Gender differences in depression and anxiety among atopic dermatitis patients

Background:

Dermatological patients invariably suffer one or the other psychological problems which may escalate to the extent of a mental disorder. One of the most common dermatological disorders is atopic dermatitis (AD), but the literature has limited data on gender differences for psychiatric morbidity in such patients.

Aims:

To evaluate and compare gender differences in the prevalence of depression and anxiety in AD.

Materials and Methods:

This cross-sectional study with consecutive sampling was done in an outpatient clinic of Dermatology at a Tertiary Care Center. AD subjects giving informed consent were evaluated on a brief semi-structured performa for collecting demographic and clinical information. Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to assess the presence of psychiatric symptoms in these patients. Descriptive analysis was done for the socio-demographic profile and independent sample t-test, Chi-square and Cramer's V test was carried out to find in-between group differences for males and females.

Results:

A total of 81 patients were included in the final analysis (males = 36, females = 45) with no significant difference in mean age between male and female subjects (36.14 ± 17.62 and 33.98 ± 14.49 years, respectively; P = 0.54). When including moderate to severe grade of depression or anxiety, the current study found prevalence rates of 15% and 12% respectively. Females had significantly more anxiety and depression scores than males (P = 0.04 and P = 0.03 respectively).

Conclusions:

There is a female preponderance of depression and anxiety disorder in AD patients.

Electrospun nitric oxide releasing bandage with enhanced wound healing

Research has shown that nitric oxide (NO) enhances wound healing. The incorporation of NO into polymers for medical materials and surgical devices has potential benefits for many wound healing applications. In this work, acrylonitrile (AN)-based terpolymers were electrospun to form non-woven sheets of bandage or wound dressing type materials. NO is bound to the polymer backbone via the formation of a diazeniumdiolate group. In a 14 day NO release study, the dressings released 79 μmol NO g(-1) polymer. The NO-loaded dressings were tested for NO release in vivo, which demonstrate upregulation of NO-inducible genes with dressing application compared to empty dressings. Studies were also conducted to evaluate healing progression in wounds with dressing application performed weekly and daily. In two separate studies, excisional wounds were created on the dorsa of 10 mice. Dressings with NO loaded on the fibers or empty controls were applied to the wounds and measurements of the wound area were taken at each dressing change. The data show significantly enhanced healing progression in the wounds with weekly NO application, which is more dramatic with daily application. Further, the application of daily NO bandages results in improved wound vascularity. These data demonstrate the potential for this novel NO-releasing dressing as a valid wound healing therapy.

A validation of the Oswestry Spinal Risk Index

PURPOSE

The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC).

METHODS

We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper.

RESULTS

Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004).

CONCLUSIONS

Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSCC.

Hashimoto's Encephalitis: Unusual Cause of Reversible Dementia

Hashimoto's encephalopathy (HE) is a poorly understood and often misdiagnosed rare autoimmune disease with varied neurological and psychiatric features. The low prevalence and varied clinical features coupled with unclear pathogenesis and histopathologic characteristics have caused still doubts in any particular diagnostic criteria. Therefore, more case studies are needed to characterize the clinical, laboratory and imaging features and outcomes of HE patients. We describe a case of such a patient with HE presenting with dementia and focus on its early recognition as the cognitive changes are reversible.

A review of web based interventions focusing on alcohol use

Alcohol continues to be a major contributor to morbidity and mortality globally. Despite the scientific advances, alcohol use related problems continue to pose a major challenge to medicine and public health. Internet offers a new mode to provide health care interventions. Web based interventions (WBIs) provide the health care services at the door steps of the end users. WBIs have been developed for alcohol use related problems over the past few years. WBIs offer a potentially relevant and viable mode of service delivery to problem alcohol users. Hence, it is important to assess these interventions for their effectiveness. Some of the existing WBIs for alcohol use assessed systematically in controlled trials. The current review evaluates the available evidence for the effectiveness of WBIs for reducing alcohol use. The literature search was performed using MedLine, PubMed, PsycINFO and EMBASE for relevant English language articles published up to and including April 2013. Only publications focused on reducing alcohol use through WBIs were included.

Signaling eco-certification

Purpose –

The purpose of this paper is to use an eco-friendly service concept framework to demonstrate the effect of credible eco-certification signaling.

Design/methodology/approach

– The authors examine a cross-sectional data set consisting of 2,481 hotel sites across the US. The authors measure the performance of the operations component of eco-friendly service by operations-driven resource efficiency (ODF), and the performance of the marketing component by customer-driven resource efficiency (CDF). A series of multivariate regressions compare these two resource efficiency measures between credibly eco-certified hotel sites and others.

