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Tympanostomy is one of the most commonly performed surgical procedures in otolaryngology, and its complexity is challenging for trainee surgeons. Investing in medical education is a cornerstone of good patient safety practices. For trainees, use of simulators before operating on actual patients helps mitigate risks. This study aimed to develop a three-dimensional printed model simulator for myringotomy, tympanostomy and ventilation tube placement.
An articulated model with a detachable portion, base and plastic bag to simulate the external auditory canal, middle ear and tympanic membrane, respectively, was modelled and printed.
The final simulator was made from acrylonitrile butadiene styrene polymer and measured 4 × 4 × 12 cm. It was designed to mimic the angulation of patient anatomy in the myringotomy position and simulate the texture and colour of the tissues of interest. The cost was low, and testing with an operating microscope and endoscope yielded satisfactory results. The advent of three-dimensional printing technology has made surgical simulation more accessible and less expensive, providing several advantages for medical education.
The proposed model fulfilled expectations as a safe, inexpensive, reproducible, user-friendly and accessible surgical education tool that can be improved and reassessed for further research.
In this experimental study, multiscale rough surfaces with regular (cuboid) elements are used to examine the effects of roughness-scale hierarchy on turbulent boundary layers. Three iterations have been used with a first iteration of large-scale cuboids onto which subsequent smaller cuboids are uniformly added, with their size decreasing with a power-law as the number increases. The drag is directly measured through a floating-element drag balance, while particle image velocimetry allowed the assessment of the flow field. The drag measurements revealed the smallest roughness iteration can contribute to nearly 7 $\%$ of the overall drag of a full surface, while the intermediate iterations are responsible for over $12\,\%$ (at the highest Reynolds number tested). It is shown that the aerodynamic roughness length scale between subsequent iterations varies linearly, and can be described with a geometrical parameter proportional to the frontal solidity. Mean and turbulent statistics are evaluated using the drag information, and highlighted substantial changes within the canopy region as well as in the outer flow, with modifications to the inertial sublayer (ISL) and the wake region. These changes are shown to be caused by the presence of large-scale secondary motions in the cross-plane, which itself is believed to be a consequence of the largest multiscale roughness phase (spacing between largest cuboids), shown to be of the same order of magnitude as the boundary-layer thickness. Implications on the classical similarity laws are additionally discussed.
The production of specialty coffee has several factors and parameters that are added up in the course of production, so that the quality is expressed in the act of consumption. Based on this scenario, this study included the analysis of ten genotypes of arabica coffee, the materials being subjected to irrigated and rainfed water regimes, in a low altitude region, to identify responses for sensory and physical–chemical quality. The genotypes were evaluated in a split-plot scheme with a randomized block design, with three replications. Arabica coffee fruits were harvested with 80% cherry seeds and processed by the wet method. Subsequently, the characteristics related to physical–chemical and sensory analyses were evaluated. The genotypes of the Paraíso group showed great variability for the physical–chemical and sensory variables for rainfed and irrigated regimes. The genotypes of the Catuaí group, however, showed less variability for sensory characteristics in both cultivation environments and for physical–chemical characteristics in the irrigated regime. In the sensorial data set, the genotypes Catuaí 144 CCF and Catuaí 144 SFC (when irrigated) and Paraíso H 419-3-3-7-16-2, Paraíso H 419-3-3-7-16-11 and Catucaí 24-137 (rainfed cultivation), are more favourable to the production of specialty coffee at low altitude.
Applied linguistic work claims that multilinguals’ non-native languages interfere with one another based on similarities in cognitive factors like proficiency or age of acquisition. Two experiments explored how trilinguals regulate control of native- and non-native-language words. Experiment 1 tested 46 Dutch–English–French trilinguals in a monitoring task. Participants decided if phonemes were present in the target language name of a picture, phonemes of non-target language translations resulted in longer response times and more false alarms compared to phonemes not present in any translation (Colomé, 2001). The second language (English) interfered more than the first (Dutch) when trilinguals monitored in their third language (French). In Experiment 2, 95 bilinguals learned an artificial language to explore the possibility that the language from which a bilingual learns a third language provides practice managing known-language interference. Language of instruction modulated results, suggesting that learning conditions may reduce interference effects previously attributed to cognitive factors.
