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1.
Artigo em Inglês | MEDLINE | ID: mdl-31661852

RESUMO

The rapid economic growth in Asian countries has witnessed a persistent increase in air pollution complementing adverse health challenges for children in these countries. Quantification of health effects attributable to air pollution (PM2.5) is important in policy implications to tackle air pollution and associated health problems. This study aims to explore the nexus between air pollution and neonates' deaths embedded in acute respiratory infection. We collected panel data from the 12 most vulnerable Asian countries over the period of 2000-2017 and analyzed through the fixed-effect model. Empirical results show a positive relation between air pollution, temperature, and neonates' deaths in the studied Asian countries. The results have attested negative impacts of income and education while positive effect of population density on neonates' deaths due to acute respiratory infection. Diagnostic and prognostic measures have checked the pace of the respiratory diseases caused by PM2.5 and resultant deaths in Asian countries; yet alarming factors, like mounting industrial air pollution and rapid expansion of industrial zones in urban areas, need to be addressed in policy implications for long term sustainable solutions.

2.
Hum Genet ; 138(10): 1183-1200, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471722

RESUMO

The glutamate pyruvate transaminase 2 (GPT2) gene produces a nuclear-encoded mitochondrial enzyme that catalyzes the reversible transfer of an amino group from glutamate to pyruvate, generating alanine and alpha-ketoglutarate. Recessive mutations in GPT2 have been recently identified in a new syndrome involving intellectual and developmental disability (IDD), postnatal microcephaly, and spastic paraplegia. We have identified additional families with recessive GPT2 mutations and expanded the phenotype to include small stature. GPT2 loss-of-function mutations were identified in four families, nine patients total, including: a homozygous mutation in one child [c.775T>C (p.C259R)]; compound heterozygous mutations in two siblings [c.812A>C (p.N271T)/c.1432_1433delGT (p.V478Rfs*73)]; a novel homozygous, putative splicing mutation [c.1035C>T (p.G345=)]; and finally, a recurrent mutation, previously identified in a distinct family [c.1210C>T (p.R404*)]. All patients were diagnosed with IDD. A majority of patients had remarkably small stature throughout development, many < 1st percentile for height and weight. Given the potential biological function of GPT2 in cellular growth, this phenotype is strongly suggestive of a newly identified clinical susceptibility. Further, homozygous GPT2 mutations manifested in at least 2 of 176 families with IDD (approximately 1.1%) in a Pakistani cohort, thereby representing a relatively common cause of recessive IDD in this population, with recurrence of the p.R404* mutation in this population. Based on variants in the ExAC database, we estimated that approximately 1 in 248 individuals are carriers of moderately or severely deleterious variants in GPT2.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/genética , Genes Recessivos , Predisposição Genética para Doença , Mutação , Fenótipo , Transaminases/genética , Adolescente , Alelos , Substituição de Aminoácidos , Deficiências do Desenvolvimento/metabolismo , Ativação Enzimática , Éxons , Feminino , Frequência do Gene , Estudos de Associação Genética , Genética Populacional , Genótipo , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/genética , Imagem por Ressonância Magnética , Masculino , Mitocôndrias/genética , Mitocôndrias/metabolismo , Modelos Moleculares , Linhagem , Conformação Proteica , Sítios de Splice de RNA , Análise de Sequência de DNA , Relação Estrutura-Atividade , Transaminases/química , Transaminases/metabolismo
3.
Artigo em Inglês | MEDLINE | ID: mdl-31261672

RESUMO

The spread of dengue has become a major public health concern in recent times due to alarming climate change. Using country level panel data over the 2000-2017 period, this paper examines the effects of climate change and socio-economic variables on the incidence of dengue-borne diseases in some of the most highly vulnerable countries. Empirical analysis shows a positive association between climate change and socio-economic conditions in the advent of dengue-borne diseases. We find that climate change, as measured by temperature, is proactively contributing to the spread of dengue-borne diseases. However, redressing the contributive factor behind climate change, via better awareness through education and improved public health facilitation, can assist in managing the occurrences and spread of dengue-borne diseases.