Findings

– The results indicate that credible eco-certifications achieve the signaling effect. Eco-certified hotels outperform others in both ODF and CDF measures; and eco-certified hotels still achieve higher CDF after controlling for ODF.

Practical implications

– The findings suggest that eco-friendly service design requires not only eco-friendly operations but also a built-in credible signaling mechanism. This mechanism engages the customers in eco-friendly service coproduction and in doing so integrates the operations and marketing components of eco-friendly service strategy through eco-certifications.

Originality/value

– This study is among the first to demonstrate empirically the signaling effect of credible eco-certifications in services. It increases understanding of eco-friendly service design and delivery by exploring the role of credible eco-certifications in linking customer benefits with the service organization's strategic intent.

Coating doxorubicin-loaded nanocapsules with alginate enhances therapeutic efficacy against Leishmania in hamsters by inducing Th1-type immune responses

BACKGROUND AND PURPOSE

The aim of the present study was to evaluate the immunomodulatory and chemotherapeutic potential of alginate-(SA) coated nanocapsule (NCs) loaded with doxorubicin (SA-NCs-DOX) against visceral leishmaniasis in comparison with nano-emulsions containing doxorubicin (NE-DOX).

EXPERIMENTAL APPROACH

NE-DOX was prepared using low-energy emulsification methods. Stepwise addition of protamine sulphate and SA in a layer-by-layer manner was used to form SA-NCs-DOX. SA-NCs-DOX, NE-DOX and Free DOX were compared for their cytotoxicity against Leishmania donovani-infected macrophages in vitro and generation of T-cell responses in infected hamsters in vivo.

KEY RESULTS

Size and ζ potential of the NE-DOX and SA-NCs-DOX formulations were 310 ± 2.1 nm and (-)32.6 ± 2.1 mV, 342 ± 4.1 nm and (-)29.3 ± 1.2 mV respectively. SA-NCs-DOX was better (1.5 times) taken up by J774A.1 macrophages compared with NE-DOX. SA-NCs -DOX showed greater efficacy than NE-DOX against intramacrophagic amastigotes. SA-NCs-DOX treatment exhibited enhanced apoptotic efficiency than NE-DOX and free DOX as evident by cell cycle analysis, decrease in mitochondrial membrane potential, ROS and NO production. T-cell responses, when assessed through lymphoproliferative responses, NO production along with enhanced levels of iNOS, TNF-α, IFN-γ and IL-12 were found to be up-regulated after SA-NCs-DOX, compared with responses to NE-DOX in vivo. Parasitic burden was decreased in Leishmania-infected hamsters treated with SA-NCs-DOX, compared with NE-DOX.

CONCLUSIONS AND IMPLICATIONS

Our results provide insights into the development of an alternative approach to improved management of leishmaniasis through a combination of chemotherapy with stimulation of the innate immune system.

A review of web based interventions for managing tobacco use

Web based interventions (WBIs) have been developed for various health conditions. These include interventions for various psychoactive substance use disorders including tobacco and alcohol. Tobacco use has remained the single largest preventable cause of global mortality and morbidity for many years. It is responsible for around 6 million deaths annually world-wide. Ironically, most of the tobacco users reside in resource poor low and middle-income countries. The article reviews the existing literature on WBIs for management of tobacco use. The literature search was performed using MedLine, PubMed, PsycINFO, Embase and Cochrane Review for relevant English language articles published from 1998 up to 2013. There is limited support for effectiveness of WBIs for managing tobacco use among adolescents. Although most of the trials among adults found WBIs to be more effective at short term follow-up (a few days to weeks), the benefits failed to extend beyond 3 months in most of the studies. All but one interventions studied in a randomized controlled trial is for smoking forms.

Auto cannibalism in mental retardation

Mental retardation (MR) deems an individual more vulnerable to psychopathologies. The individual may develop an array of behavioral disturbances manifesting themselves in the form of aggressive and destructive conduct, violent fits of anger, stereotyped, or self-injuring behavior. Self-injurious behavior is heterogeneous in nature ranging from mild to severe variant. We report a case of a 7-year-old boy with MR with self-inflicted severe oral injuries of cannibalistic nature presenting as cleft lip and palate. A more extensive research is needed on the problem behaviors in mentally retarded patients for early detection and effective and timely intervention leading to a better outcome.

Karniouchina E, van der Rhee B, Verma R, Victorino L. The role of coordinated marketing-operations strategy in services

Purpose

– The purpose of this paper is to discuss the importance of a coordinated marketing and operations strategy in goods and service producing business organizations. Customer engagement and co-production are imperative service delivery considerations, and therefore an aligned marketing and operations strategy is essential for the formulation, development, and effectiveness of managerial decisions especially for service sector firms.

