Complaints Of Irritation Research Articles

ANALISIS KADAR SISA KLORIN DAN PH AIR DI KOLAM RENANG UMUM KOTA PEKANBARU

Kualitas air kolam renang merupakan aspek penting yang harus dikelola dan diperhatikan agar tidak menjadi suatu gangguan kesehatan di lingkungan kolam renang. Kadar klorin pada kolam renang berguna untuk membunuh mikroorganisme pathogen, namun apabila kadar berlebih di dalam air dapat menimbulkan gangguan kesehatan seperti keluhan iritasi mata dan pH air yang terlalu tinggi ataupun rendah akan mengakibatkan kerja klorin tidak optimal dan dapat mengakibatkan pengendapan kapur. Penelitian ini bertujuan untuk mengetahui kadar sisa klorin dan pH air kolam renang umum di Kota Pekanbaru. Jenis penelitian ini penelitian deskriptif, yaitu untuk mengetahui kadar sisa klorin dan Ph pada kolam renang menggunakan test kit. Penelitian ini dilakukan di 7 kolam renang umum yang ada di Kota Pekanbaru. Analisis data menggunakan analisis univariat. Hasil penelitian menunjukkan dari 7 kolam renang, 4 kolam renang tidak memenuhi syarat. Hanya 3 kolam renang yang memenuhi syarat dalam sisa klorin dan Ph.

Low-dose-rate brachytherapy as a minimally invasive curative treatment for localised prostate cancer has excellent oncological and functional outcomes: a retrospective analysis from a single centre.

IntroductionLow-dose-rate (LDR) brachytherapy is a widely used therapeutic option for localised prostate cancer. The aim of this study was to analyse the oncological and functional outcomes after 10 years of experience with brachytherapy for localised prostate cancer.Material and methodsAll patients who underwent brachytherapy between April 2006 and September 2017 were included for analysis. Initial prostate-specific antigen (PSA) levels, tumour stages, Gleason scores, positive biopsies, prostate volumes, dosimetric parameters, and urinary symptoms were noted.ResultsA total of 201 patients underwent brachytherapy between April 2006 and September 2017. Of these patients, 159 had >3 years of oncological and functional follow-up. Only these relevant patients were included in the statistical analysis. This showed a significant, persistent decline in PSA levels (p <0.0001): the mean PSA was 1.2 ng/ml after 6 months, 1.1 ng/ml after 1 year, and 0.49 ng/ml after 3 years. Only 9 patients had tumour recurrence (3 patients with Gleason score 6 and 6 patients with Gleason score 7). After receiving adequate treatment, the patients underwent oncological follow-up.Important obstructive and irritative complaints were most pronounced during the first 9 months and decreased strongly after 18 months of follow-up.ConclusionsLDR brachytherapy has excellent oncological outcomes with limited functional inconveniences that are adequately treatable. Our 10 years' experience shows that brachytherapy is a safe and effective method for the treatment of low-risk localised prostate cancer.

Consumo de cannabis na adolescência: relato de caso

Introduction: The illicit use of drugs has increased among adolescents. These are a risk group and cannabis is the drug preferentially used. Drug abuse is a clinical indication for family assessment. The aim is to alert illicit drug use in adolescence and emphasize the importance of family assessment and brief intervention by the family doctor. Case description: A 18-year-old adolescent male, belonging to a nuclear family at stage V of the Duvall cycle and middle social class, living with his parents with deafness and a 14-year-old sister. Family history of alcoholism. Initiated cannabis use at age 16 and regular use motivated school failure. In April 2015 with complaints of irritability and loss of motivation, associated with lack of concentration. Complaints were justified by the revolt in relation to deaf parents. In Family Circle, the adolescent put his sister in the center of the family and parents apart. According to the Family APGAR, it was a family with moderate dysfunction. It was decided not to intervene with family because it was not considered a high-risk situation and to not go against the adolescent will. Advice was provided to drug abuse, adapted to the stage of change. In September 2015 stopped using cannabis, remaining abstinent in March 2016 and more motivated at school. The maintenance of abstinence and prevention of relapse were promoted. Comment: The family continues to be the most consistent social support. The family dynamics can be prejudiced when parents, especially deaf, deal with the problems of adolescents, increasing the risk of illicit drug use. The family assessment and evaluation of the motivation for change by the family doctor are essential because only in this way is possible to improve doctor-patient relationship and chances of therapeutic success.

