Insight and psychopathology in never-treated schizophrenia

Insight is a feature of schizophrenia related to psychopathology, which could be modified by treatment. The real relationship will be more evident in the never-treated state. This study compared insight and its relationship to psychopathology in 143 never-treated patients with chronic schizophrenia with 183 treated patients. The treated patients had not received any structured intervention for improvement of insight. The item on insight and judgment from the Positive and Negative Syndrome Scale for schizophrenia was used as a measure of insight. Never-treated patients were more ill and poorer in insight than the TT group. Sex, age, duration of illness, negative symptoms related to insight only in the TT group. Positive symptoms score correlated with insight in both the groups, but negative symptoms correlated with insight only among the treated patients. Delusions, uncooperativeness, and poor attention predicted 27% of variation in the level of insight in the never-treated, whereas age; duration of illness; and symptoms of emotional withdrawal, difficulty in abstract thinking, and uncooperativeness predicted 30.3% of variation in insight of the TT group. The observed differences between the never-treated and treated subjects were due to influence of treatment on the association between insight and psychopathology. A subgroup of patients with a treatment-resistant trait of negative symptoms associated with poor insight was hypothesized.     

Pictorial review: magnetic resonance imaging of colonic diverticulitis

Magnetic resonance imaging (MRI) is rapidly emerging as a useful imaging modality for the evaluation of the gastrointestinal tract. Increasingly rapid sequences and improving hardware have significantly improved the visualisation of diseases of the colon. MRI has a major advantage over CT in that there is no ionising radiation. In our institution, MRI has increasingly been used as a complimentary imaging modality to CT in the diagnosis and evaluation of diverticulitis and its complications. In this review article, we illustrate the emerging role of MRI in the diagnosis and evaluation of colonic diverticulitis.     

An assessment of post-tsunami psychosocial training programmes in Tamilnadu, India

BACKGROUND: After the Tsunami struck Tamilnadu in India in 2004, a spate of psychosocial training programmes were held by a host of agencies, both government and non-government. AIM: This study is an empirical approach to the assessment of the psychosocial training programmes held after tsunami.The nature and quality of training received by the community level workers (CLWs) and the interventions carried out by them are described. METHODS: CLWs were interviewed using a questionnaire to assess details about training and interventions carried out by them. Qualitative information was also gathered both from CLWs and the community. A comparison was made between CLWs of government, non-governmental organizations (NGOs) and those belonging to self-help groups. RESULTS: While most CLWs seemed to have benefited greatly from the training programmes, they had several suggestions to make about refining its quality. Multiple programmes, not well coordinated, resulted in a lot of overlap.The community was generally happy with the interventions provided and felt that they were necessary for about six months at least. One-to-one interventions are preferred to group activities, except in the case of children. CONCLUSIONS: Psychosocial support (PSS) training programmes after a disaster situation will need to be coordinated by a nodal agency. Too many players on the field with their own agenda do not benefit the community and can well be a waste of resources.     

Blood cells and their use in active immunotherapy of prostate cancer

Immune therapy has traditionally had a limited role in the treatment of solid malignancies, outside of renal cancer and melanoma. However, early evidence of the ability to provoke an effective anti-tumor immune response in prostate cancer has led to interest in developing a variety of immune activating strategies in this disease. The first immune therapy to attain success in prolonging survival for metastatic prostate cancer patients is Sipuleucel-T. Rather than utilizing a typical vaccine approach in which antigens and immune activators are injected into the cancer host, sipuleucel-T was developed to stimulate autologous dendritic cells ex vivo, in order to evade the immune suppressive environment created by the cancer. We review the components of the immune system which may be harnessed in the development of immunotherapy in the setting of the recent success with sipuleucel-T.     

Mobilising financial resources for maternal health

Coverage of cost-effective maternal health services remains poor due to insufficient supply and inadequate demand for these services among the poorest groups. Households pay too great a share of the costs of maternal health services, or do not seek care because they cannot afford the costs. Available evidence creates a strong case for removal of user fees and provision of universal coverage for pregnant women, particularly for delivery care. To be successful, governments must also replenish the income lost through the abolition of user fees. Where insurance schemes exist, maternal health care needs to be included in the benefits package, and careful design is needed to ensure uptake by the poorest people. Voucher schemes should be tested in low-income settings, and their costs and relative cost-effectiveness assessed. Further research is needed on methods to target financial assistance for transport and time costs. Current investment in maternal health is insufficient to meet the fifth Millennium Development Goal (MDG), and much greater resources are needed to scale up coverage of maternal health services and create demand. Existing global estimates are too crude to be of use for domestic planning, since resource requirements will vary; budgets need first to be developed at country-level. Donors need to increase financial contributions for maternal health in low-income countries to help fill the resource gap. Resource tracking at country and donor levels will help hold countries and donors to account for their commitments to achieving the maternal health MDG.     

Sarcoma of the oral and maxillofacial soft tissue in adults.