4.
Psychiatry Res ; 278: 242-247, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31229838

RESUMO

Association of cannabis use with schizophrenia is a well-established finding. Its role in causation, however, is debated. Different studies have found that cannabis use impacts the outcome of schizophrenia and is associated with treatment non-adherence and a higher rate of relapses. In this paper, we investigated the impact of self-reported cannabis use on treatment response in a cohort of schizophrenia patients from Pakistan, a middle-income country. The data was collected from a psychiatric hospital in Khyber Pakhtunkhwa province of Pakistan where cannabis use is prevalent. Clinical evaluation and therapeutic response were established using the Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impressions Scales-Severity (CGI-S) and Improvement (CGI-I) scale. Lack of response to adequate treatment with two trials of antipsychotics was classed as treatment resistance. We compared the treatment-resistant and treatment responsive groups for different variables including cannabis use, age at onset of illness, duration of untreated psychosis and consanguinity. We had data on 230 patients. More than ninety percent of our participants were men. The rate of treatment resistance was over 60%. Ongoing use of cannabis had an association with treatment resistance. We only included cases where treatment adherence was not a problem.

5.
Int J Dermatol ; 58(8): 946-952, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077348

RESUMO

BACKGROUND: Autosomal recessive wooly hair/hypotrichosis is an inherited disorder of hair characterized by less dense, short, and tightly curled hair on the scalp and sometimes less dense to complete absence of eyebrows and eyelashes. Autosomal recessive wooly hair/hypotrichosis phenotypes are mostly associated with pathogenic sequence variants in LIPH and LPAR6 genes. METHODS: To find out the molecular basis of the disease, five families with autosomal recessive wooly hair/hypotrichosis were recruited for genetic analysis. Direct Sanger sequencing of LIPH and LPAR6 genes was carried out using BigDye chain termination chemistry. P2RY5 protein homology models were developed to study the effect of mutation on protein structure in a family having novel mutation. RESULTS: Sanger sequencing revealed a novel homozygous missense mutation (c.47A>T) in the LPAR6 gene in family A, while recurrent mutation (c.436G>A) was detected in the rest of the four families (B-E). Protein homology models for both native and mutant P2RY5 protein were developed to study the difference in subtle structural features because of Lys16Met (K16M) mutation. We observed that P2RY5K16M mutation results decrease in the number of ionic interactions detrimental to the protein stability. Protein modeling studies revealed that the novel mutation identified here decreased the number of ionic interactions by affecting physicochemical parameters of the protein, leading to an overall decrease in protein stability with no major secondary structural changes. CONCLUSION: The molecular analysis further confirms the frequent involvement of LPAR6 in autosomal recessive wooly hair/hypotrichosis, while the bioinformatic study revealed that the missense mutation destabilizes the overall structure of P2RY5 protein.

6.
Chemosphere ; 227: 72-81, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30981972

RESUMO

Although biochar and conventional organic materials have been widely studied for lowering cadmium (Cd) uptake by plants but information regarding their comparative effectiveness is lacking. In this study, biochars from different feedstocks viz. rice husk biochar (RHB), cotton sticks biochar (CSB) and wheat straw biochar (WSB) were compared with conventional organic materials viz. farm manure (FM), poultry manure (PM) and press mud (PrMd) for their effectiveness to promote plant growth and to reduce Cd uptake by wheat and rice plants grown rotationally in a Cd-spiked (50 mg kg-1) soil. Each amendment was applied at the rate of 2% (w/w) in three replicates. Results showed that the application of amendments improved the soil properties and plant growth, by retaining Cd in the soil and restricting its uptake by plants. The amendments decreased the ammonium bicarbonate diethylene penta acetic acid extractable soil Cd, and improved soil organic carbon (SOC) and cation exchange capacity (CEC) as compared to only Cd-contaminated soil. The highest SOC content of 2.68 and 1.68% and CEC of 8.77 and 9.39 cmolc kg-1 were found in RHB treated post-wheat and post-rice soil, respectively. Amendments treated soil showed lower concentrations of bioavailable Cd and the maximum reduction was recorded in RHB and PrMd amended soil. Similarly, bioaccumulation of Cd was decreased with the application of all amendments; the maximum decrease was recorded in RHB and PrMd treated soil. Our results suggested that RHB and PrMd could be used for reducing the bioaccumulation of Cd in cereal grains in alkaline soils.


