Common Aetiological Factor Research Articles

Clinical pattern of acute pancreatitis in eastern India and comparison of Ranson, BISAP and APACHE II as a predictor of severity, local complications and mortality

Background: Acute pancreatitis is the single most frequent gastrointestinal cause of hospital admissions. Scoring systems have been used since the 1970s for assessment of its severity. This study was aimed to assess the clinical pattern of acute pancreatitis and to compare various predicting systems like Ranson, BISAP and APACHE II in predicting severity, local complications and mortality in acute pancreatitis.Methods: In this prospective study, 91 consecutive cases of acute pancreatitis admitted, between April 2015 to March 2017, were studied. The diagnostic criteria include the presence of at least two of the three features; abdominal pain, serum amylase and lipase levels and findings on imaging studies. Patients were divided into two groups each, BISAP Ranson ≥3 and <3, APACHE II ≥8 and <8, and analyzed statistically.Results: Out of total of 91 patients, 81 were male and 14 were female with mean age was 36.14 years. Commonest aetiological factor was alcoholism in 57.89% followed by gallstones in 23.16%. Serum amylase was raised in 83.26% patients while 95.79% had raised serum lipase levels. 75.79% patients were of MAP while 24.21% patients were of MSAP and SAP. 7.37% patients developed local complications and mortality rate was 6.32%. All the scoring systems were found similar in predicting severity, local complication and mortality, had low sensitivity and high specificity (P value < 0.05).Conclusions: There is no ideal predicting system for acute pancreatitis. These scoring systems can be used to triage patients for better healthcare delivery.

Pattern of Hearing Impairment in a Tertiary Institution in Ado Ekiti, Nigeria

Background: Hearing impairment is a common sensory impairment affecting all age group worldwide. Aims: This study aimed at determining the prevalence, sociodemographic features, aetiology, audiometry findings, impact on quality of life and management of hearing impairment in a tertiary health institution in Ado-Ekiti, Nigeria. Materials and Methods: This was a prevalence hospital-based study of patients with complaints of hearing impairment in the ear, nose and throat department of Ekiti state university teaching hospital, Ado Ekiti. The study was carried out from May 2017 to April 2018. Consent was obtained from the patients/parents/guardian.Data were obtained by using pretested interviewers assisted questionnaire. All the data obtained were collated, documented and analyzed using SPSS version 18. Results: Prevalence of hearing impairment was 21.2%. There were 36.5% males and 63.5% female with a male to female ratio of 1:1.5. Bilateral hearing impairment was predominant and accounted for 51.9%. Common aetiologic factors of hearing impairment among the patients were; 20.2% earwax impaction, 13.5% ototoxicity, 12.5% otitis media, 11.5% presbyacusis, 11.1% otitis externa and 10.1% febrile illnesses. Common clinical features were earwax, earache, hard of hearing/ear blockage, ear discharge and tinnitus in 49.5%, 45.2%, 40.4%, 36.5% and 29.8% respectively. The most Common type of hearing impairment was a sensorineural hearing loss in 46.2%. Type A tympanometry (normal) was the commonest findings in 47.1%. Pure tone audiometry revealed mild, moderate and moderate-severe hearing impairment to be 44.7%, 27.9%, and 20.2% respectively. Common effect on quality of life was the embarrassment, aggressiveness, social dysfunction and poor academic performance of 13.9%, 11.5%, 10.1% and 6.7%. Majority of the patients in 63.5% had prehospital treatment. Conservative treatment was done in 26.9%. The surgery/procedure were done in 47.6%. Amplification and speech therapy in 13.5% and 6.7% respectively. Conclusion: Hearing impairment is a hidden and common otologic disease with significant associated negative effect on quality of life in Ado- Ekiti, Nigeria

Glucose-6-phosphate dehydrogenase inhibition attenuates acute lung injury through reduction in NADPH oxidase-derived reactive oxygen species.

