Metal Negatrode Supercapatteries: Advancements, Challenges, and Future Perspectives for High-Performance Energy Storage.

Metal negatrode supercapattery (MNSC) is an emerging technology that combines the high energy storage capabilities of batteries with the high-power delivery of supercapacitors, thereby offering promising solutions for various applications, such as energy storage systems, electric vehicles, and portable electronics. This review article presents a comprehensive analysis of the potential of MNSCs as a prospective energy storage technology. MNSCs utilize a specific configuration in which the negatrode consists of a metal or metal-rich electrode, such as sodium, aluminum, potassium, or zinc, whereas the positrode functions as a supercapacitor electrode. The utilization of negatrodes with low electrochemical potential and high electrical conductivity is crucial for achieving high specific energy in energy storage devices, despite facing numerous challenges. The present study discusses the design and fabrication aspects of MNSCs, including the selection of appropriate metal negatrodes, electrolytes, and positrodes, alongside the fundamental operational mechanisms. Additionally, this review explores the challenges encountered in MNSCs and proposes solutions to enhance their performance, such as addressing dendrite formation and instability of metal electrodes.

Understanding the Behavior of Supercapacitor Materials via Electrochemical Impedance Spectroscopy: A Review.

Energy harvesting and energy storage are two critical aspects of supporting the energy transition and sustainability. Many studies have been conducted to achieve excellent performance devices for these two purposes. As energy-storing devices, supercapacitors (SCs) have tremendous potential to be applied in several sectors. Some electrochemical characterizations define the performance of SCs. Electrochemical impedance spectroscopy (EIS) is one of the most powerful analyses to determine the performance of SCs. Some parameters obtained from this analysis include bulk resistance, charge-transfer resistance, total resistance, specific capacitance, response frequency, and response time. This work provides a holistic and comprehensive review of utilizing EIS for SC characterization. Overall, researchers can benefit from this review by gaining a comprehensive understanding of the utilization of electrochemical impedance spectroscopy (EIS) for characterizing supercapacitors (SCs), enabling them to enhance SC performance and contribute to the advancement of energy harvesting and storage technologies.

Unravelling effects of phytochemicals from buckwheat on cholesterol metabolism and lipid accumulation in HepG2 cells and its validation through gene expression analysis.

BACKGROUND: The objective of this research was to elucidate the hypocholesterolemic effects of a bioactive compound extracted from buckwheat, and to delineate its influence on the regulatory mechanisms of cholesterol metabolism. The compound under investigation was identified as quercetin. MATERIAL AND RESULTS: In vitro experiments conducted on HepG2 cells treated with quercetin revealed a significant reduction in intracellular cholesterol accumulation. This phenomenon was rigorously quantified by assessing the transcriptional activity of key genes involved in the biosynthesis and metabolism of cholesterol. A statistically significant reduction in the expression of HMG-CoA reductase (HMGCR) was observed, indicating a decrease in endogenous cholesterol synthesis. Conversely, an upregulation in the expression of cholesterol 7 alpha-hydroxylase (CYP7A1) was also observed, suggesting an enhanced catabolism of cholesterol to bile acids. Furthermore, the study explored the combinatory effects of quercetin and simvastatin, a clinically utilized statin, revealing a synergistic action in modulating cholesterol levels at various dosages. CONCLUSIONS: The findings from this research provide a comprehensive insight into the mechanistic pathways through which quercetin, a phytochemical derived from buckwheat, exerts its hypocholesterolemic effects. Additionally, the observed synergistic interaction between quercetin and simvastatin opens up new avenues for the development of combined therapeutic strategies to manage hyperlipidemia.

Prevalence and associated factors of sexual dysfunction in female hemodialysis patients: first report from Somalia.