Eriocitrin is a citrus flavonoid with a high capacity to reduce the oxidative stress related to metabolic disorders and obesity. We assessed the effects of low doses of eriocitrin on the oxidative stress, inflammation, and metabolism of glucose and lipids of high-fat diet (HFD)-fed obese mice. Fifty male C57BL/6J mice were randomly assigned into five groups (n 10). The mice were fed an HFD (45 % kcal from fat, i.e. lard) for 4 weeks for obesity induction. After this period, the mice continued receiving the same HFD, but supplemented with eriocitrin at 10, 25 or 100 mg/kg body weight (bw) for an additional 4 weeks. Control groups were fed with standard diet (10 % kcal of fat, i.e. soy oil) or with HFD without eriocitrin, for eight consecutive weeks. At the end of the study, mice supplemented with eriocitrin showed lower levels of blood serum glucose and blood and liver triacylglycerols (P < 0⋅05). There was also improved levels of insulin, HOMA-IR, total-cholesterol, resistin and lipid peroxidation in the supplemented mice. It was concluded that the 25 mg dose of eriocitrin improved all the parameters studied and had positive effects on oxidative stress, systemic inflammation and metabolism of lipids and glucose in general.
Background: Loss of a spouse is a frequent occurrence in later life, with about 10% of the individuals finding themselves unable to cope and progressing to prolonged grief, risking further mental and physical problems.
Objective: The development and implementation of an online grief program, such as LEAVES (optimizing the menta L hEalth and resilience of older Adults that haVe lost th Eir spou Se via blended, online therapy), intends to improve prevention and treatment of prolonged grief, so that elderly mourners can continue to lead an active, meaningful and dignified life.
Methods: The LEAVES program, a project under AAL (Active and Assisted Living) 2019 Call for Sustainable Smart Solutions for Ageing Well, is in development by an international consortium and integrates academical, clinical and technical experts. The project will take place between February 2020 and January 2023 and involve real-life evaluation of 315 end-users. The Psychiatric Department at the Health Unit of Baixo Alentejo (ULSBA) will offer the service to its primary users, blending online services with telephone, video calls and face-to-face sessions. Widowed older adults >65 that express the need for help in mourning their spouse will be recruited in the community as well as via the geriatric psychiatry team and primary care.
Results: With LEAVES program we aim for older adults to process the loss of a spouse in a blended online/presential environment, detecting olders at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The evaluation will focus on wellbeing and involve several measures to assess grief symptoms, loneliness, hopelessness, satisfaction and quality of life. Conclusions: ULSBA will use LEAVES to improve clinical practice on preventing and managing prolonged grief as well as, after testing and validating it in this project, to save economical costs and improve effectiveness, both to hospital and patients.
Accurate estimates of methane (CH4) production by cattle in different contexts are essential to developing mitigation strategies in different regions. We aimed to: (i) compile a database of CH4 emissions from Brazilian cattle studies, (ii) evaluate prediction precision and accuracy of extant proposed equations for cattle and (iii) develop specialized equations for predicting CH4 emissions from cattle in tropical conditions. Data of nutrient intake, diet composition and CH4 emissions were compiled from in vivo studies using open-circuit respiratory chambers, SF6 technique or the GreenFeed® system. A final dataset containing intake, diet composition, digestibility and CH4 emissions (677 individual animal observations, 40 treatment means) obtained from 38 studies conducted in Brazil was used. The dataset was divided into three groups: all animals (GEN), lactating dairy cows (LAC) and growing cattle and non-lactating dairy cows (GCNL). A total of 54 prediction equations available in the literature were evaluated. A total of 96 multiple linear models were developed for predicting CH4 production (MJ/day). The predictor variables were DM intake (DMI), gross energy (GE) intake, BW, DMI as proportion of BW, NDF concentration, ether extract (EE) concentration, dietary proportion of concentrate and GE digestibility. Model selection criteria were significance (P < 0.05) and variance inflation factor lower than three for all predictors. Each model performance was evaluated by leave-one-out cross-validation. The Intergovernmental Panel on Climate Change (2006) Tier 2 method performed better for GEN and GCNL than LAC and overpredicted CH4 production for all datasets. Increasing complexity of the newly developed models resulted in greater performance. The GCNL had a greater number of equations with expanded possibilities to correct for diet characteristics such as EE and NDF concentrations and dietary proportion of concentrate. For the LAC dataset, equations based on intake and animal characteristics were developed. The equations developed in the present study can be useful for accurate and precise estimation of CH4 emissions from cattle in tropical conditions. These equations could improve accuracy of greenhouse gas inventories for tropical countries. The results provide a better understanding of the dietary and animal characteristics that influence the production of enteric CH4 in tropical production systems.