A novel TRPM8 agonist relieves dry eye discomfort

BackgroundPhysical cooling of the eye surface relieves ocular discomfort, but translating this event to drug treatment of dry eye discomfort not been studied. Here, we synthesized a water-soluble TRPM8 receptor agonist called cryosim-3 (C3, 1-diisopropylphosphorylnonane) which selectively activates TRPM8 (linked to cooling) but not TRPV1 or TRPA1 (linked to nociception) and tested C3 in subjects with mild forms of dry eye disease.MethodsA set of 1-dialkylphosphoryalkanes were tested for activation of TRPM8, TRPV1 and TRPA1 receptors in transfected cells. The bioactivity profiles were compared by perioral, topical, and intravenous delivery to anesthetized rats. The selected lead candidate C3 or vehicle (water) was applied with a cotton gauze pad to upper eyelids of patients with dry eye disease (n = 30). Cooling sensation, tear film break-up time (TBUT), basal tear secretion, and corneal staining were evaluated. C3 was then applied four times daily for 2 weeks to patients using a pre-loaded single unit applicator containing 2 mg/mL of C3 in water (n = 20) or water only. TBUT, basal tear secretion, and corneal staining, and three questionnaires surveys of ocular discomfort (VAS scale, OSDI, and CVS symptoms) were analyzed before and at 1 and 2 weeks thereafter.ResultsC3 was a selective and potent TRPM8 agonist without TRPV1 or TRPA1 activity. In test animals, the absence of shaking behavior after C3 perioral administration made it the first choice for further study. C3 increased tear secretion in an animal model of dry eye disease and did not irritate when wiped on eyes of volunteers. C3 singly applied (2 mg/ml) produced significant cooling in <5 min, an effecting lasting 46 min with an increase in tear secretion for 60 min. C3 applied for 2 weeks also significantly increased basal tear secretion with questionnaire surveys of ocular discomfort indices clearly showing improvement of symptoms at 1 and 2 weeks. No complaints of irritation or pain were reported by any subject.ConclusionsC3 is a promising candidate for study of TRPM8 function on the eye surface and for relief of dry eye discomfort.Trial registrationISRCTN24802609 and ISRCTN13359367. Registered 23 March 2015 and 2 September 2015.

Ovarian Inguinal Herniation

A 3 days female newborn , born at term by Cesearean section, with a birth weight of 3200 g, was brought to the casualty with the complaints of irritability and a lump in her right groin by her mother. On physical examination, a non-fluctuant mass which was irreducible was palpated in the right inguinal region, just above the labium majora. JMS 2016; 19(1):35

An exploratory clinical study of disruptive mood dysregulation disorder in children and adolescents from India.

Children with chronic non-episodic irritability were frequently diagnosed as suffering from pediatric bipolar disorder. Therefore in DSM-5 a new diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) was included for such children. This study aimed to identify DMDD in children and adolescents in Indian child and adolescent psychiatry clinic and elicit its phenomenology and co-morbidities. Children of 6-16 years, presenting with irritability for more than one year were assessed using DSM 5 diagnostic criteria to make a diagnosis of DMDD. Severity of irritability was assessed using Affective Reactivity index (ARI). Co-morbidities were screened on Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version (KSADS-PL) and diagnosed as per DSM-IV TR criteria. Overall behavioral problems were assessed on Conner's parent symptom questionnaire (CPSQ) and impairment in functioning on children's global assessment of functioning scale(C-GAS). 21 subjects were diagnosed with DMDD. Majority of the subjects (15, 71.4%) were in the age group 6-12 years (mean age11.1±2.9 years) and were males (16, 76.2%). Most common presenting complaints were, frequent irritability and anger outbursts in 21 (100%) and inattention towards studies in 20 (95.2%) subjects. Most of the subjects (18, 85.7%) had moderate to severe irritability. 13 (61.9%) subjects had co-morbidities. Mean CGAS was 46.1±6.9. DMDD can be diagnosed in Indian children using DSM 5 criteria. Such children presented with complaints of irritability and problems in studies. They commonly had co-morbidities and had moderate impairment of functioning.

