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REVIEWIn the event a patient demands a skinbiopsy, it may be worthwhile to do onerather than risk losing rapport with thepatient. Koo and Lee (2001) suggest makinga verbal agreement beforehand, and thatthe patient be more flexible in his or herthinking if the biopsy returns negative; thismay make it easier to convince the patientto take antipsychotic medications afterthe biopsy. 8 When antipsychotic therapyis initiated, it is advisable to offer themedication as an empirical therapy whileemphasizing the potential for reductionin symptoms, like biting and crawlingsensations. 8 Potential side effects of theantipsychotics should be discussed withthe patient beforehand, to enhance patientcompliance. Considering the patient’s comorbiditieswhen selecting the particularantipsychotic to be used can help tailorthe choice; for example, in a patient withdiabetes, olanzapine should be avoideddue to its potential for metabolic syndromeside effects. Depot injections (risperidone)should only be pursued as an optionif the patient is willing to be regularlymonitored by a psychiatric team. Workingin conjunction with the patient’s familyphysician to monitor both the side effects ofthe antipsychotic medication and course ofthe DP will reduce the risks of complicationsfrom the therapy, especially if the patientrefuses the involvement of psychiatry.CONCLUSIONThere has never been a randomizedcontrol trial directly comparing atypicalantipsychotics to typical antipsychotics,which would be useful in establishing aclear treatment of choice for DP. 10 However,based on the efficacy of drugs in bothclasses as shown in Tables 1 and 2, it wouldappear that atypical antipsychotics have alower side effect profile while achieving apartial to full remission rate similar to typicalantipsychotics. The reduction in adverseiatrogenic events would improve patientcompliance to treatment and help constructa therapeutic relationship between thepatient and physician.References:1. Wilson FC, Uslan DZ. Delusionalparasitosis. 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, VanVoorhis W, McMullen R, Buckner FS,et al. Delusional parasitosis: six-yearexperience with 23 consecutive cases at anacademic medical center. Int J Infect Dis.2010;14:e317-21.4. DSM-IV-TR. Diagnostic and statisticalmanual of mental health disorders (4thed, text revision). In. Washington DC:American Psychiatric Association, 2000.5. Huber M, Kirchler E, Karner M,Pycha R.Delusional parasitosis and the dopaminetransporter. A new insight of etiology? MedHypotheses. 2007;68:1351-8.6. Donabedian H. Delusions of Parasitosis.Clin Infect Dis. 2007;45:e131-4.7. Driscoll MS, Rothe MJ, Grant-KelsJM, Hale MS. Delusional parasitosis:a dermatologic, psychiatric, andpharmacologic approach. J Am AcadDermatol. 1993; 29:1023-33.8. Koo J, Lee CS. Delusions of parasitosis.A dermatologist’s guide to diagnosis andtreatment. Am J Clin Dermatol. 2001;2:285-90.9. Robles DT, Romm S, Combs H, OlsonJ, Kirby P. Delusional disorders indermatology: a brief review. DermatolOnline J. 2008;14:2.10. Lepping P, Russell I, Freudenmann RW.Antipsychotic treatment of primarydelusional parasitosis: systematic review. BrJ Psychiatry. 2007;191:198-205.11. Lorenzo CR, Koo J. Pimozide indermatologic practice: a comprehensivereview. Am J Clin Dermatol. 2004;5:339-49.12. Elmer KB, George RM, Peterson K.Therapeutic update: use of risperidonefor the treatment of monosymptomatichypochondriacal psychosis. J Am AcadDermatol. 2000;43:683-6.13. Ungvari G, Vladar K. Pimozide treatmentfor delusion of infestation. Act Nerv Super(Praha). 1986;28:103-7.14. Opler LA, Feinberg SS. The role ofpimozide in clinical psychiatry: a review. JClin Psychiatry. 1991;52:221-33.15. Hamann K, Avnstorp C. Delusions ofinfestation treated by pimozide: a doubleblindcrossover clinical study. Acta DermVenereol. 1982;62:55-8.16. Zomer SF, De Wit RF, Van Bronswijk JE,Nabarro G,Van Vloten WA. Delusions ofparasitosis. A psychiatric disorder to betreated by dermatologists? An analysis of33 patients. Br J Dermatol. 1998;138:1030-2.17. Lyell A. The Michelson Lecture. Delusionsof parasitosis. Br J Dermatol. 1983;108:485-99.18. Bhatia MS, Jagawat T, Choudhary S.Delusional parasitosis: a clinical profile. IntJ Psychiatry Med. 2000;30:83-91.19. Lindskov R, Baadsgaard O. Delusions ofinfestation treated with pimozide: a followupstudy. Acta Derm Venereol. 