Neurofibroma: Case Series with Clinical Features and Recommendations.

Neurofibroma is an autosomal benign disorder. It can be localized, diffuse or invasive like plexiform neurofibroma that involves the nerves, muscle, tissues, skeleton. It represents itself as a destructive variant of neurofibroma, mostly present as orbital or periorbital neurofibroma or may be associated with autosomal dominant disease. Clinical diagnosis of neurofibromatosis (NF) according to National Institutes of Health (NIH) criteria should have more than two of the seven features including lisch nodules, cafe'- au-lait spots, plexiform neurofibroma, optic glioma, freckling, first degree relative with NF or dysplasia of cortical bones. However, proper early diagnosis is still crucial due to its various presentation such as cheek mass, painless swelling on skin, chalazion, intratracheal tumor, genital swelling or ptosis. It is reported that neurofibroma often represents as ocular or facial swelling. Here we are presenting features of neurofibroma of eight cases of patients from Civil Hospital, Karachi. These cases had main complain of overhanging skin mass mainly on orbital or periorbital region that damage the area and with poor daily activities. Multiple nodules on face and body along with them Cafe'-au-lait spots and lisch nodules were main signs. While, other signs i.e. ptosis, pterygium, telecanthus and muddy discoloration of conjunctiva need further evaluation for correlation with neurofibromatosis. Debulking surgery was planned for most of the cases but the huge disfigurement caused by overhanging skin mass and nodules made it a challenge for plastic surgeons to provide good outcomes with minimum damage. Keywords: neurofibroma; lisch nodules; ptosis; Cafe'-au-lait spot; periorbital; overhanging skin.

Bipolar disorder research 2.0: Web technologies for research capacity and knowledge translation.

RATIONALE, AIMS AND OBJECTIVES: Current Web technologies offer bipolar disorder (BD) researchers many untapped opportunities for conducting research and for promoting knowledge exchange. In the present paper, we document our experiences with a variety of Web 2.0 technologies in the context of an international BD research network: The Collaborative RESearch Team to Study psychosocial issues in BD (CREST.BD). METHODS: Three technologies were used as tools for enabling research within CREST.BD and for encouraging the dissemination of the results of our research: (1) the crestbd.ca website, (2) social networking tools (ie, Facebook, Twitter), and (3) several sorts of file sharing (ie YouTube, FileShare). For each Web technology, we collected quantitative assessments of their effectiveness (in reach, exposure, and engagement) over a 6-year timeframe (2010-2016). RESULTS: In general, many of our strategies were deemed successful for promoting knowledge exchange and other network goals. We discuss how we applied our Web analytics to inform adaptations and refinements of our Web 2.0 platforms to maximise knowledge exchange with people with BD, their supporters, and health care providers. CONCLUSIONS: We conclude with some general recommendations for other mental health researchers and research networks interested in pursuing Web 2.0 strategies.

Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond.

OBJECTIVES: To provide health care professionals in Canada with the basic knowledge and tools to provide nutrition guidance to women through their lifecycle. OUTCOMES: Optimal nutrition through the female lifecycle was evaluated, with specific focus on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The guideline begins with an overview of guidance for all women, followed by chapters that examine the evidence and provide recommendations for the promotion of healthy nutrition and body weight at each life stage. Nutrients of special concern and other considerations unique to each life stage are discussed in each chapter. EVIDENCE: Published literature, governmental and health agency reports, clinical practice guidelines, grey literature, and textbook sources were used in supporting the recommendations made in this document. VALUES: The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. CHAPTER 2: GENERAL FEMALE NUTRITION: Summary Statements Recommendations CHAPTER 3: ADOLESCENCE NUTRITION: Summary Statements Recommendations CHAPTER 4: PRE-CONCEPTUAL NUTRITION: Summary Statement Recommendations CHAPTER 5: NUTRITION IN PREGNANCY: Summary Statements Recommendations CHAPTER 6: POSTPARTUM NUTRITION AND LACTATION: Summary Statements Recommendations CHAPTER 7: NUTRITION DURING MENOPAUSE AND BEYOND: Summary Statement Recommendations.

Consensus canadien sur la nutrition féminine : adolescence, reproduction, ménopause et au-delà.

OBJECTIFS: Doter les professionnels de la santé du Canada de connaissances et d'outils de base, afin qu'ils puissent prodiguer des conseils nutritionnels aux femmes tout au long de leur cycle de vie. RéSULTATS: L'alimentation optimale a fait l'objet d'une évaluation tout au long du cycle de vie de la femme. Elle a porté en particulier sur l'adolescence, la préconception, la grossesse, la période post-partum, la ménopause et au-delà. Le présent guide fournit d'abord des directives abrégées à l'intention de toutes les femmes. Elles sont suivies de chapitres proposant un examen des données probantes, ainsi que des recommandations sur la promotion d'une alimentation saine et d'un poids santé à chaque étape de la vie. Par ailleurs, tous les chapitres présentent une analyse de nutriments d'intérêt particulier, ainsi que d'autres aspects uniques à chaque étape de la vie. DONNéES PROBANTES: Des documents publiés, des rapports d'organismes gouvernementaux et de santé, des lignes directrices de pratique clinique, de la documentation parallèle et des extraits de manuels ont servi à étayer les recommandations formulées dans le présent document. VALEURS: L'évaluation de la qualité des données probantes repose sur les critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. CHAPITRE 2 : CONSEILS GéNéRAUX SUR L'ALIMENTATION FéMININE: Déclarations Sommaires Recommandations CHAPITRE 3 : ALIMENTATION DE L'ADOLESCENTE: Déclarations Sommaires Recommandations CHAPITRE 4 : ALIMENTATION PRéCONCEPTIONNELLE: Déclarations Sommaires Recommandations CHAPITRE 5 : ALIMENTATION PENDANT LA GROSSESSE: Déclarations Sommaires Recommandations CHAPITRE 6 : ALIMENTATION ET LACTATION POST-PARTUM: Déclarations Sommaires Recommandations CHAPITRE 7 : ALIMENTATION PENDANT LA MéNOPAUSE ET AU-DELà: Déclarations Sommaires Recommandations.

Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: a pilot study.

BACKGROUND: The primary objective of this pilot study was to demonstrate reliable adherence to a group cognitive behavioral (CBT) therapy protocol when delivered using on-line video conferencing as compared with face-to-face delivery of group CBT. A secondary aim was to show comparability of changes in subject depression inventory scores between on-line and face-to-face delivery of group CBT. METHODS: We screened 31 individuals, 18 of whom met the criteria for a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) diagnosis of mood and/or anxiety disorder. All qualifying participants had the necessary equipment (computer, webcam, Internet) for participation in the study, but could exercise their preference for either the on-line or face-to-face format. Eighteen completed the 13 weekly session intervention program (ten face-to-face; eight video conferencing). We coded adherence to protocol in both intervention formats and generated pre-post changes in scores on the Beck Depression Inventory Second Edition (BDI-II) for each participant. RESULTS: Application of the CBT protocol coding system showed reliable adherence to the group CBT intervention protocol in both delivery formats. Similarly, qualitative analysis of the themes in group discussion indicated that both groups addressed similar issues. Pre-post intervention scores for the BDI-II were comparable across the two delivery formats, with 60% of participants in each group showing a positive change in BDI-II severity classification (eg, from moderate to low symptoms). CONCLUSION: This pilot study demonstrates that group CBT could be delivered in a technology-supported environment (on-line video conferencing) and can meet the same professional practice standards and outcomes as face-to-face delivery of the intervention program.

Clinically significant effects of group cognitive behavioral therapy on spouse caregivers' mental health and cognitive functioning: a pilot study.

The objective of this pilot study was to investigate whether group cognitive behavioral therapy (CBT) resulted in clinically meaningful improvements in caregiver mood, burden, and cognition. We screened 97 caregivers in Toronto, Canada, of whom 25 with DSM-IV disorders began the 13-week CBT intervention, and 12 completed therapy and the 3-month follow-up. Each caregiver experienced clinically significant improvement on at least 2 of the following outcomes: diagnostic criteria, mood, attention, memory, and caregiver burden. Despite effectiveness, the challenges of recruiting distressed caregivers for therapy suggest that CBT might be most useful as part of a stepped care model of treatment.

Feasibility of recruiting spouses with DSM-IV diagnoses for caregiver interventions.

BACKGROUND: Reviews and meta-analyses suggest that caregiver interventions have only been modestly effective in reducing caregiver distress. One possible reason is that many intervention studies have recruited heterogeneous caregivers with subclinical symptoms. This study examined the feasibility of recruiting a more homogenous group of caregivers with high clinical distress levels for an intensive therapy intervention. METHODS: During the 2-year study and under ideal circumstances, we recruited caregivers of community-dwelling older adults with dementia for group cognitive behavioral therapy at a University of Toronto affiliated and internationally recognized geriatric health sciences center. We used strict eligibility criteria to recruit primary spouse caregivers with a DSM-IV diagnosis, normal cognitive functioning, and clinically significant distress levels. RESULTS: Of the 97 caregivers screened, 61 were ineligible or uninterested. The 36 interested caregivers who met screening criteria completed a diagnostic intake assessment and only 28 were eligible to begin therapy. DISCUSSION: These results indicate that it would be extremely difficult for clinicians or researchers working in smaller cities or health care centers to run caregiver intervention groups using strict entrance criteria such as those employed in this study. The results of this study provide further support for the importance of diverse and tailored caregiver interventions.

Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues.

Neuropsychiatric problems, and how they interact to impact on quality of life (QOL) in brain tumor patients, are generally poorly understood. The objectives of this study were: (1) to document the prevalence of depression, fatigue, emotional distress, and existential issues in a sample of brain tumor patients (2) to examine the interconnectedness of these problems, and (3) to explore their relationship with disease-related variables and QOL. This is a cross-sectional, questionnaire-based survey of 73 patients with primary brain tumors who presented to a neurological clinic at a tertiary cancer centre for ongoing care. Data for 60 participants (29 women, 31 men) who completed validated questionnaires were retained for analysis. Results showed that there was a high burden of depressive symptoms as measured by the Beck Depression Inventory-II (mean score 11.1, SD 7.4), with 38% of the sample scoring in the clinically depressed range. Overall QOL scores for this sample were similar to a reference sample of brain tumor patients. The scores on the existential subscale of the McGill Quality of Life questionnaire were comparable to those of a reference sample of cancer patients receiving ongoing care (mean score 7.2; SD 1.7). Fifty per cent of the sample could be classified as struggling with existential issues. Although scores reflecting depression, fatigue, emotional distress, and existential problems were interrelated, the presence of depressive symptoms was the single most important independent predictor of QOL in this cohort of brain fumor patients. Implications for treatment are discussed.