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REVIEW In the event a patient demands a skin biopsy, it may be worthwhile to do one rather than risk losing rapport with the patient. Koo and Lee (2001) suggest making a verbal agreement beforehand, and that the patient be more flexible in his or her thinking if the biopsy returns negative; this may make it easier to convince the patient to take antipsychotic medications after the biopsy. 8 When antipsychotic therapy is initiated, it is advisable to offer the medication as an empirical therapy while emphasizing the potential for reduction in symptoms, like biting and crawling sensations. 8 Potential side effects of the antipsychotics should be discussed with the patient beforehand, to enhance patient compliance. Considering the patient’s comorbidities when selecting the particular antipsychotic to be used can help tailor the choice; for example, in a patient with diabetes, olanzapine should be avoided due to its potential for metabolic syndrome side effects. Depot injections (risperidone) should only be pursued as an option if the patient is willing to be regularly monitored by a psychiatric team. Working in conjunction with the patient’s family physician to monitor both the side effects of the antipsychotic medication and course of the DP will reduce the risks of complications from the therapy, especially if the patient refuses the involvement of psychiatry. CONCLUSION There has never been a randomized control trial directly comparing atypical antipsychotics to typical antipsychotics, which would be useful in establishing a clear treatment of choice for DP. 10 However, based on the efficacy of drugs in both classes as shown in Tables 1 and 2, it would appear that atypical antipsychotics have a lower side effect profile while achieving a partial to full remission rate similar to typical antipsychotics. The reduction in adverse iatrogenic events would improve patient compliance to treatment and help construct a therapeutic relationship between the patient and physician. References: 1. Wilson FC, Uslan DZ. Delusional parasitosis. Mayo Clin Proc. 2004;79:1470. 2. Wilson J, Miller H. Delusions of Parasitosis. Archives of Dermatology and Syphilology. 1946;54:39-56. 3. Boggild AK, Nicks BA, Yen L, Van Voorhis W, McMullen R, Buckner FS, et al. Delusional parasitosis: six-year experience with 23 consecutive cases at an academic medical center. Int J Infect Dis. 2010;14:e317-21. 12 4. DSM-IV-TR. Diagnostic and statistical manual of mental health disorders (4th ed, text revision). In. Washington DC: American Psychiatric Association, 2000. 5. Huber M, Kirchler E, Karner M,Pycha R. Delusional parasitosis and the dopamine transporter. A new insight of etiology? Med Hypotheses. 2007;68:1351-8. 6. Donabedian H. Delusions of Parasitosis. Clin Infect Dis. 2007;45:e131-4. 7. Driscoll MS, Rothe MJ, Grant-Kels JM, Hale MS. Delusional parasitosis: a dermatologic, psychiatric, and pharmacologic approach. J Am Acad Dermatol. 1993; 29:1023-33. 8. Koo J, Lee CS. Delusions of parasitosis. A dermatologist’s guide to diagnosis and treatment. Am J Clin Dermatol. 2001;2:285- 90. 9. Robles DT, Romm S, Combs H, Olson J, Kirby P. Delusional disorders in dermatology: a brief review. Dermatol Online J. 2008;14:2. 10. Lepping P, Russell I, Freudenmann RW. Antipsychotic treatment of primary delusional parasitosis: systematic review. Br J Psychiatry. 2007;191:198-205. 11. Lorenzo CR, Koo J. Pimozide in dermatologic practice: a comprehensive review. Am J Clin Dermatol. 2004;5:339-49. 12. Elmer KB, George RM, Peterson K. Therapeutic update: use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis. J Am Acad Dermatol. 2000;43:683-6. 13. Ungvari G, Vladar K. Pimozide treatment for delusion of infestation. Act Nerv Super (Praha). 1986;28:103-7. 14. Opler LA, Feinberg SS. The role of pimozide in clinical psychiatry: a review. J Clin Psychiatry. 1991;52:221-33. 15. Hamann K, Avnstorp C. Delusions of infestation treated by pimozide: a doubleblind crossover clinical study. Acta Derm Venereol. 1982;62:55-8. 16. Zomer SF, De Wit RF, Van Bronswijk JE, Nabarro G,Van Vloten WA. Delusions of parasitosis. A psychiatric disorder to be treated by dermatologists? An analysis of 33 patients. Br J Dermatol. 1998;138:1030- 2. 17. Lyell A. The Michelson Lecture. Delusions of parasitosis. Br J Dermatol. 1983;108:485- 99. 18. Bhatia MS, Jagawat T, Choudhary S. Delusional parasitosis: a clinical profile. Int J Psychiatry Med. 2000;30:83-91. 19. Lindskov R, Baadsgaard O. Delusions of infestation treated with pimozide: a followup study. Acta Derm Venereol. 