Why Personalized Treatment Decisions Are Important

Why Personalized Treatment Decisions Are Important

English

BACKGROUND: In this case report we describe a very rare case of symblepheron which hasn't been reported in literature till date, triggered by long standing cilia embedded in the subconjuctival space followed by regression of symblepheron by removing the cilia. CASE REPORT: A 65-year-old man, presented to the eye O.P.D of I.G.M.C. Shimla with complaints of irritation and foreign body sensation in the left eye from last 8-9 months. He had no history of trauma, chemical injury or surgery in left eye in the past. He had history of multiple treatments with topical antibiotics and lubricants for the complaints with no relief. Torch light examination revealed a whitish membrane in the lower palpebral conjunctiva. Slit lamp examination revealed two semilunar pseudopockets and partial symblepheron in lower fornix. Further probing revealed two eyelashes embedded in the subconjuctival space in one of the peudopockets. Search with a needle under topical anesthesia under slit lamp magnification enabled the cilia to be removed with little difficulty; the cilia were of the same size and appearance as the patient's own. He was prescribed topical antibiotics and the symblepheron regressed significantly in 8 weeks' time. CONCLUSION: Long term inflammation associated with foreign bodies like embedded cilium in the subconjuctival space may cause unusual presentations like symblepheron as in this case.

Impacted Foreign Body of Parapharyngeal Space a Rare Case Blog

Introduction Foreign bodies implanted in the Para pharyngeal space are quiet rare. Most cases occur in infants and children, and are usually accompanied by a poor and confusing history. Due to its rarity, it is not usually considered among the differential diagnosis of palatal lesions. This is a totally confusing history about a 6 months old child who presented with vague symptoms and was later diagnosed to have impacted metallic foreign body in the parapharyngeal space. Case Blog A ten months old male child came to our ENT department with complaints of dysphagia in a child and complaints of irritability, decreased sleep. On examination child was little irritable. Paediatrics opinion was taken, general examination as well as systemic examinations revealed NAD. Suspecting foreign body of nasal cavity, X ray nasopharynx lateral view was advised. Surprisingly metallic foreign body was seen in the pharynx (Figure 1). On oral cavity examination, no haematoma or swelling was observed. Oral cavity was absolutely fine. To define the exact location of the foreign body, CT scan was adviced. CT scan revealed metallic foreign body in the left side parapharyngeal space (Figure 2). The patient was immediately admitted and was planned for foreign body removal under general anaesthesia. Tran’s oral approach was done and the metallic foreign body was removed. Wound repaired with vicryl 3-0 interrupting sutures. Discussion The possibility of children inserting objects into their oral cavity is the main reason why palatal foreign bodies and injuries are most common in this age group [1]. The natural position of the tongue, thumb sucking and feeding patterns further led to the adherence of a foreign body to the roof of the oral cavity by producing a constant force on the foreign body up against the palate and also sometime it may enter the parapharyngeal space. Management of trauma to the palate and lateral pharyngeal wall will initially include hospitalisation, mucosal repair and antibiotic prophylaxis and also diagnostic studies as well as treatment if thrombosis or neurologic changes develop. Shanon et al. [2] recommended hospitalisation for 48 to 72 h, due to the devastating

Low rates of depressed mood and depression diagnoses in a clinic review of children and adolescents with autistic disorder.

The purpose of this study was to investigate the prevalence of depression diagnoses and related clinical data in an outpatient sample of youth with autistic disorder. Records of 123 psychiatrically referred children and adolescents with a Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) diagnosis of autistic disorder were examined. Mood disorder diagnoses and chief complaints along with family mood disorder history were the primary variables analyzed. Four subjects (3%) presented with depressed mood. Irritability complaints were frequent (n=78, 63%). Six subjects (5%) received a mood disorder diagnosis; all with mood disorder, not otherwise specified. No subjects received a depressive disorder diagnosis. Family history of mood disorders was common. Findings raise questions about the appropriate characterization and potential misdiagnoses of depression in youth with autistic disorder.

Hypoxanthine urolithiasis in an 11-month-old child: A case report of

Hereditary xanthinuria is a novel autosomal recessive disorder of purine metabolism resulting from the deficiency of xanthine dehydrogenase. An 11-month-old boy admitted with the complaints of irritability for 6 months, darkening of the urine and spontaneous passage of stone. Both serum and urine levels of uric acid were below normal. Urinary ultrasonography was normal. Stone analysis revealed that it was a hypoxanthine stone. The case is reported because hereditary xanthinuria is a rare cause of childhood urolithiasis.

