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BACKGROUND/OBJECTIVES Congenital juvenile xanthogranulomas are infrequently described in the medical literature. We report three previously unpublished cases and systematically review the literature to better characterize this variant. METHODS We surveyed English-language articles indexed in MEDLINE (1951-March 2017) and EMBASE (1974-March 2017) for cases of congenital-onset juvenile xanthogranulomas confirmed on histopathology. Cases were divided into two categories: cutaneous only or cutaneous with systemic involvement. RESULTS We identified 31 cases of congenital juvenile xanthogranulomas involving only the skin and 16 cases with systemic involvement. Congenital juvenile xanthogranulomas involving only the skin were large (> 3 cm), presented with various clinical morphologies, and showed signs of regression by 1 year of age. Atypical clinical presentations included exophytic tumors, infiltrative plaques, agminated plaques, and subcutaneous tumors. Complications included ulceration and anetodermic scarring. Infants with congenital cutaneous juvenile xanthogranulomas who also had systemic involvement typically had multiple cutaneous tumors and hepatic involvement and showed signs of spontaneous regression independent of treatment. CONCLUSIONS The medical literature supports that congenital juvenile xanthogranulomas behave in a fashion similar to that of juvenile xanthogranulomas of infancy or childhood. Congenital cutaneous juvenile xanthogranulomas with or without systemic involvement spontaneously regress. The varied clinical presentations in the skin may lead to misdiagnosis, inappropriate examination, and unnecessary treatments. Infants with multiple congenital cutaneous juvenile xanthogranulomas should be evaluated for systemic involvement, with a particular focus on the liver, because 72.2% of these children were found to have hepatic juvenile xanthogranulomas.

Objectives Preoperative nervousness and anxiety are frequently encountered by individuals who undergo extractions of impacted wisdom teeth. The aim of the present study is to evaluate salivary alpha amylase (sAA) level in patients for assessment of stress during third molar surgery while listening to piano music and to determine its co-relation with pain catastrophizing scale (PCS). Materials and Methods Seven patients (four males and three females) indicated for surgical extraction of bilaterally impacted mandibular third molars were included. Pre-surgical patient assessments were completed, and three samples of saliva were collected during surgery-one at baseline, one 30 minutes after commencement of surgery, and one after suturing. Assessment was performed on both sides separately with and without piano music, and the samples were assessed for sAA level and correlated with the patient's self-reported PCS. Results Statistically significant results were obtained in patients who underwent surgical extraction while listening to piano music (P=0.046). The correlation of sAA level with PCS was not significant. Conclusion Music demonstrated a beneficial effect on lowering the levels of stress and anxiety that a patient exhibits during any surgical procedure, and sAA can be a useful biomarker for similar assessments.

To determine the presence and species composition of malaria infections, we screened a subset of samples collected during a cross-sectional survey in Northern Sabah, Malaysia using highly sensitive molecular techniques. Results identified 54 asymptomatic submicroscopic malaria infections, including a large cluster of Plasmodium falciparum and 3 P. knowlesi infections. We additionally identified 2 monoinfections with the zoonotic malaria Plasmodium cynomolgi, both in individuals reporting no history of forest activities or contact with macaques. Results highlight the need for improved surveillance strategies to detect these infections and determine public health impacts.

AimsAssociations between childhood abuse and various psychotic illnesses in adulthood are commonly reported. We aim to examine associations between several reported childhood adverse events (sexual abuse, physical abuse, emotional abuse, neglect and interpersonal loss) among adults with diagnosed psychotic disorders and clinical and psychosocial outcomes.MethodsWithin a large epidemiological study, the 2010 Australian National Survey of Psychosis (Survey of High Impact Psychosis, SHIP), we used logistic regression to model childhood adverse events (any and specific types) on 18 clinical and psychosocial outcomes.ResultsEighty percent of SHIP participants (1466/1825) reported experiencing adverse events in childhood (sexual abuse, other types of abuse and interpersonal loss). Participants reporting any form of childhood adversity had higher odds for 12/18 outcomes we examined. Significant associations were observed with all psychosocial outcomes (social dysfunction, victimisation, offending and homelessness within the previous 12 months, and definite psychosocial stressor within 12 months of illness onset), with the strongest association for homelessness (odds ratio (OR) = 2.82). Common across all adverse event types was an association with lifetime depression, anxiety and a definite psychosocial stressor within 12 months of illness onset. When adverse event types were non-hierarchically coded, sexual abuse was associated with 11/18 outcomes, other types of abuse 13/18 and, interpersonal loss occurring in the absence of other forms of abuse was associated with fewer of the clinical and psychosocial outcomes, 4/18. When adverse events types were coded hierarchically (to isolate the effect of interpersonal loss in the absence of abuse), interpersonal loss was associated with lower odds of self-reproach (OR = 0.70), negative syndrome (OR = 0.75) and victimisation (OR = 0.82).ConclusionsAdverse childhood experiences among people with psychosis are common, as are subsequent psychosocial stressors. Mental health professionals should routinely enquire about all types of adversities in this group and provide effective service responses. Childhood abuse, including sexual abuse, may contribute to subsequent adversity, poor psychosocial functioning and complex needs among people with psychosis. Longitudinal research to better understand these relationships is needed, as are studies which evaluate the effectiveness of preventative interventions in high-risk groups.

Background Atopic dermatitis (AD) is a common, chronic type 2 inflammatory skin disease, typically starting in infancy, with increased risk for subsequent extracutaneous atopic morbidities. Dupilumab is the first biologic agent targeting type 2 inflammation approved by the U.S. Food and Drug Administration (USFDA); it was licensed in 2017 for adults with moderate to severe AD and 2 years later for adolescents. Systemic treatment for pediatric AD remains a significant unmet medical need. Objective To analyze off-label use of dupilumab in children with AD. Methods Multicenter retrospective review that evaluated children who were prescribed dupilumab for moderate to severe AD. Results One hundred eleven of 124 patients (89.5%) gained access to dupilumab after a mean of 9 weeks. The dosing range was 4 to 15.5 mg/kg for the loading dose and 2.0 to 15.3 mg/kg every other week for maintenance. The range was widest for 6- to 11-year-olds and was related to use of either full or half of adult dosing. Associated morbidities, treatment response, and adverse events were comparable to those in previous adolescent and adult trials. Limitations The retrospective design of the study limited uniform data collection. Conclusion Access to dupilumab was achievable for the majority of children after a mean 9-week delay because of insurance payment denial. This review supports dupilumab response and tolerability in children. Optimal dosing for patients younger than 12 years has not been defined. Availability of the drug in 2 different concentrations is an important safety issue.

