Medicalization of Nervous and Emotional Problems

Medicalization is the process of defining non-medical problems in medical terms, usually with the implication that a medical intervention is needed. It has been criticized for re-labeling “normal” human experiences as pathological or medical conditions. Some of the driving engines of medicalization include growth of pharmaceutical industry, advertising, managed care, and biotechnology. In the last few decades, serious concerns have also been raised about medicalization of mental health issues. Diagnosis such as attention-deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) and sexual disorders are discussed in context of medicalization. Also, role of various stakeholders in dealing with medicalization are discussed. Keywords: Medicalization, mental health, attention deficit hyperactivity disorder (ADHD), medical marketing, post-traumatic stress disorder (PTSD)

A Study of Sectionally Related Dispersion and Chemical Reaction Effects

This theoretical investigation is aimed at finding the influence ofthe cross-section on the equivalent dispersion coefficient of a solute in a non-Newtonian medium flowing through a channel by considering the Power law, Bingham plastic, Casson models of fluids and it has been noted that in the case of the first two, there is a steep rise with the increase of the width of the channel, but in the case of Casson model, equivalent dispersion coefficient attains a maximum atRla = 1.7. Some explanation is offered for this behaviour of the fluid

Need Assessment of Consultation Liaison Psychiatry amongst the Clinical Faculty

Nearly 20-40% of patients with medico-surgical illnesses in general hospitals have a co morbid psychiatric illness or psychosocial issues, which interfere in improvement of the primary illness. It is important to assess the attitudes and awareness of non-psychiatrist clinicians about the co-existing psychiatric morbidity in their patients and their felt needs, which can help in mitigating this morbidity. The present study attempts to gauge the non-psychiatrist clinician's perception, felt needs and barriers to referral/ intervention in a tertiary care teaching hospital. A cross-sectional, descriptive, online questionnaire-based method was used. Of the 239 clinical faculty members, only 45 responded. Responses indicated that clinicians were aware of the existence and significance of psychological problems in their patients, but could do with further increased levels of awareness and more specific training in evaluation and intervention. Stigma, lack of awareness of available services, and lack of detailed understanding regarding psychological problems were the important barriers to referral/ intervention. Better teamwork, training and more manpower were the specific suggestions for improvement in the future

Ion channels, long QT syndrome and arrhythmogenesis in ageing.

Ageing is associated with increased prevalences of both atrial and ventricular arrhythmias, reflecting disruption of the normal sequence of ion channel activation and inactivation generating the propagated cardiac action potential. Experimental models with specific ion channel genetic modifications have helped clarify the interacting functional roles of ion channels and how their dysregulation contributes to arrhythmogenic processes at the cellular and systems level. They have also investigated interactions between these ion channel abnormalities and age-related processes in producing arrhythmic tendency. Previous reviews have explored the relationships between age and loss-of-function Nav 1.5 mutations in producing arrhythmogenicity. The present review now explores complementary relationships arising from gain-of-function Nav 1.5 mutations associated with long QT3 (LQTS3). LQTS3 patients show increased risks of life-threatening ventricular arrhythmias particularly after 40 years of age consistent with such interactions between the ion channel abnormailities and ageing. In turn clinical evidence suggests that ageing is accompanied by structural, particularly fibrotic, as well as electrophysiological change. These abnormalities may result from biochemical changes producing low-grade inflammation resulting from increased production of reactive oxygen species and superoxide. Experimental studies offer further insights into the underlying mechanisms underlying these phenotypes. Thus, studies in genetically modified murine models for LQTS implicated action potential recovery processes in arrhythmogenesis resulting from functional ion channel abnormalities. In addition, ageing WT murine models demonstrated both ion channel alterations and fibrotic changes with ageing. Murine models then suggested evidence for interactions between ageing and ion channel mutations and provided insights into potential arrhythmic mechanisms inviting future exploration.KJ is funded by the Fundamental Research Grant Scheme (FRGS/2/2014/SKK01/PERDANA/02/1), Ministry of Education, Malaysia and the Research Support Fund, Faculty of Health and Medical Science, University of Surrey. KC was funded by the Physiological Society, United Kingdom. HV is funded by the Wellcome Trust Research Training Fellowship (105727/Z/14/Z) and Sudden Arrhythmic Death Syndrome (SADS), UK. SA is funded by a Medical Research Council Research Fellowship (MR/M001288/1). AG is funded by the McVeigh Benefaction and Sudden Arrhythmic Death Syndrome (SADS), UK. CLHH is funded by the Wellcome Trust, Medical Research Council, British Heart Foundation and McVeigh Benefaction

