Management of psychosexual and relationship problems in general mental health services by psychiatry trainees

AIMS AND METHODS: All psychiatry trainees (both Basic and Higher Specialist Trainees in Adult and Old Age Psychiatry) in the Nottingham (Mid-Trent rotation) were invited to complete a questionnaire evaluating the assessment and training of psychosexual and relationship problems in the general mental health services. RESULTS: Only 24% of trainees reported to routinely asked patients about psychosexual history, 65% felt comfortable about taking a detailed psychosexual history. 81% of trainees reported inadequacy whilst dealing with psychosexual disorders during their training in psychiatry. Only 30% reported asking patients for potential sexual side-effects when on psychotropic medication. All the trainees would refer the patient to a local psychosexual disorder clinic (if available). CLINICAL IMPLICATIONS: Taking a sexual and relationship (both past and current) history should be an integral part of any psychiatric assessment. Training in human sexuality should be introduced in medical schools. Training in human sexuality is a core part of psychiatric training curriculum and trainees should be tested for their competency in dealing with sexual dysfunctions.     

Use of patient-reported outcome measures in oral and maxillofacial trauma surgery: a review

In the UK, about one person/100/year sustains a facial injury, so trauma surgery accounts for a considerable part of the caseload in oral and maxillofacial surgery (OMFS). Patient-reported outcome measures (PROM) allow for patient-centred assessment of postoperative outcomes, but to our knowledge, most research in OMFS trauma does not currently include them. To investigate their use, we searched Medline to find relevant studies that reported outcomes from inception in January 1879 to August 2016. Those not in the English language and those that did not report operations were excluded. We retrieved 416 articles, of which 21 met the inclusion criteria (five randomised controlled trials and 16 cohort studies) yielding 16 outcome measures. Most of these had been devised by authors (eight studies), four studies reported use of the Geriatric Oral Health Assessment Index, and three the Nasal Obstruction Symptom Evaluation. Most were used in studies on mandibular surgery (n = 13), followed by those on nasal and facial surgery (n = 3 each). There is a great heterogeneity in the use of these assessments in OMF trauma. In view of their increasing importance compared with simpler objective measures that may not be relevant to the patients’ own perception, more research is needed to establish which of them can be used to measure the QoL of patients treated for OMF trauma.     

Invasive Haemophilus parainfluenzae maternal-infant infections: an Australasian perspective and case report

Maternal and neonatal infection with Haemophilus parainfluenzae is an unusual but potentially life-threatening occurrence. We present a case of H. parainfluenzae complicating pregnancy in the second trimester. Predisposing factors for infection with Haemophilus species and Australasian data on invasive neonatal Haemophilus infections are presented.     

Risk of needle stick injuries in health care workers - a report

Health care workers (HCW) are at a risk of occupational acquisition of Human Immunodeficiency Virus (HIV) infection, primarily due to accidental exposure to infected blood and body fluids. In our general public hospital, over a period of one year (June 2000 - 2001) a total number of 38 self reported incidences of needlestick injuries and other exposures to patient's blood and body fluids were reported by HCWs. A greater incidence of occupational exposure was seen in surgery residents as compared to medicine residents. Till date, i.e. in one and a half-year follow up period, no seroconversion was seen in any of the reported accidental injury cases. This data emphasizes, that needle stick injuries present the single greatest risk to medical personnel and the importance of increased awareness and training in universal safety precautions (USP), for prevention of nosocomial infection.     

Photomediated crosslinking of C6-cinnamate derivatized type I collagen

Synthesis and characterization of cinnamated Type I collagen and its related mechanical properties after photomediated crosslinking were investigated in detail. Using an EDC/NHS conjugation method, collagen was chemically modified to incorporate a photosensitive cinnamate moiety. The cinnamated collagen was fully characterized by 1H NMR, UV-vis, and circular dichroism (CD) spectroscopy, as well as by rheological and mechanical analyses. Cinnamated collagens with varying degrees of derivatization retained collagen triple helical structure. The rheological spectra of collagen solutions demonstrate that the storage modulus decreases with increasing cinnamate content, owing to a decrease in physical crosslinking. The kinetics of the crosslinking process in both hydrated gels and dry films were monitored by UV-vis spectroscopy and confirmed that crosslinking was complete within 60 min of irradiation. The uniaxial stress-strain behavior of crosslinked collagen films, including Young's modulus and ultimate tensile strength, was comparable to values reported for glutaraldehyde-crosslinked monomeric collagen films. These data demonstrate that derivatization of collagen with photosensitive cinnamate moieties provides a facile route for solid-state crosslinking, thereby improving the mechanical properties of collagen and enhancing the potential applicability of collagen-based materials in tissue engineering and drug delivery.     

Tuberculous meningitis and HIV

Objective : To identify factors associated with HIV-infected status in children admitted with tuberculous meningitis (TBM), and to find out whether HIV co-infection affects in-hospital outcome.Methods : This prospective hospital-based study was conducted from May 2000 to August 2003. All consecutive children, aged 1 month to 12 years of age, admitted with a diagnosis of TBM were enrolled. Relationship between 35 featuresviz., two demographic factors, nine clinical features, 13 neurological features, five laboratory (including cerebrospinal fluid) parameters, six radiological (including computed tomography scan brain) features, and the two outcomes (disabled survivor or death); with HIV-infected status was assessed.Results : Of a total 123 TBM cases enrolled, eight (6.5%) were HIV-infected. There was no significant difference between the two groups, except that more children in the HIV-infected group had Hb< 8 gm/dl: both on bivariate analysis, (OR, 12.0; 95% CI, 2.6–55.9; P = 0.001) and on multivariate analysis (OR, 12.30; 95% CI, 1.9–79.6; P = 0.008). Outcome was similar in both the groups.Conclusion: Only presence of Hb< 8 gm/dl was associated with HIV-infected status. HIV co-infection did not affect the outcome.