Assuntos
Agricultura/métodos , Carvão Vegetal/química , Grão Comestível/química , Fertilizantes , Poluentes do Solo/química , Cádmio/análise , Cádmio/toxicidade , Poluição Ambiental , Recuperação e Remediação Ambiental/métodos , Esterco , Oryza/crescimento & desenvolvimento , Fotossíntese , Solo/química , Poluentes do Solo/análise , Poluentes do Solo/toxicidade , Triticum/crescimento & desenvolvimento
7.
Chemosphere ; 226: 454-462, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30951940

RESUMO

Food contamination with cadmium (Cd) is a serious health threat to humans worldwide and Cd accumulation by rice is a major source of Cd entrance to the food chain. Silicon (Si) application decreases the Cd content in rice but the timing of Si application may need further investigation. The present study investigated the effect of split application of Si in the soil (600 kg/ha of Si) at different growth stages of rice on the growth and Cd accumulation by rice under Cd stress. Rice plants were grown in the presence and absence of Cd and Si was applied in the soil at different growth stages of rice under Cd stress. The results indicated that Cd stress alone reduced the growth and photosynthesis and increased the Cd content in different tissues and grains of rice. Silicon application improved the plant growth and reduced the Cd accumulation, translocation factor, and bioaccumulation factor in rice especially in grains, whereas the response of Si varied with the application of Si at different growth stages. The application of Si in three splits (transplanting (S1), tillering (S2), panicle initiation (S3)) was the best in improving growth and reducing Cd concentrations in plants compared to other combinations of Si application. Silicon application in three splits (S1+S2+S3) reduced the grain Cd concentrations below the threshold level (0.2 mg/kg) and reduced the Cd health risk index under the experimental conditions. Overall, split application of Si at three growth stages may function as remediator and diminishes Cd uptake into rice grains.


Assuntos
Cádmio/química , Oryza/química , Silício/química , Poluentes do Solo/química , Solo/química , Fotossíntese
8.
Chemosphere ; 225: 785-795, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30903852

RESUMO

The study aimed to assess the physicochemical parameters (pH, electrical conductivity (EC), total dissolve solid (TDS), oxidation reduction potential (ORP), Temperature) and potential toxic metals (PTMs), including Ni, Mn, Cr, Cu, Cd, Pb, Co, Fe and Zn in the groundwater of Lower Dir, Pakistan. Furthermore, the pollution sources and spatial distribution pattern of PTMs were also investigated via principal component analysis (PCA) and geographic information system (GIS) application to understand the changing behaviors of PTMs in groundwater. The average concentrations of physicochemical parameters such as pH, EC, TDS, ORP and Temperature were 7.1, 418 µS/cm, 251 mg/L, 193 mV and 25.7 ○C, while the concentrations of PTMs; Ni, Mn, Cr, Cu, Cd, Pb, Co, Fe and Zn were 0.25, 0.34, 0.09, 0.29, 0.10, 0.08, 0.10, 0.83 and 0.25  mg/L, respectively. Among the selected metals, Mn, Cr, Cd, Pb, Co and Fe were exceeded the WHO guidelines and their percentage contribution were 43%, 57%, 45%, 70%, 70% and 62%, respectively. The increasing order of PTMs were; Pb > Co > Fe > Cr > Cd > Mn > Cu > Ni > Zn in the study area. PCA represented three significant factors, which explained 76% variability in the groundwater. Whereas, clustering analysis (CA) grouped groundwater into three distinct clusters less polluted (C1), moderate polluted (C2) and highly polluted (C3). Human health risk assessment was carried out to check the suitability of groundwater for drinking and domestic uses. The HQ and HRIs values of Cd were >1, suggested that the groundwater sources are unfit for drinking and domestic purposes and may be caused potential health risk after long term ingestion.


Assuntos
Sistemas de Informação Geográfica , Água Subterrânea/química , Metais Pesados/toxicidade , Medição de Risco , Monitoramento Ambiental/métodos , Poluição Ambiental , Humanos , Análise Multivariada , Paquistão , Poluentes Químicos da Água/toxicidade , Qualidade da Água
9.
J Womens Health (Larchmt) ; 28(2): 225-232, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30596542

