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There are many advantages to improve communication between primary care and Psychiatric services. In Ireland various models of liaison with primary care are still in early stages of experimentation in some parts. We devised a pilot project of consultation-liaison model in west of Ireland.
There are 11 general practitioners working in the catchment area. All of them were given information and five agreed to participate. Based on random allocation two general practitioners were placed in experimental group. Three other general practitioners were allocated to control group. All patients from these surgeries were enrolled in study. In experimental group face to face meetings between psychiatrist and general practitioners were arranged before and after seeing patients in clinics. Feedback and exchange of information took place during these meetings. Meetings were arranged on monthly basis for six month starting in December 2009. While in the control group communication and referral was through usual method of writing letters.
Assessment of data was based on comparison of outcome in two sets of patients and surgeries. We collected data regarding number of admissions, compliance with appointments, changes in medications, number of referrals to secondary care, number of discharges back to general practitioners. Results show quantitative benefits of collaborative model in the lines of more patients being discharged back to GP and less missed appointments. There was also trend of reduced admission rate but this was statistically not significant.
To determine the frequency of Depressive Disorder among patients with breast cancer in an outpatient department of a tertiary care hospital in Pakistan.
Cancer not only affects body physically but can also affect the mind in the form of psychiatric disorder. Proper identification and treatment of these conditions can be beneficial and cost-effective.
This cross-sectional descriptive study was conducted on patients of breast cancer attending OPD of oncology department of Civil Hospital Karachi. The sample consisted of ninety three diagnosed patients of breast cancer who were screened for psychiatric morbidity through Hospital Anxiety and Depression Scale (HAD Scale). Screened patients were interviewed and diagnosed as depressive disorder according to ICD criteria. The level of depression in these diagnosed patients was quantified through ZUNG'S Depression Rating Scale.
Eighty two percent (n = 76) of the sample (n = 93) were found to have psychiatric morbidity on HAD scale. Out of these screened sample sixty percent (n = 46) were found to be depressed on Zung self rating depression scale. Majority of these patients were suffering from mild to moderate depression. Half of the female in this sample were undergone mastectomy that was not found to have any statistically significant impact on psychiatric morbidity of the patient.
This study shows high prevalence of depression in patients with breast cancer. The health professional involve in care of breast cancer should screen routinely their patients for symptoms of depression.
The endogenous opioid system (EOS) plays a critical role in addictive processes. Molecular dysregulations in this system may be specific for different stages of addiction cycle and neurocircuitries involved, and therefore may differentially contribute to the initiation and maintenance of addiction.
We here evaluated whether the EOS is altered in brain areas involved in cognitive control of addiction including the dorsolateral prefrontal cortex (dl-PFC), orbitofrontal cortex (OFC), anterior insula (AI) and hippocampus, in human alcohol dependent subjects.
Levels of EOS mRNAs were measured by qRT-PCR, and levels of dynorphins by radioimmunoassay in postmortem human specimens.
Prodynorphin kappa-opioid receptor mRNAs and dynorphins were upregulated or demonstrated higher dispersion in alcoholics.
Dysregulation in the kappa-opioid receptor/dynorphin system in alcoholics may contribute to alcohol craving and neurocognitive dysfunctions relevant for addiction and disrupted inhibitory control.
We are grateful to the NSW Tissue Resource Centre for providing human brain samples. Supported by the Swedish VR and FAS.
Chikungunya virus (CHIKV) is a re-emerging pathogen of global importance. We attempted to gain an insight into the organisation, distribution and mutational load of the virus strains reported from different parts of the world. We describe transmission dynamics and genetic characterisation of CHIKV across the globe during the last 65 years from 1952 to 2017. The evolutionary pattern of CHIKV was analysed using the E1 protein gene through phylogenetic, Bayesian and Network methods with a dataset of 265 sequences from various countries. The time to most recent common ancestor of the virus was estimated to be 491 years ago with an evolutionary rate of 2.78 × 10−4 substitutions/site/year. Genetic characterisation of CHIKV strains was carried out in terms of variable sites, selection pressure and epitope mapping. The neutral selection pressure on the E1 gene of the virus suggested a stochastic process of evolution. We identified six potential epitope peptides in the E1 protein showing substantial interaction with human MHC-I and MHC-II alleles. The present study augments global epidemiological and population dynamics of CHIKV warranting undertaking of appropriate control measures. The identification of epitopic peptides can be useful in the development of epitope-based vaccine strategies against this re-emerging viral pathogen.