Sodium channel biophysics, late sodium current and genetic arrhythmic syndromes

Arrhythmias arise from breakdown of orderly action potential (AP) activation, propagation and recovery driven by interactive opening and closing of successive voltage-gated ion channels, in which one or more Na$^{+}$ current components play critical parts. Early peak, Na$^{+}$ currents (I$_{Na}$) reflecting channel activation drive the AP upstroke central to cellular activation and its propagation. Sustained late Na$^{+}$ currents (I$_{Na-L}$) include contributions from a component with a delayed inactivation timecourse influencing AP duration (APD) and refractoriness, potentially causing pro-arrhythmic phenotypes. The magnitude of I$_{Na-L}$ can be analysed through overlaps or otherwise in the overall voltage dependences of the steady-state properties and kinetics of activation and inactivation of the Na$^{+}$ conductance. This was useful in analysing repetitive firing associated with paramyotonia congenita in skeletal muscle. Similarly, genetic cardiac Na$^{+}$ channel abnormalities increasing I$_{Na-L}$ are implicated in triggering phenomena of automaticity, early and delayed afterdepolarisations and arrhythmic substrate. This review illustrates a wide range of situations that may accentuate I$_{Na-L}$. These include (1) overlaps between steady-state activation and inactivation increasing $\textit{window current}$, (2) kinetic deficiencies in Na$^{+}$ channel inactivation leading to $\textit{bursting phenomena}$ associated with repetitive channel openings and (3) $\textit{non-equilibrium gating}$ processes causing channel re-opening due to more rapid recoveries from inactivation. All these biophysical possibilities were identified in a selection of abnormal human SCN5A genotypes. The latter presented as a broad range of clinical arrhythmic phenotypes, for which effective therapeutic intervention would require specific identification and targeting of the diverse electrophysiological abnormalities underlying their increased I$_{Na-L}$.KC was funded by the Physiological Society, United Kingdom at the University of Surrey. KJ is funded by the Fundamental Research Grant Scheme (FRGS/2/2014/SKK01/PERDANA/02/1), Ministry of Education, Malaysia, and the Research Support Fund, Faculty of Health and Medical Science, University of Surrey. ML is funded by the British Heart Foundation (PG/14/80/31106, PG/16/67/32340) and Medical Research Council (G10002647). CLHH is funded by the Medical Research Council (MR/M001288/1), Wellcome Trust (105727/Z/14/Z), British Heart Foundation (PG/14/79/31102), the McVeigh Benefaction and SADS UK

A rare case of paediatric astroblastoma with concomitant MN1-GTSE1 and EWSR1-PATZ1 gene fusions altering management

In a case of astroblastoma, methylation analysis was uninformative, with no clustering with known CNS-HGNET-MN1 cases. Whole genome sequencing however identified a novel MN1-GTSE1 gene fusion (image), confirming the diagnosis of astroblastoma, as well as an EWSR1-PATZ1 gene fusion. Whole genome sequencing, alongside methylation profiling and conventional neuropathology, will continue to lead to improved diagnostics and prognostication for children with brain tumours

Ultrastructural identification of uncoated caveolin-independent early endocytic vehicles