RESUMO

BACKGROUND: Gender difference in the workplace continues to be a subject of great discussion. Cross-sectional studies demonstrate that women are often underrepresented in key leadership roles. We sought to examine the proportion of women in cardiology leadership positions and to compare the findings with the differences prevalent in the overall cardiology faculty. Furthermore, we aspired to compare the proportion of women in leadership positions to the proportion in which they entered the cardiology field. METHODS: This is a cross-sectional online study of Cardiology fellowship programs identified by American Medical Association's Fellowship and Residency Electronic Interactive Database (AMA FREIDA), conducted from March to April 2017. Data of all (n = 512) cardiology fellowship program directors as well as 69% (n = 140) cardiology division chiefs were collected. RESULTS: A lower percentage of women held the role of division chief (5% vs. 95%) and program director (14% vs. 86%). However, when compared to the proportion of women in the 1992 fellowship cohort, women were significantly overrepresented in the role of program directors, with no significant difference in representation at the level of division chief. When compared to the overall cardiology faculty, program directors had significantly more publications and were more likely to have an academic rank of full professor (40% vs. 28%) or associate professor (37% vs. 23%). Male program directors had a significantly higher number of research publications, H-index, and academic rank than their female counterparts; however, such difference was not seen at the level of division chief. CONCLUSIONS: Gender difference is present in both program director and division chief roles. However, when compared to the historical cohort, significant overrepresentation of women was seen in the program director position, while proportionate representation was seen in the division chief role.

10.
BJPsych Bull ; : 1-9, 2018 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-30261942

RESUMO

Aims and methodTo systematically review the literature on barriers to the use of clozapine and identify any interventions for optimizing clozapine use in treatment-resistant schizophrenia. Journal databases were searched from 1972 to March 2018. The following search terms were used: treatment-resistant schizophrenia, clozapine, barriers, use, prescription rates, implementation, clozaril and prescribing practices. Following a review of the literature, 15 papers were included in the review. RESULTS: The major barriers that were identified included mandatory blood testing, fear of serious side-effects and lack of adherence by the patients, difficulty in identifying suitable patients, service fragmentation, and inadequate training in or exposure to using clozapine.Clinical implicationsIn view of consistent evidence across the studies on inadequate knowledge and skills as a significant barrier, we suggest that a certification requiring competence in initiating and managing side-effects of clozapine becomes a mandatory requirement in training programmes.Declarations of interestNone.

11.
J Family Community Med ; 25(3): 211-216, 2018 Sep-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30220853

RESUMO

BACKGROUND: Many medical students, junior doctors, and other health-care professionals have been affected by the negative experience of bullying. Research is scarce on bullying experienced by medical and nonmedical students in Saudi Arabia unlike what is found in Western countries. It is unclear whether being a nonmedical student modifies the risk of being bullied. MATERIALS AND METHODS: A cross-sectional study included 400 university students using convenient sampling. The sample comprised 295 students who responded and were stratified into medical (n = 176) and nonmedical (n = 119) groups. Statistical Package for the Social Sciences (SPSS) version 22.0 was used to analyze our data. Normality was measured using the Kolmogorov-Smirnov test. Statistical significance was tested using chi-square test for categorical variables, and t-test for continuous variables. RESULTS: Almost half of the respondents were found to have experienced some bullying, victimization, or other harassment during their medical education. The most common forms of bullying were verbal abuse and undue pressure to produce work (43.8%; n = 77). Nonmedical students experienced more bullying than medical students and were more likely to be female, single, and younger in age. The number of medical students subjected to sexual harassment (1.7%; n = 3) was higher than nonmedical students (0.8%; n = 1). Physical violence was more towards nonmedical (4.2%; n = 5) than medical students (1.1%, n = 2). The rates of bullying continue to be associated with anxiety and depression. CONCLUSIONS: Our data suggest similar bullying rates in the developed world but higher than previously reported in a Saudi study. Bullying or harassment affects both medical and nonmedical students and is associated with high levels of anxiety and depression.

12.
Case Rep Cardiol ; 2018: 6913737, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30034885

RESUMO

Iatrogenic aortocoronary arteriovenous fistula is a very rare complication of coronary artery bypass grafting in which one of the arterial grafts inadvertently forms a fistulous tract with a cardiac vein, shunting blood from the anastomosed coronary artery. We report a patient with an iatrogenic left internal mammary artery graft to cardiac vein fistula presenting with recurrent angina three years after a three-vessel coronary artery bypass grafting.

