Profile of suicidal behaviour in Guyana. A retrospective study from 2010 -2012

OBJECTIVE: To assess cases of suicidal behaviour in Guyana to characterize the suicidal profile of Guyanese at present. DESIGN AND METHODS: A nationally represented sample of 899 cases involved in suicidal behaviour, 555 who committed suicide and another 344 attempted suicides from 2010-2012, were surveyed using an epidemiologic study. Risk factors and other associations were identified by professionals through the use of a statistical review and the administration of questionnaires; the information was processed. RESULTS: Suicide was one of the biggest problems in Guyana as evidenced by the country being listed as having the highest estimated rate of suicide worldwide (44.3/100,000) with an mean of 200 lives being lost each year due to suicide. Data on respondents (patient or parents) were used for analysis. The most affected age group is 20 to 49 years (50%) Males committed suicide more frequently, with a ratio of almost 4:1 and the most commonly used methods in suicide cases were poisoning (pesticide / herbicide) with more than 65 % of cases, followed by hanging (>20%). East Indians accounted for >80 %; most of the cases were geographically concentrated in Regions 6,5,4,3 and 2 similar to the estimated cases of suicidal attempts. CONCLUSIONS: The profile of suicide had been well identified in Guyana, and it permits the development of a comprehensive multisectoral suicide prevention strategy to reduce the magnitude of suicidal behavior in Guyana.

Spasticity improvement in patients with relapsing-remitting multiple sclerosis switching from interferon-ß to glatiramer acetate: the Escala Study.

BACKGROUND: A recent pilot study suggested spasticity improvement during glatiramer acetate (GA) treatment in multiple sclerosis (MS) patients who previously received interferon-ß (IFN-ß). OBJECTIVE: To evaluate changes in spasticity in MS patients switching from IFN-ß to GA. METHODS: Observational, multicentre study in patients with relapsing-remitting MS (RRMS) and spasticity switching from IFN-ß to GA. The primary endpoint comprised changes on Penn Spasm Frequency Scale (PSFS), Modified Ashworth Scale (MAS), Adductor Tone Rating Scale (ATRS), and Global Pain Score (GPS) at months 3 and 6 after starting GA. RESULTS: Sixty-eight evaluable patients were included (mean age,41.7±9.5 years; female,70.6%; mean time from MS diagnosis to starting GA,7.6±5.7 years). Previous treatments were subcutaneous IFN-ß1a in 42.6% patients, intramuscular IFN-ß1a in 41.2% and IFN-ß1b in 32.4%, whose mean durations were 3.5±3.3, 2.7±2.5 and 4.4±3.6 years, respectively. Statistically significant reductions in mean scores on all spasticity measurements were observed from baseline to month 3 (PSFS, 1.7±0.9 vs 1.4±0.6, p<0.01; MAS, 0.7±0.5 vs 0.6±0.5, p<0.01; highest MAS score, 1.9±0.8 vs 1.7±0.8, p<0.01; ATRS, 1.6±0.6 vs 1.4±0.6, p<0.01; GPS, 29.4±22.1 vs 24.7±19.4, p<0.01) and from baseline to month 6 (PSFS, 1.7±0.9 vs 1.3±0.6, p<0.01; MAS, 0.7±0.5 vs 0.5±0.5, p<0.01; highest MAS score, 1.9±0.8 vs 1.5±0.9, p<0.01; ATRS, 1.6±0.6 vs 1.3±0.6, p<0.01; GPS, 29.4±22.1 vs 19.1±14.8, p<0.01). CONCLUSION: Spasticity improvement in terms of spasm frequency, muscle tone and pain can be noted after three months and prolonged for six months of GA treatment.

Case reports: chronic paroxysmal hemicrania-tic syndrome.

The coexistence of chronic paroxysmal hemicrania and trigeminal neuralgia is called chronic paroxysmal hemicrania-tic syndrome. We describe the case of a man who has suffered both types of pain occurring synchronously but with different localization on the ipsilateral side. The pain attacks could be abolished with indomethacin and carbamazepine. To the best of our knowledge, this is the third case to be reported, the first in the male sex. We review this new disorder and discuss the pathophysiology.

Delayed-onset dystonia in patients with antecedents of perinatal asphyxia.

We report 27 cases of delayed-onset dystonia in patients with antecendents of perinatal asphyxia after excluding other possible causes of dystonia. The patients were 16 males and 11 females (mean +/- SD age at onset of dystonia = 13.0 +/- 9.4 yr). Adverse obstetric and/or perinatal events were presented by 20 patients, and other neurological symptoms or signs were present prior to dystonia in 15 patients. The pattern of dystonia was: generalized (eight cases), segmental (six), multifocal (three), hemidystonia (two), and focal (eight). Cranial CT or MRI were normal in 21 cases, and showed brain hemiatrophy in three cases, and periventricular demyelination, subcortical atrophy and increased ventricular size in one case each. The possible cause-effect relationship is discussed.

