Cardiovascular events prior to or early after diagnosis of systemic lupus erythematosus in the systemic lupus international collaborating clinics cohort

Objective

To describe the frequency of myocardial infarction (MI) prior to the diagnosis of systemic lupus erythematosus (SLE) and within the first 2 years of follow-up.

Methods

The systemic lupus international collaborating clinics (SLICC) atherosclerosis inception cohort enters patients within 15 months of SLE diagnosis. MIs were reported and attributed on a specialised vascular event form. MIs were confirmed by one or more of the following: abnormal ECG, typical or atypical symptoms with ECG abnormalities and elevated enzymes (≥2 times upper limit of normal), or abnormal stress test, echocardiogram, nuclear scan or angiogram. Descriptive statistics were used.

Results

31 of 1848 patients who entered the cohort had an MI. Of those, 23 patients had an MI prior to SLE diagnosis or within the first 2 years of disease. Of the 23 patients studied, 60.9% were female, 78.3% were Caucasian, 8.7% black, 8.7% Hispanic and 4.3% other. The mean age at SLE diagnosis was 52.5±15.0 years. Of the 23 MIs that occurred, 16 MIs occurred at a mean of 6.1±7.0 years prior to diagnosis and 7 occurred within the first 2 years of follow-up. Risk factors associated with early MI in univariate analysis are male sex, Caucasian, older age at diagnosis, hypertension, hypercholesterolaemia, family history of MI and smoking. In multivariate analysis only age (OR=1.06 95% CI 1.03 to 1.09), hypertension (OR=5.01, 95% CI 1.38 to 18.23), hypercholesterolaemia (OR=4.43, 95% CI 1.51 to 12.99) and smoking (OR=7.50, 95% CI 2.38 to 23.57) remained significant risk factors.

Conclusions

In some patients with lupus, MI may develop even before the diagnosis of SLE or shortly thereafter, suggesting that there may be a link between autoimmune inflammation and atherosclerosis.

Hypocholestrolic effect of spent black tea leaves replaced with wheat bran in broiler ration

Black tea leaves (Camellia sinensis) have been known for many years in lowering cholesterol level. The purpose of the present study was to find the effects of spent black tea leaves as a substitute of wheat bran on cholesterol reduction in broiler chicks. For this purpose a total of hundred & fifty (150), day old broiler poultry chicks were purchased from the local market. The spent black tea leaves were collected from tea stalls. Chicks were randomly distributed into 5 main groups according to spent black tea leaves and wheat bran supplementation. Group R0 was kept as control, containing 120 g/kg wheat bran but no spent black tea leaves supplementation; group R30 received spent black tea leaves supplemented feed at the rate of 30 g/kg plus 90 g/kg wheat bran; group R60 received spent black tea leaves supplemented feed at the rate of 60 g/kg plus 60 g/kg wheat bran, group R90 received spent black tea leaves supplemented feed at the rate of 90 g/kg plus 30 g/kg wheat bran and group R120 received the spent black tea leaves supplemented feed at the rate of 120 g/kg plus 0 g/kg wheat bran respectively. Each group was carrying three replicate (10 chicks/replicate). The data was statistically analyzed, using completely randomized design. Mean liver cholesterol per chick on diet R30, R60, R90, and R120 was 102.22, 93.55, 76.22, 60.78 and 51.55 mg/100 g. Breast cholesterol per chick on diet R30, R60, R90, and R120 was 61.89, 51.33, 44.78, 37 and 32.77 mg/100 g. It was concluded that the addition of spent black tea leaves at the rate of 120 g/kg has significant effect on cholesterol reduction and over all performance of broiler chicks and recommended that expensive wheat bran can be effectively replaced by these spent black tea leaves in broiler poultry ration.

Exploratory randomized controlled trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin

Introduction

The rates of postnatal depression (PND) in British South Asian (BSA) women are higher than the general population. PND is known to cause disability and suffering in women and negative consequences for their infants and their family with huge costs to society. Due to linguistic and cultural barriers, BSA women do not access health care services.

Objectives

To conduct an exploratory trial to test the feasibility and acceptability of a culturally adapted group Cognitive Behavioural Therapy (CBT) intervention (Positive Health Programme (PHP).

Aim

We aimed to determine if depressed BSA women receiving the PHP intervention will show significant improvements in terms of severity of depression, marital support, and social support as compared to the control group.

