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We sought to assess the effectiveness of clozapine augmentation with Electroconvulsive therapy (ECT) (C+ECT) in patients with clozapine-resistant schizophrenia.
We conducted a retrospective review of electronic health records to identify patients treated with C+ECT. We determined the response to C+ECT and the rate of rehospitalisation over the year following treatment with C+ECT.
Forty-two patients were treated with C+ECT over a 10-year period. The mean age of the patients at initiation of ECT was 46.3 (SD = 8.2) years (range 27–62 years). The mean number of ECTs given was 10.6 (SD = 5.3) (range 3–25) with the majority receiving twice weekly ECT. Seventy-six per cent of patients (n = 32) showed a Clinical Global Impression-Improvement (CGI-I) score of ≤3 (at least minimally improved) following C+ECT. The mean number of ECT treatments was 10.6 (SD = 5.3) (range 3–25) with the majority receiving twice weekly ECT. Sixty-four per cent of patients experienced no adverse events. Response to C+ECT was not associated with gender, age, duration of illness or duration of clozapine treatment. Seventy-five per cent of responders remained out of hospital over the course of 1-year follow-up, while 70% of those with no response to C+ECT were not admitted to hospital. Three patients received maintenance ECT, one of whom was rehospitalised.
This study lends support to emerging evidence for the effectiveness of C+ECT in clozapine-resistant schizophrenia. These results are consistent with the results of a meta-analysis and the only randomised controlled trial (RCT) of this intervention. Further RCTs are required before this treatment can be confidently recommended.
The most common intervention performed by physicians is the writing of a prescription. All elements in the complex process of prescribing and administering drugs are susceptible to error.
To measure the extent to which information recorded on prescription cards conforms to basic standards of prescription writing.
To improve prescribing, recording and staff knowledge.
To identify common prescribing errors and focus on the same to improve our standard of practice.
An audit tool was designed to collect data and standard was set 100%.
In the initial audit, there was significant deficiency in prescription writing, which was presented at the internal teaching to all doctors and recommendations were made. This audit was repeated after a month, which showed improvement in prescription writing and recording.
Write all drugs in CAPITALS ensuring correct spelling, dose, route of administration and frequency.
Complete all fields on front of the prescription card legibly.
Document any change in prescription card in clinical notes.
All doctors to go through their current clients medication cards and ensure any gaps filled and errors corrected.
Audit report will be kept in audit folder as a reference for any rotating doctor to repeat the audit every six months in the services.
Doctors should continue to improve prescription writing and reduce any adverse events or errors.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Oxidative stress may contribute to the pathogenesis of congenital heart defects, but the role of dynamic thiol/disulphide homeostasis has not been evaluated. The objective of this study was to assess whether there are changes in thiol/disulphide homeostasis and nitric oxide levels in children with tetralogy of Fallot (TOF) and ventricular septal defect (VSD). A total of 47 children with congenital heart defects (24 TOF and 23 VSD) and 47 healthy age- and sex-matched controls were included in this study. Serum total thiol and native thiol levels were measured using a novel automatic spectrophotometric method. The amount of dynamic disulphide bonds and related ratios were calculated from these values. Serum nitric oxide levels were detected using a chemiluminescence assay. We found that the average native thiol, total thiol, and disulphide levels were decreased in patients with VSD when compared with healthy individuals (p < 0.001, p < 0.001, and p < 0.01, respectively). While native thiol levels were decreased (p < 0.01), disulphide levels were elevated in the TOF group (p < 0.05). We observed marked augmentation of disulphide/native thiol (p < 0.001) and disulphide/total thiol ratios (p < 0.01) in the TOF group. However, there was a significant decrease in native thiol/total thiol ratio in patients with TOF. No significant changes in these ratios were noted in the VSD group. We detected significant elevations in serum nitric oxide levels in children with TOF and VSD (p < 0.001 for all). These results are the first to demonstrate that thiol/disulphide homeostasis and nitric oxide are associated with TOF and VSD in children.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
New excavations at the Jebel Moya cemetery in Sudan reveal extensive evidence for Meroitic-era occupation, providing valuable data on contemporaneous diet, migration, exchange and population composition in sub-Saharan Africa.
This study aims to assess the knowledge, attitude and practice of primary care physicians (PCPs) in Lebanon regarding nutrition counseling and to investigate possible related barriers.
Nutrition counseling is an important aspect of patient care, especially with the increase in nutrition-related disorders.
This is a descriptive study among a convenience sample of PCPs in Lebanon at two annual conferences in 2014 using an anonymous questionnaire.
