A Case of Obsessive-Compulsive Disorder Comorbid with Miyoshi Myopathy

Obsessive-compulsive disorder (OCD) is a common neuropsychiatric disorder, with predominant involvement of cortico-striato-thalamo-cortico circuitry. Although late-onset cases (>35 years) usually show an association with various neurological disorders involving basal ganglia and thalamus, it is not the case with the young-onset patients. There have been no reports of OCD comorbid with dysferlinopathy which is usually considered as a disease involving only muscles. However, recently, studies suggest involvement of brain in this disease. Here, we report a case of dysferlinopathy comorbid with OCD and discuss the related literature.

Cardiopulmonary Resuscitation: Unusual Techniques for Unusual Situations

Background:

The cardiopulmonary resuscitation (CPR) in prone position has been dealt with in 2010 American Heart Association (AHA) guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations.

Aims:

This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces.

Methods:

We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces.

Results:

No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR), CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway in situ.

Conclusion:

A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma

AIM

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer aims to downstage prior to definitive management. Repeat imaging assessment of the tumour post-therapy has implications for treatment. Our aim was to assess if the inferior mesenteric vein (IMV) diameter measured on CT can be used as a surrogate marker for evaluation of tumour response to neoadjuvant treatment.

METHOD

IMV diameter was assessed in patients with and without locally advanced rectal cancer, pre- and post-radiotherapy, to ascertain if IMV diameter is a surrogate marker of tumour response.

RESULTS

IMV diameter was 5.9 mm in patients with rectal cancer vs 4.7 mm in patients without (P = 0.0001). The baseline IMV diameter was significantly higher for cases with local lymphadenopathy [N0 5.2 mm vs N1/2 6 mm (P = 0.0059)] and extramural venous invasion (EMVI) [negative 5.4 mm vs positive 6.4 mm (P = 0.0001)]. Post-radiotherapy there was a significant decrease in the IMV diameter in cases with treatment response compared to non-responders: the percentage change in IMV diameter was a 17.54% decrease vs 1.39% increase (P = 0.0001). These results were reproduced on comparing between magnetic resonance tumour regression grades using ANOVA (P = 0.0001). There was also a significant decrease in IMV diameter when assessing lymph node (LN) and EMVI response vs non-responders (P = 0.0001 and 0.0001 respectively).

CONCLUSION

Patients with rectal cancer have a dilated IMV compared with patients without rectal cancer. We confirm that IMV diameter is a potential surrogate marker of LN status and EMVI at baseline. IMV diameter is also a marker of tumour, LN and EMVI response to chemoradiotherapy.

Providing feedback to service customers

Purpose

In services, customers’ successful performance of expected roles is critical to ensuring successful service outcomes. To help customers perform their roles better, service providers offer them feedback on their performance. To improve the design of customer feedback that contains both positive and negative messages, the purpose of this paper is to examine the order and the repetition effect of feedback message types on customer feedback satisfaction, motivation, and compliance intention, focusing on the moderating effect of customer involvement level. This paper also examines whether feedback satisfaction and motivation mediate the moderation effect of the order or repetition of feedback message type and customer involvement level on compliance intention.

Design/methodology/approach

This study employs two between-subject quasi-experimental designs: 2 (feedback message order: positive message first vs negative message first) × 2 (involvement level: high vs low) and a 2 (repeated feedback type: positive vs negative) × 2 (involvement level: high vs low). Data collection occurred through an online survey using eight health checkup scenarios. Hypotheses were tested by using MANOVA and PROCESS.

Findings

The customer involvement level moderated the effect of the presentation order of feedback message type on customer responses. With highly involved customers, offering positive feedback initially produced responses that were more favorable. With customers with low involvement, the order did not matter. The effects of feedback satisfaction and motivation as mediators in the effect of order on compliance intention were significant only with highly involved customers. The mediation effect of motivation was much stronger than that of feedback satisfaction. The repetition of a particular feedback type took effect only with customers with low-involvement level. Compared to the no-repetition condition (positive-negative), when positive feedback was repeated (positive-negative-positive), motivation increased. Compared to the no-repetition condition (negative-positive), when negative feedback was repeated (negative-positive-negative), feedback satisfaction and compliance intention decreased. In terms of mediating effect, only feedback satisfaction was a meaningful mediator and only when negative feedback was repeated to low-involvement customers.

