Descending polyneuropathy in an intravenous drug user.

A 27-year-old male intravenous drug user presented to the Emergency Department of St James's Hospital with a 1-week history of progressive dysphasia, dysphagia and difficulty 'holding his head up' and 'keeping his eyes open'. He also complained of increasing weakness in his upper limbs, as a result of which he kept dropping things. He was on a methadone program but was using both intravenous heroin and cocaine at the time of presentation. Examination of his motor function revealed generalized hypotonia, hyporeflexia and reduced power in both upper limbs. No sensory loss was observed. Co-ordination was intact. The clinical picture of a proximal symmetrical descending weakness and an absence of sensory loss was suggestive of botulism. Clostridium botulinum is a spore-forming, obligate anaerobe. The three forms of human botulism are food-borne, wound and intestinal. A fourth man-made form is produced from aerosolized botulinum toxin and results in inhalational botulism. A little as 1 g of aerosolized botulinum toxin has the potential to kill 1.5 million people. Toxin is detected in serum or stool specimens in only approximately 46% of clinically diagnosed cases. Treatment involves supportive care and early passive immunization with equine antitoxin. Patients should be regularly assessed for loss of gag and cough reflex, control of oropharyngeal secretions, oxygen saturation, vital capacity and inspiratory force. When respiratory function begins to deteriorate, anticipatory intubation is indicated. Early symptom recognition and early treatment with antitoxin are essential in order to prevent mortality, and to prevent additional cases, it is important to ascertain the presence of similar symptoms in contacts of the patient and local public health officials must be notified as one case may herald an outbreak. Given the continued threat of bioterrorism, the Centre for Disease Control Surveillance System in the United States must also be notified of any cases of botulism.

Health belief assessment regarding screening colonoscopy.

The purpose of this study was to assess (by questionnaire) health beliefs related to colorectal cancer screening via colonoscopy in a population 50 years of age and older. The Health Belief Model provided the theoretical framework for data collection. The study design was a nonexperimental exploratory survey. A total of 42 subjects (31% male, 69% female) completed a 14-item questionnaire that addressed psychological factors including health beliefs. Descriptive statistics were used for data analysis. Results of this study show there is a need for appropriate health education to trigger people to take preventive action such as colonoscopy. Community based health education programs should be designed to induce behavioral change by teaching the client the benefits of prevention and early detection of colorectal cancer, to which the client is susceptible. Future health education programs guided by this research will contribute to the reduction of highly preventable deaths from colorectal cancer while lowering the enormous cost of treating this condition.