A pilot study of rivastigmine in the treatment of delirium after stroke: A safe alternative

Background

Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine.

Methods

This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS). Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium (defined as a DRS of 12 or more for more than 24 hours) were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine with a total dose between 3 and 12 mg a day. Eight patients could not be treated because of dysphagia and one because of early discharge.

Results

No major side effects were recorded. In 16 patients there was a considerable decrease in severity of delirium. The mean DRS declined from 14.8 on day one to 8.5 after therapy and 5.6 after tapering. The mean duration of delirium was 6.7 days (range; 2–17).

Conclusion

Rivastigmine is safe in stroke patients with delirium even after rapid titration. In the majority of patients the delirium improved after treatment. A randomized controlled trial is needed to establish the usefulness of rivastigmine in delirium after stroke.

Trial registration

Nederlands Trial Register NTR1395

     

Apolipoprotein C3 SstI polymorphism and triglyceride levels in Asian Indians

Background  

A close association between Sst I polymorphism in the 3' untranslated region of the apolipoproteinC3 (APOC3 ) gene and levels of plasma triglycerides (TG) had been reported by different investigators. Hypertriglyceridemia(HTG) is a known risk factor for coronary artery disease (CAD) in the context of Asian Indians. We conducted a study on the relationship between APOC3 SstI polymorphism (S1S1, S1S2 and S2S2 genotypes) and plasma TG levels in a group of 139 male healthy volunteers from Northern India.     

Phylogenetic analysis of the outer-membrane-protein genes of Chlamydiae, and its implication for vaccine development

Examination of 18 complete and 6 partial sequences of the major outer- membrane protein from 24 chlamydiae isolates was used to reconstruct their evolutionary relationships. From this analysis, assuming that the clades with 100% bootstrap support are correct, come the following conclusions: (1) The tree of these sequences is not congruent with the phylogeny of the hosts, and thus host switching would seem to have occurred, thereby limiting the extent to which there has been coevolution of parasite and host. (2) The tree is also noncongruent with clustering by type of cell infected, thereby limiting the extent to which there has been coevolution of parasite and the cell type that it infects. (3) The tree is also noncongruent with clustering by the organ infected (eyes or genitalia), thereby limiting the extent to which there has been coevolution of parasite and the organ that it infects. (4) The tree is also noncongruent with genital strains arising from lymphogranuloma venereum strains. (5) The tree is also noncongruent with the geographic site at which the isolates were obtained, thereby limiting the extent of divergence explained by geographic separation. (6) There are estimated to be 185 amino acid positions that are invariable (as opposed to unvaried) in the major outer-membrane protein. There are 10 unvaried positions in the variable domains, of which 9 appear to be invariable, giving some reason to hope that development of a vaccine might be possible. (7) The rate of change of this protein is too small to see increased divergence over the time span of isolation of these genes, giving hope to any vaccine having longevity. Bootstrapping supports those portions of the tree on which the first five conclusions above depend. The picture that these results provide is more one of pathogen versatility than one of coevolutionary constraints. In addition, we examined 10 60-KDa, outer-membrane protein- 2 genes, all but one of which were from these same strains. The tree was not, among the trachomatis strains, congruent with the major-outer- membrane protein tree, suggesting that gene exchange could be occurring among strains. Moreover, there is an apparent slowdown in divergence in this gene, among the trachomatis strains.      