Methods

We used a two-arm pragmatic single-blind randomised controlled design. Women meeting the inclusion criteria were randomised either to the experimental group receiving PHP or treatment as usual (TAU) that is standard care usually provided by the GP.

Results

A total of 615 mothers were screened for participation in the trial, of these 137 were assessed further to determine eligibility. Eighty-three mothers were randomized to receive either PHP (n = 42) or treatment as usual (TAU) (n = 41). Mothers found the intervention to be acceptable and felt an overall positive change in their attitudes, behaviour and confidence level.

Conclusion

The recruitment and retention figures (70%) highlight the ability of the research team to engage with the population. The findings suggest the acceptability of the culturally adapted PHP intervention for British South Asian women with postnatal depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Estimation of (41)Ar activity concentration and release rate from the TRIGA Mark-II research reactor

The BAEC TRIGA research reactor (BTRR) is the only nuclear reactor in Bangladesh. Bangladesh Atomic Energy Regulatory Authority (BAERA) regulations require that nuclear reactor licensees undertake all reasonable precautions to protect the environment and the health and safety of persons, including identifying, controlling and monitoring the release of nuclear substances to the environment. The primary activation product of interest in terms of airborne release from the reactor is (41)Ar. (41)Ar is a noble gas readily released from the reactor stacks and most has not decayed by the time it moves offsite with normal wind speed. Initially (41)Ar is produced from irradiation of dissolved air in the primary water which eventually transfers into the air in the reactor bay. In this study, the airborne radioisotope (41)Ar generation concentration, ground level concentration and release rate from the BTRR bay region are evaluated theoretically during the normal reactor operation condition by several governing equations. This theoretical calculation eventually minimizes the doubt about radiological safety to determine the radiation level for (41)Ar activity whether it is below the permissible limit or not. Results show that the estimated activity for (41)Ar is well below the maximum permissible concentration limit set by the regulatory body, which is an assurance for the reactor operating personnel and general public. Thus the analysis performed within this paper is so much effective in the sense of ensuring radiological safety for working personnel and the environment.

Longitudinal Stent-Shortening during Percutaneous Transluminal Angioplasty with Stenting of Right Superficial Femoral Artery: A Case Report

Longitudinal stent deformation (LSD) involving coronary arteries during PCI have been reported in several literatures. But, LSD occurring during PTA (Percutaneous Transluminal Angioplasty) involving peripheral arteries is rare. We had such a case who presented with coronary and peripheral artery disease. Longitudinal stent deformation occurred during PTA with stenting of right superficial femoral artery (SFA). For CAD, PCI to RCA and LAD was done beforehand and the peripheral procedure was done 4 days later to avoid increased contrast load. Due to LSD occurring during PTA to Rt. SFA, we had to deploy another stent to cover the lesion over that artery. There was no technical fault or difficulty during negotiating the stent and positioning it covering the lesion. So, we did not find any obvious reason for this complication. Since longitudinal stent deformation is uncommon during PCI of coronary arteries and probably rare during PTA of peripheral arteries and we did not find any literature regarding this, we decided to report this case.

Cognitive Functions and Health Related Quality of Life of Institutional Autism Spectrum Disorder Children in Dhaka city

In Bangladesh, nearly 10.5 hundred thousand individuals may have autism. Recent figures released by the CDC (2012) show that autism spectrum disorders (ASDs) now affect 1 in 88 children. Cognitive impairment, limited adaptive skills, and severe social impairment as seen in Autism Spectrum Disorders (ASD) thought to be associated with poorer health related quality of life (HRQoL). The objective of the study was to measure HRQoL and cognitive functioning in a group of autism Spectrum Disorder (ASD) children and to relate HRQoL with their socio demographic characteristics and cognitive functioning from parents' perception. This cross sectional study was conducted amongl49 purposively selected parents who have institutionalized autistic children (2 to 18 years old) from January to June 2013. HRQoL was assessed by Pediatric Quality of Life Inventory 4.0 (Vemil998) and cognitive functioning was assessed with The PedsQL TM Cognitive Functioning Scale. Three fourth of the children were male (n=-115, 77.2%) and the mean (SD) age of the children was 7.8(3.06) years. Symptoms of autism appeared at about their 2rd birthday 2.1 (.70) while the average (SD) age of diagnosis was around three years 2.9 (.98). The children were reported to go to school at an early age of 3(1.75) years. Out of 149 respondents, ten percent parents (n=14) had the history of consanguineous marriage. The sample data provides significant difference between the scores by the ability of verbal communication (p<.05), presence of autistic siblings (p<.05) and mother's occupation (p<.05). There found negative correlation between HRQoL and age of symptom appearance and cognitive functioning with age of diagnosis (r = - 0.18; p=.03). Cognitive functioning was strongly correlated with total PedsQL score and its domains (r = 0.73; p=.00). i.e. Higher cognitive function leads to good health related quality of life. Linear regression was performed to study the relationship between HRQoL and independent variables found significant in univariate analysis. The results of the regression indicated the predictors in the model explained 57 % of the variance (R2=.57, F=23.05, p<.001). It was found that fathers who were doctors and engineers by profession (t=2.34, p= .02), child's ability to communicate with words (t= 2.73, p= .007), age of symptom appearance (t= -2.71, p=.008), and cognitive functioning (t =12.28, p <0.001) significantly predicted HRQol of ASD children. Father's occupational status child's ability to communicate by word, age of symptom appearance, and Cognitive functioning of ASD children were found related to their quality of life.

