Abnormal glucose tolerance and lipid abnormalities in Indian myocardial infarct survivors

Glucose tolerance and lipid levels in a random sample of 103 Indian patients (96 males and 7 females) with coronary artery disease (CAD) aged between 20 and 55 years were compared with those in a healthy Indian control group matched as regards age and sex. Previous episodes of myocardial infarction were taken as evidence of CAD. Of tne patients 44% were overweight: Glucose tolerance was abnormal in 55% of the patients. Both cholesterol and triglyceride values in the patients withCAD were significantly higher than those in the control group. Serum cholesterol levels were over 6,5 mmol/I in 62% of the patients with CAD and serum triglyceride levels were over 2,0 mmol/I in.53%. Males with CAD tended to have lower plasma high-density lipoprotein. (HDL) cholesterollevels than the control group (P < 0,01). There was a significant negative correlation between body mass index and HDLcholesterol, and no correlation was demonstrated between b.ody mass index and total cholesterol or triglyceride levels. Furthermore, when the patients were subgrouped according to their glucose tolerances it was found that only the triglyceride levels were significantly different (values were higher in those with abnormal glucose tolerance). Our data suggest that abnormal glucose tolerance and lipid aberrations are significant risk factors in Indian patients with CAD

Zirconia nanocomposites for biomedical applications

Fully stabilised zirconia (8 mol% yttria) does not exhibit any transformation toughening effects such as those found in partially stabilised zirconia (3 mol% yttria), hence to produce a quality bioceramic a composite ceramic must be made, and this can further be aided by using nanopowders as the staring material. In this work nanosized reinforcing powders, titanium carbide and titanium nitride, were sintered with a nanosized fully stabilised zirconia matrix. These composites were sintered using spark plasma sintering, which allows for rapid heating and cooling rates and hence shorter sintering times. These allow for improved hardness and fracture toughnesses because of minimal grain growth during sintering. When dealing with nanopowders, processing problems are increased due to the higher agglomeration tendencies and oxidation of the reinforcing powders. This agglomeration problem was mitigated by creating a suspension of the powders, using a suitable dispersant and solvent, thereby allowing for homogenous nanocomposites to be made. First a suitable dispersant that could disperse each of the powders had to be found. Furthermore the solvent for the dispersant had to prevent oxidation of the reinforcing powders. The dispersant and solvent were found by testing various dispersants on micron sized powders, since micron sized powders are significantly cheaper than nanosized ones. The dispersant found was Lubrizol 2155 with hexane as the solvent. Composites materials made from micron sized powders, ZrO2-50%TiC and ZrO2-50%TiN, were prepared and sintered using Lubrizol 2155 and hexane to determine whether it would produce a homogenous distribution of the powders in a sintered sample. These were analysed using SEM, which proved that Lubrizol was a successful dispersant. The micron sized composites were used as a comparison for the nanocomposites Rheology studies were then carried out on the nanopowders to determine the optimal amount of dispersant and solid loadings. These were carried out on the individual nanopowders and on the ZrO2-10vol% TiC, ZrO2-50vol% TiC, ZrO2-10vol% TiN and the ZrO2-50vol% TiN nanocomposite systems. The results obtained were used to create suspensions of the nanocomposites for sintering of 3, 10, 30 and 50 volume percent of TiC and TiN respectively to the fully stabilised zirconia, these were mixed by a ball mill prior to sintering. The samples were then sintered using various conditions in the spark plasma sintering furnace. iv The densification of the nanocomposites showed that there was a decrease in density with increases composition of the reinforcing powders. This was particularly apparent for the composites that contained above 30 vol. % of the reinforcing component. It is believed that this is as a result of the percolation limit being surpassed. The oxygen content also proved to be a factor in the densification. The hardness values of the ZrO2-TiN system were found to typically be higher than in the ZrO2-TiC system. In both systems the highest hardness were found in the 30 volume percent samples. For the ZrO2-TiC nanocomposites hardness values of up to 13.75 GPa were achieved, with hardness values of up to 15.79 GPa achieved for the ZrO2-TiN system. The hardness values determined were in accordance with those found in literature. An increase in fracture toughness with increasing the reinforcing component composition was found in both systems with higher fracture toughness found in the TiN system. The highest fracture toughnesses were found for samples with a relative density above 97 percent, were 2.65 and 3.64 MPa.m1/2 respectively for the TiC and TiN systems. These values were slightly higher than those found in literature for fully stabilised zirconia, however were significantly lower than partially stabilised zirconia composites found in literature

Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Background. There is general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the public sector.Objectives. To conduct a systematic review of the literature on heroin detoxification in pregnancy, and to document pregnancy outcomes in heroin users detoxified with methadone at Groote Schuur Hospital (GSH), Cape Town, from 2006 to 2010.Methods. A literature search was undertaken to identify key publications on the management of heroin addiction in pregnancy. Patients for the study were identified from the GSH methadone registry, and data were collected from the clinical files.Results. A total of 20 relevant publications were identified and reviewed. Early case reports described an increased risk of stillbirths and fetal distress after methadone detoxification, but more recent case series involving larger numbers of patients showed positive outcomes. In our study, six pregnant patients received methadone withdrawal over a 5-year period at GSH, and all the neonates had good Apgar scores and were discharged home within 3 days of delivery.Conclusions. There is limited evidence on the management of heroin addiction during pregnancy, and the only two guidelines identified suggest that methadone maintenance is preferable to methadone withdrawal. The favourable pregnancy outcomes in this small sample of patients managed with methadone withdrawal suggest that it may be safe and deserves further study

Adjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A meta-analysis of randomised controlled treatment trials

Small studies have shown positive effects from adding a variety of antipsychotic agents in patients with obsessive–compulsive disorder who are unresponsive to treatment with serotonin reuptake inhibitors. The evidence, however, is contradictory. This paper reports a meta-analysis of existing double-blind randomized placebo-controlled studies looking at the addition of the second-generation antipsychotic quetiapine in such cases. Three studies fulfilled the inclusion criteria. Altogether 102 individuals were subjected to analysis using Review Manager (4.2.7). The results showed evidence of efficacy for adjunctive quetiapine (< 400 mg/day) on the primary efficacy criterion, measured as changes from baseline in total Yale–Brown Obsessive Compulsive Scale scores (P = 0.008), the clinical significance of which was limited by between-study heterogeneity. The mechanism underlying the effect may involve serotonin and/or dopamine neurotransmission

Predictors of distress and anxiety during pregnancy

Objective: There is a high incidence of distressing psychological symptoms including anxiety in pregnancy. Nevertheless, predictors of distress and anxiety during pregnancy have not been well characterized. We determined whether temperament and character, trait anxiety, resilience, and social support predicted distress and anxiety symptoms in pregnancy.Method: Pregnant women (n=105) with low risk singleton pregnancies were recruited from Midwife Obstetric Units. Assessments of distress (usingthe K-10) and anxiety (using the Spielberger State Inventory) were undertaken in trimester 2 and 3. Measures of temperament and character, trait anxiety, resilience and social support were undertaken at the same time points. Regression analyses were used to determine predictors of distress and anxiety at each trimester.Results: Predictors of distress and anxiety were lower selfdirectedness,higher harm avoidance, higher trait anxiety, lower resilience, and lower social support, at each time point.Conclusion: Understanding predictors of distress and anxiety in pregnancy may be useful in developing interventions for addressing such symptoms, as well as perhaps in preventing potential sequelae such as anxiety and mood disorders.Keywords: Distress; Anxiety; Self-directedness; Harm avoidance; Resilience; Social suppor