Acute lung injury (ALI) is a heterogeneous disease with the hallmarks of alveolar capillary membrane injury, increased pulmonary oedema and pulmonary inflammation. The most common direct aetiological factor for ALI is usually parenchymal lung infection or haemorrhage. Reactive oxygen species (ROS) generated by nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX2) are thought to play an important role in the pathophysiology of ALI. Glucose-6-phosphate dehydrogenase (G6PD) plays an important role both in production of ROS as well as their removal through the supply of NADPH. However, how G6PD modulation affects NOX2-mediated ROS in the airway epithelial cells (AECs) during acute lung injury has not been explored previously. Therefore, we investigated the effect of G6PD inhibitor, 6-aminonicotinamide on G6PD activity, NOX2 expression, ROS production and enzymatic anti-oxidants in AECs in a mouse model of ALI induced by lipopolysaccharide (LPS). ALI led to increased G6PD activity in the AECs with concomitant elevation of NOX2, ROS, SOD1 and nitrotyrosine. G6PD inhibitor led to reduction of LPS-induced airway inflammation, bronchoalveolar lavage fluid protein concentration as well as NOX2-derived ROS and subsequent oxidative stress. Conversely, ALI led to decreased glutathione reductase activity in AECs, which was normalized by G6PD inhibitor. These data show that activation of G6PD is associated with enhancement of oxidative inflammation in during ALI. Therefore, inhibition of G6PD might be a beneficial strategy during ALI to limit oxidative damage and ameliorate airway inflammation.

P.4.b.016 - Will early intervention with SSRI versus benzodiazepines reduce the risk of developing posttraumatic stress disorder?

In recent years, several twin studies adopted a dimensional approach to Autism Spectrum Disorders (ASD) and estimated the contribution of genetic and environmental influences to variation in autistic traits. However, no study was performed on adults over 18 years of age and all but two studies were based on parent or teacher ratings. Also, the genetic and environmental contributions to the interplay between autistic traits and adult personality dimensions have not been investigated.A sample of 266 complete twin pairs (30% males, mean age 40 ± 12 years) drawn from the population-based Italian Twin Register was administered the Autism-Spectrum Quotient, Temperament and Character Inventory (TCI-125), and General Health Questionnaire (GHQ-12). Genetic structural equation modelling was performed with the Mx program. Estimates were adjusted for gender, age, and GHQ-12 score.Genetic factors accounted for 44% and 20%–49% of individual differences in autistic traits and TCI dimensions, respectively. Unshared environmental factors explained the remaining proportion of variance. Consistently with the notion of a personality profile in ASD characterised by obsessive temperament, autistic traits showed significant phenotypic correlations with several TCI dimensions (positive: HA; negative: NS, RD, SD, C). Genetic and unshared environmental correlations between AQ and these TCI dimensions were significant. The degree of genetic overlap was generally greater than the degree of environmental overlap.Despite some limitations, this study suggests that genetic factors contribute substantially to individual differences in autistic traits in adults, with unshared environmental influences also playing an important role. It also suggests that autistic traits and the majority of temperament and character dimensions share common genetic and environmental aetiological factors.

Aetiological factors and clinical profile of neonatal jaundice from a rural area of North Kerala, India

Background: Neonatal jaundice is the most common problem in the first week of life leading to delayed hospital discharge and readmissions. Early recognition of neonatal hyperbilirubinemia is important to prevent serious complications. This study was done in a teaching hospital (KMCT Medical College, Mukkam, Kozhikode), in a rural area of North Kerala. It is an attempt to identify the common aetiological factors of neonatal jaundice in this setting.Methods: This observational study was conducted over a period of 6 months from January 2014 to June 2014. A total of 110 jaundiced neonates were enrolled. Data collection was done by history taking, clinical examination and relevant laboratory investigations.Results: In this study, out of 110 jaundiced neonates, 102 (92.5%) were term babies and 8 (7.3%) were preterm, 69 (62.75%) were males and 41 (37.27%) females. Physiological jaundice was seen in 44 (40%) of neonates. Various other aetiologies were ABO incompatibility 24 (21.8%), sepsis 11 (10%), Rh incompatibility 9 (8%), idiopathic 9 (8%), prematurity 8 (7.3%), cephalhematoma 7 (6.4%), breast feeding jaundice 7 (6.4%) and haemolytic anaemia 1 (0.9%).Conclusions: Physiological jaundice accounted for the bulk of cases of neonatal jaundice in our area. This was followed by ABO incompatibility. This highlights the importance of appropriate monitoring of neonates with this underlying risk factor.