Response rate was 54.6%. Overall, physicians considered that they have good to very good nutritional knowledge. Although they rated their formal nutritional education poorly, they had a positive attitude towards nutritional counseling and reported practicing general nutritional counseling with their patients. Barriers to nutritional counseling were: time, perceived poor patient adherence to diet, gap in physician’s nutritional knowledge and lack of insurance coverage for dietitian fees. Changes should be made to medical education curricula to include nutrition courses related to prevalent health problems.
Initiated Chemical Vapor Deposition (iCVD) is a well-known method for depositing polymers that are used in chemical, biological, and electrical applications. It is a variation of hot filament deposition and can used to produce conformal coatings of polymer films at relatively low reaction temperatures. It is also a solventless technique in which thin polymeric films are deposited by introducing controlled ratios of monomer and initiator gasses into the reaction chamber. Low temperatures in the reaction chamber allow the deposition of polymer films on a wide variety of substrates that include biological substrates.
We have simulated the growth of a monolayer of polymer films on two-dimensional surfaces using Monte Carlo simulation. We saw the formation of polymer chains over a time scale on the order of microseconds. We have assumed the substrate to be at room temperature while the reactor pressure close of 800 mTorr.
The grid on which we have simulated this polymer growth is represented by a 100x100 matrix, on which a series of specialized functions are executed in each time-step, or iteration. These functions can be divided into three categories: population, translation, and polymerization.
The goal of this simulation is to observe the initial growth of the iCVD surface reaction. We have obtained favorable results with the simulation and we are now looking to compare these results with experimental results for initiation growth.
Eighty-two hospitals of 66 cities in 30 countries (Argentina, Brazil, Colombia, Cuba, Dominican Republic, Egypt, Greece, India, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Poland, Salvador, Saudi Arabia, Serbia, Singapore, Slovakia, Sudan, Thailand, Turkey, Uruguay, and Vietnam) from 4 continents (America, Asia, Africa, and Europe).
Patients undergoing surgical procedures (SPs) from January 2005 to December 2010.
Data were gathered and recorded from patients hospitalized in INICC member hospitals by using the methods and definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) for SSI. SPs were classified into 31 types according to International Classification of Diseases, Ninth Revision, criteria.
We gathered data from 7,523 SSIs associated with 260,973 SPs. SSI rates were significantly higher for most SPs in INICC hospitals compared with CDC-NHSN data, including the rates of SSI after hip prosthesis (2.6% vs 1.3%; relative risk [RR], 2.06 [95% confidence interval (CI), 1.8–2.4]; P<.001), coronary bypass with chest and donor incision (4.5% vs 2.9%; RR, 1.52 [95% CI, 1.4–1.6]; P<.001); abdominal hysterectomy (2.7% vs 1.6%; RR, 1.66 [95% CI, 1.4–2.0]; P<.001); exploratory abdominal surgery (4.1 % vs 2.0%; RR, 2.05 [95% CI, 1.6–2.6]; P<.001); ventricular shunt, 12.9% vs 5.6% (RR, 2.3 [95% CI, 1.9–2.6]; P<.001), and others.
SSI rates were higher for most SPs in INICC hospitals compared with CDC-NHSN data.
To evaluate the action mode of Berberis vulgaris root extract in the alleviation of oxidative stress, female Japanese quails (n 180, aged 5 weeks) were reared, either at 22°C for 24 h/d (thermoneutral, TN) or 34°C for 8 h/d (heat stress, HS), and fed one of three diets: diets containing 0, 100 or 200 mg of B. vulgaris root extract per kg for 12 weeks. Exposure to HS depressed feed intake by 8·5 % and egg production by 12·1 %, increased hepatic malondialdehyde (MDA) level by 98·0 % and decreased hepatic superoxide dismutase, catalase and glutathione peroxidase activities by 23·5, 35·4 and 55·7 %, respectively (P< 0·001 for all). There were also aggravations in expressions of hepatic NF-κB and heat-shock protein 70 (HSP70) by 42 and 43 %, respectively and suppressions in expressions of nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and haeme-oxygenase 1 (HO-1) by 57 and 61 %, respectively, in heat-stressed quails (P< 0·001 for all). As supplemental B. vulgaris extract increased, there were linear increases in performance parameters, activities of antioxidant enzymes and hepatic Nrf2 and HO-1 expressions (P< 0·001 for all) and linear decreases in hepatic MDA level and NF-κB and HSP70 expressions at a greater extent in quails reared under TN condition and those reared under HS condition. In conclusion, dietary supplementation of B. vulgaris root extract to quails reduces the detrimental effects of oxidative stress and lipid peroxidation resulting from HS via activating the host defence system at the cellular level.