Role of ascitic fluid adenosine deaminase (ADA) and serum CA-125 in the diagnosis of tuberculous peritonitis

This cross sectional study was carried out in the department of gastroenterology, BIRDEM, Dhaka from January 2010 to May 2011 to determine the role of ascitic fluid ADA and serum CA-125 in the diagnosis of clinically suspected tubercular peritonitis. Total 30 patients (age 39.69 ± 21.26, 18M/12F) with clinical suspicion of tuberculosis peritonitis were included in this study after analyzing selection criteria. Laparoscopic peritoneal biopsy with 'histopathological diagnosis' was considered gold standard against which accuracics of two biomarkers (ADA & CA-125) were compared. Cut off value of ADA and CA-125 are 24 u/l, 35 U/ml respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ADA as a diagnostic modality in tuberculos peritonitis were 87.5%, 83.33%, 95.45%, 62.5% and 86.67% respectively where as CA-125 was found to have 83.33% sensitivity, 50% specificity, 86.9% positive predictive value, 42.85% negative predictive value and 76.6% accuracy. Both biomarkers are simple, non-invasive, rapid and relatively cheap diagnostic test where as laparoscopy is an invasive procedure, costly & requires trained staff and not without risk and also not feasible in all the centre in our country. So ascitic fluid ADA and serum CA-125 are important diagnostic test for peritoneal tuberculosis.

Markers of Hepatitis Viruses by ELISA among Healthy Blood Donors

This cross sectional study was done to have a comprehensive idea about prevalence and distribution of HBsAg and anti-HCV. The present serosurveilance study was done on healthy selected blood donors and conducted in the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh for their relatives and friends and also voluntarily from January 2001 to July 2003. Samples were collected from blood donors (Voluntary and Party) who came for donation of blood. Blood samples taken from 10,200 apparently healthy blood donors with or without the previous history of jaundice in the Transfusion Medicine department of BSMMU was tested for HBsAg and Anti-HCV by standard commercial ELISA method during the period from 1st January 2001 to 30th June 2003. Reactive samples were retested. Samples positive in duplicate tests were taken as positive. Within 10,200 samples 550(5.39%) were found positive for HBsAg and 84(0.823%) positive for anti-HCV. Among 8670(8%) male donors 470(5.42%) was positive for HBaAg and 70(0.91%) positive for anti-HCV. Among 1530(15%) female donors 80(5.29%) found positive for HBsAg and 14(0.807%) positive for anti-HCV. Prevalence of both is more in male than female, young donors below 30 years (80%) are of least prevalence 4.43% for HBsAg and 0.73% for anti-HCV. Markers are raised in prevalence with age, highest among aged donors above 40 years 14.5% and 2.62 respectively. Markers are of least prevalence among students (4.47% and 0.47%), highest among working people (7.90 and 0.91%). Within 10,200 donors no one was found concomitantly positive for HBsAg and anti-HCV, study may help to have a comprehensive idea about prevalence and distribution of HBV and HCV among healthy blood donors/party donors 9,996(98%) and voluntary donors 204(2%).