Oxygen tension regulates the miRNA profile and bioactivity of exosomes released from extravillous trophoblast cells - Liquid biopsies for monitoring complications of pregnancy.

Our understanding of how cells communicate has undergone a paradigm shift since the recent recognition of the role of exosomes in intercellular signaling. In this study, we investigated whether oxygen tension alters the exosome release and miRNA profile from extravillous trophoblast (EVT) cells, modifying their bioactivity on endothelial cells (EC). Furthermore, we have established the exosomal miRNA profile at early gestation in women who develop pre-eclampsia (PE) and spontaneous preterm birth (SPTB). HTR-8/SVneo cells were used as an EVT model. The effect of oxygen tension (i.e. 8% and 1% oxygen) on exosome release was quantified using nanocrystals (Qdot®) coupled to CD63 by fluorescence NTA. A real-time, live-cell imaging system (Incucyte™) was used to establish the effect of exosomes on EC. Plasma samples were obtained at early gestation (<18 weeks) and classified according to pregnancy outcomes. An Illumina TrueSeq Small RNA kit was used to construct a small RNA library from exosomal RNA obtained from EVT and plasma samples. The number of exosomes was significantly higher in EVT cultured under 1% compared to 8% oxygen. In total, 741 miRNA were identified in exosomes from EVT. Bioinformatic analysis revealed that these miRNA were associated with cell migration and cytokine production. Interestingly, exosomes isolated from EVT cultured at 8% oxygen increased EC migration, whilst exosomes cultured at 1% oxygen decreased EC migration. These changes were inversely proportional to TNF-α released from EC. Finally, we have identified a set of unique miRNAs in exosomes from EVT cultured at 1% oxygen and exosomes isolated from the circulation of mothers at early gestation, who later developed PE and SPTB. We suggest that aberrant exosomal signalling by placental cells is a common aetiological factor in pregnancy complications characterised by incomplete SpA remodeling and is therefore a clinically relevant biomarker of pregnancy complications.

Epidemiologic burden of hospitalisation for congestive heart failure among adults aged ≥19 years in the Philippines

ObjectivesThe study determined the prevalence of hospitalisation due to congestive heart failure (CHF) among adult patients aged 19 years and above in the Philippines and its 17 regions in 2014....

Spontaneous pneumothorax - a clinical study of 100 cases

Background: Pneumothorax is collection of air in the pleural cavity and it may be due to trauma to chest or spontaneous without any trauma. It is a common entity presenting to the emergency room and it needs prompt treatment as delay in treatment may endanger the life of the patient. Objective: To study the aetiology, clinical profile, and management protocols of spontaneous pneumothorax in adults in India. Materials and Methods: Patients admitted with spontaneous pneumothorax in a tertiary hospital of western India from January 2014 to March 2016 were prospectively studied. Study was planned so as to enrol first consecutive 100 patients admitted with diagnosis of spontaneous pneumothorax. Detailed history, clinical examination and necessary investigations of all patients were done and results were compared with popular studies carried out in India in past. The changing trends and similarities between the studies were noted. Result: Annual incidence of spontaneous pneumothorax was calculated as 21.739 per 100000 hospital admissions. Out of 100 patients studied 95 were diagnosed with secondary spontaneous pneumothorax and 5 with primary spontaneous pneumothorax. Chronic obstructive pulmonary disease (COPD) was found to be the most common aetiological factor. Male to female ratio was found to be 9:1. Age distribution showed a biphasic pattern. Conclusion: Spontaneous pneumothorax (SP) is more common in men. In India secondary spontaneous pneumothorax is far more common than Primary and COPD is the most common cause of spontaneous pneumothorax in this study.

Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study.

Epidemiological data for acute kidney injury are scarce, especially in low-income countries (LICs) and lower-middle-income countries (LMICs). We aimed to assess regional differences in acute kidney injury recognition, management, and outcomes. In this multinational cross-sectional study, 322 physicians from 289 centres in 72 countries collected prospective data for paediatric and adult patients with confirmed acute kidney injury in hospital and non-hospital settings who met criteria for acute kidney injury. Signs and symptoms at presentation, comorbidities, risk factors for acute kidney injury, and process-of-care data were obtained at the start of acute kidney injury, and need for dialysis, renal recovery, and mortality recorded at 7 days, and at hospital discharge or death, whichever came earlier. We classified countries into high-income countries (HICs), upper-middle-income countries (UMICs), and combined LICs and LMICs (LLMICs) according to their 2014 gross national income per person. Between Sept 29 and Dec 7, 2014, data were collected from 4018 patients. 2337 (58%) patients developed community-acquired acute kidney injury, with 889 (80%) of 1118 patients in LLMICs, 815 (51%) of 1594 in UMICs, and 663 (51%) of 1241 in HICs (for HICs vs UMICs p=0.33; p<0.0001 for all other comparisons). Hypotension (1615 [40%] patients) and dehydration (1536 [38%] patients) were the most common causes of acute kidney injury. Dehydration was the most frequent cause of acute kidney injury in LLMICs (526 [46%] of 1153 vs 518 [32%] of 1605 in UMICs vs 492 [39%] of 1260 in HICs) and hypotension in HICs (564 [45%] of 1260 vs 611 [38%%] of 1605 in UMICs vs 440 [38%] of 1153 LLMICs). Mortality at 7 days was 423 (11%) of 3855, and was higher in LLMICs (129 [12%] of 1076) than in HICs (125 [10%] of 1230) and UMICs (169 [11%] of 1549). We identified common aetiological factors across all countries, which might be amenable to a standardised approach for early recognition and treatment of acute kidney injury. Study limitations include a small number of patients from outpatient settings and LICs, potentially under-representing the true burden of acute kidney injury in these areas. Additional strategies are needed to raise awareness of acute kidney injury in community health-care settings, especially in LICs. International Society of Nephrology.

A study on cholestasis in infants less than six months of age presenting to Lady Ridgeway Hospital for Children, Colombo

Objectives: To determine the common clinical presentations, common aetiological factors, average age at presentation and possible means of early detection of cholestasis by primary health care workers. Method: This prospective, descriptive study analyzed 60 infants less than six months old who presented to Lady Ridgeway Hospital from October 2013 to January 2015 with evidence of cholestasis. Results: The common clinical features were jaundice (100%), hepatomegaly (83.3%), pale stools (76.6%), dark urine (61.6%) and splenomegaly (56.6%). The common causes were idiopathic neonatal hepatitis (INHS) (26.6%) and biliary atresia (26.6%). Nine cases of INHS were transient. Sepsis (15%), multifactorial (13.3%) and cytomegalovirus infection (6.6%) were the other frequent causes. The less frequent causes were Alagille syndrome (3.2%), birth asphyxia (1.6 %), progressive familial intrahepatic cholestasis (PFIC) (1.6%), biliary sludge due to haemolysis (1.6%), intestinal obstruction (1.6%) and multiple small gall bladder calculi (1.6%). The average age at presentation of infants with cholestasis was 64.2 days and the mean age at presentation of infants with cholestasis who were eventually diagnosed as biliary atresia was 81.8 days. Conclusions: Jaundice, hepatomegaly and pale stools were the common clinical features on presentation. INHS and biliary atresia were the common causes of cholestasis. There was a significant delay in the presentation of cases of cholestasis due to primary health care failure.