BACKGROUND: Sexual dysfunction is frequent in female hemodialysis patients and is related to poorer quality of life. It is often a neglected topic associated with marked distress and interpersonal difficulties. OBJECTIVE: Few studies are reported from Sub-Saharan African Countries (SSA) regarding female sexual dysfunction (FSD) in (HD) patients. The study aims to explore the prevalence and associated factors of FSD in female HD at a sole dialysis centre in Somalia. METHOD: Over a one-month period, a cross-sectional study was conducted among women with end-stage renal disease aged 18-50 years who were undergoing a dialysis program for at least three months at the dialysis center of our hospital. The participants were married, and they were living with their partners. Data regarding the sociodemographic features, clinical characteristics, frequency of sexual intercourse per week, and the Female Sexual Function Index (FSFI) scores were collected using a standard face-to-face interview questionnaire. RESULTS: During the study period, a total of 115 participants were eligible for the study's inclusion criteria. The mean patient age was 38.5 ± 9.3 years. The most common cause of ESRD was diabetes, which accounted for 53%, followed by hypertension (26.1%) and glomerulonephritis (9.6%). The mean duration of dialysis was 2.9 ± 1.4 years, and approximately two-thirds of the participants (62.5%) were in the program for more than three years. Regarding the frequency of sexual intercourse, 61.7% of female participants performed sexual intercourse less than once time/a week. The prevalence of FSD was 92.2% (n = 106) of all participants. The mean FSFI score of the participants was 16.05 ± 4.48. Longer duration of dialysis program (i.e., more than four years), increasing age (i.e., > 35 years), those with diabetes had scored lower overall FSFI scores. CONCLUSION: The prevalence of female sexual dysfunction among Somali female hemodialysis patients was very high, representing a significant problem in end-stage renal disease (ESRD). Our study findings revealed that increasing age, diabetes, and duration of dialysis negatively impact female sexual function and are significantly associated with FSD.

Transforming Waste into Wealth: Advanced Carbon-Based Electrodes Derived from Refinery and Coal By-Products for Next-Generation Energy Storage.

This comprehensive review addresses the need for sustainable and efficient energy storage technologies against escalating global energy demand and environmental concerns. It explores the innovative utilization of waste materials from oil refineries and coal processing industries as precursors for carbon-based electrodes in next-generation energy storage systems, including batteries and supercapacitors. These waste-derived carbon materials, such as semi-coke, coal gasification fine ash, coal tar pitch, petroleum coke, and petroleum vacuum residue, offer a promising alternative to conventional electrode materials. They present an optimal balance of high carbon content and enhanced electrochemical properties while promoting environmental sustainability through effectively repurposing waste materials from coal and hydrocarbon industries. This review systematically examines recent advancements in fabricating and applying waste-derived carbon-based electrodes. It delves into the methodologies for converting industrial by-products into high-quality carbon electrodes, with a particular emphasis on carbonization and activation processes tailored to enhance the electrochemical performance of the derived materials. Key findings indicate that while higher carbonization temperatures may impede the development of a porous structure, using KOH as an activating agent has proven effective in developing mesoporous structures conducive to ion transport and storage. Moreover, incorporating heteroatom doping (with elements such as sulfur, potassium, and nitrogen) has shown promise in enhancing surface interactions and facilitating the diffusion process through increased availability of active sites, thereby demonstrating the potential for improved storage capabilities. The electrochemical performance of these waste-derived carbon materials is evaluated across various configurations and electrolytes. Challenges and future directions are identified, highlighting the need for a deeper understanding of the microstructural characteristics that influence electrochemical performance and advocating for interdisciplinary research to achieve precise control over material properties. This review contributes to advancing electrode material technology and promotes environmental sustainability by repurposing industrial waste into valuable resources for energy storage. It underscores the potential of waste-derived carbon materials in sustainably meeting global energy storage demands.

Enhancement of paediatric oncology pharmacy practices in a low-middle-income country through teaching and training using the My Child Matters Grant.

