Categorization and characterization of lesions of the orbital apex

Introduction  

The apex of the orbit is formed by the union of the lesser and greater wings of the sphenoid bone and acts as an osseous tunnel for numerous neurovascular structures entering the orbit from the cranial vault. Lesions of the orbital apex are clinically important as they can have an adverse effect on vision. A broad range of lesions can occur here, and our purpose is to organize the pathologic processes which occur in the orbital apex into logical imaging differentials, establish an organized approach to image analysis, and present examples of representative lesions.     

Don't forget the bigger picture: the impact of societal issues on a community-based TB programme, Swaziland

PURPOSE: The purpose of this paper is to explore the wider societal issues that can impact on the success of a TB programme. DESIGN/METHODOLOGY/APPROACH: The paper is a qualitative study of the experiences of people involved in a community-based DOTS programme in Lubombo, Swaziland, involving patients, DOT treatment supporters, clinic nurses and other key informants. FINDINGS: The paper finds that study participants spontaneously raised two main societal issues, which had major impact on the success of the TB programme: health beliefs and poverty. It is seen that health beliefs can have a major impact on treatment-seeking behaviour and outcomes of TB treatment. Problems related to poverty were of two main types: insufficient funds to attend for review, and lack of food whilst on TB treatment. ORIGINALITY/VALUE: This paper discusses why these issues, although strictly outside the remit of the health services, are important factors to consider when implementing TB programmes. It suggests further research that may help break the link between TB and poverty (particularly relating to food insecurity) and recommends considering local health beliefs when dealing with individuals and the community. Neither the impact of health beliefs nor the impact of poverty are new ideas, yet these issues tend to be forgotten by quantitative researchers who perhaps understandably focus on issues that may be perceived as being easier to measure. This paper serves to remind one of their importance and to illustrate the value of qualitative research in highlighting them and ensuring that issues that are important to participants are not neglected.     

Methanol intoxication with putaminal and white matter necrosis: MR and CT findings.

We report a case of methanol intoxication in which the initial CT scans appeared normal. MR at 4 days showed the typical putaminal lesions of methanol intoxication and, in addition, peripheral white matter lesions that spared a thin rim of subcortical white matter. A CT scan at 17 days showed the putaminal and white matter lesions. The white matter lesions correspond well to lesions previously described in pathologic specimens.     

Collaborative care for depression in UK primary care: a randomized controlled trial

BACKGROUND: Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial. METHOD: We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to 'collaborative care' - case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication - or a usual care control. The primary outcome was symptoms of depression (PHQ-9). RESULTS: We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18-1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00-0.32). CONCLUSIONS: Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.     

Developing a healthy living intervention for people with early psychosis using the Medical Research Council's guidelines on complex interventions: phase 1 of the HELPER - InterACT programme

BackgroundYoung people with early psychosis often gain a significant amount of weight after the initiation of anti-psychotic treatment. Despite the current policy guidance to develop and evaluate ‘healthy living’ interventions for people with psychosis there remains a paucity of research. Our aim was to develop an acceptable, feasible, culturally sensitive and potentially effective ‘healthy living’ intervention, specifically for young people with early psychosis.MethodsUsing the Medical Research Council guidelines for developing and evaluating complex interventions we conducted a number of studies to devise a ‘healthy living’ intervention. We used a ‘top down’ (published evidence), bottom up (stakeholder perspectives) approach, which included updating a systematic review, identifying a theoretical basis for the intervention, exploring the perspectives of service users and health professionals, and identifying key cultural issues. The results of these studies were synthesised to determine the content and delivery of the intervention.ResultsThe intervention developed comprised eight individual sessions to be delivered by a support time recovery worker over a 12 month period with emphasis on individualised action plans to facilitate participatory exercise and changes in diet. To optimise engagement, choice and self management a booklet and website were developed to provide participants with educational advice, healthy eating recipes and other materials.ConclusionUsing the Medical Research Council guidelines we have developed a potentially effective, feasible and acceptable ‘healthy living’ intervention for people with psychosis using early intervention services in the UK.     

Predictive modeling of schizophrenia from genomic data: Comparison of polygenic risk score with kernel support vector machines approach

A major controversy in psychiatric genetics is whether nonadditive genetic interaction effects contribute to the risk of highly polygenic disorders. We applied a support vector machines (SVMs) approach, which is capable of building linear and nonlinear models using kernel methods, to classify cases from controls in a large schizophrenia case–control sample of 11,853 subjects (5,554 cases and 6,299 controls) and compared its prediction accuracy with the polygenic risk score (PRS) approach. We also investigated whether SVMs are a suitable approach to detecting nonlinear genetic effects, that is, interactions. We found that PRS provided more accurate case/control classification than either linear or nonlinear SVMs, and give a tentative explanation why PRS outperforms both multivariate regression and linear kernel SVMs. In addition, we observe that nonlinear kernel SVMs showed higher classification accuracy than linear SVMs when a large number of SNPs are entered into the model. We conclude that SVMs are a potential tool for assessing the presence of interactions, prior to searching for them explicitly.     

Proficiency of nucleic acid tests for avian influenza viruses, Australasia

An avian influenza quality assurance program was used to provide information for laboratories on the sensitivity and specificity of their avian influenza nucleic acid testing. Most laboratories were able to correctly detect clinically relevant amounts of influenza virus (H5N1), and results improved as each subsequent panel was tested.     

Calcitonin gene-related peptide (CGRP): Responsible for the increased blood flow induced by the stimulation of sensory nerves

Calcitonin gene-related peptide (CGRP) is a potent vasodilator neuropeptide contained in sensory nerves. We have examined the relative contribution of CGRP and substance P-like peptides (with which CGRP is commonly colocalized) to the increase in blood flow induced by the stimulation of sensory nerves. The sensory nerve stimulant capsaicin increased blood flow in rabbit and rat skin and this effect was substantially inhibited by the CGRP antagonist CGRP_8–37. Further, electrical stimulation of the rat saphenous nerve led to an increase in blood flow which was significantly inhibited by CGRP_8–37. CGRP_8–37 also had a partial inhibitory effect on oedema formation, an effect which is suggested to be a consequence of the inhibition of blood flow.