Reconstruction of bladder extrophy in infants and small children requires immobilization, sedation and pain management to prevent distracting forces from compromising the repair. We present 15 cases operated for bladder exstrophy in paediatric surgery workshop in January 2016. All Patients underwent surgery under combined epidural and general anaesthesia technique. Tunnelled epidural catheters were inserted in all patients and intermittently injected Inj. Bupivacain 0.25% (1ml/kg body weight). Postoperatively a continuous infusion with Inj. Bupivacaine and Inj. Dexmedetomidine was administered with syringe pump for 5 days. Intravenous fluid management was done with clinical parameters, counting the wet mobs and proper vigilance. Blood transfusion was given at the time of osteotomies. Perioperative management with tunnelled epidural catheter were resulted in an excellent cosmetic repair and pain relief with no case of bladder prolapse or wound dehiscence.

Objectives The need for proper wound closure is of paramount importance after any intra-oral surgery. Various wound closure techniques have been described in literature using traditional non-absorbable suture materials. These include like synthetic absorbable sutures, surgical staples and tissue adhesives. Cyanoacrylates are among the most commonly used biocompatible tissue adhesives. To evaluate and compare intraoral wound healing using 3-0 silk sutures and n-butyl-2-cyanoacrylate after alveoloplasty. Materials and methods A total of 20 patients requiring bilateral alveoloplasty in the same arch (upper or lower) were included in this study. Patients with any pre-existing pathology or systemic disease were excluded. After alveoloplasty was performed, the wound was closed using 3-0 braided silk sutures on one side, and using n-butyl-2-cyanoacrylate bio adhesive on the other side. Patients were evaluated based on the following parameters: time required to achieve wound closure; the incidence of immediate and postoperative hemostasis; the time to the use of the first rescue medication; the side where pain first arises; and the side where wound healing begins first. Results Compared to 3-0 silk sutures, cyanoacrylate demonstrated better hemostatic properties, reduced operative time, reduced postoperative pain and better wound healing. Conclusion These data suggest that cyanoacrylate glue is an adequate alternative to conventional sutures to close the surgical wound after alveoloplasty, and better than are 3-0 silk sutures.

Meningitis is commonly caused by infection with a variety of bacterial or viral pathogens. Acute bacterial meningitis (ABM) can cause severe disease, which can progress rapidly to a critical life-threatening condition. Rapid diagnosis of ABM is critical, as this is most commonly associated with severe sequelae with associated high mortality and morbidity rates compared to viral meningitis, which is less severe and self-limiting. We have designed a microarray for detection and diagnosis of ABM. This has been validated using randomly amplified DNA targets (RADT), comparing buffers with or without formamide, in glass slide format or on the Alere ArrayTubeTM (Alere Technologies GmbH) microarray platform. Pathogen-specific signals were observed using purified bacterial nucleic acids and to a lesser extent using patient cerebral spinal fluid (CSF) samples, with some technical issues observed using RADT and glass slides. Repurposing the array onto the Alere ArrayTubeTM platform and using a targeted amplification system increased specific and reduced nonspecific hybridization signals using both pathogen nucleic and patient CSF DNA targets, better revealing pathogen-specific signals although sensitivity was still reduced in the latter. This diagnostic microarray is useful as a laboratory diagnostic tool for species and strain designation for ABM, rather than for primary diagnosis.

Our aim was to establish the 12-month prevalence of violent victimisation in a large sample of adults with psychotic disorders (N = 1825), compare this to population estimates, and examine correlates of violent victimisation. The Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18–64 years with psychotic disorders. Interview questions included psychopathology, cognition, sociodemographics, substance use, criminality, and childhood and adult victimisation. Multivariable logistic regression models were used to examine the independent contributions of known risk factors, clinical profile and childhood abuse, on risk of violent victimisation. Differences between men and women were examined. Among adults with psychotic disorders, 12-month prevalence of any victimisation was 38.6 % (males 37.4 %, females 40.5 %), and of violent victimisation was 16.4 % (males 15.2 %; females 18.3 %). Violent victimisation was 4.8 times higher than the population rate of 3.4 % (6.5 times higher for women; 3.7 times higher for men). Significant correlates of violent victimisation were established sociodemographic and behavioural risk factors predicting victimisation in the general community: younger age, residence in the most disadvantaged neighbourhoods, homelessness, lifetime alcohol abuse/dependence, and prior criminal offending. Among clinical variables, only mania and self-harm remained significant in the multivariable model. Childhood abuse was independently associated with violent victimisation. Rates of violent victimisation are high for people with psychotic disorders, especially women, compared to population rates. Greater exposure to sociodemographic and behavioural risks may render them particularly vulnerable to victimisation. Social cognition as a valuable treatment target is discussed.

Mucuna pruriens is a plant of Fabaceae family. Seed of M. pruriens is considered as a rich source of levo-3,4 dihydroxyphenylalanine (L-DOPA), a non-protein phenolic amino acid. In the present study, three different extraction methods were compared for extract yield, concentration of bioactive compounds such as total phenol, L-DOPA and antioxidant capacity. Extracts were prepared using water acidified with hydrochloric acid (0.1 N) by conventional method of refluxing as well as two green methods namely ultrasound and microwave assisted solvent extraction. A rapid and qualified high-performance liquid chromatography method was also developed for quantification of L-DOPA in different extracts. Among the three extraction methods, microwave assisted extraction provided the best results for yield and quality of M. pruriens extract in much shorter time in comparison to refluxing method of extraction.

