Behaviors are Deceptive in Pain Estimation: A Comparison between Nurses and Psychiatrists

Aim:

This study assessed the influence of pain behaviors on pain estimation by nurses and psychiatrists.

Materials and Methods:

Pain ratings performed by nurses and psychiatrists who observed the case scenarios using role plays were assessed. The data were computed and frequencies were derived. t-test was used to compare the ratings between the groups.

Results:

There was significant difference in the ratings of the pain severity by nurses and psychiatrists.

Conclusions:

Pain assessment is essential for the comprehensive management of pain. Training health professionals in pain assessments is very essential.

Utilization of Antenatal care services in present pregnancy among the women attending in a Teaching Hospital for delivery

Aims: To study attendance of antenatal care services during present pregnancy by pregnant women coming for delivery in a teaching hospital of Kathmandu and to analyze the   impact of educational status, age group, gravida (number of pregnancy) and occupation of the women on antenatal care service utilization.Methods: Uncomplicated, term pregnant women who came for delivery in labour or for induction of labour or elective cesarean section were interviewed using semi-structured questionnaire.Results: Six hundred and four pregnant women were studied. Antenatal care coverage in studied population was found to be 94.8% with adequate (four) antenatal care visits in 83.4%. Women belonged to 20 to 30 years of age group and higher education status had higher rate of antenatal care attendance where as women who belonged to labor class (daily earner) had significantly lower rate of adequate antenatal care attendance. Number of pregnancy (gravida) of the women did not show association with rate of antenatal care attendance.Conclusions: Over all antenatal care attendance in this study is very high. Women of 20 to 30 years of age and higher education status had positive effect on antenatal care attendance, where as women who were daily earner or labour had higher rate of failure to attend antenatal care visits.

A nano-microstructured artificial-hair-cell-type sensor based on topologically graded 3D carbon nanotube bundles

A design for a unique artificial-hair-cell-type sensor (AHCTS) based entirely on 3D-structured, vertically aligned carbon nanotube (CNT) bundles is introduced. Standard microfabrication techniques were used for the straightforward micro-nano integration of vertically aligned carbon nanotube arrays composed of low-layer multi-walled CNTs (two to six layers). The mechanical properties of the carbon nanotube bundles were intensively characterized with regard to various substrates and CNT morphology, e.g. bundle height. The CNT bundles display excellent flexibility and mechanical stability for lateral bending, showing high tear resistance. The integrated 3D CNT sensor can detect three-dimensional forces using the deflection or compression of a central CNT bundle which changes the contact resistance to the shorter neighboring bundles. The complete sensor system can be fabricated using a single chemical vapor deposition (CVD) process step. Moreover, sophisticated external contacts to the surroundings are not necessary for signal detection. No additional sensors or external bias for signal detection are required. This simplifies the miniaturization and the integration of these nanostructures for future microsystem set-ups. The new nanostructured sensor system exhibits an average sensitivity of 2100 ppm in the linear regime with the relative resistance change per micron (ppm μm(-1)) of the individual CNT bundle tip deflection. Furthermore, experiments have shown highly sensitive piezoresistive behavior with an electrical resistance decrease of up to ∼11% at 50 μm mechanical deflection. The detection sensitivity is as low as 1 μm of deflection, and thus highly comparable with the tactile hair sensors of insects, having typical thresholds on the order of 30-50 μm. The AHCTS can easily be adapted and applied as a flow, tactile or acceleration sensor as well as a vibration sensor. Potential applications of the latter might come up in artificial cochlear systems. In particular, the stable mechanical bending of the sensor up to 90° opens up unique application opportunities.

Tubulocystic Renal Cell Carcinoma: A Great Imitator

Tubulocystic renal cell carcinoma (TCRC) is a rare renal tumor. Patients are usually asymptomatic; it is usually detected incidentally, during imaging studies for Bosniak type III and type IV renal cysts. These tumors rarely metastasize. The role of targeted therapy in such rare tumors is still controversial. We report a case of TCRC initially presented as a Bosniak type II renal cyst and was discovered ultimately to be a metastatic disease. This type of presentation might broaden our understanding of this rare disease.