CT Evaluation of Acute Pancreatitis and its Prognostic Correlation with CT Severity Index.

Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal CT are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. To assess prognostic correlation and clinical outcome of acute pancreatitis on the basis of CT severity index. A prospective study of 50 cases was carried out in the Department of Radio Diagnosis, with complaint suggestive of acute pancreatitis on the basis of clinical/laboratory/ultrasonography findings were evaluated in Siemens somatom 40 slice CT. The severity of pancreatitis was scored using CT severity index, modified severity index and revised Atlanta classification and classified into mild, moderate, severe categories. Clinical follow-up of the patients was done in terms of the following parameters: Length of hospital stay, Need for surgery or percutaneous intervention, Evidence of infection in any organ system, Occurrence of organ failure- respiratory, cardiovascular, renal, hepatic and haematological system, death. The clinical outcome was compared with the currently accepted Balthazar's CTSI and Modified Mortele's CTSI and revised Atlanta classification in all the cases. Gall stone disease was most common aetiological factor seen in 40% cases, it was more common in females than males. Alcohol was second most common aetiological factor seen in 38% cases and was noted only in males. Pleural effusion was the most common extra-pancreatic complication seen in 46% cases. Balthazar grade C was the most common (40%) followed by grade D and E (25% each). Acute peri-pancreatic collection was the most common findings seen in 72% cases. Majority of the cases (42%) were categorized as mild pancreatitis according Balthazar CTSI score. Majority of the cases (44%) were categorized as severe pancreatitis according modified CTSI. Majority of the cases were categorized as mild pancreatitis according revised Atlanta classification. Organ system failure, death were more seen in severe grade in modified CTSI and revised Atlanta classification. Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation. Scores obtained with the modified Mortele index, show a stronger statistical correlation for all clinical outcome parameters in all the patients better than the Balthazar index.

Drug utilization pattern of antiepileptic drugs in a tertiary care teaching rural hospital

Background: Antiepileptic drugs (AEDs) are also commonly used therapy for other conditions like prophylaxis for a manicdepressive disorder, to relieve neuralgic pain and for many more conditions apart from epilepsy. Data suggest that 45% of AEDs prescriptions were for conditions other than epilepsy. All of these uses are off-label except for some AEDs approved for limited indications. Aims and Objective: To study the AEDs utilization pattern in a tertiary care teaching rural hospital in India. Materials and Methods: Patients who prescribed AEDs by treating physician from the various outpatient departments of a tertiary care hospital were enrolled in the study irrespective of their diagnosis. Their demographic data, clinical profile and drug use related details were obtained from the case files and history and analyzed. Results: Out of total 160 patients enrolled, the majority were male 103 (64.4%), in the age group of 18-65 years (123, 76.9%), and from neuromedicine 149 (93.1%) department. 81 (50.63%), 45 (28.12%), and 10 (6.25%) were diagnosed as epilepsy, pain, and psychomotor disorders, respectively, and remaining patients having a dual indication for AEDs prescription. Partial epilepsy (45, 47.87%) was the most common type and cryptogenic (44, 46.80%) was most common aetiological factor among epileptic patients. Average number of AEDs prescribed per patient was 1.331. 113 (70.6%) patients were managed by monotherapy. Most frequently prescribed AEDs were pregabalin (20.19%) followed by phenytoin (16.90%). Conventional AEDs (78.95%) were prescribed more frequently than newer AEDs (21.05%) for epilepsy; while newer AEDs (68.10%) were frequently prescribed in patients suffering from non-epileptic condition. 52% of drugs were prescribed by generic name. No fixed dose combinations of AEDs were prescribed throughout this study period. Conclusions: The use of AEDs not limited to epilepsy only. AEDs were prescribed more frequently in neuropathic pain and psychiatric disorders other than epilepsy. AEDs are usually prescribed as monotherapy and by generic name and not as fixed dose combination. Awareness about off-label use of ADEs is essential for its appropriate use.

