An audit of the referrals to the Chris Hani Baragwanath academic hospital psychiatry outpatients department

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2016Aim The aim of this study was to conduct a clinical audit of all new referrals to the Chris Hani Baragwanath Academic Hospital (CHBAH) Psychiatry Outpatients Department (OPD) over a six month period, in order to assess the appropriateness and the quality of these referrals for the level of care provided. Objectives The study objectives were as follows: to describe, in a group of patients referred to CHBAH Psychiatry OPD, their socio-demographic characteristics, the sources of referral, the reasons for the referral, diagnoses and interventions prior to referral, as well as diagnoses, interventions and final outcomes following an assessment by the CHBAH psychiatry outpatients staff. Based on these an assessment of the appropriateness of referral was made. This was a retrospective record review of all consecutive new outpatients referred to the CHBAH Psychiatry OPD for the period of 1 July 2012 to 31 December 2012. The study was conducted at Chris Hani Baragwanath Academic Hospital, which is a tertiary level hospital whose psychiatric department caters for mental health care users in the Southern Metro District Johannesburg area in the province of Gauteng, South Africa. Results The study found that most patients who were referred were female (68.8%), aged 18-39 years (48.9%), unemployed (70.5%), single (47.2%) and had attained a secondary level of education (57.4%). The largest source of referrals was from other disciplines within CHBAH (32.4%), in particular the department of internal medicine (20.5%). The commonest referral reason, referral diagnosis (29%) and diagnosis made by the CHBAH Psychiatry OPD staff was that of depressive disorders (35.8%, 29% and 31.3% respectively). 74.4% of patients did not have investigations done prior to referral; the commonest intervention at Psychiatry OPD was the initiation of psychotropic medication (56.8%) and the commonest outcome was follow-up at Psychiatry OPD (67.6%). Only 14.8% of new referrals were assessed as being appropriate, as 55.7% of patients did not have a diagnosis on referral, the diagnosis on referral was correct in 34.7% of cases, 39.2% of patients had not been initiated on any treatment prior to referral and the majority of patients did not have investigations performed on them prior to referral. Discussion The study provides further evidence that referral pathways are often bypassed, with many patients requiring simple interventions unable to access these at lower levels of care for a variety of reasons. Thus higher levels of care may become overburdened, further impacting on quality of care. Additional resource constrictions may be incurred, which has a ripple effect across all levels of care, often with far-reaching economic consequences. It is evident that the practical implementation of policies is faced with a number of challenges; these need to be addressed in order for the health care system to appropriately perform its function.MT201

Designing Optimization for Some Eolian Power Unit Taking into Account the Seismic Loads Influence

In the eastern part of the Romanian territory there are wind intensity conditions for some big eolian power units. From lithological point of view, the mentioned area is characterized by a loessial stratum of 3 up to over 20m deep which covers green shale rocks. The paper presents the designing consideration discussed in order to obtain the most economical foundation option. The corresponding calculus conclusions about the soil-structure interactions in seismic conditions are also revealed

Bioactive Compounds of Lactic Acid Bacteria. Case Study: Evaluation of Antimicrobial Activity of Bacteriocin-producing Lactobacilli Isolated from Native Ecological Niches of Ecuador

Food preservation through natural methods represents one of the concerns worldwide to solve economic losses due to microbial decomposition of raw materials and foodstuffs. However, public concern over the emergence of strains resistant to many antibiotics, particularly pathogens such as E. coli and Salmonella sp. draw much attention as new challenge in food industry is to find new alternative quality-control methods of food products. In Ecuador, the lack of quality control, bad storage condition, and insufficient preservation against spoilage bacteria had at higher extent repercussions on food safety and security. The most frequent pathogens detected in fresh meat and drinks along with traditional local food products, represent a serious problem producing sizable food damage and associated diseases. The capacity of lactobacilli to inhibit pathogens has been recently exploited to prevent microbial spoilage. Here we briefly review the principal biopeptides (i.e., bacteriocins) of lactic acid bacteria, their main mode of action, the classification, and its biotechnological applications. Moreover, we discussed the preliminary results on the evaluation of antimicrobial activity of some native lactic acid bacteria isolated from microbiota of Ecuador against frequent contaminants found in the local market

Foundations Conditions Study for Aeolian Power Units on Soft Soils under Static and Seismic Loads. Case Study

The paper presents the analysis of foundations conditions under static and seismic loads for a wind farm located in the Eastern part of Romania. From lithological point of view, the location is characterized by a soft cohesive strata alternation over 40m deep. Some design considerations for obtaining the most economical foundation options are discussed. By taking into account the static and seismic conditions, the soil – structure interaction (S.S.I.) is also revealed together with conclusions on the aeolian towers’ foundations solutions