A Comparative Study of Clear Corneal Phacoemulsification with Rigid IOL Versus SICS; the Preferred Surgical Technique in Low Socio-economic group Patients of Rural Areas.

Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by charitable organisations. SICS continues to be a time tested technique for cataract removal in such patients. In recent times, camp patients are sometimes treated by clear corneal phacoemulsification with implantation of a rigid IOL, which being more cost effective is often provided for camp patients. This study was undertaken to find out which surgical technique yielded better outcomes and was more suited for high volume camp surgery. To find the better surgical option- phacoemulsification with rigid IOL or SICS, in poor patients from rural areas. A prospective randomised controlled trial of cataract patients operated by two different techniques. One hundred and twelve eyes were selected and were randomly allocated into two groups of 56 eyes each. At completion of the study, data was analysed for 52 eyes operated by clear corneal phacoemulsification and implantation of a rigid IOL, and 56 eyes operated by SICS. Unpaired t-test was used to calculate the p- value. The results were evaluated on the following criteria. The mean post-operative astigmatism at the end of four weeks - was significantly higher in phacoemulsification group as compared to SICS group The BCVA (best corrected visual acuity) at the end of four weeks - was comparable in both groups. Subjective complaints and/ or complications: In phaco group two patients required sutures and seven had striate keratitis , while none in SICS group. Complaint of irritation was similar in both groups. Surgical time- was less for SICS group as compared to phaco group. SICS by virtue of being a faster surgery with more secure wound and significantly less astigmatism is a better option in camp patients from rural areas as compared to phacoemulsification with rigid IOL.

Exposure of Medical fraternity to formaldehyde in Anatomy and search for better alternatives to formalin

Exposure of Medical fraternity to formaldehyde in Anatomy and search for better alternatives to formalin

HUBUNGAN SISA KLOR DENGAN KELUHAN IRITASI KULIT DAN MATA PADA PEMAKAI KOLAM RENANG HOTEL DI WILAYAH KOTA YOGYAKARTA

Background: Public places such as public baths and swimming pools are used as a gathering place by many people have potency to be a medium of disease transmission. Direct contact among visitors can transmit disease germs from one to the other visitors. Moreover, the contact can be a deployment medium of a disease. This study aimed to determine the relationship between chlorine residue with the complaints of skin and eye irritations of swimmingpool users in Yogyakarta hotels. Methods: The research was an observational analytic study by using cross sectional design. Sampling of the research uses systematic random sampling and consists of 48 respondents. Research tools used are questionnaires and laboratory tests. Data analysis uses univariate and bivariate analysis with a statistical test ChiSquare (X2). Results: Results of the study showed that 28 respondents (58.3%) have complaints and 20 respondents (41.7%) do not have complaints. From six water samples taken from swimming pool, 4 samples (66.7%) do not qualify and 2 samples (33.3%) are eligible. Bivariate analysis found that there was a significant relationship between chlorine residue with the complaints of skin and eye irritations of swimming pool users in Yogyakarta hotels (p = 0.038) smaller than alpha (? = 0.05), RP = 1,83. Conclusion: There was a relationship between residual chlorine with the complaints of skin and eye irritations of swimming pool users in Yogyakarta hotels. Keywords: Chlorine Residue, Skin and eye irritation complaints, Swimming Pool

Acute Severe Hepatotoxicity Associated with Clomipramine

Miss Y. presented with complaints of irritability, depressed mood, avolition, anhedonia, markedly decreased appetite and around 10 kg weight loss within two months, amenorrhea, dysmorphophobia, and psychomotor retardation. The psychiatric evaluation revealed major depressive episode. She was given a prescription for 25 mg/day of clomipramine for her depression, and also cognitive behavioral therapy was started. Her level of aspartate aminotransferase was 212 IU/liter, and her alanine aminotransferase level was 474 IU/liter. Therefore, clomipramine was stopped urgently. After one month, the enzymes returned to normal values. Physicians should be alert to the possibility that clomipramine can cause acute hepatotoxicity and consider early discontinuation of an antidepressant if the condition is suspected.