13.
Hum Mol Genet ; 27(18): 3177-3188, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-29893856

RESUMO

Exploring genes and pathways underlying intellectual disability (ID) provides insight into brain development and function, clarifying the complex puzzle of how cognition develops. As part of ongoing systematic studies to identify candidate ID genes, linkage analysis and next-generation sequencing revealed Zinc Finger and BTB Domain Containing 11 (ZBTB11) as a novel candidate ID gene. ZBTB11 encodes a little-studied transcription regulator, and the two identified missense variants in this study are predicted to disrupt canonical Zn2+-binding residues of its C2H2 zinc finger domain, leading to possible altered DNA binding. Using HEK293T cells transfected with wild-type and mutant GFP-ZBTB11 constructs, we found the ZBTB11 mutants being excluded from the nucleolus, where the wild-type recombinant protein is predominantly localized. Pathway analysis applied to ChIP-seq data deposited in the ENCODE database supports the localization of ZBTB11 in nucleoli, highlighting associated pathways such as ribosomal RNA synthesis, ribosomal assembly, RNA modification and stress sensing, and provides a direct link between subcellular ZBTB11 location and its function. Furthermore, given the report of prominent brain and spinal cord degeneration in a zebrafish Zbtb11 mutant, we investigated ZBTB11-ortholog knockdown in Drosophila melanogaster brain by targeting RNAi using the UAS/Gal4 system. The observed approximate reduction to a third of the mushroom body size-possibly through neuronal reduction or degeneration-may affect neuronal circuits in the brain that are required for adaptive behavior, specifying the role of this gene in the nervous system. In conclusion, we report two ID families segregating ZBTB11 biallelic mutations disrupting Zn2+-binding motifs and provide functional evidence linking ZBTB11 dysfunction to this phenotype.

14.
Cureus ; 10(3): e2392, 2018 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-29850387

RESUMO

Angioedema is a localized, non-pitting, non-dependent, submucosal, and subcutaneous swelling resulting from the extravasation of fluid into the interstitium due to the increased production of plasma kinins and histamine. It can present with urticaria or anaphylaxis and is usually associated with angiotensin-converting enzyme inhibitors (ACEis), complement deficiencies, or the side effects of tissue plasminogen activator (tPA). Orolingual angioedema following tPA for acute ischemic stroke is a transient, self-resolving hemifacial swelling contralateral to neurological deficits that can rarely progress to the airway, compromising it and leading to a life-threatening situation if not managed promptly.

15.
Cureus ; 10(4): e2453, 2018 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-29888157

RESUMO

Pyomyositis is an acute or sub-acute primary infection of the striated muscles. It is commonly misdiagnosed in its early stages due to its nonspecific presentation and lower suspicion among physicians when it comes to diagnosis. It has been historically associated with tropical climates but is being seen with increasing incidence in temperate regions. In both tropical and temperate areas, Staphylococcus aureus is the most common causative organism; gram-negative organisms are rare and traditionally only seen in immunocompromised patients. We report a case of Klebsiella pneumoniae pyomyositis in an immunocompetent patient with no risk factors. The awareness of the possibility of gram-negative pyomyositis in immunocompetent patients will broaden initial empiric antibiotic treatment, especially in those patients not responding to traditional empiric treatment.

16.
Cureus ; 10(3): e2266, 2018 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-29736351

RESUMO

Pacemaker-lead-associated right ventricular perforation is a life-threatening complication. Acute perforation usually presents within 24 hours. Patients with lead perforation are often asymptomatic but fatal complications like hemopericardium, leading to cardiac tamponade and death, are reported. Diagnosis is based on chest x-ray, computed tomography (CT) scan, and echocardiography. The management of the lead perforation is based on clinical presentation. Extraction is avoided in cases of chronic asymptomatic lead perforations because of the associated complications. Urgent intervention is needed in hemodynamically unstable patients with pericardial effusion or cardiac tamponade physiology.