Originality/value

This study contributes to research by extending feedback studies in services to include a consideration of the order and repetition of feedback message types as design variables; it contributes practically by suggesting how to design feedback for better customer responses such as feedback satisfaction, motivation, and compliance intention.

Atypical Kleine–Levin syndrome: An elusive entity?

Kleine–Levin syndrome (KLS) is a rare disorder (around 1.5 cases per million population), often presenting with triad of recurrent episodes of hypersomnia, hyperphagia, and hypersexuality. However, cases of atypical KLS with features opposite to that being commonly reported are often misdiagnosed as psychosis and present as a diagnostic challenge for the physicians, psychiatrists, and neurologists. We describe a case of atypical KLS which was misdiagnosed as unspecified nonorganic psychosis previously, highlighting the various points which would be helpful in identifying and diagnosing cases of atypical KLS in future.

Cardiopulmonary Resuscitation: Evaluation of Knowledge, Efficacy, and Retention in Young Doctors Joining Postgraduation Program

Background:

High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing.

Aims:

The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR.

Design:

The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment.

Methods:

A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results.

Statistical Analysis:

Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test.

Results:

The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%.

Conclusion:

The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.

Gonorrhoea diagnostics: An update

Diagnosis of gonorrhoea is an ongoing challenge. The organism is fastidious requiring meticulous collection and transport for successful cultivation. Asymptomatic infections are common which go undetected by conventional methods thereby leading to continued transmission and the risk of complications. The nucleic acid amplification tests, now increasingly used in developed countries, offer improved sensitivity compared to bacterial culture. However, these continue to suffer sequence related problems leading to false positive and false negative results. Further, these cannot be used for generation of data on antibiotic susceptibility because genetic markers of antibiotic resistance to recommended therapies have not been fully characterised. They are unaffordable in a setting like ours where reliance is placed on syndromic approach for sexually transmitted infection (STI) management. The use of syndromic approach has resulted in a considerable decline in the number of Neisseria gonorrhoeae isolates that have been cultured for diagnostic purposes. Many laboratories formerly doing so are no longer performing culture for gonococci, and the basic skills have been lost. There is a need to not only revive this skill but also adopt newer technologies that can aid in accurate diagnosis in a cost-effective manner. There is room for innovation that can facilitate the development of a point-of-care test for this bacterial STI.

Altered brain network integrity after childhood maltreatment: A structural connectomic DTI-study

Childhood maltreatment is associated with alterations in neural architecture that potentially put these children at increased risk for psychopathology. Alterations in white matter (WM) tracts have been reported, however no study to date has investigated WM connectivity in brain networks in maltreated children to quantify global and local abnormalities through graph theoretical analyses of DTI data. We aimed for a multilevel investigation examining the DTI-based structural connectome and its associations with basal cortisol levels of 25 children with documented maltreatment experiences before age 3, and 24 matched controls (age: 10.6 ± 1.75 years). On the global and lobar level, maltreated children showed significant reductions in global connectivity strength, local connectivity and increased path length, suggesting deviations from the small-world network architecture previously associated with psychopathology. Reductions in global connectivity were associated with placement instability, attenuated cortisol secretion and higher levels of internalizing and externalizing behaviours. Regional measures revealed lower connectivity strength especially in regions within the ventromedial prefrontal cortex (vMPFC) in maltreated children. These findings show that childhood maltreatment is associated with systemic global neurodevelopmental alterations in WM networks next to regional alterations in areas involved in the regulation of affect. These alterations in WM organization could underlie global functional deficits and multi-symptom patterns frequently observed in children with maltreatment experiences. Hum Brain Mapp 38:855-868, 2017. © 2016 Wiley Periodicals, Inc.

Basing Service Management on Customer Determinants

By studying how customers react to paired sets of product and service attributes, a manager can focus on factors that determine purchases. The procedure, known as "discrete-choice analysis" (DCA), begins with an assessment of which attributes are important to customers. Then the researcher establishes different levels for each attribute (e.g., price points, service speed). The customers' indicated preferences among several of such paired sets give managers information that allows them to adjust product and service attributes for maximum customer satisfaction and, not incidentally, better market share. The authors demonstrate how DCA works through a study of how customers chose a pizza-delivery company by trading off among several attributes (price, discount, promised delivery time, late-delivery time, variety, temperature, and money-back guarantee). The results of such a discrete-choice analysis can be incorporated into a decision-support system via a computer spreadsheet.