Reticular erythematous mucinosis in an African woman with HIV infection : case report and literature review

DATA AVAILABILITY STATEMENT : All data generated or analysed in this case report are included in the article and its online supplementary material. Further inquiries can be directed to the corresponding author.Reticular erythematous mucinosis is a rare and persistent form of primary idiopathic mucinosis, often referred to as plaque-like cutaneous mucinosis or midline mucinosis. It presents with reticulate patches or erythematous plaques with predilection for the anterior and posterior trunk. Affected patients are frequently asymptomatic. Pruritus or burning sensations were reported after exposure to the sun. The aetiology remains obscure; its pathogenesis is poorly understood, particularly in immunocompromised patients such as HIV-infected patients. The disease associations are not uniformly documented. Antimalarial agents significantly improve and shorten the course of the disease. We report a case of a 31-year-old African woman with underlying HIV infection who displayed the classical clinical and histological features of reticular erythematous mucinosis. This condition is rare among the HIV-infected patients, particularly in those of African descent, in whom lichen myxoedematosus/scleromyxoedema variants and acral persistent papular mucinoses were most frequently reported. The higher incidence of photosensitivity in HIV-infected individuals including the patients with skin of colour may play a potential role in reticular erythematous mucinosis. Its relationship with lupus erythematosus and photosensitivity in the context of HIV infection is discussed. To the best of our knowledge, this is the first reported case of reticular erythematous mucinosis in an African HIV-infected patient. This case highlights the need for diagnostic awareness in cases presenting with erythematous plaques and patches in a net-like pattern developing on the midline and sun-exposed areas of the trunk.https://www.karger.com/CDEhj2024DermatologySDG-03:Good heatlh and well-bein

Synthese substituierter Porphyrine als potentielle Energiespeicher

Im Rahmen der vorliegenden Dissertation wurden neue 5,15-meso-disubstituierte Porphyrine dargestellt. Als Bausteine für die Porphyrine wurden Aren-Aldehyde eingesetzt, deren elektronische Eigenschaften durch verschiedene Substituenten modifiziert werden konnten. Im ersten Teil der Arbeit wurde die Synthese des Dipyrrylmethan-Derivats 16 beschrieben. Die Umsetzung der Aldehyde mit 16 lieferte nach der Methode von Chang die symmetrischen Porphyrine 22, 65, 37, 41, 47 und 62. Zur Synthese der Iminophenylporphyrine 23, 25 und 28 bewährte sich die Umsetzung geeigneter Aminophenylporphyrine mit Aldehyden in Gegenwart einer katalytischen Menge Essigsäure. Die für die Synthese der substituierten Porphyrine 37, 41 und 47 notwendigen o-Alkylsalicydaldehyde 36, 40 und 46 wurden aus dem geschützten Salicylaldehyd 31 durch Mitsunobu-Reaktion hergestellt. Die Darstellung von Diphenoxyalkan-o,o'-dialdehyd 53 und 56 gelang ausgehend von Salicylaldehyd 29 nach der Williamson-Synthese in sehr guten Ausbeuten. Die substituierten Bicyclo[2.2.1]heptadiene wurden entweder direkt durch Diels-Alder-Reaktion des Cyclopentadiens mit passenden Alkinol-Dienophilen oder aus Norbornadien 58 durch Deprotonierung mit Schlosser-Base und Alkylierung mit einem Überschuss an Dibromalkan 52 oder 55 hergestellt. Da sich der Einsatz von Mikrowellenstrahlung besonderes bei empfindlichen Substraten, die bei längerer Reaktionszeit zu Nebenreaktionen neigen, bewährt hat, wurden die Porphyrine 21, 65, 62 und 37 alternativ in einem Mikrowellen-Reaktor hergestellt. Erwartungsgemäß wurden gegenüber konventionellen Reaktionsbedingungen bei kürzeren Reaktionszeiten deutlich bessere Ausbeuten erreicht. Im zweiten Teil dieser Arbeit wurden die hergestellten Porphyrine, die in ihren meso-Positionen verschiedene Substituenten tragen, mit einer Quecksilberlampe bestrahlt. Bei Bestrahlung mit Licht ohne Filtervorsatz wurde leider keine Isomerisierung dieser Porphyrin-Derivate nachgewiesen. Einzig das Norbornadien-substituierte Porphyrin 47 isomerisiert bei UV-Belichtung nach 8 Stunden Bestrahlungszeit zum Quadricyclan