The Human Immunodificiency Virus infects primarily the immune system. However, the infection may also affect the central nervous system, materialising itself, in this particular case, in neurological and neuropsychiatric disturbances.
The authors describe the case of a 48 year-old female patient with bipolar affective disease, identified since she was 21. She has a long history of regular examination in speciality consultations, including several psychiatric hospital stays. More recently, she is conducted to the psychiatric emergency department, being admitted for a maniform state. During the stay her general condition deteriorates progressively, being often taken to the regular emergency department. The serious weight-loss associates itself to altered states of consciousness, ataxia and disartry, as well as diahrrea, fever syndromes and breathing difficulty. As a consequence, the patient stays in bed. Despite several diagnosed infections and the histologic result of the cervical cancer biopsy, requested in an ambulatory regime (“lymphoproliferative disease involving the cervix”), she is always conducted to the psychiatric ward. She is admitted in the medicine ward only a month later and is, afterwards, transferred to the infectious diseases ward, with the aim of studying the neuropsychiatric condition in connection with the HIV/AIDS infection.
The authors come to the conclusion that, it is rather important that the anti-HIV antibodies research is included in the routines of complementary diagnosis examinations requested by psychiatrists.
They also reflect about the little relevance that other medicine areas give to the physical diseases of the psychiatric patients, weakening them even more.
Corticobasal degeneration is a rare neurodegenerative disorder affecting both cortex and basal ganglia with clinical and underlying pathological heterogeneity. Although motor features of CBD were emphasized in earlier descriptions psychiatric symptoms, including cognitive impairment and mood disorders, have been consistently reported during the course of the disease. Clinical diagnosis of CBD is challenging and can be difficult to differentiate from other neuropsychiatric disorders with overlapping features. This can lead to significant underdiagnosis of CBD particularly during its early stages.
We report a case of a 48 year-old female patient presenting with insidious orofacial dystonia co-occurring with depression which remained controlled for five years. Later, while experiencing major psycho-social stress factors, she presented with a rapidly progressive clinical syndrome compatible with the diagnosis of cortico-basal degeneration with severe motor, cognitive and behavioural symptoms, including alien limb phenomenon, nonfluent aphasia and personality changes. Neuropsychological assessment revealed significant frontal lobe dysfunction and SPECT imaging showed asymetrical fronto-parietal hypoperfusion.
This case illustrates the difficulties in the clinical diagnosis of CBD both in early and late stages due to its clinical overlap with mood and movement disorders as well as with Fronto-Temporal Dementia. At the same time, it highlights the influence of psycho-social stress factors in the manifestation of degenerative disorders.
Trichobezoar was first described by Baudomant in 1779. This rare entity consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome.
It is only reliably diagnosed by CT scan and its size may require removal by open surgery.
Albeit trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but scarce reports on psychiatric literature. It is estimated that 30% of cases of trichotillophagia are of patients suffering from tricotillomania, and that 1% of those will eventually require surgical treatment.
The authors report a clinical case of trichobezoar without known trichotillomania, and revise the existing relevant literature, focusing on psychiatric evaluation and management.
The goal of the authors is to stimulate reflection on the distribution in continuum of compulsive and impulsive behaviours and highlight how important it is to constantly question psychiatric diagnoses, to avoid running the risk of dangerous categorisations.
They describe the case of a 31 year-old patient who attended the Emergency department of Coimbra University Hospitals complaining of depression and obsessive-compulsive symptoms that interfered with his daily life and with his sleep. He said that he used to attend psychiatry appointments and that he was “antisocial”, but added: “I'm as impulsive as much as I'm emotional”.
