A radiotherapy technique for thyroid cancer

A treatment technique for treating patients with cancer of the thyroid is presented. This is a modification of “the bar-arc” technique that uses a centrally blocked moving field. We have introduced wedges and partial midline block to achieve uniform dose within the treatment volume. This enables the desired dose to be delivered to the primary, the lymph nodes and the cervical soft tissues at risk, yet keeping the dose to the spinal cord to a minimum in the cervical region and to acceptable levels in the superior mediastinum.     

Event-related potential abnormalities in schizophrenia: A failure to “gate in” salient information?

Sensory gating refers to the central nervous system's ability to filter sensory inputs, and can be measured by comparing the suppression of event-related brain potential (ERP) amplitudes in a paired auditory stimulus procedure. Poor gating scores in schizophrenia may be caused by abnormal responses to the first (S1), the second (S2) or both of the paired stimuli. However, since S1 and S2 responses may index separate psychological phenomenon, corresponding to the ability to “gate in” and “gate out” sensory stimuli respectively, the precise mechanism affected in schizophrenia remains unclear. To examine the extent to which saliency processing abnormalities may contribute to S1 response deficits, standard and rare (15% probability) paired stimuli were presented to 21 participants with schizophrenia and 22 healthy controls. P50 and N100 ERP amplitude as well as low, beta and gamma frequency power were measured to examine the time course and relative contributions of oscillatory activity affecting auditory processing in schizophrenia. In this study, schizophrenia patients exhibited less evoked beta 1 power (12–20 Hz) in response to salient stimuli at S1, and lower N100 amplitude in response to all S1 stimuli. No group differences were found in the low, beta 2 (20–30 Hz), or gamma frequency ranges. These findings suggest aberrant sensory processing during stages of stimulus evaluation and saliency detection in schizophrenia.     

Novel peptide nanoparticle–biased antagonist of CCR3 blocks eosinophil recruitment and airway hyperresponsiveness

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Cost-effectiveness of pharmaceutical care on patients undergoing maintenance hemodialysis – a multicenter randomized controlled study

Objectives: The aim of the study is to assess the cost-effectiveness of pharmaceutical care versus usual care on the treatment costs in patients undergoing maintenance hemodialysis (HD) in the outpatient HD centers of academic, government, and corporate hospitals.

Methods: An open-labeled randomized controlled study was registered under clinical trial registry of India (Ref. no. CTRI/2014/004900). The study was conducted for a period of 12-month follow-up in patients undergoing maintenance HD. The patients were randomized into Usual Care (UC) group and Pharmaceutical Care (PC) group by the block design method. The UC group received the usual care provided by the hospital staff like physicians, nurses, and technicians whereas, the PC group received the usual care along with the pharmaceutical care delivered by a qualified registered pharmacist. The patient perspective ‘out-of-pocket expenditures’ was considered for calculating the annual cost incurred for the treatment of HD patients.

Results: Out of 153 patients, academic hospital (n = 83), government hospital (n = 18), and corporate hospital (n = 52). The incremental cost-effectiveness ratio for academic, government, and corporate hospitals HD patients of PC group compared with UC group were 86,230 Indian Rupee (INR)/Quality-adjusted life year (QALY), 231,016.66 INR/QALY, and 87,430 INR/QALY, respectively. Our study results revealed that PC group was costlier and more effective compared to the UC group.

Conclusions: It depends upon the policymakers and regulators to take the decision, if they believe that the extra cost is worth the extra QALY.     

Familial syndromes associated with intracranial tumours: a review

Background

Most cancers of the central nervous system (CNS) occur sporadically in the absence of any known underlying familial disorder or multi-systemic syndrome. Several syndromes are associated with CNS malignancies, however, and their recognition has significant implications for patient management and prognosis. Patients with syndrome-associated CNS malignancies often have multiple tumours (either confined to one region or distributed throughout the body), with similar or different histology.

Objective

This review examines syndromes that are strongly associated with CNS cancers: the phakomatosis syndromes, familial syndromes such as Li–Fraumeni and familial polyposis syndromes and dyschondroplasia.     

Serotoninergic mechanisms in the treatment of obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a disabling psychiatric condition affecting 1-2% of the community. Although modern drug, behavioral and psychosurgical therapies have improved the prognosis of OCD considerably, approximately 30% of patients remain treatment-refractory. Currently, selective serotonin (5-HT) reuptake inhibitors (SSRIs) are the drug treatments of choice for OCD. Accordingly, this review evaluates the evidence for a role of the serotonin (5-HT) neurochemical system in the treatment and pathophysiology of OCD. However, drug treatment approaches that modify function of interrelated neurochemical systems, such as the dopamine and glutamate systems, are also briefly discussed as they promise to complement and enhance SSRI treatment effects.     

Necrobiotic xanthogranuloma

Necrobiotic xanthogranuloma is a rare, chronic, progressive granulomatous disorder which manifests as yellowish plaques and nodules, most commonly in the periorbital region. The exact aetiology is not known. It is commonly associated with monoclonal gammopathy. Various treatment modalities used include chemotherapy, intralesional and systemic steroids, radiotherapy and surgical excision. We report a case of necrobiotic xanthogranuloma involving the periorbital area causing cosmetic disfigurement.     

A psychobiological approach to personality: examination within anxious outpatients.

OBJECTIVE: To examine Cloninger's psychobiological personality model among different anxiety and depressive outpatients as well as normal healthy comparisons. In addition, the relationship between the underlying temperament dimensions and behavioral coping strategies was also studied using the tri-axial model of coping. METHODS: Subjects were 120 outpatients presenting to an anxiety disorders specialty clinic and 17 normal comparisons. They underwent a semi-structured clinical interview and completed a battery of questionnaires, including the Temperament and Character Inventory and the Strategic Approach to Coping Scale. RESULTS: On the temperament dimensions, the patients were elevated on the harm avoidance scale relative to the normal comparisons; the temperament substrate was not differentiated by the anxiety or affective diagnostic types nor was there differences between groups on the other temperament dimensions. Both severity of illness and the presence of a comorbid depressive disorder each contributed independently to harm avoidance scores. Hypotheses regarding the association between underlying temperament and behavioral coping strategies were supported for the dimensions of reward dependence and harm avoidance, but not for novelty seeking. CONCLUSIONS: Cloninger's psychobiological model is supported with the temperament of harm avoidance being the relevant dimension for anxiety and affective disorders. The underlying temperament structure also has clinical relevance for the type of coping strategies that are utilized by an individual.