Serum C-reactive Protein (CRP) Level in Tuberculous Patients

The present prospective case control study was carried out to assess the role of C-reactive protein (CRP) level as a diagnostic and prognostic tool of tuberculous patients. The study was conducted in the Department of Paediatrics over a period of one year. Total 60 persons were included. Case was 30 and control was 30. Out of 30 tuberculosis patients 18(60%) had pulmonary tuberculosis, 6(20%) had abdominal TB, 3(10%) had pleural effusion and 3(10%) had tubercular lymphadenopathy. CRP was positive>6 mg/L in 25(83.3%) cases. CRP level was negative after 4 weeks of treatment. There is significant difference at p<0.001 in serum CRP level in between tuberculosis and healthy children. The study concluded that CRP level is a useful indication for diagnosis and prognosis of tuberculous patients.

Mental health research: developing priorities and promoting its utilization to inform policies and services

Investment in research on the prevention and treatment of mental health disorders is disproportionately low in the WHO Eastern Mediterranean Region (EMR) relative to the disease burden. Scaling-up mental health research in the EMR could generate enormous returns in terms of reducing disability, improving outcomes and preventing premature death, through early diagnosis, better management and community-based rehabilitation. EMR countries must therefore work to identify research priorities, mobilize resources, develop human and infrastructure capacities and institutionalize use of research findings to guide development of policies and service delivery models. Several key strategic interventions for EMR Member States are recommended: adopt a prioritized national mental health research agenda; systematically map national and international research funding to identify and secure resources to support the implementation of the agenda; strengthen national capacity to undertake prioritized research; periodically map research output in mental health; and foster dialogue between researchers and policy-makers/programme managers.

Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous Mitral Commissurotomy for Patients of Mitral Stenosis with Atrial Fibrillation

Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral commissurotomy is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy. The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. There is controversy that whether the presence of AF has a direct negative effect on the immediate or long-term outcome after PTMC in mitral stenosis patients. The purpose of this study was to see the effect of atrial fibrillation (AF) on the immediate clinical and echocardiographic outcome of patients undergoing Percutaneous Transvenous Mitral Commissurotomy (PTMC). The immediate procedural and in-hospital clinical outcome after PTMC of 264 patients with AF were prospectively collected and compared with those of 288 patients in normal sinus rhythm (NSR) with mitral stenosis admitted in National Institute of Cardiovascular Diseases, Dhaka and Al-Helal Heart Institute, Mirpur, Dhaka, Bangladesh. Patients with AF were older than patients with normal sinus rhythm (53 ± 11 vs. 33 ± 12 years; p<0.0001) and presented more frequently with New York Heart Association (NYHA) class III-IV (78.3% vs. 58.5%; p<0.0001), echocardiographic score >8 (38.9% vs. 22.7%; p<0.0001), calcified valves under fluoroscopy (22.2% vs.12.4%, p<0.0001) and with history of previous surgical commissurotomy (21.7% vs. 10.5%; p<0.0001). In patients with AF, PTMC resulted in worse outcomes, as reflected in a smaller post-PTMC mitral valve area (1.6±0.4 vs. 2.1 ± 0.8 cm²; p<0.0001). Patients with atrial fibrillation have a worse immediate clinical and echocardiographic outcome after PTMC.

Domain I: the hidden face of antiphospholipid syndrome

IgG antiphospholipid antibodies (aPL) against β2-glycoprotein I (β2GPI) can target any of its five domains; however, aPL against the N-terminal domain (anti-DI, aDI) are considered the most clinically relevant in the antiphospholipid syndrome (APS). Circulating levels of aDI are elevated in patients with APS compared with disease and healthy controls, and crucially aDI are prothrombotic in in vivo and in vitro models. In addition, human recombinant DI has been shown to abrogate aPL-induced thrombosis in vivo. Therefore, although the potential of utilizing DI for management of APS is not yet fully defined, there is promise that DI could prove valuable both as a diagnostic and therapeutic tool.

Silkworm as an animal infection model for the screening of environmental, clinical and veterinary pathogens

Silkworm, Bombyx mori, has passive immunity and can be infected by pathogenic bacteria. Therefore, it can be used as a robust bacterial infection model for screening of pathogenic isolates from various sources. In this work, 11 environmental, clinical and veterinary isolates were screened for pathogenicity using silkworm larvae by injecting bacterial suspension through their dorsal surface and observing response. Experimental conditions were established by using Bacillus thuringiensis SW_R_F_1, Escherichia coli 0157:H7, E. coli DH5a and 0.6% saline. Nine out of 11 isolates were detected pathogenic after screening. The biochemical and genomic analysis of the nine test isolates confirmed their pathogenicity. The LD₅₀ of Pseudomonas aeruginosa 47D and Salmonella Typhimurium 77 were 4.63x107 at 12 hours was 8.02x10⁷ cells/lOOμI/gram at 24 hours respectively. These results indicated that silkworm exhibits differential pathological response for pathogenic and nonpathogenic bacteria, and can be used as an alternative to animal model for screening diverse isolates.