BackgroundIn this UK study, we investigated the impact of computerised physician order entry (CPOE) and clinical decision support (CDS) implementation on the rate of 78 high-risk prescribing errors amenable to CDS.MethodsWe conducted a preintervention/postintervention study in three acute hospitals in England. A predefined list of prescribing errors was incorporated into an audit tool. At each site, approximately 4000 prescriptions were reviewed both pre-CPOE and 6 months post-CPOE implementation. The number of opportunities for error and the number of errors that occurred were collated. Error rates were then calculated and compared between periods, as well as by the level of CDS.ResultsThe prescriptions of 1244 patients were audited pre-CPOE and 1178 post-CPOE implementation. A total of 28 526 prescriptions were reviewed, with 21 138 opportunities for error identified based on 78 defined errors. Across the three sites, for those prescriptions where opportunities for error were identified, the error rate was found to reduce significantly post-CPOE implementation, from 5.0% to 4.0% (PConclusionsImplementation of CPOE with CDS was associated with clinically important reductions in the rate of high-risk prescribing errors. Given the pre-post design, these findings however need to be interpreted with caution. The occurrence of errors was found to be highly dependent on the level of restriction of CDS presented to the prescriber, with the effect that different configurations of the same CPOE system can produce very different results.

Background The implementation of Computerised Physician Order Entry (CPOE) and Clinical Decision Support (CDS) has been found to have some unintended consequences. The aim of this study is to explore pharmacists and physicians perceptions of their interprofessional communication in the context of the technology and whether electronic messaging and CDS has an impact on this. Method This qualitative study was conducted in two acute hospitals: the University Hospitals Birmingham NHS Foundation Trust (UHBFT) and Guy’s and St Thomas’ NHS Foundation Trust (GSTH). UHBFT use an established locally developed CPOE system that can facilitate pharmacist-physician communication with the ability to assign a message directly to an electronic prescription. In contrast, GSTH use a more recently implemented commercial system where such communication is not possible. Focus groups were conducted with pharmacists and physicians of varying grades at both hospitals. Focus group data were transcribed and analysed thematically using deductive and inductive approaches, facilitated by NVivo 10. Results Three prominent themes emerged during the study: increased communication load; impaired decision-making; and improved workflow. CPOE and CDS were found to increase the communication load for the pharmacist owing to a reduced ability to amend electronic prescriptions, new types of prescribing errors, and the provision of technical advice relating to the use of the system. Decision-making was found to be affected, owing to the difficulties faced by pharmacists and physicians when trying to determine the context of prescribing decisions and knowledge of the patient. The capability to communicate electronically facilitated a non-interruptive workflow, which was found to be beneficial for staff time, coordination of work and for limiting distractions. Conclusion The increased communication load for the pharmacist, and consequent workload for the physician, has the potential to impact on the quality and coordination of care in the hospital setting. The ability to communicate electronically has some benefits, but functions need to be designed to facilitate collaborative working, and for this to be optimised through interprofessional training.

Purpose To evaluate intraobserver and interobserver agreements of anterior chamber angle measurements in children using hand-held spectral domain optical coherence tomography (HH-SDOCT). Methods HH-SDOCT (Leica Microsystems Ltd) was used to scan the anterior chamber of 30 normal children (mean age = 5.12 ± 3.5 years, range: 2 days to 12 years). Two independent observers analysed the same B-scan showing both clear nasal and temporal angles using ImageJ. They identified iridocorneal angle landmarks: scleral spur (SS), Schwalbe`s line (SL) and angle recess (AR) and used them to calculate parameters such as trabecular meshwork length (TML), SS angle opening distance (SSAOD), SL angle opening distance (SLAOD), SL angle (SLA), SS limbal distance (SSLD), SL limbal distance (SLLD), trabecular iris surface area (TISA500), nasal to temporal SS distance (SS-SSD) and pupil diameter (PD). The reproducibility of measurements were assessed using interclass correlation coefficients (ICC) and Bland-Altman plots. Results Repeated measurements of anterior chamber were calculated in 141 images. Both intra-observer and inter-observer agreements of most measurements ranged from fair to excellent (0.66 to 0.97). Intra-observer and inter-observer ICC for SSAOD, SLAOD, SLA, SSLD, SLLD, TISA500, SS-SSD and PD were 0.74, 0.78, 0.81, 0.72, 0.80, 0.76, 0.96, 0.96 and 0.83, 0.85, 0.77, 0.91, 0.89, 0.83, 0.84, 0.97, respectively. TML reproducibility was poor, ICC were 0.42 and 0.33, respectively. Bland Altman plots showed no significant difference between repeated measurements (p value were >0.05) for parameters with ICC reproducibility ≥0.7. Conclusions Reproducible quantitative measurements in children using HH-SDOCT was possible with ICC of up to 0.97. Anterior segment OCT could be a potential method in understanding the normal and abnormal ocular development of children.

Pediatric oncology patients can present with a variety of cutaneous findings, oftentimes related to administered chemotherapeutic agents. Toxic effects of chemotherapy on the skin, hair, nails, and mucous membranes are common, but not well described in children. Early recognition of cutaneous side effects of chemotherapy both by oncologists and dermatologists can aid in diagnosis and management of these conditions, to allow for complete care of cancer patients. This chapter discusses different classes of chemotherapeutic agents, their mechanisms of action, and their uses in specific malignancies. Acute cutaneous side effects of traditional chemotherapeutic agents are discussed in detail. Radiation therapy is also discussed, as well as its immediate effect on the skin, hair, mucous membranes, and nails and strategies for management.

This chapter explores a research project that began with a 'respectable passion': to reduce coronary heart disease (CHD) amongst men in the UK originating from Indian subcontinent countries of India, Pakistan, Sri Lanka, and Bangladesh. It explores how powerful questions can galvanize participation in action-based co-inquiry that, in turn, can generate possibilities for change with which people identify. Effective collaborative inquiry 'demystifies research and treats it as a form of learning that should be accessible by everyone interested in gaining a better understanding of his or her world'. Critically reflexive action research (CRAR) provided the starting-point for our enactment of alternative epistemological commitments than those that dominate in medical and primary care research, CRAR comes from a fertile mix of influences. The alternative research stance has opened up pathways through the many tensions and uncertainties that beset primary care.