The development of a successful oncology pharmacy system includes competency training, cost-efficient procurement, proper storage, preparation and administration of chemotherapy, and appropriate waste disposal. Low-middle-income countries such as Pakistan face several challenges within the realm of oncology pharmacy such as the unavailability of training programmes, resources and financial support, and inconsistencies in the safe handling of cytotoxic drugs. The Indus Hospital and Health Network (IHHN) is among the pioneers of oncology pharmacy practices in Pakistan, with a well-established Oncology Pharmacy Team and chemotherapy preparation in accordance with the United States Pharmacopeia 797 and 800 safety guidelines. The My Child Matters Grant was awarded by the Sanofi Espoir Foundation to the Department of Paediatric Hematology and Oncology at IHHN for holistic improvement in childhood cancer care through teaching, training and capacity building. Partnerships were formed with five public-sector paediatric oncology units nationwide. Initiatives were taken to improve oncology pharmacy practices including teaching and training courses, in-person assessment visits, and mentorship and liaison efforts. Despite prevailing challenges, promising improvements were noted at each centre. However, Pakistan needs to establish a national plan for childhood cancer with the creation of regional organisations for the training and monitoring of oncology pharmacists. Centralisation of pharmacy operations within hospitals is essential to maintain the availability, storage, preparation and administration standards of chemotherapy.

Medical services at the FIFA world cup Qatar 2022.

OBJECTIVE: The Football World Cup is among the biggest sporting events in the world, but data to inform the requirements of medical care for such tournaments are limited. This study describes the athlete and team medical services at the FIFA World Cup Qatar 2022 . METHODS: Three different medical service entities were identified through a needs analysis based on expert advice, team physician interviews and questionnaires prior to the event: 'Team Services' to provide any workforce or equipment needs of the teams, a 'Polyclinic' to manage any acute medical demands, and a 'recovery centre' to improve game readiness throughout the tournament. All services had been set up prior to the tournament and thoroughly tested. RESULTS: Of a total of 832 athletes, ~1300 team delegation and ~130 match officials, 167 individuals including 129 (77%) athletes and 38 (23%) non-athletes were assessed in the polyclinic. For the 129 athletes (median 4 players per team), medical imaging was the most requested service, which peaked during the group phase of the tournament. Most requests were received during normal working hours despite many games finishing late at night. 30 of the 32 participating teams solicited medical services for their players at least once. Three teams made use of the recovery facilities, and 17 teams requested additional medical equipment or clinical assistance. CONCLUSION: Central imaging services was the most used medical resource at the FIFA World Cup Qatar 2022, and over half of teams required additional medical equipment or personnel. These data may inform planning of medical services for similar events in the future.

Early Change in Platelet Count and MPV Levels of Patients Who Received Hemodialysis for the First Time: Mogadishu Somalia Experience.

Introduction: Mean platelet volume (MPV) is a marker used to assess the platelet' size and is also an indicator of platelet reactivity and prothrombotic status. Objective: In this study, we aimed to determine the relationship between MPV and biochemical parameters in patients who had received hemodialysis (HD) for the first time and then in respect of those same patients after their fourth HD. Method: 151 HD patients were enrolled in this study. Patients were eligible for inclusion if they had received their first HD session during this study protocol. Prehemodialysis blood samples were taken. Most laboratory values, including mean platelet volume (MPV) level and platelets (PLT) count, were measured before the first HD and after the fourth HD session for each patient. Results: Among the patients in our study, the mean age profile of the male patients (n = 103; 68.2%) was found to be higher than that of the female patients (n = 48; 31.8%) (53.62 ± 18.19 vs. 46.17 ± 17.9 years) (p = 0.019).In the patients' laboratory results after the fourth HD session, MPV, MPV/Plt, and Na values had increased to those after the first HD session (p < 0.001). When age and gender status were taken into account, the level of weak positive correlation with white blood cell count (WBC), neutrophil, and red cell distribution width (RDW) was found, while the weak negative correlation with platelet to lymphocyte ratio (PLR) was found (p < 0.001). Conclusions: In our study, we found that increase in MPV and MPV/PLT levels was significant in the fourth HD session of patients with CKD. It is also debatable that there are findings indicating an increase in platelet reactivity in the first weeks of the onset of HD. This could be an early indicator of the early prevention of cardiovascular diseases.

Polymeric ethosomal gel loaded with nimodipine: Optimisation, pharmacokinetic and histopathological analysis.