Al-doped ZnO Nanostructured Thin Films: Density Functional Theory and Experiment

Nanostructured Al -doped ZnO (AZO) films are deposited on glass substrates by electroless deposition technique in the present work. AZO films with Al concentration from 1 at.% to 5 at.% are investigated for their structural and morphological properties by X-ray diffraction (XRD), and atomic force microscopy (AFM). An excellent homogeneity is achieved with average crystallite sizes of below 32 nm and a nearly constant root mean square (RMS) surface roughness between 1 nm and 3 nm, for various Al doping concentrations. These smooth and uniform films are characterized for their optical and photoluminescence (PL) properties. A higher value of average transparency between 79% and 92% in the wavelength range of 300–800 nm is achieved, and the PL intensity is found to be a strong function of doping. Density functional theory (DFT) calculations agree with the measured transmittance values, in addition to their predicted electronic structure. Moreover, time-resolved PL measurements indicate that the luminescence decay time decreases with increased doping concentration.

Soluble Tim-3 is shed from CD8+ T cells by the sheddase ADAM10, is increased in plasma during untreated HIV infection, and correlates with HIV disease progression (VIR6P.1165)

Chronic HIV infection results in a loss of HIV-specific CD8+ T cell effector function, termed “exhaustion”, mediated, in part, by the co-inhibitory receptor T cell immunoglobulin mucin domain-3 (Tim-3). Like many other receptors, a soluble form of this protein has been described in human blood plasma. However, soluble Tim-3 (sTim-3) is poorly characterized and its role in HIV disease is unknown. Here we show that Tim-3 is shed from the surface of responding CD8+ T cells by the matrix metalloproteinase, ADAM10, producing a soluble form of the co-inhibitory receptor. Despite previous reports in the mouse model, no alternatively spliced, soluble form of Tim-3 was observed in humans. Shed sTim-3 was found in human plasma, and was significantly elevated during early and chronic untreated HIV infection, but was not found differentially modulated in HAART treated HIV-infected subjects or in elite controllers, when compared to HIV-uninfected subjects. Plasma sTim-3 levels positively correlated with HIV viral load and negatively correlated with CD4 counts. Thus, plasma sTim-3 shedding correlated with HIV disease progression. Despite these correlations, we found that shedding Tim-3 did not improve the function of CD8+ T cells in terms of IFN-γ production or prevent their apoptosis through galectin-9. Further characterization studies of sTim-3 function are needed to understand the contribution of sTim-3 in HIV disease pathogenesis with implications for novel therapeutic interventions.

Usefulness of the secretory unit of islet transplant objects (SUITO) index for evaluation of clinical autologous islet transplantation

BACKGROUND

Assessing the engrafted islet mass is important in evaluating the efficacy of islet transplantation. We previously demonstrated that the average secretory unit of islet transplant objects (SUITO) index within 1 month of allogeneic islet transplantation was an excellent predictor of insulin independence. However, the usefulness of the SUITO index for evaluating autologous islet transplantation has not been explored. The purpose of the present study was to assess the relationship between the SUITO index and clinical outcomes after total pancreatectomy followed by autologous islet transplantation.

METHODS

We performed 27 total pancreatectomies followed by autologous islet transplantation from October 2006 to January 2011. Cases were divided into an insulin-independent group (IIG; n = 12) and an insulin-dependent group (lDG; n = 15). The SUITO index was calculated by the formula [fasting C-peptide (ng/mL)/fasting glucose (mg/dL) -63] × 1,500. The average SUITO index within the first month of transplantation except for days 0, 1, and 2, maximum SUITO index, and most recent SUITO index were calculated in each case, and values were compared between the IIG and the IDG.

RESULTS

The average SUITO index within 1 month was significantly higher in the IIG than in the IDG (24.6 ± 3.4 vs 14.9 ± 2.0, respectively; P < .02). The maximum SUITO indices were 45.7 ± 7.7 in the IIG and 30.1 ± 8.1 in the IDG (not significant), and the recent SUITO indices were 36.9 ± 6.7 in the IIG and 22.8 ± 6.1 in the IDG (not significant).