Recurrence Risk of Febrile Seizures in Children

BACKGROUND

Identifying children with febrile seizure who are at risk for recurrence is important so that special attention can be given to them. The objective of this study was to identify the risk factors for recurrence of febrile seizures in children.

METHODS

This prospective hospital based study was conducted from July 2013 to August 2014 'among children of 6 months to 6 years of age at Bishweshwar Prasad Koirala Institute of Health Sciences (BPKIHS), Nepal. Children meeting the selection criteria were enrolled in study. Clinical, investigation, treatment and outcome parameters were analyzed.

RESULTS

A total of 92 children with febrile seizure were enrolled in study. Males accounted for 70% and females 30%. Simple febrile seizure was present in 48% and complex febrile seizures were seen in 52%. Recurrence of seizure was seen in one third of cases. Loss of consciousness was most common post-ictal phenomenon followed by confusion and lethargy. Upper respiratory infection was the most common precipitating factor. Generalized Tonic Clonic Seizure was the most common seizure type present in 79% of cases. Significant risk factors for recurrence occurred in males (p=0.088), age less than 1 year (p=0.003). Most of the recurrence occurred within one year of first seizure.

CONCLUSIONS

Febrile Seizure is common in males. Almost one third of children with febrile seizure are at risk for recurrence. The significant risk factors for recurrences are male gender and age <1year.

Role of Urinary and Serum Carbohydrate Antigen 19-9 as a Biomarker in Diagnosis of Adult Giant Hydronephrosis

INTRODUCTION

The most common cause of adult Giant Hydronephrosis (GH) is congenital Uretero-Pelvic Junction (UPJ) obstruction. Conventional imaging modalities, like Intravenous Urography (IVU) and Computed Tomography Urography (CTU) and radionuclide renal scan can be fallacious. Serum carbohydrate antigen 19-9 (CA19-9) is a useful tumour marker for gastrointestinal and pancreatic cancer. Only a few studies and case reports have shown raised serum levels due to benign hydronephrosis and GH.

AIM

To investigate the prognostic role of urine and serum CA19-9 in the diagnosis and follow-up of adult GH due to UPJ obstruction.

MATERIALS AND METHODS

The present hospital based observational study was conducted on 24 adult patients (Group 1) with unilateral GH due to UPJ obstruction. Twenty four healthy adults were included as control (Group 2). Serum and voided urine samples were collected to evaluate Carbohydrate Antigen (CA) 19-9 in each group. During surgery, urine from the affected pelvis was collected to determine CA19-9 level. Patients were followed up after surgery at 3 and 9 months with serum and voided urine samples for CA19-9 level.

RESULTS

Preoperative Serum and voided urine CA19-9 were significantly greater in Group1 than in controls, which significantly correlated inversely with preoperative percentage renal function and glomerular filtration rate. Postoperative improvement in renal function significantly correlated inversely with serum and voided urine CA19-9 at 3 and 9 months.

CONCLUSION

Voided urine CA19-9 can be a non-invasive clinical marker in adult GH due to UPJ obstruction. The clinical implications of these data for diagnosis and follow-up of these patients are significant. Our findings suggest, significant decrease in urinary Ca19-9 level during follow-up is predictive of excellent surgical outcome and resolution of renal damage.

Comparison of workers' perceptions toward work climate and health symptoms between ceramic and iron foundry workers

Background:

Workers exposed to heavy manual material handling (MMH) in a hot working environment succumb to severe physical stress and psychological stress.

Aims:

(1) Recognize the heat load at workplaces of ceramic industry and iron industry, and (2) comparatively examine the characteristics of self-reported physiological responses and heat-health perception among these workers.

Settings and Design:

Cross-sectional prospective study.

Materials and Methods:

Workplace microclimate in the ceramic industry and iron industry was monitored. An ergonomic checklist and a questionnaire was used to record self-reported workers’ perceptions toward heat stress at workplace (ceramic workers N = 321, iron foundry workers N = 253). The prevalence rates of subjective symptoms among workers of both the industries were compared.

