Development of vocational potential assessment tool and counseling module for persons with severe mental disorders

OBJECTIVE

To develop and validate the vocational potential assessment tool and counselling module for persons with severe mental disorders (SMD).

METHOD

The tool and the module were developed through review of existing assessment tools, individual interviews and focused group discussions with key stake holders- persons with SMD, caregivers, expert mental health professionals and employers. The developed tool and module were validated by experts.

RESULT

The process of tool and module development was conducted simultaneously and included 11 persons with SMD, 9 caregivers, 9 experts and 9 employers. A total of 38 themes were obtained through individual interviews and focused group discussions. The developed tool and module along with a scoring key were validated by 6 mental health experts.

CONCLUSION

The tool is easy to use and comprehensive, takes approximately 45 min to 1 h for assessment. The module provides a framework for vocational counselling. The scoring key provides a guideline for professionals during assessment.

Long-term treatment of phenylketonuria with a new medical food containing large neutral amino acids

BACKGROUND/OBJECTIVES

Phenylketonuria (PKU) is an autosomal recessive disease caused by deficient activity of phenylalanine hydroxylase. A low phenylalanine (Phe) diet is used to treat PKU. The diet is very restrictive, and dietary adherence tends to decrease as patients get older. Methods to improve dietary adherence and blood Phe control are continuously under investigation.

SUBJECTS/METHODS

A new formula Phe-neutral amino acid (PheLNAA) has been tested in this study with the purpose of improving the compliance and lowering blood phenylalanine. The formula has been tested for nitrogen balance, and it is nutritionally complete. It is fortified with more nutritional additives that can be deficient in the PKU diet, such as B12, Biotin, DHA, Lutein and increased levels of large neutral amino acids to help lower blood Phe. The new formula has been tested on 12 patients with a loading test of 4 weeks.

RESULTS

Fifty-eight percent of patients had a significant decline in blood Phe concentration from baseline throughout the study. The PheLNAA was well tolerated with excellent compliance and without illnesses during the study.

CONCLUSIONS

In conclusion, the new formula is suitable for life-long treatment of PKU, and it offers the PKU clinic a new choice for treatment.

Invasive Escherichia coli vaccines expressing Brucella melitensis outer membrane proteins 31 or 16 or periplasmic protein BP26 confer protection in mice challenged with B. melitensis

Because of the serious economic and medical consequences of brucellosis, efforts are to prevent infection of domestic animals through vaccines. Many disadvantages are associated with the current Brucella melitensis Rev.1 vaccine prompting development of alternative vaccines and delivery. Escherichia coli (DH5α) was engineered to express a plasmid containing the inv gene from Yersinia pseudotuberculosis and the hly gene from Listeria monocytogenes. These recombinant invasive E. coli expressing B. melitensis outer membrane proteins (Omp31 or 16) or the periplasmic protein BP26 were evaluated for protection of mice against virulent B. melitensis. Importantly, these invasive E. coli vaccines induced significant protection against B. melitensis challenged mice. Invasive E. coli may be an ideal vaccine platform with natural adjuvant properties for application against B. melitensis since the E. coli delivery system is non-pathogenic and can deliver antigens to antigen-presenting cells promoting cellular immune responses.

Pregnancy concomitant with metastatic adult granulosa cell tumor

INTRODUCTION

Metastatic adult granulosa cell tumor of the ovary is rarely encountered with pregnancy.

CASE REPORT AND RESULTS

Primigravida (26 years) presented at 20 weeks of gestation with acute abdomen and clinical evidence of supraclavicular lymphadenopathy and ascites. She was diagnosed of adult granulosa cell tumor (AGCT) of the right ovary following right salpingoophrectomy done 1 month prior to conception. Fine needle aspiration cytology of supraclavicular lymph node, revealed it to be a metastatic AGCT. Chemotherapy was given antepartum and she delivered a healthy preterm baby at 30 weeks. Subsequently, she had optimal debulking surgery following 6 cycles of cisplatin-based chemotherapy. Baby at 10 months of age was with normal milestones.

