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1/31. Successful treatment by meropenem of campylobacter jejuni meningitis in a chronic alcoholic following neurosurgery.

    meningitis caused by campylobacter jejuni is rare, we describe a case following neurosurgery for intra-cranial haematoma in a chronic alcoholic patient. Conventional culture of CSF and blood was supplemented by polymerase chain reaction (PCR) detection of campylobacter jejuni.
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2/31. Leader dilemmas and countertransference considerations in group psychotherapy with substance abusers.

    Leader issues and countertransference dilemmas that emerge in psychotherapy groups for substance abusers will be examined along with strategies to extricate the therapist from the impasses that emerge. Specific issues include feelings of helplessness and inadequacy when a patient relapses and resumes substance use, countertransference reactions emanating from an overlapping personal or family history of substance abuse, countertransference helplessness when the therapist is more invested in the treatment than the patient, feelings of incompetence related to partial familiarity with 12-step culture and lingo, and countertransference devaluation fostered by systemic issues in substance abuse settings.
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3/31. Spontaneous escherichia coli meningitis in an adult.

    Spontaneous meningitis due to gram-negative bacilli (excluding Hemophilus influenzae) is an infrequent infection in adult patients. It usually occurs in patients with underlying immunosuppressive conditions. Most of the cases are due to escherichia coli and represent a complication of bacteraemia. The infection has a high mortality rate which may be as high as 90%, especially if associated with septicaemia. We report the case of a 53-y-old man with spontaneous, community-acquired escherichia coli meningitis who was admitted with an unusual presentation. blood and urine cultures were negative.
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4/31. Jesus, peyote, and the holy people: alcohol abuse and the ethos of power in Navajo healing.

    Of the three religious healing traditions that coexist within the contemporary Navajo health care system, the Native American Church (NAC) and Pentecostal christianity are more actively involved in the treatment of alcohol and substance abuse than is Traditional Navajo healing. This article examines these two more recent healing traditions as religious responses to the contemporary Navajo crisis of alcohol and substance abuse as well as to socioeconomic changes. These traditions offer new kinds of power, social networks, and personal meaning that facilitate a transformation of self, a revitalized sense of community, and a new vision of the possibilities of the future for Navajo people who suffer. Examining the ethos of power that underlies Navajo healing can complement the theoretical emphasis on harmony and beauty in anthropological research on Navajo culture and religion.
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5/31. Wernicke's encephalopathy in a non-alcoholic man: case report and brief review.

    Wernicke's encephalopathy, a serious neurological disorder caused by thiamine deficiency, is most commonly found in chronic alcoholics. We present a typical case of Wernicke's encephalopathy in a non-alcoholic man. Our patient presented with altered mental status, slurred speech, fever, vomiting and headache of one-week duration. An infectious etiology of the symptoms was ruled out by spinal fluid cultures. The patient improved dramatically within 24 hours of administration of thiamine.
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6/31. Through indigenous eyes: Native Americans and the hiv epidemic.

    This article examines the phenomenon of hiv within the context of a Native American culture. Native Americans have some risk factors for hiv transmission that differ from those found in other populations. In addition, prevention and intervention activities with this population must consider cultural variables to maximize their effectiveness. Brief anecdotes are used to illustrate various concepts related to hiv and Native Americans and to include a human face along with facts and statistics. The author's unique perspective, coupled with a broad discussion of relevant issues enables non-Native American readers to understand better the phenomenon of hiv as it exists within a Native American context.
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7/31. Subacute endocarditis due to erysipelothrix rhusiopathiae.

    erysipelothrix rhusiopathiae is a rare cause of endocarditis. Most cases were observed in people working with animals. We report a case in a 45-year old man without any exposure to animals. He was admitted to our hospital because of dyspnoea. blood cultures were drawn following fever on day 8 of hospitalisation. erysipelothrix rhusiopathiae was cultured and echocardiography showed a vegetation on the mitral valve. Appropriate antibiotic therapy and surgical treatment led to a good outcome of the infection.
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8/31. Deaf culture and alcohol and substance abuse.

    Alcohol and substance abuse problems are now of concern among persons who are deaf. The problems of cultural influence, prevalence of the problem, and factors contributing to isolation and denial are addressed in this article. In addition, the issues of accessibility and service delivery are explored. Current programs that are accessible and provide alcohol and substance abuse recovery are identified.
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9/31. Biliary infarction mimicking liver metastasis.

    A 38-year-old man with a history of chronic alcohol abuse had suffered from numerous acute episodes of chronic pancreatitis in the last 7 years. Those episodes were complicated by the formation of a pseudocyst in the pancreatic head. He presented himself with vomiting and abdominal pain as well as diarrhoea for 10 days. In the ultrasound examination of the liver numerous circumscribed hypoechoic formations in both lobes of the liver were found. A subsequent computerised tomography scan confirmed multiple hypodense liver lesions. Because of suspected metastasis or abscesses in the liver, sonographically guided fine needle biopsies of these liver structures were carried out. The histological examination of the liver specimens showed bile infarcts and proliferated bile ducts; there were no signs of a malignant or infectious process. The bacteriological cultures of the biopsy specimens were negative.
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10/31. Acute endosulfan poisoning with cerebral edema and cardiac failure.

    BACKGROUND: Organochlorine insecticides are highly toxic compounds that are responsible for a number of severe intoxications worldwide with several deaths. Despite their widespread use in agriculture during the 1940s to 1960s and the well-known signs and symptoms of intoxication, the clinical picture in case of poisoning varies. We report two cases of acute intentional endosulfan intoxication with cerebral edema and cardiac failure. case reports: Both cases developed life-threatening signs like epileptic state, respiratory insufficiency and hemodynamic instability soon after ingestion. The survivor developed severe myocardial insufficiency and pulmonary edema documented by echocardiography and x-ray of the chest. The deceased patient developed severe cerebral edema and multiorgan failure ten days after ingestion of Thiodan 35. The peak serum concentration of endosulfan in the survivor was 0.12 mg/L approximately 23 hours after ingestion, whereas the peak blood concentration in the fatal case was 0.86 mg/L approximately 25 hours post-ingestion. Post-mortem endosulfan levels in different organs were determined. CONCLUSION: endosulfan is a highly toxic organochlorine insecticide that produces well-known neurological symptoms of tonic-clonic convulsions, headache, dizziness and ataxia but also can cause gastrointestinal symptoms and metabolic disturbances. life-threatening cerebral edema and hemodynamic instability may occur. Treatment is symptomatic and supportive.
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