Design/methodology/approach

– The authors present arguments in support of this paper's primary objectives by reviewing past research that have introduced theoretical frameworks, empirical support and applications in support of the close coordination between marketing and operations strategy. The paper then describes how the inter-relationship between marketing and operations strategy impacts several managerial decisions.

Findings

– The paper discusses several different types of managerial decisions within goods and service producing firms that require active interaction between marketing and operations. These decisions include aligning strategic priorities, new product development, service design, and experience design.

Research limitations/implications

– This paper is primarily theoretical and therefore does not include any new empirical data.

Practical implications

– The inter-relationship between the marketing and operations functions is well known to practicing managers. However, they may not have a specific understanding of the academic research described in this paper that shows how firm performance can be further improved by better managing these interactions for specific managerial decisions.

Originality/value

– This paper is theoretical and provides a comprehensive review of literature and a compelling argument for including marketing and operations strategy in the corporate executive suite. Therefore, this paper should be of interest to researchers and practitioners interested in the functional areas of marketing, operations, and strategy for service organizations.

Neuroimaging features and predictors of outcome in eclamptic encephalopathy: a prospective observational study

BACKGROUND AND PURPOSE

Posterior reversible encephalopathy syndrome is associated with eclampsia. We assessed the distribution and nature of typical and atypical cranial MR imaging findings in these patients and their correlation with clinical and laboratory data and predictors of outcome.

MATERIALS AND METHODS

Forty-five clinically confirmed cases of eclampsia were included in this prospective observational study. Subjects with hemolysis, elevated liver enzymes, and low platelets syndrome (n = 9) and pre-existing neurologic conditions (1 with cerebral solitary cysticercus granuloma) were excluded. Patients underwent blood investigations and cranial MR imaging.

RESULTS

Twenty-seven patients had abnormal while 8 had normal MR imaging findings. Involvement of brain regions was as follows: frontal, 88.89%; temporal, 44.44%; parietal, 100%; occipital, 100%; deep gray matter, 29.63%; cerebellum, 22.22%; brain stem, 14.81%. Cytotoxic edema was present in 33.33% of cases; 66.67% of patients had mild posterior reversible encephalopathy syndrome; 25.92% had moderate posterior reversible encephalopathy syndrome; and 7.41% had severe posterior reversible encephalopathy syndrome. Abnormal neuroimaging findings were significantly associated with altered sensorium; visual disturbances; status epilepticus; and elevated serum creatinine, uric acid, and lactate dehydrogenase (P=.006, P=.018, P=.015, P=.019, P=.003, and P=.001, respectively). Serum creatinine, uric acid, and lactate dehydrogenase values and the presence of moderate or severe posterior reversible encephalopathy syndrome were significantly associated with mortality (P<.001, P<.001, P=.009, and P=.027, respectively).

CONCLUSIONS

Neuroimaging in eclampsia demonstrates a higher incidence of atypical distributions and cytotoxic edema than previously thought. Altered sensorium; visual disturbances; status epilepticus; and elevated serum uric acid, lactate dehydrogenase, and creatinine are associated with abnormal neuroimaging findings. Higher serum creatinine, uric acid, and lactate dehydrogenase levels and moderate and severe forms of posterior reversible encephalopathy syndrome are possible predictors of poor outcome.

Is single dose povidone iodine sclerotherapy effective in chyluria?

BACKGROUND

Chyluria is a chronic debilitating condition characterized by formation of pyelo-lymphatic connections. Renal pelvic instillation sclerotherapy is a minimally invasive treatment modality in treatment of chyluria. Various sclerosant with different regimen have been described in literature but there is no single consensus on this regard.

OBJECTIVE

To evaluate the effectiveness and safety of single dose 0.2% povidone iodine renal pelvic instillation sclerotherapy for the treatment of chyluria.

METHODS

In a prospective study from August 2010 till July 2013, forty one patients presenting with milky urine were included. Apart from ether test, presence of lymphocytes in urine and urine triglycerides levels were also done to confirm chyluria. On a day care basis under local anesthesia 5F open ended ureteric catheter was introduced in the ureteric orifice of affected side. Freshly prepared 7-10 ml of 0.2% povidone iodine solution was instilled with the patient in Trendelenburg position.

RESULTS

Total of 41 patients were enrolled ( 27 males and 14 females; mean age 40 years, SD 8.9, range 19-61) with a mean follow up of 20 months. Immediate clearance was seen in all patients and recurrence in 7 (17%). Mean disease free duration was 18 months. Two patients had moderate to severe flank pain.

CONCLUSION

Single dose 0.2% povidone iodine sclerotherapy is safe and effective treatment for chyluria. As it offers treatment on a day care basis, continuous ureteral and urethral catheterizations can be avoided.