CONCLUSIONS

The case is an unusual presentation of metastatic adult granulosa cell tumor at child bearing age. Although rapidly progressing, successful prolongation of pregnancy till 30 weeks of gestation was possible with the judicious use of chemotherapy. Fetal and maternal outcomes were favorable.

Bilirubin oxidation provoked by nitric oxide radicals predicts the progression of acute cardiac allograft rejection

Bilirubin, a strong intrinsic antioxidant, quenches free radicals produced under inflammatory conditions. The oxidized bilirubin metabolites, i.e. biopyrrins, are immediately excreted into urine and can indicate the intensity of oxidation in vivo. Our preliminary studies suggested the involvement of reactive nitrogen species (RNS) in generation of biopyrrins. However, little is known about biological significance of bilirubin oxidation by RNS. Here, we analyzed the correlation between bilirubin oxidation and nitric oxide (NO) radicals during rat acute cardiac allograft rejection. In allograft recipients, urinary biopyrrins steeply increased on day 3 prior to the increase in myocardial tissue damage marker, serum troponin-T. In contrast, no significant changes in urinary biopyrrins were evident in recipients of isografts or cyclosporine-A treated allografts. Urinary nitrotyrosine, a marker of oxidation by NO radicals also increased on day 3, while administration of a NO synthase inhibitor, N(G)-monomethyl-L-arginine apparently diminished the elevation of urinary biopyrrins as well as nitrotyrosine. Immunohistochemistry revealed enhanced local expression of heme oxygenase-1, biopyrrins and nitrotyrosine in allografts in accordance with the cellular infiltrates, suggesting that changes in urinary biopyrrins reflect the bilirubin oxidation in grafts undergoing rejection. These results indicate that locally evoked bilirubin oxidation by NO radicals can predict the progression of rejection.

Synthesis and surface properties of aqueous dispersions of poly(ester-imide) prepared from anhydride terminated polyester prepolymer and diisocyanate

Aqueous dispersions of poly(ester-imide)s [P(E-I)s] have been prepared by dispersing the P(E-I)s in water without any external solubilizing agents. P(E-I)s were prepared from anhydride-terminated polyester prepolymer and diisocyanate. The -COOH groups in the polymer were then neutralized using triethylamine and the P(E-I)s were subsequently dispersed in water. The influence of the degree of ionization of polymers on the particle size and viscosity of the dispersion has been studied. The dispersions were crosslinked using polyaziridine. The crosslinked dispersion cast films were characterized for dynamic mechanical properties. As the ionic content increased the particle size decreased and the viscosity increased. When the amount of crosslinker added was varied, for a fixed percentage of ionization, the glass transition temperature Tg shifted to higher values. Critical surface tension (CST) measurements indicated reorganization of hydrophobic groups on the surface after crosslinking.

Fibrin as a matrix for grafting 2-hydroxyethyl methacrylate: preparation and characterization of the graft and its in vivo evaluation for wound healing

In this work, fibrin was used as a substrate to graft 2-hydroxyethyl methacrylate (HEMA) by free radical polymerization using potassium persulfate and sodium metabisulfite as redox initiators. The extent of grafting the synthetic polymer on the biopolymer was studied under various experimental conditions, and the optimum factors for affording maximum grafting were standardized. The graft, fib-g-p[HEMA], was characterized by Fourier transform infrared, scanning electron microscopy, and X-ray diffraction studies. The graft exhibited a higher shelf life than native fibrin. The biocompatibility of the graft has been tested by in vivo studies and the results, in terms of collagen formation and wound size, proved its suitability for wound healing.

Electrochemically synthesized polymer of the plant substance embelin (2,5-dihydroxy-3-undecyl-1,4-benzoquinone)

Among the possible new materials for microelectronics, quinones have a number of significant advantages. Similarly, polymers with quinone functionality possess biodegradability. Because natural polymers are promising candidates for functional materials for the future, we have initiated studies on the polymers of natural products. In the present study, a natural quinone (a plant substance) extracted from Embelier libes distributed in the Kerala state of India was electrochemically polymerized and its properties were investigated. The redox activity, electrical conductivity, and biodegradability are discussed.

