Adapting the cultural formulation for clinical assessments in forensic psychiatry

Even as forensic psychiatrists have increasingly contemplated the role of culture in forensic psychiatry, practical cultural evaluations remain an under-theorized area with scant research. Older conceptions of cultural competence may risk stereotyping the evaluee on the basis of perceived group characteristics. This article offers a revision of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV) Outline for Cultural Formulation for use in forensic psychiatry by adjusting its formal guidelines with recommendations from the forensic mental health literature. As a person-centered method of conducting the interview, the Cultural Formulation probes cultural explanations of identity, illness, social support, functioning, and interaction with the medical and legal systems. In line with other psychiatric subspecialties, future research in forensic psychiatry can examine the extent to which the Cultural Formulation helps trainees with cultural competence, reconfigures diagnosis and treatment, and alters legal outcomes such as length of sentence.     

Prostate cancer–specific PET radiotracers: A review on the clinical utility in recurrent disease

Prostate cancer–specific positron emission tomography (pcPET) has been shown to detect sites of disease recurrence at serum prostate-specific antigen (PSA) levels that are lower than those levels detected by conventional imaging. Commonly used pcPET radiotracers in the setting of biochemical recurrence are reviewed including carbon 11/fludeoxyglucose 18 (F-18) choline, gallium 68/F-18 prostate-specific membrane antigen (PSMA), and F-18 fluciclovine. Review of the literature generally favors PSMA-based agents for the detection of recurrence as a function of low PSA levels. Positive gallium 68/F-18 PSMA positron emission tomography/computed tomography scans detected potential sites of recurrence in a median 51.5% of patients when PSA level is <1.0 ng/mL, 74% of patients when PSA level is 1.0 to 2.0 ng/mL, and 90.5% of patients when PSA level is >2.0 ng/mL. Review of carbon 11/fludeoxyglucose 18 (F-18) choline and F-18 fluciclovine data commonly demonstrated lower detection rates for each respective PSA cohort, although with some important caveats, despite having similar operational characteristics to PSMA-based imaging. Sensitive pcPET imaging has provided new insight into the early patterns of disease spread, which has prompted judicious reconsideration of additional local therapy after either prostatectomy, definitive radiation therapy, or postprostatectomy radiation therapy. This review discusses the literature, clinical utility, availability, and fundamental understanding of pcPET imaging needed to improve clinical practice.     

The burden of prostate cancer in Trinidad and Tobago: one of the highest mortality rates in the world

Purpose

In Trinidad and Tobago (TT), prostate cancer (CaP) is the most commonly diagnosed malignancy and the leading cause of cancer deaths among men. TT currently has one of the highest CaP mortality rates in the world.

Methods

6,064 incident and 3,704 mortality cases of CaP occurring in TT from January 1995 to 31 December 2009 reported to the Dr. Elizabeth Quamina Cancer population-based cancer registry for TT, were analyzed to examine CaP survival, incidence, and mortality rates and trends by ancestry and geography.

Results

The age-standardized CaP incidence and mortality rates (per 100,000) based on the 1960 world-standardized in 2009 were 64.2 and 47.1 per 100,000. The mortality rate in TT increased between 1995 (37.9 per 100,000) and 2009 (79.4 per 100,000), while the rate in the US decreased from 37.3 per 100,000 to 22.1 per 100,000 over the same period. Fewer African ancestry patients received treatment relative to those of Indian and mixed ancestry (45.7%, 60.3%, and 60.9%, respectively).

Conclusions

Notwithstanding the limitations surrounding data quality, our findings highlight the increasing burden of CaP in TT and the need for improved surveillance and standard of care. Our findings highlight the need for optimized models to project cancer rates in developing countries like TT. This study also provides the rationale for targeted screening and optimized treatment for CaP to ameliorate the rates we report.

     

Is percutaneous coronary angioplasty less expensive than bypass surgery?