This study was performed with the main objective of formulating and evaluating the potential of ethosomesl gel (Etho gel) to deliver nimodipine (NiM) for cardiovascular disease, a potent water insoluble anti-hypertensive drug via skin to reach the deeper layers of skin. The Box-Behnken design (BBD) was used to optimize the NiM-Eth to determine the impact of the independent and depended variables. The effectiveness of drug entrapment, vesicle size, and cumulative drug release were assessed for the NiM loaded ethosomes and NiM-Eth gel using carbopol 934 as a gelling agent. Fourier transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC), Power X-ray diffraction (PXRD), and scanning electron microscopy (SEM) analysis were performed and analysed their physicochemical characters. Rat abdomen skin was used to investigate drug permeability and deposition. As compared to marketed products, NiM-Eth gel produced an improved drug permeability in ex vivo experiments. The mean AUC0 to AUC0-∞ of NiM-Eth gel when compared to oral formulation (Nymalize oral preparation) was found to be increased from 4.1 to 5.9 folds which was found to be resulted from first pass effect. Histophatlogical findings revealed that the maximum amount of NiM penetrated the stratum corneum of the skin and create drug depots in the deep layer. In summary, it can be said that NiM might be successfully prepared in NiM-Eth gel for transdermal drug delivery.

Determining the Risk of Spontaneous Bacterial Peritonitis due to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites.

OBJECTIVES: The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites. METHODS: This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm3 (cases) and non-SBP with PMN count < 250 neutrophils/mm3 (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0. RESULTS: Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05). CONCLUSIONS: Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users.

Serum Elabela Levels Are Elevated in Patients with Hyperthyroidism.

The apelinergic system plays an important role in the modulation of the cardiovascular system via the apelin peptide and the apelin receptor (APJ receptor). Apelin and elabela, also known toddler, are peptide ligands for the apelin receptor. These two peptides show similar biological actions, such as vasodilatation, increased myocardial contractility, angiogenesis, and energy metabolism. However, the serum levels of elabela in patients with hyperthyroidism are not well known. The aim of this study was to investigate the changes in serum elabela levels in patients with hyperthyroidism and its association with hypertension. This cross-sectional study included 74 patients with newly diagnosed hyperthyroidism due to Graves' disease and 20 healthy individuals. Serum elabela levels were measured by enzyme-linked immunosorbent assay. The patients were divided into two groups: hyperthyroid patients without hypertension (n = 51) and those with hypertension (n = 23). Basal heart rate, serum glucose and high-sensitive C reactive protein were significantly higher in hyperthyroid patients with and those without hypertension than in healthy controls (p < 0.05 for each). Serum elabela levels were significantly elevated in hyperthyroid patients compared with healthy controls, with higher serum elabela levels found in hyperthyroid patients with hypertension than those without hypertension. Linear regression analysis showed that serum elabela levels were correlated with systolic blood pressure (p < 0.001). In conclusion, serum elabela levels were significantly increased in patients with hyperthyroidism, especially in hyperthyroid patients with hypertension. Elevation in serum elabela levels may contribute to alleviation of cardiovascular complications of hyperthyroidism and hypertension.

Coronary Artery Calcium Assessment in CKD: Utility in Cardiovascular Disease Risk Assessment and Treatment?

Coronary artery calcification (CAC) is a strong predictor of cardiovascular event rates in the general population, and scoring with multislice computed tomography commonly is used to improve risk stratification beyond clinical variables. CAC is accelerated in chronic kidney disease, but this occurs as a result of 2 distinct pathologic processes that result in medial (arteriosclerosis) and intimal (atherosclerosis) deposition. Although there are data that indicate that very high CAC scores may be associated with increased risk of death in hemodialysis, average CAC scores in most patients are elevated at a level at which discriminatory power may be reduced. There is a lack of data to guide management strategies in these patients based on CAC scores. There are even fewer data available for nondialysis patients, and it is uncertain whether CAC score confers an elevated risk of premature cardiovascular morbidity and mortality in such patients. In this article, we review the evidence regarding the utility of CAC score for noninvasive cardiovascular risk assessment in individuals with chronic kidney disease, using a clinical vignette that highlights some of the limitations in using CAC score and considerations in risk stratification.

Low antibody levels to pregnancy-specific malaria antigens and heightened cytokine responses associated with severe malaria in pregnancy.