[Multiple cerebral hematomas: review of 7 cases]. / Hematomas cerebrales múltiples: revisión de 7 casos.

We present seven patients with multiple spontaneous cerebral haemorrhages, diagnosed by CT scan, in a 10-year period in the Hospital 12 de Octubre. The clinical presentation, radiologic features, and prognosis of this entity are analyzed, and the diverse etiologic factors are discussed. All of the patients in this series were over 50 years of age, the majority not hypertensive (57%, n = 4), and in almost half the cases (43%, n = 3) the brain haemorrhages were associated with diverse coagulation disorders. The localization of the haemorrhages was exclusively supratentorial. Four patients presented with a moderate global confusional state, and one patient with deep coma. All the patients had focal signs. The mortality was elevated, with three patients dying, but the clinical evolution and outcome of those who survived was favourable.

[Neuro-acanthocytosis with associated myopathy. A case report]. / Neuroacantocitosis con miopatía asociada. Estudio de un caso.

Abnormalities of striated muscle histology in patients with neuroacanthocytosis have been previously attributed to chronic denervation. This hypothesis is based in the presence of axonal peripheral neuropathy. In this 37-year-old patient clinical, biochemical and histologic data revealed a non specific primary myopathy. Other important findings were decreased levels of 5-hydroxy-indoleacetic acid (5-HILA) and homovanillic acid (HVA) in the CSF, cerebellar and basal ganglia atrophy seen in MRI and infertility of probable gonadal origin.

[Drop attacks as a manifestation of occipital vertebra]. / Drop attacks como manifestación de la vértebra occipital.

A proatlas, a type of manifestation of occipital vertebrae, was found in a female aged 64 with drop attacks. X-ray films and computed tomography of the craniocervical region disclosed the malformation. Magnetic resonance imaging of the same area and the posterior fossa discarded the presence of associated neural involvement, but gave no additional information about the nature of the process. Doppler-ultrasonographic study of the vertebral arteries and X-rays of the flexed and extended cervical spine failed to demonstrate the mechanism by which drop attacks were elicited.

[Congenital fiber-type disproportion: analysis of a series of 11 cases]. / Desproporción congénita de tipos de fibras: análisis de una serie de 11 casos.

We present 11 patients with congenital fiber type disproportion suggesting the existence of two different clinical groups. The first group not associated with other diseases, presents a uniform clinical picture and a generally good prognosis, although the patients with severe respiratory involvement can die. The second group includes the cases in which CFTD is associated with other congenital diseases such as Lowe's Syndrome, Möbius' Syndrome, hypothyroidism and hydrocephalus. In this group the clinical presentation and prognosis is that of the associated disease added to that of CFTD. The frequent association of CFTD with other congenital diseases suggests that CFTD may not be a specific myopathy but a histological abnormality due to different pathogenic insults which interfere with the normal growth and maturation of the muscle fibres.

Technetium-99m-methylene diphosphonate (MDP) uptake in a sympathetic effusion: an index of malignancy and a review of the literature.

We report a patient with a sympathetic pleural effusion secondary to T-cell lymphoma that accumulated the bone imaging agent, Technetium-99m-methylene diphosphonate (99mTc-MDP). This case is significant in that malignant cells were not present on three cytologic examinations of the pleural fluid or multiple pleural biopsies. We also present a review of the published literature on pleural effusions that accumulate bone tracers. We conclude that pleural effusions that accumulate 99mTc-MDP should be considered malignant or secondary to a malignancy and further work-up is essential even if the cytologic exam of the pleural fluid is unremarkable.

[West syndrome. A series of 31 cases]. / Síndrome de West. Serie de 31 casos.

In this publish we analyze etiologic, clinic, electroencephalografic, radiologic, therapeutic and evolutionary facts of a serie of 31 children with diagnostic of West's syndrome. Advances in diagnostic methodes, overall of neuroimagen have allowed us to identify the etiology of 87% of cases, with a great variability of causes. The treatment with ACTH and/or anticonvulsive drugs was effective; although for children's prognostic, etiology and previous neurologic situation before initial symptomatology was more important. So, the clinical evolution was favorable for all criptogenetic cases and those secondary one with previous normal neurologic state. The rest, 70%, remained with mental delay, associated or no with crisis. Likewise the EEG persisted to be pathologic in 67.7% of cases. Five cases progressed towards Lennox-Gastaut's syndrome, that is to say, 16% of whole.

Long-term outcome of TIAs, RINDs and infarctions with minimum residuum. A prospective study in Madrid.