The objective of the present study was to evaluate anti-diabetic effects of chromium picolinate (CrPic) and biotin supplementations in type 2 diabetic rats. The type 2 diabetic rat model was induced by high-fat diet (HFD) and low-dose streptozotocin. The rats were divided into five groups as follows: (1) non-diabetic rats fed a regular diet; (2) diabetic rats fed a HFD; (3) diabetic rats fed a HFD and supplemented with CrPic (80 μg/kg body weight (BW) per d); (4) diabetic rats fed a HFD and supplemented with biotin (300 μg/kg BW per d); (5) diabetic rats fed a HFD and supplemented with both CrPic and biotin. Circulating glucose, cortisol, total cholesterol, TAG, NEFA and malondialdehyde concentrations decreased (P< 0·05), but serum insulin concentrations increased (P< 0·05) in diabetic rats treated with biotin and CrPic, particularly with a combination of the supplements. Feeding a HFD to diabetic rats decreased PPAR-γ expression in adipose tissue and phosphorylated insulin receptor substrate 1 (p-IRS-1) expression of liver, kidney and muscle tissues, while the supplements increased (P< 0·001) PPAR-γ and p-IRS-1 expressions in relevant tissues. Expression of NF-κB in the liver and kidney was greater in diabetic rats fed a HFD, as compared with rats fed a regular diet (P< 0·01). The supplements decreased the expression of NF-κB in diabetic rats (P< 0·05). Results of the present study revealed that supplementing CrPic and biotin alone or in a combination exerts anti-diabetic activities, probably through modulation of PPAR-γ, IRS-1 and NF-κB proteins.
In spring 2009 a new strain of influenza A(H1N1) emerged and caused a worldwide pandemic. This study utilized a large collection of respiratory specimens from suspected cases of influenza A(H1N1) in the UK West Midlands during the pandemic in order to investigate which other respiratory viruses were circulating and whether they played any role in the increased hospitalization rates seen during that period. Study specimens were selected from community and hospitalized patients positive and negative for influenza A(H1N1) and tested by PCR for other respiratory viruses. A number of infections diagnosed as influenza during the summer influenza outbreak were found to be due to other virus infections (most commonly rhinovirus). No statistically significant difference was found between the rates of respiratory virus co-infection with H1N1 in patients from community or hospital locations suggesting underlying factors were likely to be more significant than viral co-infections in determining severity of influenza A(H1N1) disease.
Certain influenza outbreaks, including the 2009 influenza A(H1N1) pandemic, can predominantly affect school-age children. Therefore the use of school absenteeism data has been considered as a potential tool for providing early warning of increasing influenza activity in the community. This study retrospectively evaluates the usefulness of these data by comparing them with existing syndromic surveillance systems and laboratory data. Weekly mean percentages of absenteeism in 373 state schools (children aged 4–18 years) in Birmingham, UK, from September 2006 to September 2009, were compared with established syndromic surveillance systems including a telephone health helpline, a general practitioner sentinel network and laboratory data for influenza. Correlation coefficients were used to examine the relationship between each syndromic system. In June 2009, school absenteeism generally peaked concomitantly with the existing influenza surveillance systems in England. Weekly school absenteeism surveillance would not have detected pandemic influenza A(H1N1) earlier but daily absenteeism data and the development of baselines could improve the timeliness of the system.
The reproductive biology of the commercial seabait polychaete species Perinereis nuntia brevicirris, Lumbrineris funchalensis and Halla parthenopeia was investigated from samples obtained from the Suez Canal, Egypt, to determine sex-ratio, reproductive maturity stages, spawning season, and fecundity. Samples were collected monthly from January 2002 to February 2003. The results of sex-ratio indicated that males of the three studied worms outnumbered females through the whole study period. Based upon histological features of the coelomic contents, four maturity stages were described in females of P. nuntia brevicirris, three stages were described for females of L. funchalensis and three stages for females of H. parthenopeia. The spawning season of P. nuntia brevicirris was found to take place during spring and L. funchalensis does not have a defined breeding season, while H. parthenopeia has two reproductive periods, one in May and the second in November and lasted to January. Fecundity was estimated by counting the number of oocytes per each female—it showed that P. nuntia brevicirris is more fecund (mean = 208.358 ±2080 oocyte/female) than L. fanchalensis and H. parthenopeia (mean = 2660 ±654 and 142,068 ±2005 oocyte/female respectively). This study is the first to document aspects of the reproductive biology of the highly commercial polychaetes in the Suez Canal and adds to our knowledge for understanding their reproductive patterns and strategies.
