Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review.

BACKGROUND: UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently 'detransition'. AIMS: To describe service users' access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify 'detransitioning'. METHOD: A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and 'accessing care' or 'other outcome'. RESULTS: The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7-19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1-1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1-17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1-4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning. CONCLUSIONS: Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.

Clinical and radiological predictors of outcome in tubercular meningitis: A prospective study of 209 patients.

OBJECTIVES: The predictors of poor outcome in tuberculous meningitis (TBM) remain to be delineated. We determined role of various clinical, radiological and cerebrospinal fluid (CSF) parameters in prediction of outcome in TBM. PATIENTS AND METHODS: Current study was a prospective observational study including 209 patients of TBM. All patients underwent detailed evaluation including Gadolinium enhanced Magnetic resonance imaging (GdMRI) of brain as well as tests to detect evidence of tuberculosis elsewhere in body. They also underwent GdMRI at three and nine month follow up. All patients received treatment as per standard guidelines. RESULTS: Mean age was 30.4±13.8years. 139 (66.5%) patients had definite TBM while 70 (34.5%) had highly probable TBM. 53 (25.4%) patients died. On univariate analysis, longer duration of illness, altered sensorium, stage III TBM, hydrocephalus and exudates correlated with poor outcome. On multivariate analysis presence of hydrocephalus (p=0.003; OR=3.2; 95% CI=1.5-6.7) and stage III TBM (p<0.0001; OR=8.7; 95% CI=3.7-20.2) correlated with higher risk of mortality. In addition, there was significant positive association between presence of hydrocephalus (p=0.05; OR=2.2; 95% CI=0.97-5.1), stage III TBM (p<0.0001; OR=28; 95% CI=4.9-158) and presence of altered sensorium (p=0.05; OR=22; 95% CI=0.99-4.8) with either death or survival with severe disability. CONCLUSIONS: It is possible to prognosticate TBM using a combination of clinical and radiological. The duration of illness (65.9±92days) before diagnosis of TBM continues to be unacceptably long and this stresses on need to educate primary care physicians about TBM. Future studies where intensity and duration of treatment is guided by these cues may help in sorting out some of the most difficult questions in TBM, namely duration of antitubercular therapy as well as dose and duration of steroid therapy etc.

Early hematological effects of chemo-radiation therapy in cancer patients and their pattern of recovery - A prospective single institution study.

UNLABELLED: The purpose of this prospective study is to understand the early hematological effects of chemo-radiation therapy in cancer patients, their pattern of recovery and to ascertain their prognostic value. METHODS: 255 diagnosed cancer patients planned for definitive treatment with radiation therapy alone or with chemotherapy were included in this two year prospective study. A complete blood count was done at baseline, weekly during the course of therapy and thereafter, monthly for a period of 6 months. For the purpose of grading clinical toxicity, the Common Toxicity Criteria, CTCAE v2.0 was used while RECIST criteria was used to define the tumor response rates. This study was statistically analyzed using SPSS software. RESULTS: 255 patients were included in the study wherein head and neck cancers comprised the major patient population (28.6%) followed by cervix (18.8%) and breast (15.7%). Out of these, 37% in head-and-neck cancer subgroup, and 58.3% in cervix had anemia at start of treatment. 92.2% cases with chemoradiation developed anemia during treatment, while with radiation alone it was 95.5%. This was statistically significant in patients with cancer uterine cervix (p 〈 0.01). At the end of treatment 65% patients with normal hemoglobin had complete responses (CR), while 58.3% with mild anemia and 33.3% with moderate anemia had CR (p=0.1). CONCLUSIONS: Severe anemia during treatment is a poor prognostic indicator and is usually a sign of advanced disease. Leucopenia and thrombocytopenia occur more commonly during chemoradiotherapy as against radiotherapy alone, but improves with supportive management.

Factors influencing posttransplantation employment: does depression have an impact?