17.
J Pediatr Genet ; 7(2): 60-66, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29707406

RESUMO

Bilateral frontoparietal polymicrogyria (BFPP, MIM 606854) is a heterogeneous autosomal recessive disorder of abnormal cortical lamination, leading to moderate-to-severe intellectual disability (ID), seizure disorder, and motor difficulties, and caused by mutations in the G protein-coupled receptor 56 ( GPR56 ) gene. Twenty-eight mutations in 40 different families have been reported in the literature. The clinical and neuroimaging phenotype is consistent in these cases. The BFPP cortex consists of numerous small gyral cells, with scalloping of the cortical-white matter junction. There are also associated white matter, brain stem, and cerebellar changes. GPR56 is a member of an adhesion G protein-coupled receptor family with a very long N-terminal stalk and seven transmembrane domains. In this study, we identified three families from Pakistan, ascertained primarily for ID, with overlapping approximately 1 Mb region (chr16:56,973,335-57,942,866) of homozygosity by descent, including 24 RefSeq genes. We found three GPR56 homozygous mutations, using next-generation sequencing. These mutations include a substitutional variant, c.1460T > C; p.L487P, (chr16:57693480 T > C), a 13-bp insertion causing the frameshift and truncating mutation, p.Leu269Hisfs*21 (NM_005682.6:c.803_804insCCATGGAGGTGCT; Chr16: 57689345_57689346insCCATGGAGGTGCT), and a truncating mutation c.1426C > T; p.Arg476* (Chr16:57693446C > T). These mutations fully segregated with ID in these families and were absent in the Exome Aggregation Consortium database that has approximately 8,000 control samples of South Asian origin. Two of these mutations have been reported in ClinVar database, and the third one has not been reported before. Three families from Pakistan with GPR56 mutations have been reported before. With the addition of our findings, the total number of mutations reported in Pakistani patients now is six. These results increase our knowledge regarding the mutational spectrum of the GPR56 gene causing BFPP/ID.

18.
J Vis Exp ; (134)2018 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-29683463

RESUMO

Research on cardiac hypertrophy and heart failure is frequently based on pressure overload mouse models induced by TAC. The standard procedure is to perform a partial thoracotomy to visualize the transverse aortic arch. However, the surgical trauma caused by the thoracotomy in open-chest models changes the respiratory physiology as the ribs are dissected and left unattached after chest closure. To prevent this, we established a minimally invasive, closed chest approach via lateral thoracotomy. Herein we approach the aortic arch via the 2nd intercostal space without entering the chest cavities, leaving the mouse with a less traumatic injury to recover from. We perform this operation using standard laboratory settings for open chest TAC procedures with equal survival rates. Apart from maintaining physiological breathing patterns due to the closed chest approach, the mice seem to benefit by showing rapid recovery, as the less invasive technique appears to facilitate a fast healing process and to reduce immune response after trauma.


Assuntos
Aorta Torácica/cirurgia , Toracotomia/métodos , Animais , Constrição , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos C57BL
19.
Cureus ; 10(1): e2009, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29515938

RESUMO

We report a case of a 45-year-old male who presented with a headache, fever, vomiting, somnolence, and difficulty walking for 10 days. His cerebrospinal fluid studies revealed cryptococcal meningitis. Chest and abdominal computed tomography (CT) scans showed splenomegaly along with mediastinal, retroperitoneal and inguinal lymphadenopathy. CD4 count turned out to be 208 µL-1. Human immunodeficiency virus (HIV) testing, serum protein electrophoresis, serum light chains and quantitative immunoglobulins were non-diagnostic and CD4 lymphopenia was attributed to acute infection. However, a persistent CD4 lymphopenia was seen in subsequent outpatient testing, which prompted a detailed workup for secondary causes of immunodeficiency. Repeated lymph node biopsies with analytic cytometric immunophenotypic analysis were normal, as was the bone marrow biopsy with detailed immunophenotypic and cytogenetic studies. The patient was hence being treated as a case of idiopathic CD4 lymphocytopenia.

20.
J Appl Res Intellect Disabil ; 31(5): 885-896, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29573307

RESUMO

BACKGROUND: Despite strong evidence for cognitive behaviour therapy (CBT) in treating mental health, its use, thus far, has been limited for people with intellectual disabilities. This study describes a CBT-based guided self-help (CBT-GSH) manual for individuals with intellectual disability, and focus groups explore the views of clinicians, therapists, support staff and managers. MATERIAL AND METHODS: Using a qualitative methodology, an expert team adapted the manual. Focus groups provided feedback, followed by thematic content analysis for modifications. RESULTS: Participants supported using the manual, with varying views about the delivery. Quality of relationships and competence of the administrator determined the best person to deliver the treatment. Heterogeneity in the intellectual disability population was a challenge to delivering manual-based interventions. Participants made suggestions about language and organization. CONCLUSIONS: Amendments were made to the manual in line with expert feedback. An evaluation is warranted to test for feasibility, delivery, acceptability and efficacy.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Conhecimentos, Atitudes e Prática em Saúde , Deficiência Intelectual/reabilitação , Manuais como Assunto , Autogestão/métodos , Adulto , Humanos , Manuais como Assunto/normas
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