New-Onset Psychosis After Temporal Lobectomy

Back to table of contents Previous article Next article LETTERFull AccessNew-Onset Psychosis After Temporal LobectomyDinesh Narayanan M.B.B.S., D.P.M., M.D.,Sunny T. Varghese M.B.B.S., M.D.,Deepa Dinesh,Dinesh Narayanan M.B.B.S., D.P.M., M.D.Search for more papers by this author,Sunny T. Varghese M.B.B.S., M.D.Search for more papers by this author,Deepa DineshSearch for more papers by this author,Published Online:1 Oct 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Epilepsy is often associated with psychiatric illness such as depression, anxiety, and ictal, interictal, and postictal psychosis. Temporal lobectomy for treatment of seizures resistant to medication is rarely associated with new-onset psychotic disorders. 1 We report on a young man who developed psychosis after right temporal lobectomy was performed for seizure control. A 35-year-old man was brought to the psychiatry outpatient department with complaints of irritability, violence at home, aggressiveness, and delusions of reference and persecution for 3 days. He had been treated at another hospital for complex partial seizures, which was poorly controlled on antiepileptic medications. MRI brain scans before the surgery showed right hippocampal sclerosis and EEG showed seizure activity from the right temporal region. The patient had undergone right temporal lobectomy 4 months before the onset of psychotic symptoms. The patient did not have any seizures after the surgery and was well maintained on medications; he had been taking carbamazepine, topiramate, and clonazepam before the surgery, and they were continued. Long periods of intractable seizures preoperatively were never associated with ictal, postictal, or interictal psychosis. No new antiepileptic medications or other propsychotic medications were added; withdrawal of antiepileptic medications was not attempted. He was admitted and treated with haloperidol, 10 mg/day in divided doses, and parenteral haloperidol as required for the first 2 days. Because of persisting aggression and delusions, the dose was increased to 20 mg/day along with promethazine, 20 mg/day. The patient improved over the next 2 weeks on these medications and his violence and irritability decreased. Three weeks after admission he was discharged with haloperidol, 20 mg/day in divided doses, and was asymptomatic on follow-up. To date, only a little more than 50 patients have been reported to have de novo psychosis following surgical treatment for medically intractable epilepsy. 1 Approximately 85% of the de novo postoperative psychoses have followed right temporal lobectomies. 2 Psychosis after temporal lobectomy has been shown to have a clustering in the early postoperative period. Most of the reported cases occurred within 6 months of the surgery. 2 The presence of bilateral abnormalities, congenital lesions and pathologies other than mesial temporal lobe sclerosis have been associated with de novo onset of psychosis after the surgery. 1 , 2 , 3 Patients with bilateral functional and structural abnormalities, particularly of the amygdala, are at particular risk. 1 The various cases that have been reported suggest schizophrenia-like psychosis in these patients, who respond well to treatment with antipsychotics. Long-term studies on these patients are lacking and prognostic factors, if any, are still unknown. Any changes in the medications or recurrence of seizures can also precipitate psychosis. New-onset postictal psychosis after temporal lobectomy has also been described. 4 , 5 Antipsychotics that are not likely to lower the seizure threshold must be chosen for such patients. The physicians should be aware of the rare possibility of psychosis in patients undergoing surgery for seizures resistant to medical therapy. Professor, Department of PsychiatryAssistant Professor, Department of PsychiatryMedical Student, Department of Psychiatry, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, IndiaReferences1 . Shaw P, Mellers J, Henderson M, et al: Schizophrenia-like psychosis arising de novo following a temporal lobectomy: timing and risk factors. J Neurol Neurosurg Psychiatry 2004; 75:1003–1008Google Scholar2 . Blumer D, Wakhlu S, Davies K, et al: Psychiatric outcome of temporal lobectomy for epilepsy: incidence and treatment of psychiatric complications. Epilepsia 1998; 39:478–486Google Scholar3 . Christodoulou C, Koutroumanidis M, Hennessy MJ, et al: Postictal psychosis after temporal lobectomy. Neurology 2002; 59:1432–1435Google Scholar4 . Manchanda R, Miller H, McLachlan RS: Postictal psychosis after right temporal lobectomy. J Neurol Neurosurg Psychiatry 1993; 56:277–279Google Scholar5 . Mace CJ, Trimble MR: Psychosis following temporal lobe surgery: a report of six cases. J Neurol Neurosurg Psychiatry 1991; 54:639–644Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 20Issue 4 Fall, 2008Pages 500-501 Metrics PDF download History Published online 1 October 2008 Published in print 1 October 2008