1985;65:267-70.20. Meltzer HY. What’s atypical about atypicalantipsychotic drugs? Curr Opin Pharmacol.2004;4:53-7.21. Kapur S, Remington G. DopamineD(2) receptors and their role in atypicalantipsychotic action: still necessary andmay even be sufficient. Biol Psychiatry.2001;50:873-83.22. Westerink BH. Can antipsychotic drugs beclassified by their effects on a particulargroup of dopamine neurons in the brain?Eur J Pharmacol. 2002;455:1-18.23. Gallucci G, Beard G. Risperidone andthe treatment of delusions of parasitosisin an elderly patient. Psychosomatics.1995;36:578-80.24. De Leon OA, Furmaga KM, CanterburyAL, Bailey LG. Risperidone in thetreatment of delusions of infestation. Int JPsychiatry Med. 1997;27:403-9.25. Healy R, Taylor R, Dhoat S, LeschynskaE, Bewley AP. Management of patientswith delusional parasitosis in a jointdermatology/ liaison psychiatry clinic. Br JDermatol. 2009; 161:197-9.26. Kenchaiah BK, Kumar S, Tharyan P.Atypical anti-psychotics in DelusionalParasitosis: a retrospective case series of 20patients. Int J Dermatol. 2010; 45:95-100.27. Wenning MT, Davy LE, Catalano G,Catalano MC. Atypical antipsychotics inthe treatment of delusional parasitosis.Ann Clin Psychiatry. 2003;15:233-9.28. Nicolato R, Correa H, Romano-Silva MA,Teixeira AL, Jr. Delusional parasitosis orEkbom syndrome: a case series. Gen HospPsychiatry. 2006;28:85-7.29. Shah A, Pervez M. Risperidone LongActing Injection (RLAI) in DelusionalParasitosis. German Journal of Psychiatry.2009;12:35-7.30. Rocha FL,Hara C. Aripiprazole indelusional parasitosis: Case report. ProgNeuropsychopharmacol Biol Psychiatry.2007;31:784-6.31. Bennassar A, Guilabert A, Alsina M, PintorL,Mascaro JM, Jr. Treatment of delusionalparasitosis with aripiprazole. ArchDermatol. 2009;145:500-1.32. Sandoz A, LoPiccolo M, Kusnir D, TauskFA. A clinical paradigm of delusionsof parasitosis. J Am Acad Dermatol.2008;59:698-704.33. Freudenmann RW, Kuhnlein P, LeppingP,Schonfeldt-Lecuona C. Secondarydelusional parasitosis treated withpaliperidone. Clin Exp Dermatol.2009;34:375-7.34. Freudenmann RW, Lepping P. Secondgenerationantipsychotics in primary andsecondary delusional parasitosis: outcomeand efficacy. J Clin Psychopharmacol.2008;2:500-8.12University of Alberta Health Sciences Journal • April 2012 • Volume 7 • Issue 1
35. Wykoff RF. Delusions of parasitosis: areview. Rev Infect Dis. 1987;9:433-7.36. Milia A, Mascia MG, Pilia G, ParibelloA, Murgia D, Cocco E, et al. Efficacyand safety of quetiapine treatment fordelusional parasitosis: experience in anelderly patient. Clin Neuropharmacol.2008;31:310-2.37. Narayan V, Ashfaq M, Haddad PM.Aripiprazole in the treatment of primarydelusional parasitosis. Br J Psychiatry.2008;193:258.REVIEWStem cells in cardiac repair: A review of the changinglandscape of cardiovascular medicineNicholas A. Avdimiretz, BScMedical Student (2013), Faculty of Medicine and Dentistry University of Alberta, Edmonton, CanadaCorrespondence to Nicholas Avdimiretz: Email: naa1@ualberta.caAbstractCardiac disease is the leading cause of deathfor both men and women in developedcountries. In Canada, the incidence ofdiabetes and hypertension has recentlyincreased by 90% in middle income groups,resulting in substantially more cardiacdisease. How can medical professionalskeep up with these statistics? Imagine ifphysicians could regenerate the woundedheart post-myocardial infarction, or evenbioengineer an entirely new organ. Thisis the future of cardiovascular medicine.Regenerating myocardium is hardly an easyundertaking; the heart contains about 20million cardiomyocytes per gram of tissue,meaning – in the left ventricle alone – thereare approximately 4 billion cardiomyocytesat risk during a heart attack. Many cells arerequired to replace damaged tissue, makingcomplete regeneration challenging. In lightof the rich therapeutic potential seen inboth adult and embryonic stem cells, it is nosurprise that biomedical research on thesecells has seen an intense amount of activityin the past decade. From fetal-derivedcardiomyocytes and skeletal myoblasts, tobone marrow stromal cells and peripheralblood CD34 + cells, a myriad of cell lineshave been tested to date. The last decadehas seen an explosion of novel approachesusing these cells to restore cardiac functionpost-infarction: from developing cell-basedpacemakers