CONCLUSIONS

The average SUITO index within 1 month was an excellent predictor of insulin independence after total pancreatectomy followed by autologous islet transplantation.

Intussusception in the Afferent Limb of Gastrojejunostomy - Presenting as an unusual cause of Haematemesis

We report a case of a 54 year old male who presented with abdominal pain and hematemesis. After thorough workup, a laparotomy was done. It revealed an ante grade intussusception in the afferent limb of a gastrojejunostomy, which was done in 1978 presumably for peptic ulcer disease. In an attempt to find if such cases are still reported and under what circumstances, a Pub med search using: (intussusception) and (gastrojejunostomy or gastroentorostomy) was done and 170 publications were retrieved. Relevant articles were studied and discussed in this case report. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20348 Pulse Vol.6 January-December 2013 p.41-43

Anti-C1q antibodies in systemic lupus erythematosus

OBJECTIVE

Anti-C1q has been associated with systemic lupus erythematosus (SLE) and lupus nephritis in previous studies. We studied anti-C1q specificity for SLE (vs rheumatic disease controls) and the association with SLE manifestations in an international multicenter study.

METHODS

Information and blood samples were obtained in a cross-sectional study from patients with SLE (n = 308) and other rheumatologic diseases (n = 389) from 25 clinical sites (84% female, 68% Caucasian, 17% African descent, 8% Asian, 7% other). IgG anti-C1q against the collagen-like region was measured by ELISA.

RESULTS

Prevalence of anti-C1q was 28% (86/308) in patients with SLE and 13% (49/389) in controls (OR = 2.7, 95% CI: 1.8-4, p < 0.001). Anti-C1q was associated with proteinuria (OR = 3.0, 95% CI: 1.7-5.1, p < 0.001), red cell casts (OR = 2.6, 95% CI: 1.2-5.4, p = 0.015), anti-dsDNA (OR = 3.4, 95% CI: 1.9-6.1, p < 0.001) and anti-Smith (OR = 2.8, 95% CI: 1.5-5.0, p = 0.01). Anti-C1q was independently associated with renal involvement after adjustment for demographics, ANA, anti-dsDNA and low complement (OR = 2.3, 95% CI: 1.3-4.2, p < 0.01). Simultaneously positive anti-C1q, anti-dsDNA and low complement was strongly associated with renal involvement (OR = 14.9, 95% CI: 5.8-38.4, p < 0.01).

CONCLUSIONS

Anti-C1q was more common in patients with SLE and those of Asian race/ethnicity. We confirmed a significant association of anti-C1q with renal involvement, independent of demographics and other serologies. Anti-C1q in combination with anti-dsDNA and low complement was the strongest serological association with renal involvement. These data support the usefulness of anti-C1q in SLE, especially in lupus nephritis.

Is number sense impaired in chronic pain patients?

Background

Recent advances in imaging have improved our understanding of the role of the brain in painful conditions. Discoveries of morphological changes have been made in patients with chronic pain, with little known about the functional consequences when they occur in areas associated with ‘number-sense’; thus, it can be hypothesized that chronic pain impairs this sense.

Methods

First, an audit of the use of numbers in gold-standard pain assessment tools in patients with acute and chronic pain was undertaken. Secondly, experiments were conducted with patients with acute and chronic pain and healthy controls. Participants marked positions of numbers on lines (number marking), before naming numbers on pre-marked lines (number naming). Finally, subjects bisected lines flanked with ‘2’ and ‘9’. Deviations from expected responses were determined for each experiment.

Results

Four hundred and ninety-four patients were audited; numeric scores in the ‘moderate’ and ‘severe’ pain categories were significantly higher in chronic compared with acute pain patients. In experiments (n=150), more than one-third of chronic pain patients compared with 1/10th of controls showed greater deviations from the expected in number marking and naming indicating impaired number sense. Line bisection experiments suggest prefrontal and parietal cortical dysfunction as cause of this impairment.

Conclusions

Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research.

Miliary nodules in a patient of allergic bronchopulmonary aspergilosis

Allergic bronchopulmonary aspergilosis (ABPA) is immunological pulmonary disease caused by hypersensitivity of aspergillus fumigatus usually occurs in patients with chronic asthma, cystic fibrosis and bronchiactasis. This disease may present with divers radiological presentation like; fleeting pulmonary opacities, bronchiactasis, mucoid impaction, perihilar opacity (hailer lymphadenopathy), and lung mass or pleural effusion. We describe the case of a 30 year old housewife who presented with progressive dysponea, low grade fever, dry cough, weight loss and miliary nodule in chest radiograph and high-resolution CT (HRCT) in a tertiary level hospital of Bangladesh. A diagnosis of ABPA was established on the basis of sputum routine microscopy and culture examination for fungus (Aspergillus).