1985;65:267- 70. 20. Meltzer HY. What’s atypical about atypical antipsychotic drugs? Curr Opin Pharmacol. 2004;4:53-7. 21. Kapur S, Remington G. Dopamine D(2) receptors and their role in atypical antipsychotic action: still necessary and may even be sufficient. Biol Psychiatry. 2001;50:873-83. 22. Westerink BH. Can antipsychotic drugs be classified by their effects on a particular group of dopamine neurons in the brain? Eur J Pharmacol. 2002;455:1-18. 23. Gallucci G, Beard G. Risperidone and the treatment of delusions of parasitosis in an elderly patient. Psychosomatics. 1995;36:578-80. 24. De Leon OA, Furmaga KM, Canterbury AL, Bailey LG. Risperidone in the treatment of delusions of infestation. Int J Psychiatry Med. 1997;27:403-9. 25. Healy R, Taylor R, Dhoat S, Leschynska E, Bewley AP. Management of patients with delusional parasitosis in a joint dermatology/ liaison psychiatry clinic. Br J Dermatol. 2009; 161:197-9. 26. Kenchaiah BK, Kumar S, Tharyan P. Atypical anti-psychotics in Delusional Parasitosis: a retrospective case series of 20 patients. Int J Dermatol. 2010; 45:95-100. 27. Wenning MT, Davy LE, Catalano G, Catalano MC. Atypical antipsychotics in the treatment of delusional parasitosis. Ann Clin Psychiatry. 2003;15:233-9. 28. Nicolato R, Correa H, Romano-Silva MA, Teixeira AL, Jr. Delusional parasitosis or Ekbom syndrome: a case series. Gen Hosp Psychiatry. 2006;28:85-7. 29. Shah A, Pervez M. Risperidone Long Acting Injection (RLAI) in Delusional Parasitosis. German Journal of Psychiatry. 2009;12:35-7. 30. Rocha FL,Hara C. Aripiprazole in delusional parasitosis: Case report. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:784-6. 31. Bennassar A, Guilabert A, Alsina M, Pintor L,Mascaro JM, Jr. Treatment of delusional parasitosis with aripiprazole. Arch Dermatol. 2009;145:500-1. 32. Sandoz A, LoPiccolo M, Kusnir D, Tausk FA. A clinical paradigm of delusions of parasitosis. J Am Acad Dermatol. 2008;59:698-704. 33. Freudenmann RW, Kuhnlein P, Lepping P,Schonfeldt-Lecuona C. Secondary delusional parasitosis treated with paliperidone. Clin Exp Dermatol. 2009;34:375-7. 34. Freudenmann RW, Lepping P. Secondgeneration antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy. J Clin Psychopharmacol. 2008;2:500-8. University of Alberta Health Sciences Journal • April 2012 • Volume 7 • Issue 1
35. Wykoff RF. Delusions of parasitosis: a review. Rev Infect Dis. 1987;9:433-7. 36. Milia A, Mascia MG, Pilia G, Paribello A, Murgia D, Cocco E, et al. Efficacy and safety of quetiapine treatment for delusional parasitosis: experience in an elderly patient. Clin Neuropharmacol. 2008;31:310-2. Stem cells in cardiac repair: A review of the changing landscape of cardiovascular medicine Nicholas A. Avdimiretz, BSc Medical Student (2013), Faculty of Medicine and Dentistry University of Alberta, Edmonton, Canada Correspondence to Nicholas Avdimiretz: Email: naa1@ualberta.ca Abstract Cardiac disease is the leading cause of death for both men and women in developed countries. In Canada, the incidence of diabetes and hypertension has recently increased by 90% in middle income groups, resulting in substantially more cardiac disease. How can medical professionals keep up with these statistics? Imagine if physicians could regenerate the wounded heart post-myocardial infarction, or even bioengineer an entirely new organ. This is the future of cardiovascular medicine. Regenerating myocardium is hardly an easy undertaking; the heart contains about 20 million cardiomyocytes per gram of tissue, meaning – in the left ventricle alone – there are approximately 4 billion cardiomyocytes at risk during a heart attack. Many cells are required to replace damaged tissue, making complete regeneration challenging. In light of the rich therapeutic potential seen in both adult and embryonic stem cells, it is no surprise that biomedical research on these cells has seen an intense amount of activity in the past decade. From fetal-derived cardiomyocytes and skeletal myoblasts, to bone marrow stromal cells and peripheral blood CD34 + cells, a myriad of cell lines have been tested to date. The last decade has seen an explosion of novel approaches using these cells to restore cardiac function post-infarction: from developing cell-based pacemakers and cardiac grafts, to building bioartifical hearts. This review will paint a picture of the rapidly changing landscape of cardiovascular medicine by elaborating on these new technologies. Limitations of these approaches will be discussed, as well as future developments. In the field of cell-based cardiac repair, the possibilities seem endless. Preamble Cardiac disease is the leading cause of death for both men and women in developed countries. In fact, cardiovascular disease – including coronary heart disease, hypertension, stroke, and congestive heart failure – has ranked as the number one cause of death in the US every year since 1900, except during the 1918 influenza epidemic. 