Pharmacological challenge with a serotonin 1D agonist in alcohol dependence

BACKGROUND: Both animal and clinical studies have implicated serotonergic dysfunction in the pathogenesis of alcohol abuse and dependence. However the exact mechanisms involved remain unknown. Theoretically, low serotonin promotes alcohol seeking behavior. Sumatriptan is a serotonin1D agonist. It is postulated that sumatriptan's agonism at this terminal autoreceptor increases negative feedback, creating a net effect of decreased serotonergic neurotransmission. Administration of sumatriptan should therefore produce a craving for alcohol and the desire to drink. METHODS: Fifteen patients with alcohol dependence who had undergone detoxification were recruited. Sumatriptan (100 mg) and placebo was administered in cross-over fashion on 2 separate days 72 hours apart. Both patients and raters were blind to all treatments. Patients were assessed on the following scales at -30, 0, 30, 90, 150 and 210 minutes: A 6-item scale designed to rate the patient's intention to drink; The Sensation Scale; a 13-item affect analog scale designed to rate the pattern and extent of emotional changes; and an 8-item scale designed to rate the patient's craving for alcohol RESULTS: No significant differences were found between the placebo and sumatriptan groups and no significant cross over effects were found. CONCLUSION: The general lack of efficacy of sumatriptan in producing alcohol-like symptoms or a desire to drink alcohol may suggest that the 5HT1D receptor plays little role in the pathophysiology of alcoholism

Risk factors for substance use in pregnant women in South Africa

Objectives. To study the prevalence of alcohol and substance use in a South African antenatal population and its correlates with socio-demographic factors, depression and perceived stress. Methods. A prospective self-report study on all women presenting for their first antenatal visit who consented to the study at a midwife obstetric unit (MOU) in the East Metropole district, Cape Town, using the Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Edinburgh Depression Scale (EDS) and Perceived Stress Scale (PSS). Statistical analyses using the chi-square test, separate one-way analyses of variance (ANOVA) and logistic regression analyses were performed as appropriate. Outcome measures were depression, alcohol use and substance use. Results. The questionnaire was completed by 323 women. During pregnancy 36.8% of women smoked, 20.2% used alcohol and 4% used substances. Using EDS cut-off scores of 12 and 15, respectively, 48.9% and 33.6% of the sample had scores consistent with major depression. An EDS cut-off score of 12 was significantly associated with both alcohol use (25.9% v. 15.2%, p=0.019) and risky drinking (76.9% v. 36.8%, p=0.04), while an EDS cut-off score of 15 was significantly associated with substance use (8.2% v. 1.4%, p=0.004) as well as alcohol dependence (23.1% v. 3.1%). Conclusions. We found high rates of both alcohol abuse and antenatal depression, and a significant association between depression, substance use and alcohol abuse; EDS scores greater than 12 could be used to identify women at risk of alcohol dependence and/or substance abuse

The neural correlates of intimate partner violence in women

Objective: To examine hippocampal volume and white matter tracts in women with and without intimate partner violence (IPV). Method: Nineteen women with IPV exposure in the last year, and 21 women without IPV exposure in the last year underwent structural magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) sequences. Additional data on alcohol use and presence of psychiatric disorder was collected. Differences in fractional anisotropy (FA) between the two groups were examined, using a statistical model that included demographic measures, alcohol use and psychiatric disorder. Results: IPV subjects did not demonstrate significantly different hippocampal volumes compared to subjects without recent IPV. FA was, however, significantly reduced in the body of the corpus callosum of IPV subjects. Adjusting for age, alcohol use, smoking and psychiatric diagnosis did not change the significance of the result. Conclusion: Data on hippocampal volume in IPV are inconsistent, perhaps reflecting the fact that multiple factors influence this measure. Reduced FA in the body of the corpus callosum in IPV suggests altered integrity of this white matter tract; additional work is needed to address the underlying mechanisms and clinical correlates of this finding.Key Words: Corpus callosum; Hippocampal volume; Intimate partner violence; Neuroimagin