Management of epilepsy in adults with intellectual disability

This long-awaited report offers an important step towards clarifying the role of the psychiatrist in ID in the management of epilepsy. The proposed tiered system of professional competency gives psychiatrists the option to identify their role in care provision and ensures a framework for training. It provides a structure from which a competency evaluation can be developed. The vision should be for all psychiatrists working with people with ID to have training and certification to one of the three levels of competency (Bronze, Silver and Gold). An Appendix is provided as a separate document, which includes a list and samples of currently used good practice tools relevant to people with ID and epilepsy, as well as a ‘frequently asked questions’ section on Epilepsy that would be of particular use to patients, families and carers

Induction of central tolerance by intrathymic inoculation of adenoviral antigens into the host thymus permits long-term gene therapy in Gunn rats.

Recombinant adenoviruses are highly efficient at transferring foreign genes in vivo. However, duration of gene expression is limited by the host antiviral immune response which precludes expression upon viral readministration. We tested the feasibility of prolonging gene expression by induction of central tolerance to adenoviral antigens in bilirubin-UDP-glucuronosyltransferase-1 (BUGT1)-deficient Gunn rats. Tolerance was induced by intraperitoneal injection of antilymphocyte serum, followed by intrathymic inoculation of one of the following: a recombinant adenovirus (Ad), adenovirus human UDP-glucuronosyltransferase (Ad-hBUGT1) carrying the hBUGT1 gene; a protein extract of the same virus; or viral infected hepatocytes. Controls received intrathymic injections of normal saline. After 12 d all groups were injected intravenously with 5 x 10(9) pfu of either Ad-hBUGT1 or adenovirus beta-galactosidase (Ad-LacZ) (expressing the Escherichia coli beta-galactosidase [LacZ] gene). In all three groups of tolerized rats, hBUGT1 was expressed in the liver after administration of Ad-hBUGT1, with glucuronidation of biliary bilirubin of above 95%. Serum bilirubin levels decreased from 7.2 to 1.8 mg/dl within 1 wk and remained low for 7 wk. Similar findings were observed following repeat injections given on days 45 and 112. In control rats serum bilirubin levels were reduced for only 4 wk, and viral readministration was ineffective. In all tolerized groups, but not in controls, there was a marked inhibition of appearance of neutralizing antibodies and cytotoxic lymphocytes against the recombinant adenovirus. Injection of wild type adenovirus-5 (Ad5) into the tolerized rats elicited a wild type-specific cytotoxic lymphocyte response. This is the first demonstration of Ad-directed long-term correction of an inherited metabolic disease following central tolerization with thymic antigen

Polio Immunization: What misconceptions?

BackgroundThe government of India launched the pulse polio immunization (PPI) programme in 1995 with the aim of eradicating poliomyelitis by the end of 2000. Despite this, 733 children with polio were reported in 2009 alone. Therefore, there is a need to understand the reason underlying such high numbers of cases after so many years of programme implementation. This study was performed to assess the knowledge of the general population about poliomyelitis and PPI and their attitude and practice towards PPI.Method  This cross-sectional study was undertaken in two semi-urban areas of Mangalore city. Only houses in which children under five lived were included in the study.  Data was collected by interviewing any adult member of the household using a pretested questionnaire.ResultsThe literacy rate of study participants was 99%. Only 35(10.9%) participants knew the correct mode of transmission of polio. More than one quarter of the study population were under the impression that polio is a curable disease. The primary source of information about PPI in majority of participants was  television (n = 192; 60%). Two-hundred and eighty eight (90%) participants knew that the purpose of PPI was to eradicate polio. Only 128 (40%) participants knew that polio drops can be given to children with mild illnesses and an identical number of participants knew that hot food stuff should not be given for at least half an hour following vaccination administration. Misconceptions such as PPI causing vaccine overdose was identified among 7 (2.2%) participants,  it is a substitute for routine immunization was believed among 30 (9.4%) participants and that oral polio vaccine prevents other diseases was seen among 76 (23.7%) participants. The educational status of the participants was significantly associated with their awareness level (χ2 =13.668, DF=6, P=0.033). ConclusionThis study identified a few important misconceptions associated with polio and PPI which need to be addressed by large scale awareness campaigns in order to achieve polio eradication in the near future