1 In 2007, heart disease accounted for 26% of all deaths in the US, resulting in an age-adjusted death rate of 211 per 100,000 people. 2 Also shocking is the cost of medication, health care services, and lost productivity due to heart disease in the US: a projected $508 billion in 2010. 3 This cost is not expected to decrease any time soon. In Canada, the incidence of risk factors for cardiac disease has increased substantially over the past decade: both diabetes and hypertension have increased by 90% in middle income groups (roughly 50% of the population), 4 resulting in substantially more cardiovascular disease. What if there existed a therapeutic technique to treat that which physicians have for so long deemed incurable? What if one could regenerate the wounded heart after a myocardial infarction using stem cells? Imagine if one could bioengineer a new heart. This could be the future of cardiovascular medicine. Over the last decade, the utilization of stem cells to repair the damaged heart has seen an explosion of advancements. Novel therapeutic techniques will be addressed in detail: the methods used and the resulting applications of these innovations will be described. Limitations of these techniques and future developments will also be reviewed. 37. Narayan V, Ashfaq M, Haddad PM. Aripiprazole in the treatment of primary delusional parasitosis. Br J Psychiatry. 2008;193:258. Introduction to Cardiac Repair Cell therapy has experienced much growth over the last 25-30 years: from its first applications for reconstituting the immune system after a bone marrow transplant, to treating diabetes with pancreatic islet transplantation. 5 More recent treatments include those for liver cirrhosis, Huntington’s disease, and Parkinson’s disease. 6 As for heart disease, the majority of therapies have been centered on the treatment of heart damage post-myocardial infarction (MI). How can myocardial repair occur in an organ that is thought to be incapable of naturally self-repairing itself? The heart does not experience regeneration as the liver does; following MI, scar tissue forms over the infarcted area. Therefore, much of the research has been geared towards using cell-based approaches to regenerate myocardium directly from donor stem cells. Regenerating heart muscle following an MI is hardly an easy undertaking; the myocardium contains about 20 million cardiomyocytes per gram of tissue, so there are approximately 4 billion cardiomyocytes at risk in the left ventricle alone during a heart attack. Assuming that any repair therapy restores at least 1/2 to 2/3 of the damaged myocardium, true regeneration would require 500 to 800 million cells. 7 In light of the therapeutic potential seen in both adult and embryonic stem cells (coined ES cells by Martin in 1981), 8 it is no surprise that biomedical research on these cells has seen an intense amount of activity in the past decade. Stem Cell Sources Stem cells not only have an unlimited capacity to self-renew, but they are also pluripotent; this means that stem cells can be induced to differentiate into cells University of Alberta Health Sciences Journal • April 2012 • Volume 7 • Issue 1 13 REVIEW
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Page 3 and 4: Contents Editorial Commentary OSCE:
Page 5 and 6: University of Alberta Summer Studen
Page 7 and 8: it has been found that PPAR-γ agon
Page 9 and 10: trioglitazone greatly inhibited inf
Page 11 and 12: types of antipsychotics used in the
Page 13: antipsychotic. Of these patients, 4
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Page 19 and 20: 13. Yeh ET, Zhang S, Wu HD, Korblin
Page 21 and 22: Give Me Hope | by Vina Nguyen | Med
Page 23 and 24: creative, and actually produce some
Page 25 and 26: References 1. Brett-MacLean PJ, Cav
Page 27 and 28: The arts and Humanities in Medicine
Page 29 and 30: Diverse Classrooms. English Educati
Page 31 and 32: e defined as making judgments about
Page 33 and 34: Figure 1. Dr. Albert Ross Tilley. o
Page 35 and 36: therapy were numerous. Tannic acid
Page 37 and 38: he was acknowledged with Canada and
Page 39 and 40: Thank you The UAHSJ wishes to thank

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