New-Onset Psychosis After Temporal Lobectomy

Back to table of contents Previous article Next article LETTERFull AccessNew-Onset Psychosis After Temporal LobectomyDinesh Narayanan M.B.B.S., D.P.M., M.D.,Sunny T. Varghese M.B.B.S., M.D.,Deepa Dinesh,Dinesh Narayanan M.B.B.S., D.P.M., M.D.Search for more papers by this author,Sunny T. Varghese M.B.B.S., M.D.Search for more papers by this author,Deepa DineshSearch for more papers by this author,Published Online:1 Oct 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Epilepsy is often associated with psychiatric illness such as depression, anxiety, and ictal, interictal, and postictal psychosis. Temporal lobectomy for treatment of seizures resistant to medication is rarely associated with new-onset psychotic disorders. 1 We report on a young man who developed psychosis after right temporal lobectomy was performed for seizure control. A 35-year-old man was brought to the psychiatry outpatient department with complaints of irritability, violence at home, aggressiveness, and delusions of reference and persecution for 3 days. He had been treated at another hospital for complex partial seizures, which was poorly controlled on antiepileptic medications. MRI brain scans before the surgery showed right hippocampal sclerosis and EEG showed seizure activity from the right temporal region. The patient had undergone right temporal lobectomy 4 months before the onset of psychotic symptoms. The patient did not have any seizures after the surgery and was well maintained on medications; he had been taking carbamazepine, topiramate, and clonazepam before the surgery, and they were continued. Long periods of intractable seizures preoperatively were never associated with ictal, postictal, or interictal psychosis. No new antiepileptic medications or other propsychotic medications were added; withdrawal of antiepileptic medications was not attempted. He was admitted and treated with haloperidol, 10 mg/day in divided doses, and parenteral haloperidol as required for the first 2 days. Because of persisting aggression and delusions, the dose was increased to 20 mg/day along with promethazine, 20 mg/day. The patient improved over the next 2 weeks on these medications and his violence and irritability decreased. Three weeks after admission he was discharged with haloperidol, 20 mg/day in divided doses, and was asymptomatic on follow-up. To date, only a little more than 50 patients have been reported to have de novo psychosis following surgical treatment for medically intractable epilepsy. 1 Approximately 85% of the de novo postoperative psychoses have followed right temporal lobectomies. 2 Psychosis after temporal lobectomy has been shown to have a clustering in the early postoperative period. Most of the reported cases occurred within 6 months of the surgery. 2 The presence of bilateral abnormalities, congenital lesions and pathologies other than mesial temporal lobe sclerosis have been associated with de novo onset of psychosis after the surgery. 1 , 2 , 3 Patients with bilateral functional and structural abnormalities, particularly of the amygdala, are at particular risk. 1 The various cases that have been reported suggest schizophrenia-like psychosis in these patients, who respond well to treatment with antipsychotics. Long-term studies on these patients are lacking and prognostic factors, if any, are still unknown. Any changes in the medications or recurrence of seizures can also precipitate psychosis. New-onset postictal psychosis after temporal lobectomy has also been described. 4 , 5 Antipsychotics that are not likely to lower the seizure threshold must be chosen for such patients. The physicians should be aware of the rare possibility of psychosis in patients undergoing surgery for seizures resistant to medical therapy. Professor, Department of PsychiatryAssistant Professor, Department of PsychiatryMedical Student, Department of Psychiatry, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, IndiaReferences1 . Shaw P, Mellers J, Henderson M, et al: Schizophrenia-like psychosis arising de novo following a temporal lobectomy: timing and risk factors. J Neurol Neurosurg Psychiatry 2004; 75:1003–1008Google Scholar2 . Blumer D, Wakhlu S, Davies K, et al: Psychiatric outcome of temporal lobectomy for epilepsy: incidence and treatment of psychiatric complications. Epilepsia 1998; 39:478–486Google Scholar3 . Christodoulou C, Koutroumanidis M, Hennessy MJ, et al: Postictal psychosis after temporal lobectomy. Neurology 2002; 59:1432–1435Google Scholar4 . Manchanda R, Miller H, McLachlan RS: Postictal psychosis after right temporal lobectomy. J Neurol Neurosurg Psychiatry 1993; 56:277–279Google Scholar5 . Mace CJ, Trimble MR: Psychosis following temporal lobe surgery: a report of six cases. J Neurol Neurosurg Psychiatry 1991; 54:639–644Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 20Issue 4 Fall, 2008Pages 500-501 Metrics PDF download History Published online 1 October 2008 Published in print 1 October 2008