Background: Stress is an integral part of life. Anxiety levels may increase when it comes to being treated surgically due to road traffic accidents causing facial trauma, other pathologies or burns. The stress that is caused during a surgical procedure as well as during the treatment in debilitated patients or traumatic conditions is bound to cause disturbance in the metabolic and physiologic levels of cortisol. Therefore, a study was carried out to determine the cortisol levels just prior to surgery on the day of operation to quantify the stress levels and also aid in any preanesthetic medication changes for the patient undergoing maxillofacial surgery. Aim: To evaluate and compare pre-surgical serum cortisol levels in patients undergoing major maxillofacial surgery under general anaesthesia. Objective: To evaluate the serum cortisol level of patient 3 days prior to surgery, on the day of surgery and to compare and evaluate the difference seen in both the obtained values. Methods: A prospective, randomized, in- vivo study was carried out in the Department of Oral and Maxillofacial Surgery at a teaching dental hospital. A total of 32 patients were included in this study. Inclusion and Exculsion criteria was made along with pre-opertive assessment of the patient, informed consent was obtained from all patients involved in the study. Patient blood sample, at 8 am three days prior to surgery and on the day of surgery and sent for laboratory investigations. Result: Participants in this clinical study underwent treatment of various ailments like facial trauma, and miscellaneous pathologies like Dentigerous Cyst, Oral submucosa fibrosis, Osteomyelitis, Benign Tumor and Orthognathic surgery. The anxiety of the patients were assessed by serum cortisol level preoperatively and on the day of operation. A total of 32 patients, 26 male and 06 female were included in the study. There was statistically highly significant difference seen between the mean values obtained three days prior to surgery and on the day of surgery. Conclusion: We have concluded from this study that the serum cortisol level shows significant increase on the day of surgery. A future study can focus on association between increased levels of serum cortisol and postoperative wound healing where patients can be divided into two groups one receiving pre-operative stress reduction protocol and other not receiving the same.

Odontogenic myxoma is a rare benign neoplasm with locally aggressivebehaviour and a high risk of recurrence. It has a predilection for the man-dible and occurs in the 2nd–3rd decade. The authors report a case of anodontogenic myxoma presenting with a spontaneous oro-nasal fistula in a29-year-old male. Histo-pathological analysis of the incisional biopsyspecimen initially suggested a diagnosis of calcifying epithelial odontogenictumour. A partial maxillectomy was performed, and following assessmentof the resection specimen, a diagnosis of odontogenic myxoma was ren-dered. A 3 cm bicortical iliac crest bone graft was harvested and inset to theright maxillary defect under general anaesthesia. Rehabilitation will becompletedwiththeplacementofimplants. Casereport A 29-year-old non-Caucasian male of Chinese descentwas referred by his general dental practitioner to hislocal oral and maxillofacial surgery department forassessmentofaspontaneouspalatalfistulaintheupperright maxilla. His medical history was unremarkable.He was a non-smoker and did not consume alcohol.Intra-oral examination revealed an oro-nasal fistula inthe upper right, UR3-4 region. There was no palpablecervicallymphadenopathy.Plain radiographs including an Orthopantomograph(Fig. 1), a periapical (Fig. 2) and an upper anteriorocclusal demonstrated a radiolucency in this region.Further investigation with a cone-beam computedtomography(CT)revealedaradiolucencyintheUR3-4region, resorbing the palatal cortical bone, alveolarridge and the roots of UR3-4. An incisional biopsy wasperformed under local anaesthesia via a palatal flap.Histopathological investigation identified nests andsmall aggregates of polyhedral epithelial cells indegenerated fibro-collagenous stroma with slightmyxoid degeneration, accompanied by amyloiddeposits. Special staining with Congo red was positivein these deposits. The immunohistochemical stainMNF116 decorated the epithelial cells. Ki67 prolifera-tive index was low. A diagnosis of calcifying epithelialodontogenic tumour was made by clinico-pathologiccorrelation.The surgical management involved a partialmaxillectomy performed under general anaesthesia. Amucoperiosteal flap was raised via a crevicular incisionfrom UR6 to UR2, and no bony fenestration wasapparent. UR2–UR6 were extracted, and the partialmaxillectomy was completed with an extra marginsuperiorly excised to ensure clearance. Histo-pathological assessment was inconclusive, and sevenslides were sent for a second opinion to Leeds TeachingHospital. No evidence of calcifying epithelialodontogenictumourwasfoundinthesamples.Severalsections showed inactive-looking odontogenic epithe-lium (Fig. 3), lying within myxoid fibrous connectivetissue (Fig. 4). There was clear evidence of localdestruction of bone (Fig. 5) and tooth-root in areas.

Child abuse has been associated with risk of mental illness, including schizophrenia and other psychotic disorders and, among those with mental illness, with a more severe clinical profile. Using an extensively characterised and epidemiologically representative sample of 1825 Australians with a psychotic illness aged 18-64 years and in contact with mental health services, we estimated the proportion of individuals with psychotic disorders who self-reported child abuse and examined its relationship with clinical and other characteristics. The prevalence of child abuse in this nationally representative sample of people with psychotic illness was 30.6%. Women were almost three times more likely to report child abuse compared to males (OR, 2.8, 95% CI 2.3-3.4). When adjusted for age at interview and socio-economic status, there was no significant relationship between self-reported child abuse and type of psychosis or course of illness. Participants with child abuse were significantly more likely to have subjective thought disorder, lifetime suicide attempt and premorbid personality disorder (females only) and anxiety (males only). Our findings demonstrate that child abuse is relatively common across the range of psychotic disorders, with an elevated risk for women in particular, compounding the already high burden associated with psychotic illness. Clinicians need to inquire routinely about child abuse in order to develop appropriate treatment plans tailored to individual needs.

A validated rapid HPLC-PDA method was developed for identification and quantification of five tannin-related constituents gallic acid (GA), corilagin (CL), chebulagic acid (CB), ellagic acid (EA) and chebulinic acid (CN) in the extracts prepared from the bark and fruits of four Terminalia species available in India. The separation of the five analytes was achieved on an RP-18 column (4.6 × 250 mm, 5 µm) at 25°C using a solvent mixture comprising of acetonitrile and (0.05%) trifluoroacetic acid-water in a gradient elution mode. Limit of detection was 1.0, 0.5, 1.0, 0.5 and 1.0 μg/mL for GA, CL, CB, EA and CN, respectively. Similarly, limit of quantification was 2.5, 1.0, 2.5, 1.0 and 2.5 μg/mL for GA, CL, CB, EA and CN, respectively. Good linearity (r(2) > 0.992) was observed for all the five compounds in wide concentration range. Using the developed HPLC method, the five analytes were identified and quantified in bark and fruit extracts of Terminalia chebula, Terminalia bellirica, Terminalia arjuna and Terminalia catappa. This is the first report of identification and quantification of the five tannin-related marker constituents in the bark and fruit extracts of T. chebula, T. bellirica, T. arjuna and T. catappa.