BACKGROUND: Pregnant women living in unstable malaria transmission settings may develop severe malaria (SM). The pathogenesis of SM in pregnancy is poorly understood. METHODS: To determine whether SM in pregnancy is associated with lower malarial antibody responses and higher cytokine responses, plasma samples were collected from 121 Sudanese pregnant women of whom 39 were diagnosed with SM. Antibodies to pregnancy-specific and non-pregnancy-specific Plasmodium falciparum variant surface antigens (VSA) and concentrations of cytokines TNF, IFNγ, IL-1ß, IL-6, IL-8 and IL-10 were measured. RESULTS: Pregnant women with SM demonstrated significantly lower antibody levels to pregnancy-specific VSA (P = .020) and higher plasma IFNγ (P = .020), IL-10 (P = .0002) and IL-6 levels (P < .0001) than uninfected pregnant women. Concentrations of inflammatory cytokines IL-1ß (P = .001), IL-6 (P = .004) and IL-8 (P = .020) were inversely correlated with antibodies to VAR2CSA-DBL5 in pregnant women with SM. Lower haemoglobin levels and higher parasite densities were associated with lack of pregnancy-specific antibodies (P = .028) and higher levels of inflammatory cytokines, in particular IL-6 and IL-8. CONCLUSIONS: Pregnant women with SM lack pregnancy-specific malaria immunity, and this correlates with heightened inflammatory cytokine concentrations, low haemoglobin levels and high parasite density, suggesting that failure of antibody to control parasitaemia may contribute to SM pathogenesis.

Staphylococcus aureus bacteraemia in a UK tertiary referral centre: a 'transoesophageal echocardiogram for all' policy.

OBJECTIVES: Infective endocarditis (IE) is a feared complication in up to 38% of cases of Staphylococcus aureus bacteraemia (SAB). BSAC guidelines recommend echocardiography in all cases of SAB. The aim of this study was to determine the incidence of IE in SAB using transoesophageal echocardiography (TOE) as the first step in diagnostic imaging. This study also sought to identify clinical predictors that could improve stratification of those with and without IE. METHODS: A guideline was implemented that any SAB resulted in the microbiology department (i) recommending that the patient be referred for TOE and (ii) notifying the echocardiography department, resulting in streamlined listing of the patient for TOE. All cases of SAB were then assessed prospectively at University Hospitals Birmingham NHS Foundation Trust between September 2011 and October 2012. Previously identified risk factors for complicated S. aureus bacteraemia were recorded. RESULTS: There were 98 SAB episodes in total. TOE was performed in 58 (59%) with a further 22 episodes imaged by transthoracic echocardiography alone. IE was diagnosed overall in 13 (16%) cases investigated with echocardiography. No risk factor for IE other than presence of a cardiac device was detected in this group (P = 0.013). CONCLUSIONS: The rate of IE found in SAB is high when TOE is performed first line. There are no clear risk factors to improve yield or the type of echocardiography to be performed. Echocardiography should be performed in all cases and TOE should be considered where it is expected to influence management, as long as local resources allow.

Association between environmental tobacco smoke and periodontal disease: a systematic review.

The aim of the present study was to systematically review the association between environmental tobacco smoke (ETS) and periodontal disease. The addressed focused question was "Is there a relationship between ETS and periodontal disease?" PubMed/MEDLINE and Google-Scholar databases were searched from 1987 up to March 2014 using different combinations of the following keywords: "Environmental tobacco smoke", "passive", "periodontal disease", "secondhand" and "smoking". Letters to the Editor, review articles, commentaries, case-reports and articles published in languages other than English were excluded. Thirteen studies were included. Nine studies were clinical and 4 studies were performed in-vitro. Five studies reported the odds ratios for periodontal disease to be significantly higher among individuals exposed to ETS than controls (non-smoking individuals unexposed to ETS). In 2 studies, ETS exposure showed no association with periodontal disease. In 2 studies, salivary aspartate aminotransferase, lactoferrin and albumin levels were reported to be significantly higher in individuals exposed to ETS than controls. In one study, levels of salivary interleukin-1ß were reported to be significantly higher in individuals exposed to ETS than controls. The in-vitro studies reported ETS exposure to enhance the production of proinflammatory proteins and phagocytic activity of salivary polymorphonuclear leukocytes thereby contributing to periodontal disease. The association between ETS and periodontal disease remains debatable and requires further investigations.