Statistical Analysis:

Chi-square test was used to examine the association between stressors and health complaints at a significance level set at P < 0.05.

Results:

Iron foundries recorded higher mean ambient temperature (43.4 ± 3.7°C) and wet-bulb globe temperature (WGBT) index (31.5 ± 0.7°C) as compared to ceramic industries (39.9 ± 3.3°C and 28 ± 1.5°C, respectively). Heavy sweating, elevated body temperature, sleeplessness, excessive thirst, muscular discomforts, and fatigue were prime symptoms recorded among workers of both industries. Skin-related disorders (red face, dry skin, bumps, itching) were significantly higher among iron foundry workers, whereas sleeplessness, high blood pressure, heavy sweating, kidney stone, decreased urination, muscular discomforts, and fatigue were significantly more among ceramic workers. Young workers reported more sweating and fatigue than older workers.

Conclusions:

A hot work climate and heavy manual labor designate ceramic and iron industries as arduous. Direct contact with hot surface and continuous MMH in tandem with the mechanical pace of production process makes work in ceramic industries more difficult than iron foundries.

Yoga intervention and functional pain syndromes: a selective review

The definition of functional pain syndromes is varied across literature. No effort has been made to see all functional pain disorder groups under broad nomenclature which would exclude conditions for which pathophysiology is strongly known. Since these disorders are commonly treated with alternative treatment modalities and impose significant burden on health utilization, an effort to look into studies on yoga-based interventions on 'functional pain syndromes' (FPS) was made. This study defined FPS as 'Chronic relapsing remitting pain conditions, the origin of which is difficult to trace with no definite physical pathology on clinical suspicion or available laboratory measures and are valid based on subjective pain reporting, associated distress and socio-occupational dysfunction'. Chronic headache, neck pain, back pain, fibromyalgia, pelvic pain, Irritable Bowel Syndrome, Chronic Fatigue Syndrome, and somatoform pain disorders were included for this review. The review found four meta-analyses on the selected topic both indicating modest efficacy and benefit of yoga in these disorders. Future efforts should be directed to do a large meta-analysis of functional pain syndromes.

Abstract P2-09-06: Multi-gene panel testing for hereditary cancer risk

Background: Multi-gene panels are widely available for assessing hereditary cancer risk in high risk individuals. Due to the use of these panels, many genetic mutations other than BRCA 1 or 2 can be detected which can potentially affect management. This study presents the results of multi-gene panel testing performed at Beaumont Health System.

Methods:All patients who underwent multi-gene panel testing at Beaumont Health System between November 1, 2012 and January 15, 2015 were included in this study. This cohort consisted of patients who met criteria for genetic testing due to personal or family history. All patients received comprehensive pre and post-test genetic counseling. The panels ranged from 5 to 43 genes associated with risk for breast and other cancers.

Results: 653 multi-gene panel tests were performed. The majority of these consisted of either a 5 gene high risk breast panel (25%), an 18 gene moderate to high risk breast panel (21%), or a 9 gene high risk breast and gynecologic panel (17%). 184 variants of undetermined significance (VUS) were identified with a pooled VUS rate of 28%. Among the commonly used panels, there was a positive correlation between VUS rate and the number of genes included in the panel (r = 0.86, p = 0.01, Range 6% to 70%). A pathogenic mutation was identified in one or more genes in 65 (10%) panels for a total of 67 mutations. Of these, 17 mutations were in BRCA1 or BRCA2 gene. Fifty non-BRCA deleterious mutations were identified with the following frequencies: CHEK2(12), MUTYH(7 monoallelic, 1 biallelic), TP53(4), PTEN(4), ATM(4), MSH6(3), PALB2(3), MSH2(2), CDH1(2), APC(2), NF1(2), BARD1(2), MLH1(1) and PMS2(1). Of these non-BRCA mutations, 41(82%) had a significant impact on management.

Conclusions: Our study demonstrates that multi-gene panel testing identifies several genes that can impact management and would likely not have been discovered by pedigree analysis alone. However, this added detection is associated with a higher VUS rate, especially using larger panels. Further research is needed to better define the role of multi-gene panel testing in high risk patients, with a focus on choosing appropriate genes, understanding the magnitude of cancer risk and delineating impact on management.