Orthokeratinized odontogenic keratocyst is a less-aggressive non-syndromic variant of odontogenic keratocyst (OKC). In this case report, we are highlighting an unusual presentation of OKC with paresthesia, non-vital teeth, and minimal cortical expansion. The radiograph of the patient revealed a radiolucency crossing the midline in the anterior mandible. This manuscript discusses a case which presented as a diagnostic dilemma due to variable clinical and radiological features mimicking different pathologies occurring in the anterior mandible. We have discussed various clinical and radiographic differential diagnoses of the same.

BackgroundThere are insufficient data from nationwide surveys on the prevalence of specific psychotic disorders and associated co-morbidities.MethodThe 2010 Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18–64 years with psychotic disorders in contact with public treatment services from an estimated resident population of 1 464 923 adults. This paper is based on data from 1642 participants with an International Classification of Diseases (ICD)-10 psychotic disorder. Its aim is to present estimates of treated prevalence and lifetime morbid risk of psychosis, and to describe the cognitive, physical health and substance use profiles of participants.ResultsThe 1-month treated prevalence of psychotic disorders was 3.10 cases per 1000 population aged 18–64 years, not accounting for people solely accessing primary care services; lifetime morbid risk was 3.45 per 1000. Mean premorbid intelligence quotient was approximately 0.5 s.d.s below the population mean; current cognitive ability (measured with a digit symbol coding task) was 1.6 s.d.s below the population mean. For both cognitive tests, higher scores were significantly associated with better independent functioning. The prevalence of the metabolic syndrome was high, affecting 60.8% of participants, and pervasive across diagnostic groups. Of the participants, two-thirds (65.9%) were current smokers, 47.4% were obese and 32.4% were sedentary. Of the participants, half (49.8%) had a lifetime history of alcohol abuse/dependence and 50.8% lifetime cannabis abuse/dependence.ConclusionsOur findings highlight the need for comprehensive, integrative models of recovery to maximize the potential for good health and quality of life for people with psychotic illness.

Background: The turtle plastron is composed of a keratinized epidermis overlying nine dermal bones. Its developmental origin has been controversial; recent evidence suggests that the plastral bones derive from trunk neural crest cells (NCCs). Results: This study extends the observations that there is a turtle-specific, second wave of trunk NCC delamination and migration, after the original NCCs have reached their destination and differentiated. This second wave was confirmed by immunohistochemistry in whole-mounts and serial sections, by injecting DiI (1,1′, di-octadecyl-3,3,3′,3′,-tetramethylindo-carbocyanine perchlorate) into the lumen of the neural tube and tracing labeled cells into the plastron, and by isolating neural tubes from older turtle embryos and observing delaminating NCCs. This later migration gives rise to a plastral ectomesenchyme that expresses NCC markers and can be induced to initiate bone formation. Conclusions: The NCCs of this second migration have properties similar to those of the earlier NCCs, but also express markers characteristic of cranial NCCs. The majority of the cells of the plastron mesenchyme express neural crest markers, and have osteogenic differentiation capabilities that are similar or identical to craniofacial ectomesenchyme. Our evidence supports the contention that turtle plastron bones are derived from a late emigrating population of cells derived from the trunk neural crest. Developmental Dynamics 242:1223–1235, 2013. © 2013 Wiley Periodicals, Inc.

The production of secondary metabolites in medicinal plants is influenced by quality of light. Two senna cultivars (ALFT 2 and Sona) were studied under field conditions at four different light levels (25, 50, 70 and 100 % of full sunlight) for photosynthetic performance and sennoside accumulation. The cultivar ALFT 2 recorded highest P n values of 31.27 μmol CO2 m−2 s−1 at 100 days after sowing (DAS), whereas Sona recorded the highest value of 30.7 μmol CO2 m−2 s−1 at 60 DAS under 100 % light. Lowest P n values of 12.1 and 11.07 μmol CO2 m−2 s−1 were recorded in ALFT 2 (120 DAS) and Sona (150 DAS), respectively under 25 % light. Sennoside A reduced by 30 % under 25 % light in leaf tissue of ALFT 2, whereas, a reduction of only 16 % was observed in Sona. Highest sennoside B content was observed in ALFT 2 under full sun light (2.03 %). ALFT 2 recorded comparatively higher total sennosides (4.76 %) in pods than Sona (4.57 %) under full light. The gradual decline in P n with later growth stages could be the reason for steady decline in sennosides content, particularly in the leaves and pods of both the cultivars.

Background: Both maternal schizophrenia and obstetric complications have been implicated in risk for psychotic illness. Other environmental stressors (e.g., childhood abuse, social disadvantage, and discontinuity in parenting) have also been implicated. Previously (ICOSR 2015), we have shown that children of mothers with schizophrenia are more likely than comparison children to be exposed to these other environmental stressors. Our aim in this paper is to assess the independent contribution of maternal schizophrenia and obstetric complications to risk for developing a psychotic illness, covarying for exposure to other environmental stressors in childhood.

As part of the UK response to the 2013–2016 Ebola virus disease (EVD) epidemic in West Africa, Public Health England (PHE) were tasked with establishing three field Ebola virus (EBOV) diagnostic laboratories in Sierra Leone by the UK Department for International Development (DFID). These provided diagnostic support to the Ebola Treatment Centre (ETC) facilities located in Kerry Town, Makeni and Port Loko. The Novel and Dangerous Pathogens (NADP) Training group at PHE, Porton Down, designed and implemented a pre-deployment Ebola diagnostic laboratory training programme for UK volunteer scientists being deployed to the PHE EVD laboratories. Here, we describe the training, workflow and capabilities of these field laboratories for use in response to disease epidemics and in epidemiological surveillance. We discuss the training outcomes, the laboratory outputs, lessons learned and the legacy value of the support provided. We hope this information will assist in the recruitment and training of staff for future responses and in the design and implementation of rapid deployment diagnostic field laboratories for future outbreaks of high consequence pathogens. This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.