A group of patients with transient ischemic attacks (65 cases), reversible ischemic neurologic deficits (37 cases) and infarctions with minimum residuum (41 cases) was included in a prospective follow-up for a mean period of 5.2 years. Most of the patients were treated with acetylsalicylic acid or other antiplatelet agents, or with anticoagulants. Principal complications during follow-up were: cerebral infarction, 15 cases (10.4%); cerebral hematoma, 2 (1.3%); transient ischemic attacks, 17, (11.8%); reversible ischemic neurologic deficits, 9 (6.2%); myocardial infarction, 4 (2.7%); and death, 11 (7.6%). The cumulative incidence for stroke or death was 6.2% for the first year and 14% for the fifth year. There were no significant risk factors for the occurrence of stroke or vascular death on time-related multivariate analysis (Cox). Disabling stroke was less frequent after infarctions with minimum residuum than after transient ischemic attacks or reversible ischemic neurologic deficits.

Persistent splenic visualization on technetium-99m DISIDA hepatobiliary studies.

Tc-99m DISIDA is widely used for studying a variety of biliary conditions. It is generally recognized that the spleen is normally visualized on DISIDA imaging only during the blood pool phase. Upon review of our experience with DISIDA, visualization of the spleen was found more common than generally acknowledged. All DISIDA examinations performed at our two institutions were retrospectively reviewed; 95 studies were performed at Institution #1 and 150 studies at Institution #2. There were 138 men and 107 women. Quality control to confirm radiochemical purity included sephadex gel column chromatography. Of 245 patient studies, persistent splenic visualization was identified in one patient (1.0%) at Institution #1 and in 11 patients (7.3%) at Institution #2. There was no correlation between age, sex or final diagnosis and persistent visualization of the spleen. It is suggested that persistent splenic visualization may be caused by an elevated concentration of reduced hydrolized technetium (colloid) in DISIDA.

Evaluation of technetium-99m disofenin by column and instant thin-layer chromatography: demonstration of radiocolloid as a cause for splenic uptake.

We found persistent splenic uptake in 5% of patients undergoing hepatobiliary imaging with Tc-99m Disofenin when administered within a few minutes after labeling, suggesting the presence of radiocolloid. Hydrolyzed reduced Tc-99m colloid (HR-Tc) present in labeled Disofenin kits is controversial and may be dependent on method of assay and radiochemical kinetics. Kits were therefore evaluated by gel column (GCC) and instant thin-layer (ITLC) chromatographic methods. Tc-99m Disofenin was prepared according to the manufacturer's instructions and was maintained at room temperature (23 degrees C) or was incubated at 37 degrees C for 0.5 hr and then held at 23 degrees C. Aliquots were obtained at intervals over 5 hr and applied to Sephadex G-15 resin columns and ITLC-SG strips, with distilled water as mobile phase. GCC showed 14.9% +/- 3.4% and 11.0% +/- 2.9% initial values of HR-Tc at 23 degrees C and 37 degrees C treatments, respectively. HR-Tc decreased over time with each treatment. ITLC showed 1.2% +/- 0.4% and 1.3% +/- 0.2% HR-Tc, with no change over time. ITLC appears to be an insensitive method for the detection of HR-Tc. Incubation of Tc-99m with Disofenin kits for 30 min at 37 degrees C or for 1 hr at 23 degrees C offers an empiric method to ensure HR-Tc levels acceptable for nuclear imaging.

Characterization of the rotating display.

The rotating display is a useful method for reviewing single photon emission computed tomography (SPECT) data. This study evaluated the requirements for a subjectively pleasing and useful implementation of this technique. Twelve SPECT data sets were modified and viewed by several observers who recorded the minimum framing rates for apparent smooth rotation, 3D effect, effects of image size, and other parameters. The results showed that a minimum of 16 frames was needed for a useful display. Smaller image sizes and more frames were preferred. The recommended minimal framing rate for a 64-frame study is 16-17 frames per second and for a 32-frame study, 12-13 frames per second. Other enhancements also were useful.

Comparison of bone mineral density in both hips.

Dual-photon absorptiometry (DPA) was performed on both hips of 40 patients to determine if the calculated bone-mineral density (BMD) of one hip could be used to predict the BMD of the opposite hip. For the Ward triangle, femoral neck, and greater trochanter the correlation coefficients between the BMD of the two hips was .920, .917, and .843, and the standard errors (SE) of the estimate for the linear regression of the left hip on to the right were 0.067, 0.063, and 0.077 g cm-2. The absolute error of predicting one hip from the other was not a function of BMD and thus the relative error increases with lower BMD values. The relative errors were 17%, 8%, and 7% for BMDs of 0.4, 0.8, and 1.0 g cm-2, respectively. The interobserver variability was small, with an r value of .96 and an SE of the estimate value of 0.036 g cm-2. The relative error in the mild-to-moderate osteoporosis categories was 2.5 times the precision of the instrument, indicating that the asymmetry of BMD is due to real differences between hips. Therefore the BMD of one hip cannot be used to predict that of the other with sufficient accuracy to discriminate clinically relevant trends in BMD.