The attitudes of health care professionals in Malta towards patients who take drug overdoses were studied. It was found that the intention of the overdose had a marked effect on the attitude of the health care professional towards the patients. Differences between different professionals were noted and the Maltese results were compared with those of a similar study in London.
Introduction and Aims: Intravenous iron has been postulated to increase oxidative stress in chronic kidney disease(CKD).We assessed the oxidant effect of intravenous (IV) iron sucrose in CKD stage 4 and 5 patients by estimating change in levels of highly sensitive C reactive protein (hsCRP), malondialdehyde (MDA) and myeloperoxidase (MPO) pre and post intravenous iron therapy.
Methods: After obtaining clearance from the institutional ethics committee,we prospectively assessed change in levels of hsCRP,MDA and MPO prior to and 48 hours after a 100mg dose of intravenous iron sucrose in patients of CKD 4 and 5 with iron deficiency.Iron deficiency was diagnosed by either iron saturation(serum iron/total iron binding capacity) less than 20% or serum ferritin less than 200ng/L. Results were analysed on SPSS version 15.Wilcoxon signed rank test was used to compare mediansand a p value less than 0.05 was considered significant.
Results: There were 32 patients in the study group with a mean age of 55.31 ± 12.18 years. The mean creatinine clearance was 16.69 ± 8.71 ml/min and the mean serum albumin was 3.54 ± 0.58 g/l.The mean iron saturation and serum ferritin were 23.8 ± 12.2 % and 134.2 ± 117.7 ng/L respectively. There was a significant increase in the levels of hsCRP (P = 0.005), MDA (p = 0.003), and MPO (p < 0.05) after IV iron therapy as shown in table 1.
Conclusions:We observed an increased oxidative stress following intravenous iron in CKD stage 4 and 5.The clinical relevance of these findings and their effects need further study.
Serum levels of amitriptyline plus nortriptyline were measured by radioimmunoassay at 1 and 6 weeks in depressed out-patients treated with amitriptyline for 6 weeks. Serum concentrations at 6 weeks were higher in older patients. Serum levels showed no relationship to clinical response at 6 weeks, and a week inverse relationship with response at 2 weeks. Routine monitoring of serum levels appears to be of little value in depressed out-patients treated with amitriptyline.
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To evaluate and compare quality of life in pre dialysis (CKD stage4) and patients with End stage renal disease (ESRD) on maintenance hemodialysis and to analyze the correlation of sociodemographic, clinical and laboratory parameters with quality of life This was a cross-sectional study in which 100 pre dialysis(CKD stage4) and 100 ESRD patients on maintenance hemodialysis were enrolled. SF 36 questionnaire was used to assess quality of life. Quality of life was compared between the two groups and the correlation of quality of life with sociodemographic ,clinical and laboratory parameters was assessed. Pre dialysis group had better SF 36 scores than patients on hemodialysis (64.93±13.05 vs. 59.55±13.29 p=0.004). Erythropoietin use, higher albumin and more frequent dialysis emerged as independent predictors of better quality of life. Perceived quality of life was worse for patients on hemodialysis when compared to pre dialysis patients. Use of erythropoietin, higher albumin levels, and more frequent dialysis were independent predictors of better quality of life.
We have studied the association of muscle strength (quadriceps, biceps, handgrip), measured by a portable chair technique, with functional status (Barthel Index, manual dexterity, Mental Test Score, history of falls, fracture, prescribed drugs), in a sample of 92 elderly subjects attending a Local Authority Day Centre and Day Hospital. Anthropometric measurements and hand-grip strength were also measured in 30 young controls. Muscle area, mass and strength were significantly greater in young controls. Elderly men had significantly greater muscle area, mass and strength than elderly women. Muscle strength correlated with several measures of functional status. Using stepwise multiple regression, an independent association of muscle strength with manual dexterity, Barthel Index and receipt of domiciliary services is demonstrated.
It is 16 years since the Royal College of Psychiatrists published its recommendations for the training of psychiatrists. The guidelines for the training of general psychiatrists in psychotherapy have recently been reviewed and, once again, experience in behavioural psychotherapy was an integral part of such training.
Aerobic bacterial infections often complicate vascular access in patients receiving haemodialysis, leading to Catheter-Related Blood Stream Infections (CRBSI). Various studies report Gram - positive bacteria, Staphylococcus aureus (S. aureus) in particular, as the most common aetiologic agent. Studies on microbiological analysis in this subset of population from India are very few.To examine clinical and bacteriological profiles of haemodialysis patients developing CRBSI, the antibiotic susceptibility of the bacteria isolated from these patients and determine nasal carriage of S. aureus in the study subjects.Using a prospective observational design 127 patients receiving haemodialysis (84 males; 43 females) from October 2011 to March 2013 were enrolled in this study. At each dialysis session, catheters were examined for any evidence of infection. In case of suspicion for infection, pus swab, blood culture and the catheter tips were sent to microbiology laboratory for site specific investigations. Vancomycin injection was empirically administered to these patients pending culture results. Data obtained was examined for relationship of CRBSI with clinical and socio-demographic risk factors.Out of 127 patients, 19 developed CRBSI, 10 developed exit-site infections and 33 patients were noted to have colonization of their catheters. The most common organisms included S. aureus in 24 (45.2%) catheter tips, followed by Pseudomonas aeruginosa in 9 (17%), Acinetobacter spp. in 5 (9%), Enterobacter spp. in 4 (7.5%) and Klebsiella pneumoniae in 3 (5.6%) catheter tips. Bacteraemia was found in 19 (20.7%) patients and P. aeruginosa was the most commonly isolated organism amongst them (38.8%). Staphylococcal nasal carriage was seen in 60 (69%) patients and 36 (41.4%) of these isolates were methicillin-resistant. Significant factors associated with CRBSI included history of bacteraemia, presence of diabetes mellitus, long duration (>15 days) of catheterization and antibiotic use within three months (p<0.05 for all).Although S. aureus was the most common colonizer of non-tunnelled central access catheters among haemodialysis patients, CRBSI was most frequently caused by P. aeruginosa, which may have a bearing on our current antibiotic policy.
While research has shown community-based psychiatric care to be as good as, or better than, hospital-based care, generalisation to clinical practice has been difficult. This prospective, randomised controlled study examined a community-based approach feasible within NHS conditions. Ninety-four patients were randomly allocated to experimental and 78 to control treatments and followed for one year. The groups were well matched apart from an excess of psychotic control patients. No differences in clinical or social functioning outcome were found. Both groups improved substantially on clinical measures in the first six weeks, with some slow consolidation thereafter. There were three suicides in the control group and one in the experimental group. Access to care was better in the experimental group (93% attended assessment) than in the control group (75% attended assessment).
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