Spatial distribution of transparent exopolymer particles in the Bransfield Strait, Antarctica

Transparent exopolymer particles (TEP) are recognized to playan important role in the flux of exported carbon to the deepocean. However, there is little information on how TEP standingstocks are affected by different hydrographic conditions andother relevant ecological factors in situ. This lack of knowledgeis particularly serious for the Southern Ocean. During Australsummer 1999, the Strait of Bransfield presented high mesoscalevariability. Two fronts were present, the Bransfield hydrographicfront and a slope front along the South Shetland Islands andseveral mesoscale anticyclonic eddies and/or frontal meanders.The spatial distributions of biological properties were largelyaffected by this complex hydrography. Chlorophyll a (Chl a)(0.05–4.81 µg L^–1), TEP (from undetectableto 346 µg GXeq L^–1) and heterotrophic bacteria (HB)(1.7–9.4 x 10⁵ cells mL^–1) were positively correlateddespite the wide hydrographic heterogeneity of the BransfieldStrait. Higher abundances of autotrophic biomass, and correspondlyhigher TEP and heterotrophic bacteria (HB), were found in themore stratified waters. TEP spatial distribution was mostlyrelated to the abundance of autotrophic biomass although localhigh TEP concentrations were not matched by similarly high valuesof Chl a in some areas where diatoms were relatively abundant.     

Western Palaearctic phylogeography of an inquiline oak gall wasp,Synergus umbraculus

Insect‐induced galls on plants comprise species‐rich but self‐contained communities of herbivores and natural enemies. In the present study, we focus on galls induced by cynipid gall wasps on oaks, and on the least‐known trophic level that these galls contain: inquilines. These insects, also cynipids, feed on gall tissue and are an abundant but taxonomically poorly understood part of an otherwise well‐studied system. We used DNA sequence data to examine spatial patterns in the genetic diversity of Synergus umbraculus Olivier 1791 (Hymenoptera: Cynipidae: Synergini), a widespread species attacking many host galls across the Western Palaearctic. Analysis of 239 cytochrome b sequences revealed eight haplogroups showing significant phylogeographic pattern across the Western Palaearctic, corresponding to putative glacial refugia in Iberia, Central Europe, Turkey, and Iran. There were significant genetic discontinuities across the Pyrenees and the Anatolian diagonal but no impact of the Alps, suggesting that significant discontinuities have biotic rather than physical causes. Detailed analysis of sites in the Carpathian Basin reveal a high diversity and low spatial structure, and identify Central Europe as the source of colonists for Quaternary colonization of Germany, France, and Britain. We found no evidence for host‐associated differentiation of S. umbraculus lineages associated with the most common cynipid host galls, suggesting frequent shifts within the host gall assemblage by inquiline lineages. © 2011 The Linnean Society of London, Biological Journal of the Linnean Society, 2011, 102 , 750–764.     

Systematic re‐appraisal of the gall‐usurping wasp genus Synophrus Hartig, 1843 (Hymenoptera: Cynipidae: Synergini)

Several unanswered questions remain regarding the taxonomy and phylogeny of inquiline gallwasps (Cynipidae: Synergini), obligate inhabitants of plant galls induced primarily by other gallwasps (Cynipidae: Cynipini and Diplolepidini). Here we use morphological and molecular data to revise the inquiline genus Synophrus, members of which are notable for extensively modifying the structure of galls induced by oak gallwasp hosts on oaks in the section Cerris of Quercus subgenus Quercus in the Western Palaearctic. Previous taxonomic treatments have recognized three Western Palaearctic species of Synophrus: S. pilulae, S. politus and S. olivieri. Our results support the establishment of four additional Western Palaearctic species: Synophrus hungaricus sp.n. , S. libani sp.n. , S. syriacus sp.n. and S. hispanicus sp.n. We describe and diagnose these new taxa, analyse their phylogenetic relationships, and show that Synophrus inquilines are able to impose their own gall phenotypes on those of their hosts. We provide an updated key to Synophrus.     

Are we ready for therapeutic drug monitoring of biologic therapeutics?

In the previous issue of Arthritis Research & Therapy, Ducourau and colleagues report that they retrospectively detected anti-infliximab antibodies in 21% of patients with rheumatic diseases. Patients with anti-infliximab antibodies had lower serum drug concentrations. These findings contribute to the existing evidence of immunogenicity of biologicals and its clinical relevance. We argue for therapeutic drug monitoring to optimize treatment response.