Prevalence, Recognition, And Management Of Mental Disorders In Primary Care

According to latest figures, 50% of individuals will have a minimum of one mental health issue in their lifetime, with at least 25% experiencing a mental condition in the previous year. primary care doctors are overwhelmingly responsible for recognition, evaluation, therapy, and referral, with at least one-third of their consultations containing a direct and obvious mental aspect Primary care physicians are the foundation of the majority of medical care programs that involve recognizing, diagnosing, treating, and referring patients to specialists for every kind of diseases, whether physical, mental, or both. Over the last two decades, there has been a greater emphasis on this position, notably in the treatment of mental problems in primary care

Axonal sensorimotor polyneuropathy after starting guselkumab

Guselkumab is an IL-23 inhibitor that binds to the p19 subunit of IL-23 that is highly efficacious and well tolerated for the treatment of moderate-to-severe plaque psoriasis. We report a 20-year-old male who developed sensorimotor axonal polyneuropathy starting treatment with guselkumab, confirmed by neurological examination and serial neurophysiologic studies. His symptoms improved within 5 months of stopping the treatment. The neurophysiologic studies also showed improvement but with continued neuropathy and re-innervation changes on electromyography after about 10 months of stopping treatment. The time line of symptoms and a positive de-challenge are strong but not definitive evidence of guselkumab as a cause

Kafala and Social Reproduction: Migration Governance Regimes and Labour Relations in the Gulf

With its roots in a system of imperial labour governance that ‘delegated responsibility over the conduct of individuals to other parties’ (AlShehabi 2019), kafala has often been understood as a policy by which states in the Gulf regulate, police, and exploit migrant labour. This chapter instead works to develop a concept of kafala as a migration governance regime, a way for states to integrate citizens as actors in the migration governance complex and, in doing so, obfuscate questions of accountability, transparency, and regulation. This is most keenly seen in the case of domestic workers who stand to benefit the least from recent reforms to kafala across the region. By focusing on the ways that kafala integrates individual households into the migration governance complex, this chapter aims to foreground the importance of the socially reproductive work done by migrant labourers to the Gulf, and attempts to explain the mechanisms through which their work sits outside the purview of the state’s governance of migrant labourers to the Gulf. The chapter attempts to explain the mechanisms through which domestic work is often excluded from wider considerations regarding migrant labour, even as domestic work is the most common form that migrant labour takes

Bedside ultrasonography screening for congenital renal anomalies in children with congenital heart diseases undergoing cardiac repair

Introduction: Ultrasound (US) assessment of renal anomalies in children requiring pediatric cardiac surgery is not a standard practice. This study is highlighting the role of bedside US performed by intensivist to detect occult renal anomalies associated with congenital heart disease (CHD). Methods: A cross sectional study for 100 consecutive children with CHD admitted to Pediatric Cardiac Intensive Care Unit (PCICU) in 2015. US of kidneys screening was performed by trained pediatric cardiac intensivists to ascertain the presence of both kidneys in renal fossae without gross anomalies and to investigate if early detection of occult kidney anomaly would have any impact on outcome. Results: After screening of 100 consecutive children with CHD with renal US, we identified in 94 cases (94%) normal right and left kidney in the standard sonographer shape within the renal fossae. In 6 cases further investigation revealed ectopic kidney in 3 patients (50%), solitary functional kidney in 2 patients (33%) and bilateral grade IV hydronephrosis in one patient (17%). Urinary tract infection developed peri-operatively in 66% of the cases with kidney anomalies with statistical significance compared to patients with normal renal US (P: 0.0011). No significant renal impairment was noted in these patients post-surgery. We observed no specific association between the type of renal anomaly and specific CHD. Conclusion: Routine renal US in children with CHD demonstrated prevalence of associated congenital renal anomalies in 6% of children undergoing cardiac surgery. The presence of occult renal anomalies was associated with higher UTI risk. Performing routine renal US as a standard practice in children with CHD is justifiable. Keywords: Renal ultrasound, Congenital renal anomalies, Congenital heart diseas

Evaluation of piezocision and laser-assisted flapless corticotomy in the acceleration of canine retraction: a randomized controlled trial

Abstract Background To evaluate the effectiveness of two minimally invasive surgical procedures in the acceleration of canine retraction: piezocision and laser-assisted flapless corticotomy (LAFC). Methods Trial design: A single-centre randomized controlled trial with a compound design (two-arm parallel-group design and a split-mouth design for each arm). Participants: 36 Class II division I patients (12 males, 24 females; age range: 15 to 27 years) requiring first upper premolars extraction followed by canine retraction. Interventions: piezocision group (PG; n = 18) and laser-assisted flapless corticotomy group (LG; n = 18). A split-mouth design was applied for each group where the flapless surgical intervention was randomly allocated to one side and the other side served as a control side. Outcomes: the rate of canine retraction (primary outcome), anchorage loss and canine rotation, which were assessed at 1, 2, 3 and 4 months following the onset of canine retraction. Also the duration of canine retraction was recorded. Random sequence: Computer-generated random numbers. Allocation concealment: sequentially numbered, opaque, sealed envelopes. Blinding: Single blinded (outcomes’ assessor). Results Seventeen patients in each group were enrolled in the statistical analysis. The rate of canine retraction was significantly greater in the experimental side than in the control side in both groups by two-fold in the first month and 1.5-fold in the second month (p  0.05). There were no significant differences between the two flapless techniques regarding the studied variables during all evaluation times (p > 0.05). Conclusions Piezocision and laser-assisted flapless corticotomy appeared to be effective treatment methods for accelerating canine retraction without any significant untoward effect on anchorage or canine rotation during rapid retraction. Trials registration ClinicalTrials.gov (Identifier: NCT02606331)

Integrated Security System (ISS) Design and Evaluation for Commercial Nuclear Power Plant

Physical security system, which is also called physical protection system, is very crucial in the nuclear industry for protecting staff, visitors, buildings, assets, and nuclear materials against theft, sabotage, and harmful activities. Theft of nuclear materials has a major impact on the essence of nuclear safeguards. Sabotage of a nuclear facility could endanger the public at large. Reviewing the published literature, it is found that there are no complete physical security system designs based on an integrated network of electronic devices that are devoted to commercial NPPs. And there is no definite evaluation factor that was set to approve such a system. This paper is an evolving solution to this deficiency by proposing an unpreceded integrated security system design applicable to a commonly structured physical layout of any commercial NPP. This proposal provides comprehensive security coverage for the NPP boundaries employing a high level of integration for all subsystems communicated via an IP data network controlled by central management software. This paper is proposing also testing procedures to be followed to evaluate the proposed design. The security system effectiveness will be calculated using mathematical codes by assuming external intrusion attack scenarios. Attributes of each attack scenario will be numerically introduced to the evaluation software EASI and ASSESS codes developed by Sandia Labs, USA. This paper also proposes a threshold value of such security system effectiveness which should be achieved by the commercial NPP security system to achieve the so-called security license