The role of molecular interactions in ball milled solid dispersions in determining the aqueous solubility of the poorly water-soluble drug, griseofulvin (GF) has been examined. Ball milled solid dispersions of GF and hydroxypropylmethylcellulose acetate succinate (HPMCAS) and GF and polyvinylpyrrolidone (PVP) were prepared and characterized by laser diffraction, scanning electron microscopy and X-ray powder diffraction and the aqueous saturation solubility measured and analyzed using one way ANOVA. The results showed that solid dispersions of GF and HPMCAS possessed an aqueous GF saturation solubility of about ten times higher than the GF solubility achieved from PVP-based solid dispersions. Furthermore, although the aqueous solubility of GF did not vary with the milling conditions used to prepare the solid dispersions with PVP, significant changes in solubility were observed upon changing the milling conditions for preparation of the GF/HPMCAS solid dispersions. Surprisingly, the GF/HPMCAS solid dispersion prepared using spray drying exhibited a significantly lower aqueous solubility than those prepared by bead milling despite their smaller particle size and GF being fully in its amorphous form. It is thought that the higher surface energy of the spray-dried solid dispersions negatively affected the aqueous solubility of GF. In conclusion, the results suggest that the molecular interactions occurring between GF and HPMCAS affect the aqueous solubility of GF and that the molecular interactions appear to remain in the liquid state. In contrast no molecular interactions were evident in the GF/PVP solid dispersions.

Objective: The 2010 Survey of High Impact Psychosis (SHIP) is Australia’s second national psychosis survey. This paper provides an overview of its findings, including comparisons with the first psychosis survey and general population data. Methods: The survey covered 1.5 million people aged 18–64 years, approximately 10% of Australians in this age group. A two-phase design was used. In phase 1, screening for psychosis took place in public mental health services and non-government organizations supporting people with mental illness. In phase 2, 1825 of those screen-positive for psychosis were randomly selected and interviewed. Data collected included symptomatology, substance use, functioning, service utilization, medication use, education, employment, housing, and physical health including fasting blood samples. Results: The estimated 1-month treated prevalence of psychotic disorders in public treatment services was 3.1 people per 1000 population; the 12-month treated prevalence was 4.5 people per 1000. The majority (63.0%) of participants met ICD-10 criteria for schizophrenia/schizoaffective disorder. One-half (49.5%) reported attempting suicide in their lifetime and two-thirds (63.2%) were rated as impaired in their ability to socialize. Over half (54.8%) had metabolic syndrome. The proportion currently smoking was 66.1%. Educational achievement was low. Only 21.5% were currently employed. Key changes in the 12 years since the first survey included: a marked drop in psychiatric inpatient admissions; a large increase in the proportion attending community mental health clinics; increased use of rehabilitation services and non-government organizations supporting people with mental illness; a major shift from typical to atypical antipsychotics; and large increases in the proportions with lifetime alcohol or drug abuse/dependence. Conclusion: People with psychotic illness face multiple challenges. An integrated approach to service provision is needed to ensure that their living requirements and needs for social participation are met, in addition to their very considerable mental and physical health needs.

This study evaluated and compared the donor site morbidity following minimally invasive and conventional open harvesting of iliac bone for secondary alveolar bone grafting in cleft palate patients. A thorough electronic search of PubMed, Google Scholar, EMBASE, and an institutional library and manual search of various journals was done; Inclusion criteria: 1) full-text articles using a minimally invasive or conventional open harvesting technique for iliac bone for secondary alveolar grafting in cleft palate patients and 2) articles published between January 1, 2001 and June 30, 2017 and Exclusion criteria: 1) articles published in languages other than English, 2) case reports, case series, animal studies, in vitro studies, and letters to the editor, and 3) full-text article unavailable even after writing to the authors. Preliminary screening of 274 studies excluded 223 studies for not meeting the eligibility criteria. Of the remaining 51 studies, 19 were removed for being duplicates. Of the remaining 32 studies, 15 were excluded after reading the abstract. Of the 17 studies that were left, 2 were excluded because they were in a language other than English, and 2 were excluded because the study group did not mention cleft palate patients. Thus, 13 studies providing results for a total of 654 patients were included in this qualitative synthesis. Minimally invasive bone graft harvest techniques are better than the conventional open iliac bone harvest method because they offer shorter operative time, decreased requirement for pain medications, less pain on discharge, and a shorter hospital stay.

Partnership working between health and the voluntary and community sector has become an increasing political priority. This paper describes and explores the extent and patterns of partnership working between health and the voluntary and community sector in the context of Early Intervention Services for young people with a first episode of psychosis. Data were collected from 12 Early Intervention Services and through semistructured interviews with 47 voluntary and community sector leads and 42 commissioners across the West Midlands of England. Most partnerships were described as ad hoc and informal in nature although four formal partnerships between Early Intervention Services and voluntary and community sector organizations had been established. Shared agendas, the ability to refer clients onto an organization that could provide a service they could not and shared training facilitated partnership working in this context. Barriers to closer working included differences in culture such as managing risk, the time required to make and maintain relationships and recognition of the advantages of remaining a small and autonomous organization. The four more formal partnerships were also built on the organizations' experience of working together informally, in one case through a specific pilot project. The voluntary and community organizations involved were also branches of larger national organizations for whom finding sustainable funding was less of an issue. In theoretical terms, eight Early Intervention Service: voluntary and community sector partnerships were at a stage of 'pre-partnership collaboration', three at 'partnership creation and consolidation' and one at 'partnership programme delivery'. The empirical data viewed through the lens of the partnership life-cycle model could help early intervention services, and voluntary and community sector professionals better understand where they are, why they are there and the conditions needed to realise the full potential of partnership working.

