Plasma brain derived neurotrophic factor (BDNF) and response to ketamine in treatment-resistant depression.

Ketamine produces rapid antidepressant effects in treatment-resistant depression (TRD), but the magnitude of response varies considerably between individual patients. Brain-derived neurotrophic factor (BDNF) has been investigated as a biomarker of treatment response in depression and has been implicated in the mechanism of action of ketamine. We evaluated plasma BDNF and associations with symptoms in 22 patients with TRD enrolled in a randomized controlled trial of ketamine compared to an anaesthetic control (midazolam). Ketamine significantly increased plasma BDNF levels in responders compared to non-responders 240 min post-infusion, and Montgomery-Åsberg Depression Rating Scale (MADRS) scores were negatively correlated with BDNF (r=-0.701, p = 0.008). Plasma BDNF levels at 240 min post-infusion were highly negatively associated with MADRS scores at 240 min (r = -0.897, p=.002), 24 h (r = -0.791, p = 0.038), 48 h (r = -0.944, p = 0.001) and 72 h (r = -0.977, p = 0.010). No associations with BDNF were found for patients receiving midazolam. These data support plasma BDNF as a peripheral biomarker relevant to ketamine antidepressant response.

Hospital-based caesarean section in the Arab region: an overview.

This article provides an overview of hospital-based rates of caesarean delivery in 18 Arab countries and the association between these rates and selected demographic and socioeconomic characteristics. Data on caesarean section were based on 2 of the most recent national hospital-based surveys in each country and on published studies based on hospital samples. High levels of caesarean delivery were found in Egypt (26% in 2003), followed by Sudan (20% in 1993). Six countries and the West Bank area of Palestine had rates >15% and 11 countries and Gaza had rates between 5% and 15%. The findings indicate an increasing trend of caesarean section delivery in the region. Policies aiming at reducing surgical deliveries should seek to identify and address these risk factors.

Gender and sexual health in clinical practice in Lebanon.

This study examines the readiness of obstetricians/gynecologists (Ob/Gyns) in Lebanon to provide sexual consultation, their degree of comfort when discussing issues of sexual health, and their attitudes regarding assessment, treatment, and referral. Data on these concepts were collected through face-to-face interviews with 286 randomly selected Ob/Gyns. Most Ob/Gyns reported feeling comfortable discussing sexuality during consultations, which they attributed much more to professional experience than to training. Most Ob/Gyns reported giving proper time for management of sexual health issues and follow-up, as these issues are brought up frequently by their women clients. However, results suggest that only one-third (31%) of Lebanese Ob/Gyns nearly always take the initiative in asking patients about their sexual health. Moreover, almost 45% of participating Ob/Gyns did not recognize a strong relationship between reproductive health and sexual functioning. Gender was not found to be an important predictor for any of the indicators measured in the present study. Ob/Gyns in Lebanon are significant consultants on various sexual issues, and they need better postgraduate training, continuing medical education, and access to medical congress resources on the topic of sexuality and its relationship to reproductive health.

Neurostimulation therapies in depression: a review of new modalities.

OBJECTIVE: In response to an increased understanding of the neurobiology of severe psychiatric disorders, new therapeutic modalities are entering clinical practice that involve the direct stimulation of the brain. METHOD: We provide a review of published literature regarding the clinical use of vagus nerve stimulation (VNS) therapy, transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) in psychiatric disorders, with an emphasis on treatment-resistant depression (TRD). RESULTS: Vagus nerve stimulation is approved for use in both the EU and US for TRD. TMS has been approved for TRD in Canada, Australia, New Zealand, the European Union and Israel, but not yet in the United States. DBS remains in the early stages of investigation. CONCLUSION: While additional studies are clearly warranted, treatments that directly stimulate the brain appear to hold great therapeutic promise for severe psychiatric disorders.

Antispasmodic drugs to reduce discomfort and colonic spasm during barium enemas: comparison of oral hyoscyamine, i.v. glucagon, and no drug.