Percutaneous transluminal coronary angioplasty is widely considered to be an acceptable and less expensive alternative to bypass surgery in carefully selected patients. We compared expenditures related to cardiac care for 79 unselected patients undergoing coronary angioplasty with expenditures for 89 unselected patients undergoing elective coronary bypass surgery without a previous attempt at angioplasty. All the patients had single-vessel disease. The mean aggregate one-year monetary outlay was 15 per cent lower in the angioplasty group than in the bypass-surgery group. A major component of the expense of angioplasty was the treatment of restenosis in the 33 per cent of patients in this group in whom this late complication occurred. We conclude that percutaneous transluminal coronary angioplasty has potential for reducing expenditures for cardiac revascularization and that a further reduction may be obtainable when the rates of restenosis are improved.     

Slow troponin T mRNA in striated muscles is expressed in both cell type and developmental stage specific manner

We have cloned cDNA sequences of both rat and mouse slow troponin T gene. These sequences share a high level of homology with each other and with the human slow troponin T gene although we were unable to detect an alternatively spliced exon present at 3 end of human slow troponin T cDNA in either mouse or rat cDNAs. Northern blot analysis detected a high level expression of slow troponin T in adult mouse Soleus with a lower level expression in mixed postnatal skeletal muscles. Unlike late fetal and postnatal skeletal muscles in which slow troponin T expression is restricted to slow muscle fibre rich regions only, in situ hybridisation analysis detected this isoform to be highly expressed in somitic myotome and all muscle masses at 10–14 days of gestation after which its expression was rapidly downregulated. The unexpected expression of slow troponin T mRNA in fetal heart was apparent by both northern blotting and in situ hybridisation analyses. Slow troponin T mRNA in fetal heart was first detected at 10 day in utero reaching maximum levels of expression at 12–15 days gestation. The slow troponin T in the heart was mainly expressed in the ventral ventricles until day 15 after which low level expression was also observed in both atria. Slow troponin T mRNA in both atrium and ventricle was mainly expressed in outer wall of the myocardium although it was also expressed in interventricular septum. This study therefore shows that in addition to being a cell type specific marker during later fetal and postnatal skeletal muscle development, slow troponin T represented one of the major developmental isoforms expressed in embryonic and fetal skeletal muscle as well as in the cardiac muscle.     

Dynamic interaction of trace gases (VOCs,ozone, and NO<Emphasis Type="Italic">x</Emphasis>) in the rural atmosphere of sub-tropical India

The atmospheric chemistry and health implications of pollutants are important scientific concerns in the rural atmosphere. The current study investigates the estimation of seasonal and diurnal variability of VOCs, ozone, and NOx in the rural area located in a tropical region of India during the year 2013–2014. Results showed that most of the targeted VOCs were higher in winter followed by summer and autumn. The diurnal variability of aromatic hydrocarbons showed similar pattern with different amplitudes as maxima and minima during morning (07:00–10:00 h) or evening (16:00–19:00 h) and daytime (10:00–16:00 h), respectively. The sum of aromatic VOCs are found to be in the range from 27.3 to 87.9 μg/m³. In addition to this, O₃ and NOx were observed as 45.04 ± 15.19 μg/m³ and 12.41 ± 3.49 μg/m³, respectively, during the observation period. The estimated VOC/NOx ratios (ranged from 3.4 to 3.7) indicated that the selected rural area was VOC limited in terms of ozone sensitivity. The sources of the VOCs have been explained by characteristic ratios, correlation, and principal component analysis. Further, ozone-forming potential (OFP) of the targeted aromatic VOCs has been evaluated using maximum incremental reactivity which suggested toluene (benzene) contributed the largest (lowest) in the ozone formation. Exposure assessment in terms of lifetime cancer and non-cancer risks lies within the acceptable range of USEPA guidelines.     

Double right coronary artery with acute inferior wall myocardial infarction

A double right coronary artery arising from a single ostium in the right sinus of Valsalva is an extremely rare coronary artery variation. We report for the first time in the literature a case of inferior wall myocardial infarction due to a double right coronary artery occlusion that was successfully managed with percutaneous coronary intervention. The rarity of this unusual coronary artery anomaly, its angiographic diagnosis and an important diagnostic dilemma of a high takeoff of a large right ventricular branch are discussed here.