Development of a catastrophic cognition questionnaire

Catastrophic cognitions are theorized to be an important construct for the development and maintenance of panic disorder with or without agoraphobia. However, there is a lack of reliable and valid self-report instruments for measuring catastrophic cognitions. This study presents the development and validation of the Catastrophic Cognition Questionnaire (CCQ) using 507 students from introductory psychology classes. Factor Analysis yielded a five-factor solution, which accounted for 54% of the total variance. The five are the Emotional, Physical, Mental, Social, and Bodily Catastrophes factors. The CCQ shows good reliability with Cronbach's Alpha for individual scales ranging from .86 to .94. The CCQ has good discriminant validity and correlates moderately with other self-report questionnaires that measure anxiety and cognitions associated with anxiety problems.     

Microvascular decompression in the surgical management of trigeminal neuralgia

The pathophysiological mechanisms underlying trigeminal neuralgia are not clearly understood and several therapeutic modalities have been advocated. Microvascular decompression (MVD) is a widely used surgical approach for the decompression of the affected root entry zone (REZ) of the fifth cranial nerve. In this paper, we present our experience based on 32 patients with trigeminal neuralgia who were treated with MVD, and discuss the role of this procedure in the surgical management of trigeminal neuralgia.All patients had typical TN pain and had had previous medical management which was unsuccessful. Fourteen patients (44%) had been previously treated with other surgical procedures and had persisting pain at the time of admission. Preoperatively, computerized tomography was obtained in all patients; twelve patients (37.5%) were evaluated with magnetic resonance imaging. These neuroradiological studies revealed an asymmetrical vascular structure at the involved REZ in nine patients (28%). All patients underwent MVD, and a vascular loop causing compression on the REZ of the fifth cranial nerve was demonstrated in each case. No mortality was observed, and the only permanent morbidity was cerebellar infarction in one patient (3%). Symptorns disappeared in all patients in the early postoperative period, and only three recurrences (12%) were observed within the follow-up period (mean: 26 months).     

Splenic Abscess Due to Clostridium difficile and Pseudomonas Paucimobilis

Extraintestinal infection by Clostridium difficile is a rare entity. Herein we describe a 62-yr-old man with C. difficile bacteremia complicated by a splenic abscess. Of particular interest was the isolation of C. difficile and Pseudomonas paucimobilis from the splenic abscess. Prompt antibiotic therapy and splenectomy resulted in a favorable outcome. Although rare, these organisms should be considered in the differential diagnosis of a splenic abscess.     

American Cancer Society's report on the status of cancer disparities in the United States, 2021

In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.     

Ships’ Ballast Water Treatment by Chlorination Can Generate Toxic Trihalomethanes

The International Maritime Organization (IMO) will enforce a new abundance-based performance standard for ballast water in September, 2017. Strong oxidants, like chlorine, have been proposed as a method for achieving this standard. However chlorine treatment of ballast water can produce hazardous trihalomethanes. We assessed maximum trihalomethane production from one chlorine dose for three types of ballast water (fresh, brackish and marine) and three levels of total organic carbon (TOC) concentration (natural, filtered, enhanced). While the current standard test considers a 5 day voyage, there is a high possibility of shorter trips and sudden change of plans that will release treated waters in the environment. Water source and TOC significantly affected trihalomethane production, with the highest amounts generated in brackish waters and enhanced TOC concentration. The concentration of brominated trihalomethanes increased from background levels and was highest in brackish water, followed by marine and fresh water.     

Post-traumatic stress disorder and its predictors in emergency medical service personnel: a cross-sectional study from Karachi,Pakistan

Background

Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan.

Methods

Data were gathered from 518 personnel working in an EMS setting from February to May 2014. Participants were screened for post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R). Demographic and work-related characteristics, coping styles and the social support systems of the participants were assessed. Linear regression was used on the IES-R to identify predictors of post-traumatic stress symptoms.

Results

The mean score of the IES-R was 23.9?±?12.1. EMS personnel with a dysfunctional coping style (β?=?0.67 CI 0.39?–?0.95), anxiety, and depression (β?=?0.64 CI 0.52?–?0.75) were more likely to have increased severity of post-traumatic stress symptoms. Age was found to have an inverse relationship with stress symptoms (β?=??0.17 CI 0.33 – -0.023), indicating the susceptibility of younger EMS personnel to stress.

Conclusion

The EMS personnel in this setting were found to have a moderate level of post-traumatic stress symptoms. The significant predictors of post-traumatic stress symptoms in this EMS population were age, coping style, and levels of anxiety and depression. These predicting factors can be a potential avenue for interventions to improve the mental health of these frontline workers.

     

Ten years of experience with pediatric neuroendoscopic third ventriculostomy: features and perioperative complications of 210 cases

Obstructive hydrocephalus remains a problem, and improvements in fiberoptic technology have promoted interest in neuroendoscopic ventriculostomy (NTV) as an alternative to standard cerebrospinal fluid shunts. The present study assessed 210 pediatric NTVs performed between 1994 and 2004 in patients aged 2 months to 10 years. Five children needed same-session ventriculoperitoneal shunting due to insufficient bypass of the obstruction. The other 205 procedures were technically successful, but 7 patients needed early-postoperative shunting and 10 required late shunting. During NTV, 86 (40.1%) of the patients developed arrhythmia. One patient arrested during balloon dilatation, but normal rhythm returned after deflation and epinephrine/atropine therapy, with no resultant morbidity. Twenty-six (10.2%) patients developed tachycardia (without hypertension) followed by bradycardia, and 6 children (2.8%) developed hypertension. In 1 case (0.5%), a branch of the basilar artery ruptured during fenestration and the hemorrhage was controlled after craniotomy. In 5 cases, mild venous bleeding was controlled by irrigation. The early complications included transient ocular divergence (n = 1), anisocoria (n = 2), and hyponatremia (n = 5). Five children were diagnosed with temporary diabetes insipidus in the late-postoperative period. The neuroendoscopic approach is considered safe for treating hydrocephalus in children, but complications can be severe or lethal and the anesthesiologist must respond accordingly.     

Partial hydatidiform mole

A case of partial hydatidiform mole is presented, occurring in a young primiparous woman after natural conception. She presented with incomplete miscarriage. Histological diagnosis of partial mole was made. Failure of beta HCG to fall resulted in the start of chemotherapy. WHO scoring placed her in low risk group. In spite of the low risk, she required third line chemotherapy for complete eradication of disease.