It has been proposed that dehydroepiandrosterone and dehydroepiandrosterone sulfate (DHEAS) exert neuroprotective effects in the brain, yet evidence of associations between the endogenous levels of these steroids and measures of cognitive function is lacking.The objective of the study was to investigate whether circulating levels of DHEAS independently contribute to aspects of cognitive function in women in the community.This was a community-based, cross-sectional study.Two hundred ninety-five women, aged 21-77 yr, were recruited from a community-based data set and participated between September 2003 and December 2004. Women were excluded if they reported any health condition that might potentially adversely affect cognitive function.The individual scores of a comprehensive battery of tests of cognitive function and the serum level of DHEAS (square root transformed) were measured.In the multiple linear regression analysis, the DHEAS term made a significant independent positive contribution to the Controlled Oral Word Association Test score, a measure of executive function. In addition, women with a DHEAS level in the highest tertile who also had more than 12 yr of education performed better on both Digit Span Forward and Digit Span Backward tests, which are tests of simple concentration and working memory, respectively.Higher endogenous DHEAS levels are independently and favorably associated with executive function, concentration, and working memory.

Biometric recognition is a way of recognizing people on the basis of their behavioral and physiological characteristics. Palm print recognition is a very popular biometric recognition method because of its stable line features, need of low cost capturing device, low resolution imaging and user friendliness. Palm print recognition has been area of interest for many researchers since last many years due to the unique and stable characteristics present in a Palm. Researchers have suggested various preprocessing, feature extraction and matching techniques for recognition of a Palm print. This paper discusses various stages of Palm print recognition and research work performed in field of Palm Print recognition.

This article describes the literature specific to partnership working across the National Health Service, social services and voluntary and community sector in order to summarise the potential advantages and challenges of partnerships. We explore the meaning of partnership working and review the policy developments and investment initiatives underpinning the Government's emphasis on partnership working between statutory services and the voluntary and community sector. A number of barriers hinder effective partnership working and we examine some possible solutions to overcome these. We then address the key issues influencing the approach to increasing the voluntary sector's participation in partnership activities within mental health services and provide brief examples of good practice. Finally, we discuss practical issues relevant to planning partnerships and the role consultant psychiatrists can play in initiating and developing partnership working between the voluntary sector and statutory mental health services.

BACKGROUND AND OBJECTIVES: Propranolol is first-line therapy for problematic infantile hemangiomas (IHs). Rebound growth after propranolol discontinuation is noted in 19% to 25% of patients. Predictive factors for rebound are not completely understood and may alter the management approach. The goal of the study was to describe a cohort of patients with IHs treated with propranolol and to identify predictors for rebound growth. METHODS: A multicenter retrospective cohort study was conducted in patients with IHs treated with propranolol. Patient demographic characteristics, IH characteristics, and specifics of propranolol therapy were obtained. Episodes of rebound growth were recorded. Patients’ responses to propranolol were evaluated through a visual analog scale. RESULTS: A total of 997 patients were enrolled. The incidence of rebound growth was 231 of 912 patients (25.3%). Mean age at initial rebound was 17.1 months. The odds of rebound among those who discontinued therapy at CONCLUSIONS: Rebound growth occurred in 25% of patients, requiring modification of systemic therapy in 15%. Predictive factors for rebound growth included age of discontinuation, deep IH component, and female gender. Patients with these predictive factors may require a prolonged course of therapy.

Objective To identify approaches of using stand-alone and more integrated hospital ePrescribing systems to promote and support the appropriate use of antibiotics, and identify gaps in order to inform future efforts in this area. Methods A systematic scoping review of the empirical literature from 1997 until 2015, searching the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Trials, International Standard Randomised Controlled Trial Number Registry, Economic Evaluation database and International Prospective Register of Systematic Reviews. Search terms related to different components of systems, hospital settings and antimicrobial stewardship. Two reviewers independently screened papers and mutually agreed papers for inclusion. We undertook an interpretive synthesis. Key findings We identified 143 papers. The majority of these were single-centre observational studies from North American settings with a wide range of system functionalities. Most evidence related to computerised decision support (CDS) and computerised physician order entry (CPOE) functionalities, of which many were extensively customised. We also found some limited work surrounding integration with laboratory results, pharmacy systems and organisational surveillance. Outcomes examined included healthcare professional performance, patient outcomes and health economic evaluations. We found at times conflicting conclusions surrounding effectiveness, which may be due to heterogeneity of populations, technologies and outcomes studied. Reports of unintended consequences were limited. Conclusions Interventions are centred on CPOE and CDS, but also include additional functionality aiming to support various facets of the medicines management process. Wider organisational dimensions appear important to supporting adoption. Evaluations should consider processes, clinical, economic and safety outcomes in order to generate generalisable insights into safety, effectiveness and cost-effectiveness.

Background Loneliness involves subjective, rather than objective, social isolation and has a range of negative effects on mental and physical functioning. The purpose of this study was to examine the prevalence of loneliness in psychotic disorders and its association with symptoms and cognitive performance. Method Data were drawn from the second Australian National Survey of Psychosis and comprised responses from 1642 participants with an International Classification of Diseases 10 diagnosis of psychotic disorder who had completed a semi-structured interview of symptoms and social functioning (including loneliness), along with standardized assessments of current (digit symbol coding; DSC) and premorbid (National Adult Reading Test) cognitive ability. We examined the prevalence of loneliness across the diagnostic categories of psychosis, and its association with psychotic and non-psychotic symptoms and digit symbol coding scores. Results The prevalence of loneliness was high, ranging from 74.75% in participants with delusional disorders to 93.8% in depressive psychosis, and was significantly higher than in the general population. Loneliness was also significantly associated with anhedonia and subjective thought disorder. Participants feeling socially isolated/lonely for company had significantly lower DSC scores than those who only felt lonely occasionally. Unexpectedly, participants who reported not feeling lonely had the lowest DSC scores. Conclusions Loneliness is common across all psychotic disorders, particularly in depressive psychosis. It is specifically associated with ongoing loss of pleasure and disordered thoughts as well as impairment in current cognitive functioning. However, poor cognitive functioning is not inevitably associated with loneliness. Implications for personalized treatment of psychosis are discussed.

