Mental health impacts of COVID-19 in Ireland and the need for a secondary care mental health service response.

The COVID-19 pandemic is a global health emergency, the scale, speed and nature of which is beyond anything most of us have experienced in our lifetimes. The mental health burden associated with this pandemic is also likely to surpass anything we have previously experienced. In this editorial, we seek to anticipate the nature of this additional mental health burden and make recommendations on how to mitigate against and prepare for this significant increase in mental health service demand.

The prevalence of clinical presentations and pathological characteristics of antrochoanal polyp.

OBJECTIVE: Antrochoanal polyps (ACPs) originating from the maxillary sinus, are considered as benign inflammatory lesions. In fact, these polyps are the hypertrophy of the mucous membrane of the maxillary sinus, which for unknown reasons grow through the maxillary sinus ostium towards the other portions of the nasal cavity and the choana, such a way that they may grow all the way to the nasopharynx and even oropharynx. ACP is usually unilateral however, the bilateral forms have been observed in some instances. Its most frequent clinical manifestations are nasal obstruction and rhinorrhea, whereas in many cases some other presentations such as epistaxis, dyspnea, and dysphagia, and weight loss have been also noticed. The aim of this study was to investigate the relative prevalence of clinical manifestations and pathological characteristics in 87 patients with ACPs during a period of 15 years in this hospital. METHODS: It was a descriptive cross-sectional study, accomplished retrospectively, and based on existing data in the records of the patients admitted in Imam Khomeini Hospital of Ahvaz. In this study, the patients above 16 years old have been considered as adults. Each patient's data were collected using a questionnaire. Data analysis was performed by the statistical SPSS software (descriptive statistics and Chi-square test). RESULTS: 87 patients were registered with the diagnosis of ACP during 1999 and 2014. Out of these patients 60% were females and 40% were males. Predominant clinical manifestation was nasal obstruction with an incidence of 39%; and the least frequent manifestation was weight loss with an incidence of 0%. Moreover, the left nasal cavity was more involved with the incidence of 55%. Among the existing surgical techniques. Functional Endoscopic Sinus Surgery (FESS), Caldwell- Luc procedure, and combined approach were the most common applied techniques,with frequencies of 64%, 24% and 12%, respectively. Confidence Interval (CI) = 0.03 ± 0.2, Odd ratio = 0.26, and p = 0.21. CONCLUSION: Nasal obstruction was the predominant clinical symptom of ACP. The left nasal cavity was more involved than the right-side. FESS was the commonest employed surgical procedure; and the inflammatory pattern has been the most pathological presentation.

Effects of water concentration on the structural and diffusion properties of imidazolium-based ionic liquid-water mixtures.

We have used molecular dynamics simulations to study the properties of three ionic liquid (IL)-water systems: 1-butyl-3-methylimidazolium chloride ([bmim]Cl), 1-ethyl-3-methylimidazolium acetate ([emim][Ac]), and 1,3-dimethylimidazolium dimethylphosphate ([dmim][DMP]). We observe the transition of those mixtures from pure IL to aqueous solution by analyzing the changes in important bulk properties (density) and structural and bonding properties (radial distribution functions, water clustering, hydrogen bonding, and cationic stacking) as well as dynamical properties (diffusion coefficients) at 12 different concentration samplings of each mixture, ranging from 0.0 to 99.95 mol % water. Our simulations revealed across all of the different structural, bonding, and dynamical properties major structural changes consistent with a transition from IL-water mixture to aqueous solution in all three ILs at water concentrations around 75 mol %. Among the structural changes observed were rapid increase in the frequency of hydrogen bonds, both water-water and water-anion. Similarly, at these critical concentrations, the water clusters formed begin to span the entire simulation box, rather than existing as isolated networks of molecules. At the same time, there is a sudden decrease in cationic stacking at the transition point, followed by a rapid increase near 90 mol % water. Finally, the diffusion coefficients of individual cations and anions show a rapid transition from rates consistent with diffusion in IL's to rates consistent with diffusion in water beginning at 75 mol % water. The location of this transition is consistent, for [bmim]Cl and [dmim][DMP], with the water concentration limit above which the ILs are unable to dissolve cellulose.

Interferon-ribavirin treatment in chronic hepatitis C--the less talked about aspects.

BACKGROUND: Combination therapy with interferon and ribavirin has become the standard of care in the treatment of Chronic Hepatitis C (CHC) infected patients. Treatment response, however, is not 100% and is accompanied with side effects faced by the patient as well as observed in haematologic indices. Studies are focusing on daily or high-dose induction therapy with interferon, the titration of interferon dosing to initial viral load, higher doses of interferon throughout treatment, and adjustment of interferon dosing to the viral responses. The safety and efficacy of these approaches have not been sufficiently established. Objectives were to see the response of 2 different dosage regimens, effects and side effects and to assess the efficacy and side effects of 2 treatment regimens of Interferon and Ribavirin in CHC. METHODS: A total of 32 patients with CHC at Department of Gastroenterology and Hepatology, Shaikh Zayed Postgraduate Medical Institute Lahore from June 2001 to February 2003 were included in the study and were divided into two groups for treatment. Group A (14 patients) received 5 MU of injection Interferon alpha 2 b S/C daily for 2 weeks followed by 3 MU thrice weekly for the next 22 weeks. Group B (18 patients) received injection interferon alpha 2 b 3 MU S/C thrice weekly for 24 weeks. Ribavirin therapy was started at 1200 mg daily in 3 divided doses and later modified according to side effects. Patients were evaluated at 2, 4, 8, 12, 16, 20 and 24 weeks during the therapy and then 24 weeks after the completion of treatment. RESULTS: Out of 32 adult patients included in the study, 18 were males and 14 females. Haemoglobin was more than 12 gm/dl in females and more than 13 gm/dl in males, WBC count was more than 3.0 x 10(9)/L and Platelet count was more than 100 x 10(9)/L. Twenty patients completed 6 months combination treatment, 16 reported with their end of treatment HCV RNA PCR results, 8 from each group. Twelve patients were lost to follow up. End of treatment response (ETR) in group A was 88% and 62.5% in group B. Sustained virological response in group-A was 5/8 (62.5%) and 4/5 (50%) in group-B. The frequency and severity of flu like symptoms like fever, body aches, skin rash, hair loss, cough and psychiatric symptoms were more in group A than in group B. There was no significant difference in the 2 groups for haematologic side effects. CONCLUSIONS: Treatment with 5 MU interferon daily for initial two weeks followed by 3 MU thrice weekly for 22 weeks is more effective than 3 MU thrice weekly for 24 weeks but with more side effects.