Progressive volumetric changes in the brains of people with schizophrenia have been attributed to a number of factors.
To determine whether glutamatergic changes in patients with schizophrenia ...correlated with grey-matter losses during the first years of illness.
Left anterior cingulate and thalamic glutamatergic metabolite levels and grey-matter volumes were examined in 16 patients with first-episode schizophrenia before and after 10 months and 30 months of antipsychotic treatment and in 16 healthy participants on two occasions 30 months apart.
Higher than normal glutamine levels were found in the anterior cingulate and thalamus of never-treated patients. Thalamic levels of glutamine were significantly reduced after 30 months. Limited grey-matter reductions were seen in patients at 10 months followed by widespread grey-matter loss at 30 months. Parietal and temporal lobe grey-matter loss was correlated with thalamic glutamine loss.
Elevated glutamine levels in never-treated patients followed by decreased thalamic glutamine and grey-matter loss in connected regions could indicate either neurodegeneration or a plastic response to reduced subcortical activity.
Abstract We examine the relationship between achieving remission of positive symptoms within 3 months in first episode psychosis and outcomes 5 years later. Time to remission of positive symptoms, ...other early characteristics and 5 year outcomes were assessed in a prospective study of 132 patients being treated for the first time for a psychotic disorder. Just under 60% of patients showed remission of positive symptoms within 3 months. In comparison to later remitters, they showed lower levels of positive symptoms, greater likelihood of competitive employment and less likelihood of collecting a disability pension at 5 years. Earlier remission of positive symptoms may have prognostic significance for longer term outcomes.
Endometrial polyps are localized overgrowth of endometrial glands and stoma through the uterine cavity. They are associated with postmenopausal bleeding, infertility and menorrhagia and are affected ...by unbalanced oestrogen therapy or increased frequency of tamoxifen exposure. We report a case of giant endometrial polyp in postmenopausal female without vaginal bleeding and hormone or drug use. A 65-year-old, postmenopausal female P3L2 with hypertension and Diabetes Mellitus (DM) came for routine health check-up. Her physical examination was normal. Pelvic examination uterus was multiparous sized, mid positioned and bilateral fornices were free. Patient was planned for hysteroscopic guided biopsy as her Ultrasonography (USG) showed endometrial thickness to be 12.3 mm. On hysteroscopy, there was hyperplastic endometrium with large endometrial polyp of size 8.5 cm. Polypectomy was done and the same was sent for histopathological evaluation. Report showed cystic hyperplasia without atypia. To summarize, postmenopausal female will not always present with symptoms and USG can also quite frequently miss the diagnosis, so proper evaluation is needed using hysteroscopy which is gold standard for diagnosis and treatment of endometrial polyp.
Purpose
To evaluate various laparoscopic methods for management of tubal ectopic pregnancy and study the incidence of ectopic pregnancy including the incidence of cornual ectopic pregnancy and ...conversion to laparotomy during laparoscopic procedure.
Methods
A retrospective study was conducted in North Point Hospital, Delhi, on all laparoscopies conducted in 4 years, i.e., from January 2008 to December 2011.
Results
Incidence of ectopic pregnancy was 4.62 % (out of all laparoscopic surgeries over 4 years) and that for cornual pregnancy was 4.65 % (out of all ectopic pregnancies); no laparotomy was done for the management of ectopic pregnancy. The site of ectopic pregnancy in the tubal pregnancy varied, with 76.75 % in the ampullary region, 16.27 % isthumic, 2.33 % fimbrial, and 4.65 % in the cornual region. Salpingectomy was done in 53.5 % cases and 46.5 % of patients underwent a conservative approach in the form of salpingostomy.
Conclusion
The laparoscopic management of ectopic pregnancy is a safe and effective option with greatly reduced morbidity.