1. A series of experiments have been carried out with Drosophila melanogaster in order to improve further a population, highly selected for a quantitative character, by introducing genetic material from an inferior population. The effects of selecting the latter before crossing to the selected line, of waiting after crossing before restarting selection and of varying the intensity of selection after crossing have been studied. The inferior population used was the large random breeding population from which the selected line had been produced by selecting downwards for sternopleural bristles.
2. There proved to be some incompatibility between the conditions necessary to achieve the two criteria of success—the time to surpass the selected line and the extent by which it was eventually exceeded. The lines which surpassed it soonest had not been selected before crossing and had been selected intensely immediately afterwards. Those which surpassed it most had had the greatest amount of selection before crossing followed by the most intense selection afterwards.
3. Crossing-over did not appear to be a limiting factor after crossing. Neither a period of relaxation after crossing nor a lower intensity of selection after crossing increased the chance of success.
4. Genetic analyses were made of several lines which had exceeded the original selected line. In separate lines, second, third and fourth chromosomes were found which were superior to the chromosomes of the selected line. This and other evidence shows that the limits in such lines with a small number of parents are not in any way absolute but artefacts of the selection programme. The extreme third and fourth chromosomes were both recessive to that of the selected line in the effect on bristle score.
5. A theoretical discussion of such selection programmes is given, assuming that the character is controlled by independently segregating loci. It is shown that, if two alleles at different loci have an equal but small chance of fixation in the initial selection, one because it is rare and the other because, though frequent, it has little effect on the character, such a programme will tend to pick up the former rather than the latter. Of two such rare alleles with an equal initial chance of fixation, the one additive and the other recessive, the chance of fixation of the latter will be greater in a crossing programme.
Measurement of extremely new phenomena during the interaction of laser pulses with terawatt and higher power and picoseconds with plasmas arrived at drastically different anomalies in contrast to the usual observations if the laser pulses were very clean with a contrast ratio higher than 108. This was guaranteed by the suppression of prepulses during less than dozens of ps before the arrival of the main pulse resulting in the suppression of relativistic self-focusing. This anomaly was confirmed in many experimental details, and explained and numerically reproduced as a nonlinear force acceleration of skin layers generating quasi-neutral plasma blocks with ion current densities above 1011 A/cm2. This may support the requirement to produce a fast ignition deuterium tritium fusion at densities not much higher than the solid state by a single shot PW-ps laser pulse. With the aim to achieve separately studied ignition conditions, we are studying numerically how the necessary nonlinear force accelerated plasma blocks may reach the highest possible thickness by using optimized dielectric properties of the irradiated plasma. The use of double Rayleigh initial density profiles results in many wavelength thick low reflectivity directed plasma blocks of modest temperatures. Results of computations with the genuine two-fluid model are presented.
Acute mastoiditis, a destructive bacterial infection of the mastoid bone and air cell system, is relatively uncommon today but remains a potentially serious condition. There is a lack of information in the literature regarding the long term otological problems that children may face following an episode of this condition.
Our aim was to examine the presentation, complications and hospital course in this patient population, and to ascertain whether these patients had long term otological problems.
We retrospectively reviewed the medical records of all patients presenting with acute mastoiditis between January 1990 and December 2005. Patients' parents were contacted by telephone and questioned about further otological problems.
Twenty-nine patients were included in the study, and 27 of these patients' parents were contactable to complete the telephone questionnaire. Sixty-nine per cent of children had no previous history of acute otitis media prior to presentation. Forty-five per cent of patients had received oral antibiotics prior to presentation. Sixty-two per cent of patients developed complications, i.e. a subperiosteal abscess or failure to respond to medical therapy, resulting in the need for surgical intervention (in the form of incision and drainage of periosteal abscess, cortical mastoidectomy, or grommet insertion). Mean follow up of patients was eight years and one month; five (17 per cent) patients had been followed up for less than one year. Two (7 per cent) patients developed a further episode of mastoiditis within six weeks of initial presentation, both of whom required cortical mastoidectomy. Three (10 per cent) patients had further problems with recurrent acute otitis media, requiring tympanostomy tube insertion. One patient required a modified radical mastoidectomy for cholesteatoma (15 years later). Twenty-two patients (91 per cent) had been followed up for longer than one year; these patients had subjectively normal hearing and were asymptomatic at the time of study.
The majority of patients who had suffered an episode of acute mastoiditis had no adverse long term otological sequelae.