Experience of psychologists in the delivery of cognitive behaviour therapy in a non-western culture for treatment of substance abuse: a qualitative study.

BACKGROUND: Psychotherapy is the preferred form of treatment for psychological disorders worldwide. Cognitive behaviour therapy (CBT) is one of the most widely used psychotherapies due to its proven efficacy for psychological disorders, including substance abuse. However, CBT was developed in the West according to the culture of developed countries. Therefore, it requires cross-cultural adaptation for non-Western countries. Pakistan is one of the developing non-Western countries where substance use disorders are increasing at an alarming rate. Despite the proven efficacy of CBT for substance use disorders, there is a dearth of its utilization in Pakistan. Therefore, in the present study, in-depth qualitative interviews were conducted with CBT practitioners in Pakistan to understand barriers and challenges in this regard. The study was a part of a broader project aimed at cultural adaptation of CBT for people with substance use disorders (SUDs) in Pakistan. METHODS: In-depth qualitative interviews were conducted with CBT practitioners (N = 8) working in rehabilitation centres and hospitals in Islamabad, Pakistan. Thematic content analysis was conducted to develop core themes from the data. RESULTS: CBT for SUDs requires some adjustments according to Pakistani culture for successful utilization. The challenges in providing CBT for SUDs revolved around three main themes, i.e., the mental health system, societal practices, and therapeutic issues, and 10 subthemes. CONCLUSION: In order to utilize the benefits of CBT for SUDs in Pakistan, cultural adaptation is necessary as an initial step. However, its delivery requires stringent modifications in the health care system to address these challenges.

Determinants Of Bowel Resection In Childhood Intussusception.

BACKGROUND: Intussusception is an acute surgical emergency and one of the most common causes of acute abdomen in early paediatric age group with peak incidence between 3 months to 3 years. It is considered the most common cause of intestinal obstruction in first two years of life. Early diagnosis and management may prevent major complications of bowel ischemia and necrosis thus avoiding morbidity and mortality. Our objective was to evaluate the risk factors or determinants of bowel resection in childhood intussusception. METHODS: It is a prospective, descriptive and cross-sectional study in which 102 consecutive cases of intussusception presenting to The Children's Hospital PIMS, from January 2018 to May 2019, were included. RESULTS: Total 102 patients were included in the study. Seventy-three (71.6%) were male and 29 (28.4%) were female. Mean age at presentation was 16.30 months (ranged from 1 day to 9 years). Mean duration of symptoms was 3.1 days. 52.9% (53/102) patients had mass palpable on abdominal examination while 22.5% (23/102) had palpable mass on digital rectal examination (DRE). Mean haemoglobin at presentation was 10.2 g/dL (min 4g/dL, max 26g/dL) and mean haematocrit was 32.6%. The most common type of intussusception was ileo-colic (57.8%) followed by ileo-ileal (21.6%). 36.3% (37/102) patients had to undergo bowel resection due to bowel gangrene/necrosis while in 66 (64.7%) patients had manual reduction. Statistically significant relationship was found between resection and duration of symptoms more than 24 hours (p=0.01, CI=95% OR= 6.24), haemoglobin less than 10g/dL (p=0.022, CI=95% OR=2.78) and haematocrit less than 30% (p=0.028, CI=95% OR=2.63). CONCLUSIONS: Prevention of anaemia and early presentation to a facility where trained paediatric surgeons are available can reduce the chances of bowel resection in childhood intussusception.

Human chorionic gonadotropin: a model molecule for oligopeptide-based drug discovery.

Small degradation products of proteins can have regulatory powers in biological systems. We have studied the role of selected oligopeptides derived from the pregnancy hormone human chorionic gonadotropin (hCG) in several(patho)physiological systems. The employed oligopeptides (3 up to 7 amino acids) were designed according to the known nick sites in 'loop-2' of ß-hCG. These oligopeptides can inhibit severe inflammation, the onset of type I diabetes, renal failure and tumorigenesis. One of the oligopeptides (AQGV) appeared capable of accelerating recuperation after lethal radiation of mice, thereby reducing the number of deaths among the irradiated mice. This particular oligopeptide has already been successfully tested in human Phase I and IIa studies. Regulating oligopeptides are not only released as a specific subset by degradation of the pregnancy hormone hCG, but also during the degradation of other body proteins and possibly also by transcription of so-called 'non-coding' mRNA. Based on a system's biology approach we designed a series of oligopeptides with particular physico-chemical properties based on the primary structure of ß-catenin and C-reactive protein (CRP). Several of the designed oligopeptides were able to inhibit vital genes involved in cell division in a plant model. We call such oligopeptides with regulating activity 'peptide-i' peptides, referring to their ability to interfere with the expression of particular genes, and thus with the expression of the related biological activities. The fact that the selected oligopeptides can inhibit the multiplication of plant cells suggests that these peptides, through evolution, are part of a hitherto unknown conserved regulatory system. Based on the data presented we foresee the development of many new regulatory oligopeptide-based pharmaceuticals, which could be a serious option for addressing new therapeutic challenges.

Chick feed technique versus standard chop technique in micro incision cataract surgery.

BACKGROUND: The important factor for improving the cataract surgery is reduction in size of corneal incision. Small incision results in less induced astigmatism, and faster visual rehabilitation. METHODS: An analysis of 100 eyes of 80 patients operated for phacoemulsification through micro incision by standard chop technique (50 eyes) in group-I, and chick feed technique (50 eyes) in group-II is presented. All of the patients were operated on by posterior limbal corneal incision under topical or sub-tenon anesthesia. In all patients, posterior chamber bag fixation foldable intraocular lens implantation was performed through 1.4 to 1.6 mm corneal incision. RESULTS: Forty patients (80%) out of fifty operated in group-2 had an over all visual recovery of 6/12 to 6/9 on day one post operative, as compared to group-1 where only ten (20%) patients out of fifty had visual recovery of 6/12 to 6/9. In the second week, out of 37 patients operated in group-2, thirty patients (81%) had visual acuity 6/6. Similarly in second week post operative, out of forty three patients operated in group-1, only eighteen patients (41.8%) had V/A of 6/6. Maximum visual recovery was observed in early post operative phase in group-2 patients. CONCLUSION: The chick feed technique has been proved to be the most compromising method in micro incision cataract surgery, as compared to standard chop method, due to its capability of working on low energy and negligible vacuum.

Non phaco suture less cataract extraction through temporal approach.

BACKGROUND: Non Phaco suture less cataract extraction through temporal approach retains most of the advantages of phacoemulsification but can be delivered at lower cost with better visual out come. METHODS: Extra capsular cataract extraction followed by posterior chamber intraocular lens implantation was performed, on 300 eyes of 250 patients. The technique involved was posterior limbal corneal tunnel incision through temporal approach, followed by implantation of PMMA posterior chamber intraocular lens. Visual acuity at the time of discharge, third post operative week and sixth week was recorded. Surgically induced astigmatism was reported. RESULTS: The uncorrected visual acuity at discharge was 6/18 or better in 63.2% eyes. The best corrected visual acuity was 6/9 and better in 96.0% subjects at six weeks. Poor visual outcome (< 6/60) occurred in 0.5% eyes. 0.4% subjects had posterior capsule rent followed by vitreous show. There was no increase in against the rule astigmatism, as the corneal incision was given through temporal approach. CONCLUSION: Suture less manual extra capsular cataract surgery through temporal approach ensures rapid visual recovery with minimum astigmatism against rule.