Asherman syndrome is a rare acquired clinical condition resulting in the obliteration of the uterine cavity causedby the presence of partial or complete fibrous intrauterine adhesions involving at ...least two-thirds of the uterine cavity potentially obstructing the internal cervical orifice. Common reported symptoms of the disease are alterations of the menstrual pattern with decreased menstrual bleeding leading up to amenorrhoea and infertility. Hysteroscopy is currently considered the gold standard diagnostic and therapeutic approach for patients with intrauterine adhesions. An integrated approach, including preoperative, intraoperative and postoperative therapeutic measures, however, are warranted owing to the complexity of the syndrome. This review aims to summarize the most recent evidence on the recommended preoperative, intraoperative and postoperative procedures to restore the uterine cavity and a functional endometrium, as well as on the concomitant use of adjuvant therapies to achieve optimal fertility outcomes.
Background: Robotic-assisted surgery has attained widespread acceptance within clinical practice, emerging as the definitive standard for various medical indications. Within the realm of Gynae ...surgery, there has been a notable upsurge in the utilization of robotic and laparoscopic techniques. The Versius robotic system, developed by CMR Surgical, has demonstrated its efficacy on a global scale since its introduction in 2018, marking a significant stride in the landscape of robotic-assisted surgery. This review article was dedicated to providing an impartial assessment of robotic technology, elucidating our insights gleaned from 53 gynaecological surgeries conducted with the Versius robotic system. Methods: A meticulous examination of 53 cases was undertaken, wherein average operative time, estimated blood loss, postoperative hospital stay, Intraoperative and postoperative complications, and conversion rates were subjected to retrospective scrutiny. Results: The study conducted at a Tertiary care hospital involved the analysis of 53 gynecological cases using the Versius system. Results indicate the feasibility, efficiency, and patient- friendly nature of the Versius system, with notable advantages such as reduced hospital stay and smoother manipulation of tissues. Conclusions: We acknowledge the ongoing evolutionary trajectory of robotic surgery and it is evident that its merit has already been substantiated by the endorsement of numerous medical practitioners and patients worldwide. The Versius robotic system stands as a revolutionary force within the healthcare paradigm, distinguished not only by its favorability among medical professionals but also by its patient-friendly attributes. In the realm of minimally invasive gynecologic surgery, robot-assisted surgery emerges as a compelling alternative. Keywords: Gynecological, Hysterectomy, Laparoscopy, Robot, Versius
There continues to be controversy concerning the long term benefits of specialized early intervention programs (SEI) for psychotic disorders. Recent reports of five year outcomes for SEI programs ...indicate that benefits of early intervention programs at two year follow-up have disappeared at five years. The Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario offers continuity of care for five years, with a lower intensity level of specialized intervention after the initial two years. In this paper we examine whether the outcomes observed at two years were maintained at five year follow-up. In addition, it was possible to compare PEPP outcomes with those of the OPUS project at two and five years.
Results indicate that improvement of symptoms between entry into PEPP and two year follow-up were maintained at five years. In addition, there was further improvement in global functioning between two and five year follow-up. Comparison of PEPP outcomes at two and five year follow-up to those of OPUS suggest that longer term continuity of care within SEI is associated with continuing benefits at least with respect to level of positive symptoms and functioning.
To determine the clinical relevance of different definitions of symptom remission for prediction of functional outcome in first-episode psychosis (FEP).
One hundred forty-one individuals receiving ...treatment for an FEP at a specialized early intervention service had positive and negative symptoms and functional status rated every month over the first 2 years of treatment using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Social and Occupational Functioning Assessment Scale. Subjects were classified according to 4 definitions of remission varying the criteria for severity (negative symptom inclusion/exclusion) and duration (3/6 mo sustained).
Positive symptom remission was achieved by 94% and 84% of subjects for 3 and 6 months, respectively, compared with 70% and 56% for positive and negative symptom remission, respectively. Linear regression analyses showed that only definitions of remission containing both positive and negative symptoms independently predicted functional outcome. This was confirmed by receiver operating characteristic analyses where remission based on positive and negative symptoms was marginally better than positive symptoms alone (difference in area under the curve; z = 1.94, P = .052). There was little difference between a time criterion of remission of positive and negative symptoms of 3 (sensitivity = 100%, specificity = 42%) or 6 (sensitivity = 90%, specificity = 57%) months.
Consistent with the consensus definition of remission in schizophrenia, severity of both positive and negative symptoms in defining remission in FEP is necessary although a 3-month criterion had equal predictive validity to the 6-month criterion.
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