Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires

BACKGROUND

Screening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires.

METHOD

Adult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R).

RESULTS

Complete data were available for 598 participants (participation rate 99.3%). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51% to 77% at the optimal cut-off scores.

CONCLUSIONS

There is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.

Genitourinary tuberculosis after renal transplantation-a report of three cases with a good clinical outcome

Tuberculosis (TB) continues to be a major opportunistic infection after renal transplantation especially in the tropical countries. The risk of TB in renal transplant recipients is reported to be 20-74 times higher than that in the general population. Genitourinary TB that occurs after renal transplantation in uncommon and appears to present differently than genitourinary TB in the non-transplant population. An increased risk of graft rejection and graft loss has been reported. We report three cases of genitourinary TB in renal transplant recipients, all of whom had a good clinical outcome and a review of published literature.

Sleep and EEG profile in neonatal hippocampal lesion model of schizophrenia

Sleep architecture, EEG power pattern and locomotor activity were investigated in a putative animal model of schizophrenia. The model was prepared by excitotoxic damage of the ventral hippocampus on postnatal day 7 (PD 7), after which locomotor activity and electroencephalographic (EEG) sleep profile were compared between lesioned and sham operated animals respectively, at prepuberty (postnatal day PD 35) and postpuberty (PD 56). An enhancement of locomotor activity was observed in lesioned adult PD 56, but not in juvenile PD 35 rats. Spontaneous EEG/EMG recordings during 24 h showed no major differences between both groups at PD 35 and at PD 56. However, quantitative analysis of the EEG revealed an enhancement of power in delta (delta), theta (theta) and alpha (alpha) activities in lesioned animals at PD 35 during wakefulness in both light and dark phases. At PD 56, the power in the delta and theta bands was increased during the light and dark periods in both wakefulness and non-REM sleep. These findings suggest that ventral hippocampus lesion is not associated with disturbance of sleep architecture in rats, while consistent changes were observed in the dynamic of EEG slow wave frequency domain. Thus, the data indicate that neonatal lesion of ventral hippocampus did not mimic sleep abnormalities observed in schizophrenia, however this rodent model may model some EEG features seen in schizophrenia such as a frontally pronounced slowing of the slow EEG activity in delta and theta frequency bands.

A persistent left superior vena cava

Persistent left superior vena cava is the most common form of anomalous venous drainage involving the superior vena cava, and represents persistence of the left horn of the embryonic sinus venosus, which normally involutes during normal development to become the coronary sinus. Almost always, a persistent left superior vena cava enters the right atrium through the orifice of an enlarged coronary sinus. In this case report of a 60-year-old male cadaver, we describe a persistent left superior vena cava and discuss its embryology and clinical significance.

Development of alternative support system for viable count of cyanobacteria by most probable number method

A technique was developed to evaluate alternative support systems to test tubes used in the standard most probable number technique, for simultaneous isolation and enumeration of cyanobacteria. Five different support systems were tested for their suitability in terms of accuracy, sensitivity, economics and ease of handling. PCR plates with 96 wells and carrying capacity of 300 microL per well were found to be most sensitive, besides being cost- and time-effective. This technique can also be useful for isolation of cyanobacteria, due to immobilization of colonies in the gel matrix and storage of samples at room temperature, without loss of viability for 5-6 weeks. This technique can help to process large sample size with ease--both for enumeration and isolation and can be extended for enumeration of other microorganisms from diverse sources.

Automatic segmentation of pancreatic images using ISODATA alorithm

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Background: Pancreatic cancer is the second most common gastrointestinal malignancy in the United States, where it ranks 4th among all deaths caused by cancers. Early detection of pancreatic cancer remains a challange. Methods: MR images with different T1 and T2 weighting from the anatomical regions with the same imaging parameters were obtained. ISODATA segmentation algorithm, a multivariate method was used to reliable detect the various clusters in the data sets. Results: In all the four subjects, the pancreatic region was found to be from a different (and unique) cluster. This cluster covered the pancreatic region in all the four subjects. Conclusions: The ISODATA algorithm presented could detect the pancreatic region without manual tracing.

No significant financial relationships to disclose.