Voices of Change: Stakeholders' Roles in the Fight Against Substance Abuse in Mogadishu, Somalia.

Aim: This study explores the roles, challenges, and collaborative efforts of key stakeholders engaged in addressing substance abuse. Methods: Using a qualitative narrative approach, the study examined stakeholder roles in tackling substance abuse in Mogadishu, Somalia. Purposive sampling was utilised to select all available community stakeholders actively addressing substance abuse. Semi-structured interviews were conducted to collect data, allowing participants the freedom to share their experiences openly. Thematic analysis was employed to identify patterns, commonalities, and diversities in the stakeholders' roles. The study focused on a population of five key stakeholders, including the Somali police force, a National Medicines Regulatory Authority officer, two social workers, and a representative from the Ministry of Endowments & Religious Affairs. Results: The research reveals a significant prevalence of psychoactive substances in Mogadishu, with emerging trends like the misuse of pregabalin driven by accessibility and affordability. Emphasising collaborative efforts, the study highlights the importance of effective communication and coordination among stakeholders to provide comprehensive support for individuals with substance abuse issues. Despite these challenges, such as limited resources, evolving drug trends, and addiction complexity, ongoing efforts and adaptation are crucial. Additionally, the research elucidates the established link between substance abuse and criminal behaviour, emphasising the potential consequences of drug addiction on financial desperation, violent acts, drug trafficking, and other criminal behaviours. Conclusion: The study reveals widespread substance abuse, necessitating adaptable authorities. Collaborative stakeholder efforts are vital for supporting individuals affected. Challenges demand sustained efforts. The study links substance abuse to crime. Effective resolution requires stakeholder unity, prevention programs, expanded treatment access, and adaptation to the evolving drug landscape while supporting those affected.

Hypokalemic periodic paralysis as the first sign of thyrotoxicosis- a rare case report from Somalia.

BACKGROUND: Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare complication of hyperthyroidism characterized by thyrotoxicosis, hypokalemia, and paralysis. It is the most common form of acquired periodic paralysis. THPP is precipitated by strenuous exercise, a high carbohydrate diet, stress, infection, alcohol, albuterol, and corticosteroid therapy. It is most common in Asian men with hyperthyroidism and exceptionally rare in black people. CASE PRESENTATION: A 29-year-old man was admitted to the emergency department in Somalia with a sudden onset of paralysis after a high carbohydrate meal. Laboratory investigations showed low serum potassium 1.8 mEq/l (3.5-4.5), and biochemical thyrotoxicosis with TSH 0.006 miu/l (0.35-5.1), total T3 3.2 ng/ml (0.9-2.8) and total T4 13.5 ng/ml (0.6-1.2). He was successfully treated with potassium chloride infusion and an antithyroid drug, methimazole. CONCLUSION: To prevent life-threatening cardiac and respiratory complications, it is critical to consider and diagnose THPP early, even in populations where the condition is rare.

Psychiatrists and homicidal threats: a cross-sectional study.

OBJECTIVES: To investigate the frequency, characteristics and impact of death threats by patients towards psychiatrists. METHODS: A cross-sectional survey of psychiatrists (n = 60) was undertaken to investigate the frequency, characteristics and impact of death threats by patients in one Irish healthcare region serving a mixed urban-rural population of 470,000. RESULTS: Forty-nine responses (82%) were received. Thirty-one per cent of respondents experienced death threats by patients during their careers. Victims were more likely to be male and in a consultant role. Patients making the threats were more likely to be males aged 30-60 with a history of violence and diagnosis of personality disorder and/or substance misuse. A majority of threats occurred in outpatient settings and identified a specific method of killing, usually by stabbing. Prosecution of the perpetrator was uncommon. Of the victimised psychiatrists, 53% reported that such threats affected their personal lives, and 67% believed their professional lives were impacted. In half of the incidents, there were adverse incidents subsequent to the threats, involving either the patient or the clinician. CONCLUSIONS: Death threats by patients have significant psychological and professional impacts on psychiatrists. Early liaison with employers and police and transferring the care of the patient to another clinician may be useful measures.