AIMS: Sarcoma occurring in oral and maxillofacial soft tissue is rare. This study was carried out to evaluate the prevalence of oral soft tissue sarcoma and to record its natural history and survival. METHODS: Retrospective analysis of the patients with histologically proven oral and maxillofacial soft tissue sarcoma treated at the Regional Cancer Centre (RCC), Trivandrum, betweeen 1990-1998 was carried out. RESULTS: During this period, ten cases of oral and maxillofacial sarcomas were registered. Three lesions were located on the cheek mucosa, two on the tongue and two on the mandibular alveolus, while there was one lesion each in the parotid region, maxilla and face (NOS). Mean age at presentation was 31.3+/-14.1 years (range 15-54 years). Seven of the patients (70%) were males. There were three cases of rhabdomyosarcoma (RMS), three cases of spindle cell sarcoma and one case each of angiosarcoma, haemangioendothelioma, malignant schwannoma and malignant fibrous histiocytoma (MFH). All the patients were treated with surgery as a primary modality. Median follow-up time was 30 months (range 5-94 months). An overall srvival of 87.5% at 5 years was observed; however, 5-year disease free survival was 60.0% (95% CI 19.5-85.2). CONCLUSIONS: Soft tissue sarcomas are of comparatively less frequent occurrence in oral and maxillofacial soft tissue than in other tissues. A good survival rate can be achieved by multimodality treatment.     

Fine-scaled human genetic structure revealed by SNP microarrays

We report an analysis of more than 240,000 loci genotyped using the Affymetrix SNP microarray in 554 individuals from 27 worldwide populations in Africa, Asia, and Europe. To provide a more extensive and complete sampling of human genetic variation, we have included caste and tribal samples from two states in South India, Daghestanis from eastern Europe, and the Iban from Malaysia. Consistent with observations made by Charles Darwin, our results highlight shared variation among human populations and demonstrate that much genetic variation is geographically continuous. At the same time, principal components analyses reveal discernible genetic differentiation among almost all identified populations in our sample, and in most cases, individuals can be clearly assigned to defined populations on the basis of SNP genotypes. All individuals are accurately classified into continental groups using a model-based clustering algorithm, but between closely related populations, genetic and self-classifications conflict for some individuals. The 250K data permitted high-level resolution of genetic variation among Indian caste and tribal populations and between highland and lowland Daghestani populations. In particular, upper-caste individuals from Tamil Nadu and Andhra Pradesh form one defined group, lower-caste individuals from these two states form another, and the tribal Irula samples form a third. Our results emphasize the correlation of genetic and geographic distances and highlight other elements, including social factors that have contributed to population structure.Microarray technology has generated unprecedented quantities of data on human genetic variation. These data are useful for fine-scaled inferences of human evolutionary history (Jakobsson et al. 2008; Li et al. 2008; Novembre et al. 2008; Tian et al. 2008) and, under some circumstances, the estimation of individual ancestry (Seldin et al. 2006; Bauchet et al. 2007; Price et al. 2008; Tian et al. 2008). In this context, the new data have contributed to a better and more nuanced understanding of the relationship between genetics and “race” (Race, Ethnicity, and Genetics Working Group 2005; Witherspoon et al. 2007). In addition, a more thorough knowledge of between-population genetic variation also has been important in improving the design and interpretation of case-control studies of common diseases (Wellcome Trust Case Control Consortium 2007; Nelson et al. 2008; Price et al. 2008).For a variety of reasons, most studies have focused primarily on European populations (Seldin et al. 2006; Bauchet et al. 2007; Novembre et al. 2008; Price et al. 2008; Tian et al. 2008), and worldwide coverage of human populations remains incomplete. For example, the Human Genome Diversity Project (HGDP) database, one of the most widely used resources, lacks coverage in the Indian subcontinent. Other major regions, such as Eastern Europe and northern Africa, are also underrepresented in databases of human genetic variation.Among these underrepresented populations, those of the Indian subcontinent, which contains one-sixth of the world''s inhabitants, are of particular interest. The origins of and relationships among Indian populations are the subjects of continuing debate (Bamshad et al. 1998, 2001; Basu et al. 2003; Vishwanathan et al. 2004; Watkins et al. 2005; Rosenberg et al. 2006; Chaubey et al. 2007), but most previous genetic studies of these populations have been based on modest data sets. Indian populations are also used increasingly in linkage and case-control studies of genetic disease (Alcais et al. 2007; Chambers et al. 2008; Holliday et al. 2008). A better understanding of the genetic structure in India will facilitate these studies.Here, along with another 21 populations from around the world, we analyzed six Indian populations, including five caste populations and one tribal population, from two southern Indian states (Andhra Pradesh and Tamil Nadu). The inclusion of caste populations from different states and with different languages allowed us to assess the effects of social status, geography, and language on genetic structure in Indian populations. We have also included Daghestanis from the Caucasus region and Ibans from Sarawak, Malaysia to improve coverage in other underrepresented regions. Our analysis offers new insights on the genetic affinities and evolution of populations residing between commonly studied populations in sub-Saharan Africa, Europe, and East Asia.