sensitivity was 24.4% and 17.8% after centrifugation and sedimentation with 5% NaOCI, respectively (P > 0.05). Although there was no statistical significance difference between the two NaOCI concentration methods, 3.5% NaOCI with centrifugation indicated a higher yield. CONCLUSION: Use of NaOCI significantly enhances positivity of smear negative sputum for diagnosis of tuberculosis when used with fluorescent microscopy. This approach could be recommended for screening all tuberculosis suspects especially in settings with potential smear negative tuberculosis.

Clinical presentation among HIV-infected and non-infected adults with community acquired pneumonia in Nairobi.

SETTING: Risk factors for mortality in hospitalized patients with community-acquired pneumonia (CAP) are well known. There are limited data on prognostic indicators among out-patients. OBJECTIVE: To compare the clinical presentation, outcome and prognostic factors for clinical improvement in human immunodeficiency virus (HIV) infected and non-HIV-infected out-patients with CAP. METHODOLOGY: Adults in Nairobi with CAP were treated with erythromycin as first-line therapy. Clinical symptoms were evaluated using a validated CAP-related symptom score (CSS). Clinical improvement was defined as reduction of baseline CSS by > or = 50%. RESULTS: Of 531 adults enrolled with CAP, 422 (79.5%) completed follow-up. Participants had a mean age (+/- SD) of 33.7 +/- 11.4 years, 274 (51.6%) were male and 193 (37%) were HIV-seropositive with a higher baseline CSS (27 vs. 25, P < 0.006). Overall, 196 of 422 (46%) had clinical improvement by 28 days. Factors independently associated with a longer time to clinical improvement included not being married (adjusted hazard ratio [aHR] 0.66, 95% CI 0.48-0.92) and higher baseline CSS (aHR 1.05, 95% CI 1.03-1.06). CONCLUSIONS: HIV-infected and non-infected patients with CAP responded similarly to out-patient treatment, but HIV-infected patients were more likely to present with severe symptoms. Baseline CSS and marital status were predictive of time to clinical improvement.

Ca(BH4)2-Mg2NiH4: on the pathway to a Ca(BH4)2 system with a reversible hydrogen cycle.

The Ca(BH4)2-Mg2NiH4 system presented here is, to the best of our knowledge, the first described Ca(BH4)2-based hydride composite that reversibly transfers boron from the Ca-based compound(s) to the reaction partner. The ternary boride MgNi2.5B2 is formed upon dehydrogenation and the formation of Ca(BH4)2 upon rehydrogenation is confirmed.

Planning for PPM-DOTS implementation in urban slums in Kenya: knowledge, attitude and practices of private health care providers in Kibera slum, Nairobi.

SETTING: Kibera, the largest slum in Nairobi, Kenya. OBJECTIVE: To determine the tuberculosis (TB) knowledge, attitude and practices (KAP) of private health care providers (PHCPs) to identify their training needs and willingness to participate in a National Leprosy and Tuberculosis Control Programme (NLTP) guided TB control effort in the slum. DESIGN AND METHODOLOGY: A cross-sectional survey. The KAP of PHCPs was assessed using an interviewer administered questionnaire. RESULTS: Of 75 PHCPs interviewed, the majority (96.0%) were paramedics; 51 (77.1%) did not consider sputum smear microscopy crucial in patients presenting with prolonged cough or when a chest X-ray was suggestive of TB; of 29 (38.7%) who indicated familiarity with the drugs used in TB treatment, 20 (58.5%) would have chosen the NLTP-recommended regimens for the treatment of the various types of TB; 16 (21.3%) PHCPs indicated that they treated TB, six (37.5%) of whom were not familiar with anti-tuberculosis drug regimens. All the PHCPs referred TB suspects to the public sector for diagnosis. CONCLUSION: This study reveals a significant gap in TB knowledge among the PHCPs in Kibera slum. However, given appropriate training and supervision, there is potential for public-private mix for DOTS implementation in this setting.

Isolation of multidrug-resistant tuberculosis strains in patients from private and public health care facilities in Nairobi, Kenya.

SETTING: Health care facilities in Nairobi, Kenya. OBJECTIVE: To document the presence of multidrug-resistant tuberculosis (MDR-TB) strains in patients from Nairobi between September 1999 and October 2001. DESIGN: Descriptive study. RESULTS: Of the 983 referred patients who submitted sputum for culture and drug susceptibility testing (DST), 59% were males. Two hundred and nine (21.3%) patients had a positive culture, of whom 15.2% had a request for DST against isoniazid, rifampicin, streptomycin and ethambutol. Of these, 65 (43.6%) had an isolate resistant to one or more drugs, while 17 (11.4%) had MDR-TB. Ten (59.0%) cases were referred from public health care facilities while seven (41%) were from the private sector. Sixteen isolates were resistant to all four drugs. All MDR-TB cases but one were from Nairobi. CONCLUSION: The emergence of MDR-TB in Nairobi is a cause for concern. An outbreak would be catastrophic, creating not only increased morbidity and mortality but also a tremendous strain on already limited health care resources. Lack of policies for the treatment and management of MDR-TB and the unavailability of appropriate diagnostic facilities may increase its spread. Efforts to prevent outbreaks of MDR-TB should be emphasised.

Identification of MDR-TB Beijing/W and other Mycobacterium tuberculosis genotypes in Nairobi, Kenya.