OBJECTIVE: Parenterally administered glucagon is currently the agent of choice for reducing abdominal discomfort and colonic spasm during a barium enema. Because glucagon is expensive and frequently causes nausea, we evaluated the use of oral hyoscyamine sulfate as an alternate agent and compared it with IV glucagon and no medication. SUBJECTS AND METHODS: A total of 349 adult patients undergoing barium enema examinations were randomly assigned in a prospective fashion to one of four groups: (1) no medication (87 patients); (2) 1 mg of IV glucagon (88 patients); (3) 0.125 mg of oral hyoscyamine sulfate (87 patients); and (4) 0.25 mg of oral hyoscyamine sulfate (87 patients). The degree of distension of the colon on radiographs obtained after fluoroscopy, the amount of abdominal distress after the procedure, and the number of side effects (nausea, palpitations, blurred vision, dry mouth) were analyzed. To evaluate the amount of abdominal discomfort more completely, we asked the last 248 patients to estimate the level of severity of the discomfort (none, mild, moderate, or severe). RESULTS: We found no difference in the degree of distension of the colon in the four groups (p = .63). Most patients (79%) had some degree of abdominal discomfort. Fewer patients in the group who received no medication (10%) had no or mild pain compared with those given glucagon (15%, p < .05), 0.125 mg of hyoscyamine (14%, p < .05), or 0.25 mg of hyoscyamine (12%, p = .15). Less nausea occurred in the group that received 0.125 mg of hyoscyamine than in the other groups (p < .03). No patients in any of the groups had allergic or severe side effects. CONCLUSION: When compared with IV glucagon, oral hyoscyamine had fewer side effects, but the degree of colonic distension or abdominal distress was not significantly different. In addition, hyoscyamine is considerably less expensive than glucagon and can be given orally. Patients who received medications had less discomfort than those who did not. However, the degree of distension was not different.

MR imaging of tophaceous gout.

OBJECTIVE: MR imaging is not routinely used for evaluation of tophaceous gout. However, gout may present clinically in an atypical, unusual, or confusing manner. A gouty tophus occasionally mimics an infectious or neoplastic process, and MR imaging may be obtained under these circumstances. The purpose of this study was to determine the MR imaging characteristics of intraosseous and soft-tissue tophi. MATERIALS AND METHODS: We identified 13 MR imaging examinations performed during a 27-month period on nine patients with gouty arthritis. All were men 42-70 years old. T1-, proton density-, and T2-weighted spin-echo MR images were obtained for all the examinations. Nine examinations included contrast-enhanced MR images. The findings were then evaluated, as were the corresponding radiographs. RESULTS: Five patients presented with articular involvement, three patients with an isolated soft-tissue mass, and one patient with persistent soft-tissue swelling. The duration of symptoms ranged from 3 months to more than 20 years. Nearly all the tophi were of intermediate signal intensity on T1-weighted images. On T2-weighted images, three sites revealed an overall increase in the signal intensity of the tophi, whereas 10 studies showed a heterogeneous decrease in signal intensity. All but one tophus showed homogeneous enhancement. Erosion of adjacent bone, synovial pannus, joint effusion, soft-tissue edema, and bone marrow edema were common associated findings. CONCLUSION: The MR appearance of tophi in patients with tophaceous gout is constant on T1- but quite variable on T2-weighted images. This variability in signal intensity could be related to calcium within a tophus. Tophaceous gout should be considered in the differential diagnosis when a mass reveals heterogeneously low to intermediate signal intensity, particularly if the adjacent bone shows typical erosive changes or if other joints are involved. When faced with this situation, radiologists may find it helpful to obtain a further clinical history and recommend evaluating the patient's serum urate level.

Comparison of no medication, placebo, and hyoscyamine for reducing pain during a barium enema.

OBJECTIVE: We carried out a prospective, randomized study to evaluate the usefulness of premedication with an oral anticholinergic for relief of pain during and after a barium enema of the colon. SUBJECTS AND METHODS: Patients were randomized into three groups: no medication, placebo, and sublingual 1-hyoscyamine sulfate. The placebo or hyoscyamine tablet was placed under the tongue 15-30 min before the examination. After the procedure the patients were interviewed. An analog scale (0-10) was used to score the level of pain that the patients experienced during the examination. Forty-eight hours after the examination, the patients returned by mail a survey that used the same scale and asked about delayed pain. RESULTS: Data from 110 patients were studied. Sixty-nine patients were women, and 41 were men. They ranged from 24 to 82 years old (mean, 55 years). For the no-medication group (n = 36), the mean pain score was 4.1; for the placebo group (n = 34), 3.8; and for the hyoscyamine group (n = 40), 4.2. No statistically significant difference in pain scores was found between any groups (p = .72). Six patients from each group reported minor side effects. The mean scores from the returned surveys (n = 79) were 3.8 for the no-medication group (n = 26) and placebo group (n = 22) and 3.1 for the hyoscyamine group (n = 31). No statistically significant difference was found between any of these groups (p = .48) or between delayed pain responses and initial pain responses (p = .27). CONCLUSION: Although safe, hyoscyamine seems to provide no benefit over no drug or a placebo when used as a pain premedication for patients undergoing a barium enema.