BACKGROUND: Depressive disorders are the leading cause of disability in the United States. Liver transplant recipients often have significant psychiatric morbidity, including depression. One of the potential consequences of depression is the inability to work. OBJECTIVE: The objective of this study was to determine if there is any relationship between depression and posttransplantation employment status in liver transplant recipients. METHODS: Patients, 18 years of age or older, who had received liver transplants from January 2007 to July 2009 were identified for the retrospective analysis. Individual posttransplantation patient charts were reviewed for patient demographics, transplantation indication, employment history, depression diagnosis, and medications. The pretransplantation charts were used to obtain family psychiatric history, patient psychiatric history, past drug, alcohol, and tobacco use, and pretransplantation employment status. RESULTS: A total of 91 patients were evaluated, of which 59.3% were males and 40.7% were females, with a mean age of 56 years. In our sample, 23% and 29% of patients were depressed pretransplantation and posttransplantation, respectively. The number of unemployed patients also increased from 10.9%-23.1%. A logistic regression was performed to identify the factors influencing employment posttransplantation, which indicated pretransplantation employment, gender (males more likely to return to work), and depression post transplantation as significant factors with odds rations of 128, 4.1, and 11.5 and corresponding P values of <.0001, .04 and .008, respectively. CONCLUSION: Posttransplantation depression is significantly associated with post-liver transplantation unemployment. Improved management of depression may facilitate a patient's return to work after transplantation.

Whole saliva physico-biochemical changes and quality of life in head and neck cancer patients following conventional radiation therapy: a prospective longitudinal study.

BACKGROUND: We investigated the physico-biochemical changes in saliva and its relation to quality of life (QOL) in head and neck cancer patients following conventional radiation therapy (RT). MATERIALS AND METHODS: 53 consecutive head and neck cancer patients underwent conventional RT using telecobalt photons. We analyzed objective sialometry and sialochemical parameters of salivary gland function and a physician reported Oral Assessment Protocol to assess the patients' QOL during (baseline, 3 and 6 weeks) and post RT (3 and 6 months). Statistical analysis was done using SPSS software (version 15.0; SPSS, Inc., Chicago, IL, USA). RESULTS: Stimulated salivary flow rates had shown a consistent decline during and in post-RT analysis (P < 0.001). A significant correlation was seen between mean salivary flow rates at 6 months post-RT and mean salivary electrolytes and amylase levels during the same period (P < 0.001). Mean global QOL scores had significantly worsened during RT and were still significantly poorer at 6 months than initial pre-RT levels (P < 0.001). Further, significant correlation was established between salivary pH values with global QOL scores at 6 months (P = 0.05). CONCLUSIONS: Radiation-induced hyposalivation invariably persists and correlates with poor global QOL scores seen during and following conventional RT. Post RT, there is a trend for biochemical reversal toward pre-irradiation levels suggesting a subsiding inflammation or a probable functional recovery.

Endoscopic assessment of chloroquine phosphate-induced damage to esophageal, gastric, and duodenal mucosa.

Eighteen patients with Plasmodium vivax malaria were prospectively evaluated to assess the time of onset and extent of upper gastrointestinal mucosal injury caused by oral administration of four tablets (600-mg base) of chloroquine. Endoscopy was performed in the group of three separate patients. Each patient underwent endoscopy, both before the drug was given, and at intervals of 1, 2, 4, 12, 24, and 36 h. Before the drug was given, endoscopy was normal in all of the patients. However, mucosal erosions developed in four of 18 patients who were endoscoped 24 and 36 h after chloroquine ingestion (gastric, four; duodenal, two; esophageal, one). The same doses of chloroquine failed to produce any mucosal lesions when given to these four patients while they were afebrile and when given to 11 healthy individuals who served as controls. Poor correlation was noted between subjective symptoms and endoscopic findings. In conclusion, neither malaria alone nor chloroquine alone causes mucosal lesions. However, chloroquine administered during malarial fever causes mucosal damage in susceptible individuals.

Prevalence of psychiatric morbidity among medical in-patients.

One hundred patients admitted in medical wards of G. G. S. Medical College, Faridkot, were examined for presence of Psychiatric illness. 31 cases were found to be suffering from some sort of psychiatric illness. Out of 31, 16 patients were found to be suffering from primary affective disorders and physical symptoms in them appeared to be direct consequences of depression. Other psychiatric morbidity was constituted by hysteria (6), organic bran syndrome (5), anxiety neuroses (3) and schizophrenia (l). Psychiatric cases were found to be maximum in age group of 31-60 years and more patients belonged to middle class. Relationship of psychiatric illness with duration and type of medical illness is also discussed.

An epidemiological study of psychiatric disorders in rural faridkot (punjab).

Epidemiological study of priority psychiatric disorders in a rural area of Faridkot it described. Prevalence is found to be 22.12 per thousand and this is comparable to figures reported by other studies. The prevalence is highest in age group of 35-44, males are more affected than females, and prevalence it more in widows and divorced. Psychiatric morbidity is found to be more in nuclear families as compared to joint families. Among various diagnostic categories prevalence of Manic depressive psychoses (13.08 per thousand) is found to be most common. The implications of the above observations are discussed and compared with the previous reported studies.