Psychotic symptoms and cognitive impairment with herpes encephalitis

Herpes encephalitis with psychiatric symptoms and cognitive impairment are reported previously. We report a case of herpes encephalitis who had delirium, psychosis and depressive disorder respectively during the acute encephalitis and post encephalitic term.A 27 years old man, who was hospitalized by microbiology clinic, diagnosed with herpes encephalitis by PCR. The MRI study showed high-signal areas in bilateral temporal lobes. He had delirium symptoms during acute encephalitis so a low-dosage of Haloperidole was added to herpes treatment. Delirium symtoms recovered in a few days. 2 months after discharge he admitted to psychiatry outpatient clinic with the complaints of irritability and hipomnesia. In psychiatric examination; delusions, hallucinations, aggression, disorganized behavior were found, postencephalitic lesions in bilateral temporal lobes and abscess formation in left hippocampus secondary to encephalitis determined by repeated MRI. At the neurupsychiatric evaluation; deficits in verbal-episodic memory, visuoperceptual functions and disorientation were present. Olanzapine was started and titrated up to 20 mg/day. His psychotic symptoms recovered but few mounts later depressive symptoms especially feelings of insufficiency occurred. Olanzapine was gradually decreased; simultaneously Sertralin was started and titrated up to 150 mg/day. The following MRI studies showed a recovery in the counts and sizes of abscess formations. At the end of one year depressive symptoms and cognitive impairment continued with a partial recovery.The pathologic changes and alterations including bilateral temporal lobes and hippocampus may be responsible for the occurrence and variety of symptoms in this case so it highlights the relationship between psychiatric disorders and different brain regions.

Lid margin split in the surgical correction of epiblepharon

To describe the technique of splitting the lid margin combined with the excision of redundant skin and muscle during the surgical correction of epiblepharon and to report its clinical outcome. A combined procedure that included splitting the lid margin to repair lower eyelid epiblepharon was performed on 31 eyes of 19 consecutive patients. Lid margin splitting was performed along the grey line on the medial third or half of the lower eyelid by making a 1 mm-deep incision. Having made a transverse subciliary skin incision and a dissection between the tarsus and the orbicularis oculi muscle, the subcutaneous tissue of the superior edge of the incision was secured to the tarsus with interrupted sutures to evert the cilia. An excision of the redundant skin and orbicularis tissue was made and the skin was closed. The patients were followed for direct inspection of the wound, the split lid margin, the direction of the lashes and the status of the cornea. The mean postoperative follow-up period was 29.4 weeks. Symptoms disappeared in all patients. In 30 eyelids of 19 patients the cilia did not touch the cornea, even in the down-gaze. In one eyelid the cilium touched the medial conjunctiva, but not the cornea. The cosmetic outcome of the lower lid was satisfactory in all cases and the wounds of the split lid margin healed without scarring. To date, there have been no complications such as wound dehiscence, ectropion or eyelid retraction. The lamellar splitting of the lid margin is a beneficial addition to the repair of prominent lower lid epiblepharon, especially on the medial aspect of the eyelid. This simple technique ensures easier eversion of the cilia in epiblepharon repair, without disturbing the posterior lamella or causing unfavourable results.

Hand washing: Changes in the skin flora

Frequent hand washing may result in skin damage and increase the number of microorganisms that colonize the skin. The purpose of this study was to evaluate changes in total flora of healthy and damaged hands that were caused by the use of gloves, soap, and antiseptics. Samples were collected from the healthy and damaged hands of 30 health care professionals before and after washing with water and nonmedicated soap for the technique of sterile polyethylene bag. Fifteen additional volunteers (technicians and students) were asked to wash their hands 20 times with water and soap; those with complaints of irritation were evaluated separately. Damaged or healthy hands did not present statistically significant differences (P > .05) in terms of qualitative analysis of epidemiologically important microorganisms; however, washing with water and soap was effective only for healthy hands. In short, the water and soap washing of damaged hands was not effective in reducing their contamination.