Search

Psychiatric/behavioral symptoms in the context of neurological disease are particularly challenging to treat in the geriatric population. Patients with Parkinson’s disease (PD), stroke, and traumatic brain injuries (TBI), all can develop psychiatric symptoms which then interact and exacerbate their neurological symptoms. The medications prescribed to treat psychiatric symptoms can also adversely impact neurological symptoms. These interactions are further complicated by the effects of comorbid medical conditions, as well as geriatric changes in pharmacokinetics, pharmacodynamics, and excretion of medications. This chapter offers evidence-based guidelines for management of psychiatric symptoms seen in three neurological conditions common among geriatric inpatients.

To determine the frequency of HPV in eaters of Gutka (betel, areca, lime and tobacco concoction), presenting with oral lesions.A descriptive study.Ziauddin University Research Laboratory, from February to July 2010.Subjects munching Gutka fulfilled the inclusion criteria. Samples were collected in the form of 20 - 40 ml oral rinse from 262 subjects who were habitual eaters of Gutka after an informed consent. Gentle brushings from the lesion were taken from subjects with the help of a brush at the other end of dental floss and the oral rinse was stored at 4°C until DNA extraction. DNA was extracted and PCR was performed using HPV consensus primers Gp5+/Gp6+. Oral cavity was examined for the presence of ulcer, trismus, sub-mucosal fibrosis, leukoplakia and/or warts.Out of 262 subjects, 42 were females and 220 males with an average age of 27± 10 years. HPV was positive in 47 subjects (17.9%). HPV frequency was 2.7% greater in chewers with more than 10 years of habit compared to less than 10 years. Examination of oral cavity showed 78% presenting with more than one complaint including oral ulcers (25%), rough mucosa (62%), sub-mucosal fibrosis (24%), leukoplakia (20%) and erythroplakia (10.6%). Highest frequency of HPV was observed in erythroplakia (25%). Association between presence of symptoms and HPV shows an ODDS RATIO: ad/bc= 4982/430=11.6.Oral lesions caused by constant exposure to Gutka are associated with high frequency of HPV infection, which may be a risk factor for squamous cell carcinoma of the oral cavity. People should be educated about the consequences of Gutka abuse.