Testicular fine needle aspiration cytology for the diagnosis of azoospermia and oligospermia

OBJECTIVE

To evaluate qualitative and quantitative cytologic features on testicular fine needle aspiration biopsy in the diagnosis of azoospermia and oligospermia and to correlate cytologic and histologic diagnoses.

STUDY DESIGN

In this prospective study, 50 infertile males selected from the infertility clinic of Guru Tegh Bahadur Hospital were studied. Fine needle aspiration cytology (FNAC) smears from both testes of 27 azoospermic and 23 oligospermic patients (sperm count < 10 million per milliliter) were stained with May-Grünwald-Giemsa and Papanicolaou stain. Differential counting of 500 spermatogenic cells was done, and the number of Sertoli cells per 500 germ cells was determined for calculating the spermatic index and Sertoli cell index, respectively. FNAC and testicular biopsy were performed under local anesthesia as a minor surgical procedure.

RESULTS

Six groups were identified on FNAC smears from azoospermic patients: I. normal spermatogenesis (8), II. hypospermatogenesis (2), III. maturation arrest (2), IV. Sertoli cells only (6), V. atrophic pattern (7), and VI. Leydig cell predominance (2). In oligospermic patients two groups were identified: I. those with normal spermatogenesis (4), and II. those with subnormal spermatogenesis (19). Correlation with histopathologic examination was seen in 81.5% azoospermic and 65.2% oligospermic patients.

CONCLUSION

Qualitative and quantitative evaluation of testicular FNAC provides useful information on both azoospermic and oligospermic patients. FNAC performed under local anesthesia is an acceptable outpatient procedure that consistently yields sufficient diagnostic material in all patients.

Infertility and psychosexual disorders: relationship in infertile couples

175 consecutive infertile couples were interviewed together and individually in accordance with a 25 point questionnaire. Amongst the males, premature ejaculations 66% was most common problem followed by erectile dysfunction 15%, decreased libido 11% and orgasmic failure 8%. Amongst females dyspareunia 58%, decreased libido 28% and orgasmic failure 14% were most common problems. Various type of misconceptions were also observed in the infertile couples. Lack of sexual awareness and education formed an important part of observations. Psychosexual dysfunction and infertility was found to occur, in a large number of couples, together in association. Most common cause for this problem seems to be ignorance and lack of sex education.

Initial encounters between people with a mild mental handicap and psychiatrists: an investigation of a method of evaluating interview skills

This study reports the results of an initial study into the ability of psychiatrists to interview people with a mild mental handicap who are accompanied by a caregiver. Initial interviews by 12 psychiatrists of different ages (30-57 years) and differing levels of experience with this client group were recorded on video tape. Three of the recordings were used to train four judges who were familiar with examining clinical interactions, though not between doctors and patients. The judges used a specially designed rating scale. The remaining nine interviews were evaluated independently by the four judges. There was a correlation of 0.65 (Kendall's coefficient of concordance, W) for the judges' evaluations using the rating scale for the nine interviewers. However, there was greater agreement between judges as to who were the best and worst interviewers (W = 0.86). Some of the aspects of the interviews which contributed to the variability in the judgments are discussed.

Structure–reactivity correlations of substituted 2-phenylthiazolidines

Systematic investigations of the kinetics of the reactions of ethyl bromoacetate (EBA) and of picryl bromide (PB) with 2-phenylthiazolidines (PT) in 100% ethanol were undertaken at 30, 35, 40, and 45 °C. The most incisive information concerning the Hammett equation comes from the extensive studies on the substituted 2-phenylthiazolidines, establishing linear Hammett plots with negative ρ values. The kinetic data, plotted in a Brønsted fashion against pKa of the corresponding thiazolidinium ions, yield linear relationships. The activation parameters were computed. The linear relationships between ΔH≠ and ΔS≠ signify a consistent mechanism throughout the series.