Citation Format: Yadav S, Ladkany R, Fulbright J, Dreyfuss H, Reeves A, Campian S, Thomas V, Zakalik D. Multi-gene panel testing for hereditary cancer risk. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-06.

Cell and matrix response of temporomandibular cartilage to mechanical loading

OBJECTIVES

The generation of transgenic mice expressing green fluorescent proteins (GFPs) has greatly aided our understanding of the development of connective tissues such as bone and cartilage. Perturbation of a biological system such as the temporomandibular joint (TMJ) within its adaptive remodeling capacity is particularly useful in analyzing cellular lineage progression. The objectives of this study were to determine: (i) if GFP reporters expressed in the TMJ indicate the different stages of cell maturation in fibrocartilage and (ii) how mechanical loading affects cellular response in different regions of the cartilage.

DESIGN/METHODS

Four-week-old transgenic mice harboring combinations of fluorescent reporters (Dkk3-eGFP, Col1a1(3.6 kb)-GFPcyan, Col1a1(3.6 kb)-GFPtpz, Col2a1-GFPcyan, and Col10a1-RFPcherry) were used to analyze the expression pattern of transgenes in the mandibular condylar cartilage (MCC). To study the effect of TMJ loading, animals were subjected to forced mouth opening with custom springs exerting 50 g force for 1 h/day for 5 days. Dynamic mineralization and cellular proliferation (EdU-labeling) were assessed in loaded vs control mice.

RESULTS

Dkk3 expression was seen in the superficial zone of the MCC, followed by Col1 in the cartilage zone, Col2 in the prehypertrophic zone, and Col10 in the hypertrophic zone at and below the tidemark. TMJ loading increased expression of the GFP reporters and EdU-labeling of cells in the cartilage, resulting in a thickness increase of all layers of the cartilage. In addition, mineral apposition increased resulting in Col10 expression by unmineralized cells above the tidemark.

CONCLUSION

The TMJ responded to static loading by forming thicker cartilage through adaptive remodeling.

Pelvic paraganglioma: a rare and unusual clinical presentation of paraganglioma

Paraganglioma of the urinary bladder is a rare tumour of the urinary bladder causing palpitation, headache, paroxysmal hypertension, tachycardia, blurring of vision and haematuria. Patients may present with these exaggerated symptoms during or just after micturition. We present a case of a 15-year-old girl who presented to us with accelerated hypertension, headache, palpitation and blurring of vision. On the basis of a positive family history, laboratory investigations and imaging studies, she was diagnosed to have an extra-adrenal paraganglioma. Complete enucleation of the tumour with preservation of the bladder was done. This case is reported because of the rarity of the disease in urology.

Extreme Thrombocytosis

A 55 years old female presented with hitherto abdominal pain and gangrenous changes of lower limbs. Patient was found to have extreme thrombocytosis. Approach to thrombocytosis is discussed here.

A study of pathway of care in children and adolescents with attention deficit hyperactivity disorder

OBJECTIVE

Attention deficit hyperactivity disorder (ADHD) is associated with impairment in all aspects of the patient's life. Despite availability of effective treatments for ADHD, a majority of the patient lack access to or have a significant delay in seeking help. This study aimed to assess the pathway of care in ADHD among patients attending the outpatient psychiatric services of a tertiary care centre in India.

METHODS

57 newly registered cases of the age group 6-16 years with the diagnosis of ADHD as per DSM-IV-TR criteria were included in the study. Pathway of care was assessed on the semi structured proforma.

RESULTS

The mean duration of delay in seeking help for ADHD symptoms was 3.96 Years (SD=1.96). Only 50% of the subjects consulted psychiatrists as first contact. Majority of the patients (45.61%) were referred by school teachers. Major reason given by the family members was that the patient was naughty rather than having any disorder for not seeking treatment in (89.47%).

CONCLUSION

Our study showed that there was lack of recognition of ADHD at the level of other qualified practitioners and subsequent delay in referral to CAMHS. Sociocultural beliefs affected the help seeking by the parents.