SETTING: Suspected tuberculosis (TB) patients in Nairobi, Kenya. OBJECTIVE: To identify the presence of multidrug-resistant (MDR) Beijing/W type and other genotypes of Mycobacterium tuberculosis. METHODS: Thirty-three isolates resistant to one or more drugs (resistance ratio method), including 15 MDR isolates and 40 susceptible isolates selected at random, were analysed by dot-blot hybridisation for mutations associated with resistance to isoniazid, rifampicin, streptomycin and ethambutol. All strains were genotypically classified using spoligotyping. RESULTS: Of the 33 drug-resistant isolates, 21 (64%) were from males and 12 (36%) were from females. Mutations associated with resistance to isoniazid (katG 315) and rifampicin (rpoB526, 531) were confirmed in 83.3% and 100% of the isolates, respectively, and in 87% of the MDR isolates. Mutations were detected in 25% and 71.5% of the isolates resistant to streptomycin (rpsL43) and ethambutol (embB306), respectively. No mutations were detected in drug-susceptible isolates. Spoligotyping grouped the isolates into 25 groups. Ten of these groups corresponded to previously identified strain groups, including seven families in the international database. One of these families (CAS1) comprised six (40%) of the 15 MDR isolates. Another family (Beijing) had six (8.3%) isolates, of which two (33.3%) were MDR (Beijing/W). CONCLUSION: This study is the first in Kenya and the second in sub-Saharan Africa to report the presence of MDR Beijing/W type and other possible drug-resistant outbreak strains. Application of the molecular techniques and markers will allow us to monitor the spread of existing drug-resistant strains and the appearance of new ones.

Anti-tuberculous initial drug resistance of Mycobacterium tuberculosis in Kenya: a ten-year review.

Our experience at the Respiratory Diseases Research Unit (RDRU), over the last 10 years (1981-1990) on the initial drug resistance pattern, focusing on three drugs viz: isoniazid (H), streptomycin (S) and rifampicin (R) is presented. Records on all isolates of M. tuberculosis from one specimen of every newly diagnosed patient recruited countrywide between 1981-1990 were reviewed. We analyzed records of 6,514 isolates and found that total resistance to the three drugs had increased from 8.9% to 14.4%. Resistance to H alone increased from 6.8% to 10.2% while that of S alone from 0.8% to 1.8%. Resistance to R was between 0.1% and 0.3%. Generally, the increase in the resistance trend to both H and S was statistically significant (p = < 0.05 and 0.03, respectively). Although in our analysis we did not address the possible impact of HIV infection, we hope that these findings form a basis for evaluation of this and other possible factors on the emergence of anti-TB drug resistance in future studies.

PIP: A retrospective review of medical records of 6514 Mycobacterium tuberculosis isolates of newly diagnosed patients at the Respiratory Diseases Research Unit of the Kenya Medical Research Institute between 1981 and 1990 aimed to determine the initial drug-resistance pattern for isoniazid, streptomycin, and rifampicin. Overall resistance increased from 8.9 to 14.4% (p 0.001). The increase in the resistance trend to isoniazid and to streptomycin were statistically significant (6.8-10.2; p 0.05 and 0.8-1.8; p = 0.03, respectively) as well as the trend among isolates resistant to both isoniazid and streptomycin (1.2.4; p = 0.03). The trend was more pronounced during 1987-1990 than during 1981-1986. There was no trend in the resistance to rifampicin alone (0.1-0.3%). Just 4 isolates were resistant to both isoniazid and rifampicin. Only 1 was resistant to both streptomycin and rifampicin. None were resistant to all 3 antibiotics. These first-line drugs are used widely in Kenya. These rates of initial resistance to the drugs are lower than those in other developing countries. The lower resistance rate is unlikely to continue, however, due to higher prevalence of HIV infection and the associated increase in tuberculosis incidence. These findings provide researchers a baseline with which to study M. tuberculosis drug resistance and other risk factors as drug resistance increases in Kenya.

Evaluation of verapamil efficacy in Peyronie's disease comparing with pentoxifylline.

INTRODUCTION: Peyronie's disease described as penile curvature, fibromathosis and pain that occur most often in men aged 40 to 60 years. The main complaint that caused the patient to visit the clinic is nodules on the upper surface of the penis, causing curvature and distortion particularly during erection, but they don't have any urinary problem. In this study, we evaluated the effect of verapamil compared to pentoxifylline in Peyronie's disease. METHODS: In this study, 90 patients with signs and symptoms of Peyronie's disease which were diagnosed and were in the age range 40 to 70 years enrolled. The patients were randomly divided into 3 groups. First group received pentoxifylline orally at a dose of 400 mg three times a day, in the second group verapamil (10 mg every other week for up to 12 sessions) was injected into the lesion and the third group received both treatments in combination. RESULTS: In patients, who received pentoxifylline, curvature reduction was 26.7%, plaque size reduction was 30%, the recovery rate of erectile dysfunction was 46.7% and pain reduced was 73.3%. Each of these cases in patients, who used beta-blockers, was 36.7%, 33.3%, 66.7% and 76.6%. In combination therapy, curvature reduction was 36.7%, plaque size reduction was 33.3%, the recovery rate of erectile dysfunction was 86.7% and pain reduced was 80%. CONCLUSION: In our study there was no significant difference between two groups using verapamil or pentoxifylline, but there was a significant improvement in combination therapy group. Due to our results we propose that combination therapy can improve results and should be considered as a choice in treatment of Peyronie's disease.