Inappropriate Dexamethasone Use by a Trekker in Nepal: A Case Report.

We present a case of inappropriate dexamethasone use in a trekker in the Everest region of Nepal. We aim to increase awareness among health professionals of the possible use of this medication by trekkers and promote knowledge of potential complications. In this case, a previously altitude-naive trekker was prescribed prophylactic dexamethasone by physicians in a Western travel clinic before high-altitude trekking in Nepal. There were no indications for prophylactic medication nor for the use of dexamethasone. The trekker reported that no discussion regarding risks and benefits, alternatives, side effects, contraindications, or dose tapering on completion of the course had occurred before travel. Side effects were temporary, but serious complications may have ensued if it not for timely interventions by doctors at the International Porter Protection Group rescue post. The events leading to inappropriate dexamethasone use in this case cannot be known for certain. However, it is clear that the trekker lacked the knowledge to use the medication safely. Although the efficacy of dexamethasone in the prevention of acute mountain sickness is undisputed, associated side effects and other limitations make acetazolamide the prophylactic drug of choice. Inappropriate use of dexamethasone can lead to severe complications, and such a case has been reported from Mount Everest. Clinicians prescribing dexamethasone must understand the indications and risks, and health professionals at altitude should be aware of its use by trekkers and the potential complications.

Beliefs of people taking antidepressants about causes of depression and reasons for increased prescribing rates.

BACKGROUND: Public beliefs about the causes of mental health problems are related to desire for distance and pessimism about recovery, and are therefore frequently studied. The beliefs of people receiving treatment are researched less often. METHOD: An online survey on causal beliefs about depression and experiences with antidepressants was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants. RESULTS: The most frequently endorsed of 17 causal beliefs were family stress, relationship problems, loss of loved one, financial problems, isolation, and abuse or neglect in childhood. Factor analysis produced three factors: 'bio-genetic', 'adulthood stress' and 'childhood adversity'. The most strongly endorsed explanations for increases in antidepressant prescribing invoked improved identification, reduced stigma and drug company marketing. The least strongly endorsed was 'Anti-depressants are the best treatment'. Regression analyses revealed that self-reported efficacy of the antidepressants was positively associated with bio-genetic causal beliefs, negatively associated with childhood adversity beliefs and unrelated to adulthood stress beliefs. The belief that 'People cannot׳ get better by themselves even if they try' was positively associated with bio-genetic beliefs. LIMITATIONS: The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression. CONCLUSIONS: Clinicians׳ should consider exploring patients׳ causal beliefs. The public, even when taking antidepressants, continues to hold a multi-factorial causal model of depression with a primary emphasis on psycho-social causes. A three factor model of those beliefs may lead to more sophisticated understandings of relationships with stigma variables.

Transsphenoidal pituitary surgery in the elderly is safe and effective.

OBJECT: With an increasingly ageing population, the number of elderly people diagnosed with pituitary tumours continues to rise. There is a concern that with increasing age and comorbidities, there is higher anaesthetic risk, as well as peri-operative morbidity and mortality from pituitary surgery. This study aimed to audit the benefits and complications of transsphenoidal surgery performed in a large pituitary centre in elderly patients. METHODS: Data on all elderly patients (age: ≥ 70 years) undergoing transsphenoidal surgery at a large tertiary referral centre between November 2003 and August 2012 were collected retrospectively. RESULTS: A total of 104 operations were performed on 102 patients during 106 months. Median age was 75.2 years (range: 70-94) and 63 (61%) of the patients were male. Median follow-up was 15.2 months (range: 2.3-84.4). The majority presented with either peripheral visual field defects (26.4%) or pituitary hormone deficits (17.9%). A significant number (21.7%) of tumours were incidental radiological findings while investigating other diagnoses like stroke and dementia. 48.1% of operations were undertaken microscopically and the remaining 51.9% were endoscopic. Median hospital stay was 4 days (range: 3-18). Intra-operative complications included hypotension (1.9%) and blood loss requiring transfusion (2.9%). The 30-day complications included transient diabetes insipidus (9.6%), syndrome of inappropriate anti-diuretic hormone secretion (8.7%), delayed cerebrospinal fluid leak requiring lumbar drainage (0.9%) with no patient requiring formal repair. There were no peri-operative deaths. Long-term assessment suggested 79% had improved or stable endocrine function with 7% achieving biochemical cure and 91% showed improved or stable visual fields. CONCLUSIONS: Pituitary surgery in the elderly, whether microscopic or endoscopic, has low morbidity and mortality and is a safe and effective intervention for both symptom control and functional outcomes.

Myopia and personality: the genes in myopia (GEM) personality study.

PURPOSE: A long-held view among the medical and broader community is that people who are short-sighted (myopic persons) have distinctive personality characteristics such as introversion and conscientiousness. However, existing research on this question is flawed, and its findings are inconsistent. The authors therefore aimed to determine whether myopia and personality are associated. METHODS: The authors examined twins recruited through the Australian Twin Registry and a clinical-based family sample through a proband from a Melbourne Excimer Laser Clinic. There was no relation between family members and twins recruited in our study. Each individual underwent a full eye examination, completed a standard medical and general questionnaire, and was administered a five-factor model International Personality Item Pool (IPIP) inventory (Openness, Conscientiousness, Extroversion, Agreeableness, Neuroticism). Myopia was defined as worse than or equal to -0.50 (DS) spherical equivalent in the eye with the least refractive error. RESULTS: Data from 633 individual twins aged 18 to 83 years (mean, 53.04 years) and 278 family members aged 11 to 90 years (mean, 49.84 years) were analyzed. Prevalence of myopia was 35.7% for twins and 47.6% for family members. Mean spherical equivalent was +0.13 DS (95% CI, +/-0.16) for twins and -1.13 DS (95% CI, +/-0.25) for family members. Correlation and regression results for personality for both sample cohorts after multivariate analysis did not support the view that myopic persons are introverted or conscientious; however, there was a significant but small association between myopia and Agreeableness (r = 0.08, P < 0.05). In multivariate analysis with age, sex, education, and the five personality factors entered as predictors, Openness was the only significant personality predictor of myopia in both samples. CONCLUSIONS: This is the first multivariate study to assess links between personality and myopia using the IPIP. The long-held view that myopic persons are introverted and conscientious may reflect intelligence-related stereotypes rather than real correlations. Furthermore, the predictive characteristic of intellect, subsumed in Openness, appeared to be representative of a previously reported link between intellective abilities (IQ) and myopia rather than personality and myopia.