Early laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy.
From January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy.
All patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively.
In summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy.
Children with obstructive sleep apnoea commonly undergo adenotonsillectomy as first-line surgical treatment. This paper aimed to investigate whether this intervention was associated with weight gain after surgery in the paediatric population with obstructive sleep apnoea.
Two independent researchers systematically reviewed the literature from 1995 to 2014 for studies on patients who underwent adenotonsillectomy with weight-based measurements before and after surgery. The databases used were Ovid Medline, Embase and PubMed.
Six papers satisfied all inclusion criteria. Four of these papers showed a significant weight increase and the others did not. The only high quality, randomised, controlled trial showed a significant increase of weight gain at seven months follow up, even in patients who were already overweight before their surgery.
The current evidence points towards an association between adenotonsillectomy and weight gain in patients with obstructive sleep apnoea in the short term.
The poultry sector is an important and vibrant segment of agriculture in Pakistan with a significant contribution to the national GDP (1.3%). Commercial poultry production in Pakistan started in the 1960's and has been providing a significant portion of daily proteins to the Pakistani population ever since. During its evolution the industry enjoyed promotional policies of the Government, but has faced several challenges such as disease outbreaks and retail price fluctuations. Despite its important role in the country's economy, not a single scientific study is available on its evolutionary history. The data available in this regard are scattered and lack reliability. This review is an effort to encompass the history of the overall growth of the poultry industry in Pakistan, its present status (2012 statistics) and future directions and challenges. This article may serve as the basic source of information on Pakistan's poultry industry achievements. It will also guide poultry experts and policy makers for developing strategic planning for further growth of the industry.
Necrotic enteritis (NE) caused by Clostridium spp. is an economically significant bacterial disease of poultry worldwide. Traditionally the disease has been prevented through feed supplementation with antibiotics sub-therapeutically as antimicrobial growth promoters (AGPs). However this practice has led to the emergence of resistant pathogenic microbes and drug residues, potentially threatening animal and public health. Therefore the marketing and incorporation of AGPs into poultry feed has been banned in Europe which has exacerbated the incidence of NE, bringing about huge economic losses to poultry farmers. Poultry researchers, exporters and consumers have emphasised AGP-free poultry rearing and have been searching for non-antibiotic and cost effective alternatives to control NE. Strategies suggested include vaccination, coccidiosis control, probiotics, competitive exclusion products, prebiotics, egg yolk immunoglobulins, bacteriophages (or phage gene products), organic acids, feed enzymes, plants and plants extracts/essential oils and nutritional changes.
There are many predisposing as well as virulence factors for NE induction and pathogenesis and more are expected to be discovered in the future. The ambiguous pathogenesis trend of the disease is still hindering the development of a potent active vaccine against NE. The choice of a single and fully effective approach is difficult. However, probiotics and specific egg yolk immunoglobulins (IgYs) alone or in combination could serve as promising strategies for controlling NE in broilers in the absence of AGPs.
Newcastle Disease (ND) is regarded as one of the major diseases of poultry because of the devastating losses that the virulent form of the ND virus can impose on both commercial and domestic chickens. However, the disease can be controlled through the administration of effective vaccines. Almost all the commercially available ND vaccines require refrigeration and begin to deteriorate rapidly after 1-2 hours if left at room temperature (around 25°C). Subsequently, because maintaining an adequate supply of refrigerated facilities may be a difficult task in many countries with unreliable electrical supplies, the development and large scale production of an effective thermostable ND vaccine seems imperative to support the poultry industry. Such vaccines should be resilient to damage associated with either very cold or hot environments so there are no concerns about the viability of the vaccine in response to temperatures fluctuations that can occur in extreme environments when the difference in temperature during cold and warm seasons can vary greatly. In the following review paper, the development of such a vaccine is discussed, including molecular characterisation, organ tropism of vaccine strains, production, as well as administration methods and their efficacy. It addition, the potential payback has been calculated alongside opportunities provided by removing vaccines from cold chain storage.