Anaesthesia-related maternal mortality

Complications of anaesthesia leading to death in young pregnant women might be prevented if more experienced personnel could be entrusted with the job. The contribution of anaesthesia to maternal mortality in the United Kingdom is 1.7 per million pregnancies with almost similar incidence from United States. The commonest single factor responsible for anaesthesia-related death is difficult or failed intubation. A pregnant woman with a potentially difficult airway should receive aspiration prophylaxis (mechanical or pharmacological) as soon as operative delivery is anticipated. Anaesthetists should make a plan that comes into effect as soon as failure to view the larynx or to intubate the trachea becomes evident. Unsuspected difficult airway can be managed if the skill of the anaesthetists is of high standard. Pulmonary aspiration is one cause of death in obstetric anaesthesia. Regurgitation and vomiting prevention can minimise pulmonary aspiration. In regional anaesthesia, local anaesthetics toxicity is another cause of concern. This should be tackled with some safe local anaesthetics. Preventing a high spinal or epidural block involves ways to detect inadvertent injection of local anaesthetic into the cerebrospinal fluid. Postoperative care after anaesthesia in obstetric cases is very important.

Absence of inferior pancreaticoduodenal artery compensated by dorsal pancreatic artery: a case report

Consideration of new aspects of vascular anatomy of the pancreaticoduodenal region is required for further improvement of surgical procedures. Awareness of variations in arteries supplying the duodenum and pancreas can help in minimizing the blood loss during surgery. We report the absence of inferior pancreaticoduodenal artery, which was compensated by a large dorsal pancreatic artery arising from proximal part of the splenic artery. This artery replaced inferior pancreaticoduodenal artery and formed a large loop of anastomosis with the gastroduodenal artery.

Unusual position of external carotid artery: a case report

The arterial pattern of the human body is one of the systems that show a large number of variations. Many reports are available regarding variations of common carotid, external and internal carotid arteries and branches of external carotid artery. We describe a very rare case of lateral position of external carotid artery. The external carotid artery was lateral to the internal carotid artery at the bifurcation of the common carotid artery. The clinical importance of this variation is discussed.

Collateral artery aneurysm: a unique presentation of thoracic outlet syndrome

Aneurysms of collateral arteries are unusual. A case of transverse cervical artery aneurysm as the sole presentation of vascular thoracic outlet syndrome is presented and the relevant literature reviewed.

The value of Bilicheck as a screening tool for neonatal jaundice in term and near-term babies

AIMS

To determine the accuracy of Bilicheck in assessing serum bilirubin. To evaluate the effectiveness of Bilicheck as a screening device in a population of jaundiced term and near-term babies.

METHODS

Prospective evaluation of paired Bilicheck measurements and serum bilirubin in 300 babies.

RESULTS

There was a strong correlation between Bilicheck and serum bilirubin. The mean difference between Bilicheck and serum bilirubin was -10.7 micromol/l, but the 95% limits of agreement were wide at -80 micromol/l to +60 micromol/l. Bilicheck identified significant jaundice (serum bilirubin above 250 micromol/l) with a sensitivity (95% confidence interval) of 91% (88% to 94%) and specificity of 66% (60% to 71%). The area under the receiver operator characteristic curve was 0.85. There were five false negatives, all of whom had a serum bilirubin below 300 micromol/l. If Bilicheck had been used as a screening device, there would have been a 55% decrease in blood samples taken in these babies.

CONCLUSION

Bilicheck cannot be used to measure serum bilirubin in term and near-term babies with jaundice, but is an effective screening method, which can be used to safely reduce the number of blood tests in these babies.

Evaluation of herbal toothpowder for its piperine content

Objective - A well-known herbal toothpowder was evaluated & standardized for its Piperine contents. Methods-The formulation was subjected for physical constants like Moisture content, Ash value, and Extractive values in various solvents including Petroleum ether, Ethanol and Water. Thin layer chromatography and spectroscopic studies was carried out for the qualitative analysis of Piperine content. Results & Conclusion _Present study reveals the presence of Piperine in toothpowder. As the present scenario is moving towards the herbal medicines, these evaluation parameter will further help to set up a standard validation process for herbal formulations.