Factors that contribute to cognitive decline in women from midlife remain poorly understood. There are circumstantial data indicating a positive association between homocysteine and cognitive decline and that endogenous and exogenous estrogen may influence homocysteine levels. The aim of this review was to establish what is known of the relationships between cognitive change and homocysteine levels, and the impact of the menopause transition and exogenous estrogen on homocysteine levels.We reviewed the recent published literature from 1993 to 2005 pertaining to the current understanding of the relationship(s) between plasma homocysteine levels and cognitive functioning and endogenous hormone levels and exogenous estrogen use in women.Hyperhomocysteinemia is consistently associated with cognitive decline. Dietary supplementation with vitamins may assist in normalizing homocysteine levels; however, there is no evidence that this results in favorable effects on cognition. Changes in endogenous estrogen levels are inversely associated with changes in serum homocysteine. Consistent with this, estrogen therapy is associated with reductions in plasma homocysteine, with the greatest effects reported in women with higher levels of homocysteine at baseline. Limited data indicate that tibolone is associated with little change in homocysteine. The use of raloxifene, the most studied selective estrogen receptor modulator, is associated with a modest reduction in homocysteine.There are data to suggest an underlying link between homocysteine levels and cognitive decline. There is also evidence for a link between both the menopause transition and use of exogenous estrogen therapy and homocysteine levels. Clinical data do not support a role for exogenous estrogen in the prevention of dementia in older women; however, the 'window of opportunity' theory suggests that there is a need for randomized controlled trials to evaluate the role of estrogen in the early postmenopausal years to protect against cognitive decline in later life.

The aim of the study was to conduct a rapid assessment of breastfeeding knowledge amongst health workers in an area of high HIV prevalence. A cross-sectional survey using semi-structured questionnaires and problem-based scenarios was carried out. Responses were compared to those recommended in the World Health Organization (WHO) Breastfeeding Counselling Course. The setting was a rural area of KwaZulu Natal, with a population of 220 000 people. At the time of the study approximately 36 per cent of pregnant women were HIV-infected and no programme to prevent mother-to-child transmission was in place. A convenient sample of 71 healthcare workers (14 doctors, 25 professional nurses, 16 staff nurses, and 16 community health workers) were included in the study. Over 50% of respondents had given breastfeeding advice to clients over the previous month. However, there were significant discrepancies in breastfeeding knowledge compared to WHO recommendations. Ninety-three per cent (n = 13) of doctors knew that breastfeeding should be initiated within 30 min of delivery, but 71 per cent (n = 10) would recommend water, and 50 per cent (n = 7) solids to breastfed infants under 6 months of age. Fifty-seven per cent (n = 8) considered glucose water necessary for neonatal jaundice, constipation, and for infants immediately after delivery. Only 44 per cent (n = 7) of staff nurses and 56 per cent (n = 14) of professional nurses knew that breastfeeding should be on demand. The majority would recommend water, formula milk, and solids to breastfed infants under 6 months of age, and glucose water for neonatal jaundice and immediately after delivery. Knowledge of community health workers differed most from WHO recommendations: only 37 per cent (n = 6) knew that breastfeeding should be initiated within 30 min of delivery, 68 per cent (n = 11) thought breastfeeding should be on schedule and not on demand, and the majority would recommend supplements to infants under 6 months of age. Few respondents suggested taking a feeding history or observing a breastfeed in response to the problem scenarios. The most commonly given responses to problems of babies who were perceived to be thirsty, unsatisfied, or crying after feeds was to supplement with other fluids or feeds. There is a need for systematic and ongoing training in breastfeeding and infant feeding counselling in the context of HIV, so that breastfeeding is not undermined by the current HIV pandemic, and exclusive breastfeeding continues to be promoted for all HIV-uninfected women, women of unknown status, and HIV-infected women who choose to breastfeed.

Purpose The authors planned a clinical and histopathologic study to examine the behavior of nasolabial tissues (full-thickness skin flap) after being inset into the oral cavity for oral submucous fibrosis (OSMF) under the premise that skin that is foreign tissue to the oral cavity would be devoid of pathologic changes. Materials and Methods Fourteen patients with OSMF and mouth openings with an interincisal distance shorter than 28 mm were included. The flap was evaluated clinically for 10 years, during which biopsy specimen was obtained from the mucocutaneous junction of the inset flap for histopathologic examination. Results In this series, complications such as flap loss, infection, flap necrosis, obstructive sialadenitis, and damage to facial nerve branches were not observed. However, intraoral hair growth and extraoral scar at the donor site were seen in all patients, 3 of whom subsequently underwent scar revision. Histopathologically, the inset flap showed decreased keratinization and loss of adnexal structures. A mean mouth opening of 43.2 mm was achieved at 10 years postoperatively (mean increase, 24.4 mm). No relapse was encountered, even at the last follow-up. Conclusion The nasolabial island flap or any other full-thickness skin flap could be a viable and reliable option for reconstruction of intraoral defects from OSMF.

Desmodium gangeticum L. DC. (Family - Fabaceae) is a medicinal legume that grows in dry hilly areas and dried roots are used as general tonic and aphrodisiac. It has a calming, sedative effect and is also used to control inflammation, fever and neurological imbalances. Genetic variability for leaf water potential and photosynthetic activities which attributes for biomass was assessed in 31 accessions collected from various agro climatic zones of India. The accessions were screened for three gas exchange parameters viz ., photosynthetic rate (P n ), stomatal conductance (g s ) and transpiration rate (E) during active photosynthetic period and leaf water potential (Ψ) during pre-dawn, noon and dusk. Plant biomass was recorded for the accessions during harvest. There were considerable variations in leaf water potential of genotypes during pre-dawn and noon. The genotypes differed significantly for the gas exchange parameters studied. High positive correlation was observed between P n and g s (R 2 = 0.68) with E (R 2 = 0. 75) and significant negative correlation with noon ψ w (-0.26). The genotypes were categorized into 2 main clusters namely, A and B with 4 sub clusters. Cluster A contained 13 genotypes of which 6 had higher photosynthetic performance with superior water relations and cluster B contained 18 genotypes of which 3 accessions (DDG 3, DDG 22 and DDG 33) formed a sub group and exhibited poor photosynthetic performance. The positive correlation of g s and E with photosynthesis can be helpful for improvement of D. gangeticum .