The Genetic Absence Epilepsy Rats from Strasbourg model of absence epilepsy exhibits alterations in fear conditioning and latent inhibition consistent with psychiatric comorbidities in humans.

Behavioural, neurological, and genetic similarities exist in epilepsies, their psychiatric comorbidities, and various psychiatric illnesses, suggesting common aetiological factors. Rodent models of epilepsy are used to characterize the comorbid symptoms apparent in epilepsy and their neurobiological mechanisms. The present study was designed to assess Pavlovian fear conditioning and latent inhibition in a polygenetic rat model of absence epilepsy, i.e. Genetic Absence Epilepsy Rats from Strasbourg (GAERS) and the non-epileptic control (NEC) strain. Electrophysiological recordings confirmed the presence of spike-wave discharges in young adult GAERS but not NEC rats. A series of behavioural tests designed to assess anxiety-like behaviour (elevated plus maze, open field, acoustic startle response) and cognition (Pavlovian conditioning and latent inhibition) was subsequently conducted on male and female offspring. Results showed that GAERS exhibited significantly higher anxiety-like behaviour, a characteristic reported previously. In addition, using two protocols that differed in shock intensity, we found that both sexes of GAERS displayed exaggerated cued and contextual Pavlovian fear conditioning and impaired fear extinction. Fear reinstatement to the conditioned stimuli following unsignalled footshocks did not differ between the strains. Male GAERS also showed impaired latent inhibition in a paradigm using Pavlovian fear conditioning, suggesting that they may have altered attention, particularly related to previously irrelevant stimuli in the environment. Neither the female GAERS nor NEC rats showed evidence of latent inhibition in our paradigm. Together, the results suggest that GAERS may be a particularly useful model for assessing therapeutics designed to improve the emotional and cognitive disturbances associated with absence epilepsy.

Possible Common Aetiology behind Maternal Preeclampsia and Congenital Heart Defects in the Child: a Cardiovascular Diseases in Norway Project Study.

The aetiology of congenital heart defects (CHD) is mostly unknown, but maternal factors may modify the infant risk of CHD. We investigated the association between maternal preeclampsia and offspring risk of severe CHD in a nation-wide cohort study. Information on all births registered in the Medical Birth Registry of Norway, 1994-2009, was completed with information on CHD diagnoses from national health registries and the Cardiovascular Diseases in Norway Project (CVDNOR). Among 914 703 singleton births without chromosomal abnormalities, 32 864 (3.6%) were born after a pregnancy with preeclampsia. The preeclampsia was diagnosed before the 34th week of pregnancy (early-onset preeclampsia) in 2618 (8.0% of preeclamptic pregnancies). CHDs were diagnosed in 10 691 infants; of these, 2473 had severe CHD. The risk of severe CHD was compared between births with and without maternal preeclampsia and estimated with binomial log-linear regression. When adjusting for year of birth, maternal age, parity, and pregestational diabetes, the risk ratio (RR) for severe CHD in offspring of mothers with any preeclampsia was 1.3 [95% confidence interval (CI) 1.1, 1.5], and in pregnancies with early-onset preeclampsia, the RR was 2.8 (95% CI 1.8, 4.4). The association between early-onset preeclampsia and specific types of severe CHD was stronger for atrioventricular septal defects (AVSD), with adjusted RR 13.5 (95% CI 6.8, 26.8). Early-onset preeclampsia was strongly associated with infant risk of severe CHD, specifically; the risk of AVSD was 15-fold higher if the mother was diagnosed with early-onset preeclampsia, suggesting common aetiological factors for early-onset preeclampsia and erroneous fetal heart development.

Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital

Background . Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or initial presenting symptoms. There are often grey areas with regard to neuropsychiatric disorders in which psychiatrists and specialists from other clinical disciplines would need to co-manage or share ideas on the comprehensive treatment of a presenting patient. Objectives. This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP) service at the Helen Joseph Hospital (HJH) in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a comorbid medical condition, including delirium, dementia and a mood or psychotic disorder due to a general medical condition. Methods. A retrospective record review of all patients referred to the HJH CLP team over a 6-month period. Results. A total of 884 routine and emergency consultations were done for 662 patients (males n=305; females n=357) between the ages of 13 and 90 years who were referred from various other clinical departments. The most common documented reason for referral was a request for assessment (n=182; 27.5%), which consisted of mental state assessment, reconsultation and assessing capacity. A total of 63 patients (10.0% of cases consulted) were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, dementia and/or a mood or psychotic disorder due to a general medical condition (although admission wards were identified in 55 files only). The medical wards admitted the majority (n=37; 67.3%) mostly for delirium (n=28; 50.9%). HIV was identified as the most common systemic aetiological factor (n=23; 67.7%). Conclusion. In this study, a female patient between 31 and 45 years of age was slightly more likely to be referred to the HJH CLP service for assessment, and was more likely to be managed in the medical wards for delirium, which was most often associated with HIV/AIDS. The study highlighted the need for development of guidelines to facilitate adequate and effective use of this service for the local practice of CLP in a general specialist referral hospital like HJH, which would cover the following: clinical management; training needs; and administrative procedures.

Cerebral sinus venous thrombosis: clinical and pathogenetic perspectives from Tuscany.

Cerebral sinus venous thrombosis (CSVT) is a rare condition representing the 0.5-1% of all stroke cases which can have serious consequences. Early diagnosis and complete screening for acquired or inherited risk factors is crucial for decreasing morbidity and mortality. We have investigated clinical and aetiological factors in an Italian cohort of 43 patients with cerebral sinus venous thrombosis. Common presentation complaints were headache (81.4%), focal signs (20.9%), vomiting (11.6%) and seizures (6.9%). Acquired or inherited conditions were observed in more than 80% of cases. The commonest aetiological factors were contraceptives (74.1% of women), congenital thrombophilia (34.9%), infections and dysthyroidism (16.3%), hyperhomocysteinemia (9.3%), migraine (11.6%), cranial trauma (9.3%) and chronic myeloproliferative diseases (11.6%). Outcome was favourable in more than 80% of patients. Early diagnosis and anticoagulant treatment may decrease mortality and/or morbidity rates related with CVST in these patients. Thrombophilic abnormalities, either inherited or acquired, are worthy to be widely investigated.

Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;. Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or initial presenting symptoms. There are often grey areas with regard to neuropsychiatric disorders in which psychiatrists and specialists from other clinical disciplines would need to co-manage or share ideas on the comprehensive treatment of a presenting patient. Objectives. This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP) service at the Helen Joseph Hospital (HJH) in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a comorbid medical condition, including delirium, dementia and a mood or psychotic disorder due to a general medical condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; Methods.&lt;/strong&gt; A retrospective record review of all patients referred to the HJH CLP team over a 6-month period. Results. A total of 884 routine and emergency consultations were done for 662 patients (males n=305; females n=357) between the ages of 13 and 90 years who were referred from various other clinical departments. The most common documented reason for referral was a request for assessment (n=182; 27.5%), which consisted of mental state assessment, reconsultation and assessing capacity. A total of 63 patients (10.0% of cases consulted) were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, dementia and/or a mood or psychotic disorder due to a general medical condition (although admission wards were identified in 55 files only). The medical wards admitted the majority (n=37; 67.3%) mostly for delirium (n=28; 50.9%). HIV was identified as the most common systemic aetiological factor (n=23; 67.7%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt; Conclusion.&lt;/strong&gt; In this study, a female patient between 31 and 45 years of age was slightly more likely to be referred to the HJH CLP service for assessment, and was more likely to be managed in the medical wards for delirium, which was most often associated with HIV/AIDS. The study highlighted the need for development of guidelines to facilitate adequate and effective use of this service for the local practice of CLP in a general specialist referral hospital like HJH, which would cover the following: clinical management; training needs; and administrative procedures.&lt;/p&gt;