and cardiac grafts, to buildingbioartifical hearts. This review will paint apicture of the rapidly changing landscapeof cardiovascular medicine by elaboratingon these new technologies. Limitationsof these approaches will be discussed, aswell as future developments. In the field ofcell-based cardiac repair, the possibilitiesseem endless.PreambleCardiac disease is the leading causeof death for both men and women indeveloped countries. In fact, cardiovasculardisease – including coronary heart disease,hypertension, stroke, and congestive heartfailure – has ranked as the number onecause of death in the US every year since1900, except during the 1918 influenzaepidemic. 1 In 2007, heart disease accountedfor 26% of all deaths in the US, resultingin an age-adjusted death rate of 211 per100,000 people. 2 Also shocking is the costof medication, health care services, and lostproductivity due to heart disease in the US:a projected $508 billion in 2010. 3 This costis not expected to decrease any time soon.In Canada, the incidence of risk factors forcardiac disease has increased substantiallyover the past decade: both diabetes andhypertension have increased by 90% inmiddle income groups (roughly 50% ofthe population), 4 resulting in substantiallymore cardiovascular disease. What if thereexisted a therapeutic technique to treat thatwhich physicians have for so long deemedincurable? What if one could regenerate thewounded heart after a myocardial infarctionusing stem cells? Imagine if one couldbioengineer a new heart. This could be thefuture of cardiovascular medicine.Over the last decade, the utilization ofstem cells to repair the damaged heart hasseen an explosion of advancements. Noveltherapeutic techniques will be addressed indetail: the methods used and the resultingapplications of these innovations will bedescribed. Limitations of these techniquesand future developments will also bereviewed.Introduction to Cardiac RepairCell therapy has experienced muchgrowth over the last 25-30 years: fromits first applications for reconstitutingthe immune system after a bone marrowtransplant, to treating diabetes withpancreatic islet transplantation. 5 More recenttreatments include those for liver cirrhosis,Huntington’s disease, and Parkinson’sdisease. 6 As for heart disease, the majorityof therapies have been centered on thetreatment of heart damage post-myocardialinfarction (MI). How can myocardial repairoccur in an organ that is thought to beincapable of naturally self-repairing itself?The heart does not experience regenerationas the liver does; following MI, scar tissueforms over the infarcted area. Therefore,much of the research has been gearedtowards using cell-based approaches toregenerate myocardium directly fromdonor stem cells. Regenerating heartmuscle following an MI is hardly an easyundertaking; the myocardium containsabout 20 million cardiomyocytes per gram oftissue, so there are approximately 4 billioncardiomyocytes at risk in the left ventriclealone during a heart attack. Assumingthat any repair therapy restores at least1/2 to 2/3 of the damaged myocardium,true regeneration would require 500 to 800million cells. 7 In light of the therapeuticpotential seen in both adult and embryonicstem cells (coined ES cells by Martin in1981), 8 it is no surprise that biomedicalresearch on these cells has seen an intenseamount of activity in the past decade.Stem Cell SourcesStem cells not only have an unlimitedcapacity to self-renew, but they are alsopluripotent; this means that stem cellscan be induced to differentiate into cellsUniversity of Alberta Health Sciences Journal • April 2012 • Volume 7 • Issue 1 13
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Page 4 and 5: COMMENTARYOSCE: The subjective expe
Page 6 and 7: RESEARCHRosiglitazone decreases ang
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Page 19 and 20: 13. Yeh ET, Zhang S, Wu HD, Korblin
Page 21 and 22: MUSAGive Me Hope | by Vina Nguyen |
Page 23 and 24: creative, and actually produce some
Page 25 and 26: References1. Brett-MacLean PJ, Cave
Page 27 and 28: The Arts and Humanities inMedicine
Page 29 and 30: Diverse Classrooms. English Educati
Page 31 and 32: e defined as making judgments about
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Page 39 and 40: Thank youThe UAHSJ wishes to thank

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