The patient's records show that he was always diagnosed with antisocial personality disorder, established by the first consultant he saw,specifically mentioning: “problems obeying rules”, “impulsiveness”, “getting into fights and brawls entailing legal action” with the obsessive-compulsive symptoms being secondary. However, the follow-up of the patient conduced by me revealed obsessive-compulsive symptoms in special compulsive checking rituals (which began in childhood), excessive concern with the size of his nose (and other parts of the body) that started in adolescence, as well as a personality marked by impulsiveness and a poor frustration tolerance, leading to highly aggressive episodes triggered by events/circumstances that he himself did not regard as particularly relevant. The results of the studies on the relationship between impulsiveness and compulsiveness could have a strong impact on reformulating the psychiatric nosology. Whenever we come across a new patient, as complete a clinical history as possible should be taken and easy diagnoses should be avoided.
In Portugal, Recognition, Validation and Certification of Competences (RVCC) allows adults to achieve recognition of competences acquired by formal and informal learning using a Competences Reference System. By creating a portfolio describing their life story, adults may explore and question their own living experiences.
This communication aims at promoting deep consideration on the importance of an RVCC process in promoting adult mental health. It analyses the relation between mental health and the RVCC process, and its benefits to prevention and rehabilitation. Methods include my experience as a psychologist at a Centra de Novas Oportunidades (New Opportunities Centre) and scientific literature on the subject. Adults are involved in activities which contribute to developing their social competences. They increase self-confidence and self-esteem, control over life choices and accountability for their actions. In Portugal, this process also involves patients with mental disorders and offers appropriate Key Competences Reference Systems. Adults suffering from mental disorder and undergoing a RVCC process re-establish their self-confidence, self-esteem, self-efficacy and gain a positive hope for the future. Empowerment leads them to cooperate more actively with mental health professionals in their own treatment and rehabilitation plan.
Despite being highly criticized as a system which only validates competences, such criticisms to this process are clearly reductive.
The results of an investigation conducted on the Formulario Especial dos Medicamentos para o Hospital de alienados em Rilhafoles (1901), a mental disease drug formulary for the oldest Portuguese psychiatric hospital, are presented. The study considered the Portuguese situation within the European setting.
This study quantifies the number of drugs and pharmaceutical forms and establishes a comparison with the most commonly used international psychiatric medication at the time. The present study aims at contributing to the history of psychiatric drug therapy before the advent of psychoactive drugs. The most commonly used pharmaceutical forms and therapeutic groups in psychiatry are evaluated. Furthermore, we also wish to contribute to the evaluation of how Portugal received and implemented innovations in drug therapy.
Quantitative and qualitative document analysis of the above mentioned formulary, using the comparative method.
The edition of this formulary arose from the need to standardize specific medication for mental patients. In the Formulario, 61 medicinal products are proposed. There were 8 different pharmaceutical forms. The potions were the most commonly referred (32). Hypnotics represented approximately half of the medicinal products (28), followed by hypokinetics (9), and analgesics and antipyretics (8).
The formulary was in line with foreign scientific innovations. Pharmacotherapeutic variety of drugs was short and resorting to non-drug therapies was also usual. The edition of this formulary was mainly due to the work conducted by the psychiatrist Miguel Bombarda (1851–1910), a prominent public figure in medicine and in the political and cultural arena.
Compulsive hoarding has been generally described as the compulsive acquisition of possessions and the inability to discard them. It has been considered as a syndrome consisting of compulsive acquisition, difficulty discarding and clutter. It is described mainly in association with obsessive-compulsive disorders (OCDs) and in geriatric populations, although it may be seen in a range of other disorders.
Compulsive buying or shopping disorder has been characterized by excessive or poorly controlled preoccupations, urges, or behaviours regarding shopping and spending that lead to subjective distress or impaired functioning. Although it has been considered as part of impulse control disorders, it has also been reported associated with other disorders.
These two entities have raised relevant questions regarding whether they are part of dimensional or categorical constructs, symptoms or well established disorders. By presenting two case reports, the authors address some of these issues and the existing scientific literature.
The term somatoparaphrenia was firstly used by Gerstmann to describe a form of asomatognosia in which unawareness of ownership is accompanied by delusional misidentification and/or confabulation. This is a rare phenomenon and the few published case reports showed an association of this psychopathological entity with brain-damage. We present a patient with schizophrenia who believed his right arm and right foot were not his own. According to his delusion of foreign ownership, his foot didn’t belong to him because it was a “big foot only suited for work” and his right arm belonged to Maria, a woman from his neighbourhood. Remarkably, no organic causes were found to exist. To our knowledge, this is one of the rare cases of schizophrenia in which somatoparaphrenia can be identified. We further elaborate on the phenomenology of this particular patient.