Abstract P2-08-03: The association between primary breast cancer and thyroid cancer: A meta-analysis

Abstract Background: Previous studies have suggested an aetiological link between breast cancer and thyroid cancer, however, there has never been a formal meta-analysis which collates the existing evidence supporting the hypothesis that breast cancer or thyroid cancer predispose an individual to developing the other. Method: A systematic search was carried out using the electronic databases Pubmed and Medline. We searched for articles containing epidemiological evidence of breast cancer following thyroid cancer and vice versa. Additionally, we searched for articles that included epidemiological data involving the incidence of all second primary malignancies following both breast cancer and thyroid cancer, and compared the data sets. Results: The meta-analysis performed in a total of 18 studies, showed that there is a significantly increased risk of developing thyroid cancer as a second primary malignancy of breast cancer (RR=1.59, 95% CI: 1.28-1.99; I2=79.99, p&amp;lt;0.001). Additionally, there was marginally increased risk of developing breast cancer as a second primary malignancy of thyroid cancer (RR=1.24, 95% CI: 1.18-1.30; I2=24.67, p=0.18), compared to the general risk of developing a second primary malignancy following thyroid cancer. Conclusion: The findings of this meta-analysis suggest that there is less likely to be a common aetiological factor of the two cancers, but rather a specific aspect of the pathophysiology of breast cancer which pre-disposes individuals to develop thyroid cancer. Elucidation of the common mechanisms between breast cancer and thyroid cancer will have important implications in both diagnostic and therapeutic management of these cancers. Benefit of thyroid ultrasound screening after breast cancer surgery needs to be assessed. Citation Format: Kyle R Joseph, Senarath Edirimanne, Guy Eslick. The association between primary breast cancer and thyroid cancer: A meta-analysis [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-08-03.

Aetiology of Spontaneous Intracerebral Haemorrhage in Young Adults Admitted at a Tertiary Care Hospital in Dhaka

Spontaneous Intracerebral Haemorrhage (SICH) in young adult occurs due to multiple risk factors. The purpose of the present study was to determine the aetiological factors of spontaneous intracerebral haemorrhage in the young adult patients. This case control study was carried out in the Department of Neurology, Department of Neurosurgery and Department of Internal Medicine at Dhaka Medical College Hospital, Dhaka from September 2010 to August 2011 for a period of one (01) year. Patients aged 15 to 45 years who presented with spontaneous intracerebral haemorrhage were taken as case (Group A) and those more than 45 years of age with spontaneous intracerebral haemorrhage were taken as control (Group B). All the aetiological factors were recorded in a predesigned data sheet. A total of 430 patients with clinical feature of stroke were admitted through emergency and outpatient department during the study period, of which 152(35.34%) patients had spontaneous intracerebral haemorrhage. Based on the inclusion and exclusion criteria 35 patients were recruited from 15-45 years age range as case and 25 patients were recruited as control. The risk factors of SICH in younger patients were arteriovenous malformation (45.7%), toxaemia of pregnancy (31.4%), hypertension (17.1%), cavernous angioma (2.9%), bleeding disorder (2.9%) and coagulation disorder (2.9%). In patients >45 years most of the ICH was due to HTN (52%) followed by arteriovenous malformation (20%). In conclusion arteriovenous malformation is the most common aetiological factors of young stroke patients followed by hypertension and toxaemia of pregnancy.

Gastroduodenal Artery Aneurysm: A Case Report and Concise Review of Literature.

Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest aetiological factor. Its main complication is rupture, which is not uncommon and carries high risk of mortality. Clinical suspicion and advanced imaging tools should be employed in a timely fashion to make a diagnosis before this ominous event. We report a case of successfully treated GDA aneurysm who presented with minor bleeding episodes before suffering a major bleed and briefly discuss this pathology in light of the existing literature.