Hydropericardium syndrome (HPS) is a fatal disease of broiler chickens causing high mortality and heavy economic losses in various countries. More than 100 million birds have been affected by this destructive disease in less than two years worldwide. As it is a viral disease, the only solution is to vaccinate chickens. Different types of vaccines are being used against this disease in different areas of the world. Liver organ inactivated vaccines are more extensively used to control the disease initially. These vaccines have many drawbacks regarding their dose, un-predictable immune response and secondary bacterial infections. Following this, oil adjuvant vaccine was used to control the disease, however the handling stress and the formation of granuloma at the site of injection remains a problem. Consequently there is a need for cell culture adapted and attenuated vaccines, which can be administered through oral routes. A chicken embryo-adapted inactivated vaccine has shown good results but requires a continuous supply of specific, pathogen-free chicken embryos and a continuous life killing process. The continuous cell lines are a more promising solution for the production of cell culture-adapted and attenuated vaccines, which are safer, more economical and easy to administer. The following review discusses the development of modern HPS vaccines.
Copper–tin (CuxSn1−x) nanocluster is a promising system for gas sensing applications, mainly because of its sensitivity and selectivity for H2S. In this work, pure Sn and Cu as well as composite CuxSn1−x nanoclusters were synthesized using the dc magnetron sputtering gas condensation technique. Nanoclusters with different Sn to Cu ratios were produced by changing the ratio of Sn and Cu in the target. The dependence of Sn, Cu, and CuxSn1−x nanoclusters’ size distribution on various source parameters, such as the inert gas flow rate and aggregation length, has been investigated in detail. The results show that as the inert gas flow rate increases, the mean nanocluster size increases for Sn, decreases for Cu, while increases and then decreases for CuxSn1−x. The results could be understood in terms of the contribution percentage of the nanocluster formation mechanism. Furthermore, this work demonstrates the ability of tuning the CuxSn1−x nanoclusters’ size and composition by a proper optimization of the source operation conditions.
We report a case of bilateral acute mastoiditis and subperiosteal abscesses successfully managed with simultaneous surgery.
A case report and literature review are presented.
A two-year-old boy presented with fever, otalgia, otorrhoea and bilateral protruding ears. He was treated for 72 hours with intravenous antibiotics but failed to improve. Computed tomography confirmed bilateral mastoid abscesses with destruction of the mastoid cortex. Bilateral drainage of the subperiosteal abscesses and bilateral cortical mastoidectomies were carried out. Post-operatively, he recovered well, and free field audiometry showed a normal hearing threshold of 20 dB across all test frequencies.
This is only the second reported case of bilateral mastoiditis and subperiosteal abscesses. This case illustrates the use of bilateral cortical mastoidectomy in the successful management of this condition following failed antibiotic therapy, and highlights important management considerations.
Hydropericardium syndrome has caused huge economic losses to the poultry industry in Pakistan. The disease was reported for the first time in 1987 at Angara Goth, a broiler producing area near Karachi and given the name Angara disease. The disease is prevalent in 3–7 week old broilers and characterized by its sudden onset, accumulation of a jelly like fluid in the pericardial sac, inflamed liver with basophilic intranuclear inclusion bodies, congested kidneys and up to 70% mortality rates. Fowl adenovirus 4 has been found to be the causative agent. In Pakistan, the status of scientific research on various aspects of hydropericardium syndrome is quite unsatisfactory. There is an extensive use of formalin inactivated liver homogenate vaccines for the prevention and control of disease. Moreover, the gross lesions seen in post mortem examination are only the criteria for the clinical diagnosis of disease. Keeping in view the economic significance of hydropericardium syndrome, the need for additional scientific research on proper diagnosis and control of disease is suggested.
a rare case of axillary artery injury following a displaced surgical neck of humerus fracture is presented. the epidemiology and pathoanatomy of the condition are described. a literature review is presented emphasising the need for prompt diagnosis and treatment.
We report the design, manufacturing, and testing of a new cesium enhanced negative carbon ion source that can be useful to synthesize hard and/or electron emitting carbon nitride and diamond-like carbon (DLC) thin films. The design of the source includes a conventional magnetron-sputtering gun, low voltage ion extraction lenses, and a cesium oven to provide cesium vapor for formation of a fractional mono layer of Cs on the carbon target. Cs reduces the surface work function of the carbon target and enhances the emission of negative carbon ions. Argon and argon-nitrogen gas mixtures were used to ignite and sustain the plasma in the chamber. We compare the properties of carbon nitride and DLC films deposited with and without cesium. Nitrogen composition in the Ar-N2 gas mixture was observed to be an important process parameter affecting mechanical properties of the film. The effect of the Cs oven temperature on deposition rate and current absorbed at the substrate was also investigated for RF powers from 0 to 150 W.