The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.
Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.
The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.
Combination therapy of peginterferon and ribavirin for HCV has been recommended as a first choice for chronic hepatitis C. INF therapy has been associated with various IFN-related adverse events, such as psychological disturbances. Beyond that preexisting mental disorders are considered risk factors for INF-alfa-induced severe psychiatric side effects such as depression and/or suicidality, consequently many of these patients remain untreated even tough they fulfil the medical criteria for antiviral treatment of chronic hepatitis C.
The authors relate the case of a patient, 56 year's old, sent to infecciology consultation because she had alterations in abnormal liver function tests. She had a previous history of mental disorder with neurotic personality traits and she was treated with psychiatric medication.
She had treatment for chronic hepatitis C with peginterferon and ribavirin as well psychiatric and psychotherapeutic support.
A low sustained virologic response was obtained however the depressive picture has been difficult to handle so she had had already had a psychiatric hospitalization. There were several adverse life events that can not be forgotten as they certainly trigger and exacerbate the depressive symptomatology.
We assume that psychiatric patients have more depressive symptoms before and during treatment compared with patients without no psychiatric history. This shows that this patients have an increase need for treatment with antidepressants and that a close cooperation with a psychiatrist is always needed.
Although probably undereported, musical hallucinosis is very rare and usually bilateral. It refers to auditory complex hallucinations, for which the patient has full insight, and includes melodies, tunes, rhythms and timbres.
A 71-year-old women was seen for a history of hearing music in the right ear. She had mild hypertension and auricular fibrillation, being chronically medicated with aspirine, bisoprolol and hydroclorothiazide. Three months previously she started hearing some popular folk Portuguese songs in the right ear. She could identify the lyrics and sing the songs she heard. Weeks later fado and classical music were added to the repertoire, and later on she started hearing less well-formed sounds like “dlam... dlam” or “uhh... uhh”. There were no other auditory or visual hallucinations. She was seen by an otorhinolaryngologist, and made an audiogram showing bilateral, right-predominant, pre-coclear deafness with normal evoked brainstem auditory potentials. An MRI showed small deep subcortical lacunar lesions. EEG was normal. PET scan showed left temporal hypometabolism. On benzodiazepines she had discrete improvement.
Musical hallucinosis has been found mainly in deaf patients, and a similar mechanism to that of Charles-Bonnet syndrome has been proposed. Sensory deprivation of primary auditory cortex would “release” the secondary auditory cortex, to produce complex auditory hallucinations with full insight. In our patient we were able to demonstrate the integrity of the brainstem pathway, supporting a direct link between diminished right ear sound transmission and left temporal lobe diminished activation as ascertained by the pet scan.
To estimate the prevalence of depression and of depressive symptoms among older people living in retirement homes within Penacova county. to estimate the percentage of elderly depressed people receiving adequate treatment. to study associations between recorded clinical variables and depression.
We visited all the retirement homes of Penacova County to interview institutionalized men and women older than 64 years, applying a semi-structured protocol that included GDS (geriatric depression screening scale), MMSE, pain scale, Clock Drawing Test, Barthel Index and BSI (Brief Symptom Inventory).
We included 78 subjects (22 Men and 56 Women) with a mean age of 81.3 years. among them 29 were illiterate, 34 had < 4 years of education, 13 had 4 years of education and 2 had a university degree. 56 were widowers and 49 were born in Penacova. the mean GDS value was 17.27. 19,2% were not depressed, 46.1% were depressed and 34,6% were severely depressed.
These results suggest that depression is a common problem affecting older people living in retirement homes. A significant percentage of depressed patients were not adequately treated. This study highlights the importance of screening this population for depression.
The boundaries of simulation and dissociative amnesia are thin and not rarely unclear. Diagnostic criteria and a thorough clinical history are sometimes not enough to shed light on the nature and essence of one's will and conduct. Throughout history, psychiatry has been challenged to testify before society over patients’ truth and deceit. Do they share common grounds or must we accept that uncertainty is the inevitable price of truth?
The authors present a clinical case of a young man coming to the emergency services with multiple lacerations in the upper abdomen and limbs, referring “amnesia” for the last five years of his life. The patient had no previous psychiatric record or any known family or social dysfunction. Approach, management and diagnosis are discussed.