The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review

BACKGROUND

Cultural adaptations of evidence-based psychological treatments (PTs) are important to enhance their universal applicability. The aim of this study was to review systematically the literature on adaptations of PTs for depressive disorders for ethnic minorities in Western countries and for any population in non-Western countries to describe the process, extent and nature of the adaptations and the effectiveness of the adapted treatments.

METHOD

Controlled trials were identified using database searches, key informants, previous reviews and reference lists. Data on the process and details of the adaptations were analyzed using qualitative methods and meta-analysis was used to assess treatment effectiveness.

RESULTS

Twenty studies were included in this review, of which 16 were included in the meta-analysis. The process of adaptation was reported in two-thirds of the studies. Most adaptations were found in the dimensions of language, context and therapist delivering the treatment. The meta-analysis revealed a statistically significant benefit in favor of the adapted treatment [standardized mean difference (SMD) -0.72, 95% confidence interval (CI) -0.94 to -0.49].

CONCLUSIONS

Cultural adaptations of PTs follow a systematic procedure and lead primarily to adaptations in the implementation of the treatments rather than their content. Such PTs are effective in the treatment of depressive disorders in populations other than those for whom they were originally developed.

Training primary health care workers in mental health and its impact on diagnoses of common mental disorders in primary care of a developing country, Malawi: a cluster-randomized controlled trial

BACKGROUND

Mental health problems are common in primary care, with prevalence rates of up to 40% reported in developing countries. The study aim was to evaluate the impact of a specially designed toolkit used to train primary health care (PHC) workers in mental health on the rates of diagnosed cases of common mental disorders, malaria and non-specific musculoskeletal pains in primary care in Malawi.

METHOD

Clinics with out-patient services in the designated district were randomly divided into control and intervention arms. Using a two-phase sampling process, Self-Reporting Questionnaire scores, data on diagnoses made by PHC workers and results of the Structured Clinical Interview for DSM-IV for depression were collected from 837 consecutively attending adult patients in the pre-intervention study and 2600 patients in the post-intervention study.

RESULTS

The point prevalence rates for probable common mental disorder and depression were 28.8% and 19%, respectively. Rates for both anxiety and depression diagnoses by PHC workers at baseline were 0% in both arms. Following training, there were significant differences between the two arms in the rates of diagnosed cases of depression [9.2% v. 0.5%, odds ratio (OR) 32.1, 95% confidence interval (CI) 7.4-144.3, p ≤ 0.001], anxiety (1.2% v. 0%, p ≤ 0.001) and malaria (31% v. 40%, OR 0.62, 95% CI 0.43-0.89, p = 0.01). The intervention arm had more cases diagnosed with depression and anxiety while the control arm had more cases diagnosed with malaria.

CONCLUSIONS

Training of PHC workers in mental health with an appropriate toolkit will contribute significantly to the quality of detection and management of patients seen in primary care in developing countries.

Simulation Study of Thermotropic LCPs and Prediction of Normal Stress Difference at High Shear Rate

The shear viscosity and normal stress difference of two filled and two unfilled thermotropic liquid crystal polymer (TLCPs) were studied. The rigid and rod like molecules of TLCPs orientate differently at different shear rates. Under low shear rate, the molecules tend to align in the direction of the flow but also tumble and wagging on their own axis. The abnormal orientation of the molecules also depends upon temperature, fillers contents, aspect ratio and elastic nature of LCP molecules. These behaviors lead to unusual rheological properties of LCPs, such as negative first normal stress difference for filled LCPs at low shear rates. But with the increase of shear rate, the molecules are oriented in the direction of flow, which lead to isotropic flow at high shear rates. The complicated rheological properties and characteristic anisotropic properties of LCPs are modelled by recently developed Leonov's viscoselastic constitutive equations. Simulation has been carried out using Mathematica software and the characteristic anisotropic properties of LCPs have been identified. The experimentally measured viscosities at high shear rate have been compared with model predictions. Moreover, the normal stress differences using at high shear rates have been estimated using Leonov's model, which is experimentally not accessible.