Using quantitative light microscopy and a modified immunoelectron microscopic technique, we have characterized the entry pathway of the cholera toxin binding subunit (CTB) in primary embryonic fibroblasts. CTB trafficking to the Golgi complex was identical in caveolin-1null (Cav1−/−) mouse embryonic fibroblasts (MEFs) and wild-type (WT) MEFs. CTB entry in the Cav1−/− MEFs was predominantly clathrin and dynamin independent but relatively cholesterol dependent. Immunoelectron microscopy was used to quantify budded and surface-connected caveolae and to identify noncaveolar endocytic vehicles. In WT MEFs, a small fraction of the total Cav1-positive structures were shown to bud from the plasma membrane (2% per minute), and budding increased upon okadaic acid or lactosyl ceramide treatment. However, the major carriers involved in initial entry of CTB were identified as uncoated tubular or ring-shaped structures. These carriers contained GPI-anchored proteins and fluid phase markers and represented the major vehicles mediating CTB uptake in both WT and caveolae-null cells

Age-dependent atrial arrhythmic phenotype secondary to mitochondrial dysfunction in Pgc-1β deficient murine hearts

Introduction: Ageing and several age-related chronic conditions including obesity, insulin resistance and hypertension are associated with mitochondrial dysfunction and represent independent risk factors for atrial fibrillation (AF). Materials and methods: Atrial arrhythmogenesis was investigated in Langendorff-perfused young (3–4 month) and aged (>12 month), wild type (WT) and peroxisome proliferator activated receptor-γ coactivator-1β deficient (Pgc-1β ) murine hearts modeling age-dependent chronic mitochondrial dysfunction during regular pacing and programmed electrical stimulation (PES). Results and discussion: The Pgc-1β genotype was associated with a pro-arrhythmic phenotype progressing with age. Young and aged Pgc-1β hearts showed compromised maximum action potential (AP) depolarization rates, (dV/dt) , prolonged AP latencies reflecting slowed action potential (AP) conduction, similar effective refractory periods and baseline action potential durations (APD ) but shortened APD in APs in response to extrasystolic stimuli at short stimulation intervals. Electrical properties of APs triggering arrhythmia were similar in WT and Pgc-1β hearts. Pgc-1β hearts showed accelerated age-dependent fibrotic change relative to WT, with young Pgc-1β hearts displaying similar fibrotic change as aged WT, and aged Pgc-1β hearts the greatest fibrotic change. Mitochondrial deficits thus result in an arrhythmic substrate, through slowed AP conduction and altered repolarisation characteristics, arising from alterations in electrophysiological properties and accelerated structural change.We acknowledge financial support from the Medical Research Council (MR/M001288/1), the Wellcome Trust (105727/Z/14/Z), British Heart Foundation (PG/14/79/31102 and PG/15/12/31280), Sudden Arrhythmic Death Syndrome (SADS) UK, The McVeigh Benefaction and the Fundamental Research Grant Scheme, Ministry of Education, Malaysia (FRGS/2/2014/SKK01/PERDANA/02/1)

Pathways to care in first-episode psychosis in low-resource settings: Implications for policy and practice.

Developing countries such as India face a major mental health care gap. Delayed or inadequate care can have a profound impact on treatment outcomes. We compared pathways to care in first episode psychosis (FEP) between North and South India to inform solutions to bridge the treatment gap. Cross-sectional observation study of 'untreated' FEP patients (n = 177) visiting a psychiatry department in two sites in India (AIIMS, New Delhi and SCARF, Chennai). We compared duration of untreated psychosis (DUP), first service encounters, illness attributions and socio-demographic factors between patients from North and South India. Correlates of DUP were explored using logistic regression analysis (DUP ≥ 6 months) and generalised linear models (DUP in weeks). Patients in North India had experienced longer DUP than patients in South India (β = 17.68, p < 0.05). The most common first encounter in North India was with a faith healer (45.7%), however, this contact was not significantly associated with longer DUP. Visiting a faith healer was the second most common first contact in South India (23.6%) and was significantly associated with longer DUP (Odds Ratio: 6.84; 95% Confidence Interval: 1.77, 26.49). Being in paid employment was significantly associated with shorter DUP across both sites. Implementing early intervention strategies in a diverse country like India requires careful attention to local population demographics; one size may not fit all. A collaborative relationship between faith healers and mental health professionals could help with educational initiatives and to provide more accessible care. [Abstract copyright: Copyright © 2023. Published by Elsevier B.V.