Preparation and evaluation of herbal shampoo powder

Two preparations of herbal shampoo powder were formulated using some common traditional drugs used by folk and traditional people of Bundelkhand region (M.P) India, for hair care. The preparations were formulated using bahera, amla, neem tulsi, shikakai henna & brahmi evaluated for organoleptic, powder charecterestics, foam test and physical evaluation. As the selected drugs being used since long time as single drug or in combination, present investigations will further help to establish a standard formulation and evaluation parameters, which will certainly help in the standardization for quality and purity of such type of herbal powder shampoos.

Analgesic activity of the roots of baliospormum montanum linn

The ethanolic extract and its chloroform soluble and chloroform insoluble fractions of the roots of Baliospermum montanum were investigated in albino rats to evaluate the analgesic activity. Tailo - flick animal model was employed to test analgesic activity and compaired with a standard drug, Diclofenac sodium. The results indicate that the ethanolic extract and its chloroform soluble fraction are significantly effective (p<0.05) with respect to standard. The activity was found to be dose dependant. Results of present study justify the folklore use of B.montanum as analgesic drug.

Congenital reducible atlantoaxial dislocation: classification and surgical considerations

BACKGROUND

Reducible atlanto-axial dislocation (AAD) may cause severe motor and respiratory compromise due to recurrent spinal cord and/or brain stem impingement. To the best of the authors' knowledge, this is the first study concentrating on the classification, the protocol of the surgical management and the outcome of congenital, reducible AAD.

METHODS

109 patients with congenital, reducible AAD underwent posterior stabilization. Their preoperative disability was graded as: I (n=11, 10.09%) no functional disability (a history of minor trauma led to quadriparesis that subsequently improved); II (n=31, 28.44%) independent for activities of daily living with minor disability; III (n=42, 38.53%) partially dependent on others for their daily needs; and, IV (n=25, 22.93%) totally dependent. They were classified into 4 groups depending upon their association with: a normal odontoid and posterior arch of atlas (n=27); a dysplastic odontoid and normal posterior arch (n=25); an assimilated posterior arch (n=49); and, Arnold Chiari malformation type I (n=8). Nine patients with a dysplastic odontoid had a "hypermobile" AAD with an unrestricted backward and forward movement of the axis relative to the atlas in flexion as well as in extension of the neck, respectively. The surgical procedures included Brooks' (n=12) or modified Brooks' C1-2 fusion (n=39); Goel's C1-2 fusion (3); Ransford's contoured rod fusion (n=7); Jain's occipitocervical fusion (n=47); and, transoral decompression and Jain's occipitocervical fusion (n=1). There were 6 peri-operative mortalities in the series.

FINDINGS

At follow-up (ranging from 3 months to 6 years; n=86), 64 patients had shown improvement by one grade or more; 8 patients, who had a history of transient quadriparesis but were without neurological deficits at presentation, remained in grade I; 11 had achieved stabilization of neurological functions; while 3 had deteriorated despite adequate radiological reduction of AAD and fusion of the construct. A follow-up of 6 months or more was available in 79 of these 86 patients, in whom a dynamic intrathecal CT scan showed a good osseous union.

INTERPRETATION

The patients with congenital reducible AAD, depending on their surgical management, may be classified into four groups. Some patients with a dysplastic odontoid have a "hypermobile" AAD and require special care during intubation, positioning and stabilization. An assimilated posterior arch is often associated with asymmetrical lateral occipito-C1-C2 joint synostosis rendering transarticular screw placement difficult. The various causes of failure of constructs are discussed.

Bending properties of carbon nanotubes encapsulating solid nanowires

Using empirical potentials and atomistic simulations, we model three-point bend tests of single-walled carbon nanotubes encapsulating metal nanowires. The presence of a metal nanowire inside the nanotube greatly suppresses the tube-buckling instability. Increasing tube diameter leads to an increase in the bending strength; however, in contrast to hollow tubes, there is no decrease in the maximum deflection before buckling. Analysis of the principal bending vibrational mode shows a lowering of the frequency, associated with increased tube inertia. Remarkably, metal-filled tubes exhibit strong damping of oscillations whereas unfilled single-walled and multiwalled tubes show no damping. Our studies demonstrate the benefits of filling tubes with solids to modify bending strength and flexibility, suggesting applications for nanotube-based elements in micromechanical devices or nanoprobes.