Patients and Relatives' Perspectives about Electroconvulsive Therapy (ECT) In Khartoum, Sudan

@#Lack of knowledge and inappropriate attitude towards electroconvulsive therapy (ECT) treatment may affect the outcome of psychiatric’s morbidity and mortality. However, less systematic studies have been done on this area. This study aimed to assess the patients’ and relatives’ perspectives, i.e. knowledge, attitude and compliance on ECT in Khartoum State, Sudan. This was an observational hospital-based study conducted among 103 psychiatric patients and their relatives respectively who visited the Taha Basher and Eltigani Elmahi psychiatric hospitals during 2016. Both the patients and their relative inquired about different criteria of knowledge and attitude towards ECT. The percentage of score was calculated based on their positive answers by selecting the most appropriate answer or by calculating the mean of many positive answers. All the data were collected through a pre-designed questionnaire, and further analyzed statistically. Male was represented 61 (59.2%) and the commonest age group of patients was 16-30 years. The overall score of knowledge towards ECT among patients and their relative was 54.9% and 59.4%, respectively. Acceptance on the use of ECT were agreed by 43.7% of patients and more than 70% of patients and their relatives believed giving ECT for emergency psychiatric cases. Psychiatrist was the most frequent source of information reported by both patients (73.8%) and relatives (67%). Male relatives showed significantly higher attitude of recommending ECT treatment (p=0.004) for other patients. Patients and their relatives were reported to have moderate and better knowledge and attitude towards the use of ECT, respectively.

An unusual case of shortness of breath.

Myopathy is a well-known complication of hypercortisolism and commonly involves proximal lower-limb girdle. We report a rare case of Cushing's syndrome in a 60-year-old female presenting with significant respiratory muscle weakness and respiratory failure. She had history of rheumatoid arthritis, primary biliary cirrhosis and primary hypothyroidism and presented with weight gain and increasing shortness of breath. Investigations confirmed a restrictive defect with impaired gas transfer but with no significant parenchymatous pulmonary disease. Respiratory muscle test confirmed weakness of respiratory muscles and diaphragm. Biochemical and radiological investigations confirmed hypercortisolaemia secondary to a left adrenal tumour. Following adrenalectomy her respiratory symptoms improved along with an objective improvement in the respiratory muscle strength, diaphragmatic movement and pulmonary function test. LEARNING POINTS: Cushing's syndrome can present in many ways, a high index of suspicion is required for its diagnosis, as often patients present with only few of the pathognomonic symptoms and signs of the syndrome.Proximal lower-limb girdle myopathy is common in Cushing's syndrome. Less often long-term exposure of excess glucocorticoid production can also affect other muscles including respiratory muscle and the diaphragm leading to progressive shortness of breath and even acute respiratory failure.Treatment of Cushing's myopathy involves treating the underlying cause that is hypercortisolism. Various medications have been suggested to hinder the development of GC-induced myopathy, but their effects are poorly analysed.

Vibrational spectroscopic evidence for (NO)3 formation on Cu(111).

The formation of (NO)3 on Cu(111) was recently reported based on scanning tunneling microscopy observations [A. Shiotari et al., J. Chem. Phys. 141, 134705 (2014)]. We herein report studies into this system using electron energy loss spectroscopy and verify the above findings through vibrational analysis. For the surface covered with mixed isotopes of N(16)O and N(18)O, we observed four peaks corresponding to N-O stretching vibrations, which were ascribed to the four isotopic combinations of the trimer. Dynamic coupling within the trimer was evaluated from model calculations of the coupled oscillators. Furthermore, we observed hindered rotation and translation modes in the dipole scattering regime, suggesting that the molecular axis is tilted from the surface normal. These results provide spectroscopic support for the formation of (NO)3 on Cu(111).

Adsorbed states of chlorophenol on Cu(110) and controlled switching of single-molecule junctions.

A molecular junction of substituted benzene (chlorophenol) is fabricated and controlled by using a scanning tunneling microscope (STM). Prior to the junction formation, the bonding geometry of the molecule on the surface is characterized by STM and electron energy loss spectroscopy (EELS). EELS shows that the OH group of chlorophenol is dissociated on Cu(110) and that the molecule is bonded nearly flat to the surface via an O atom, with the Cl group intact. We demonstrate controlled contact of an STM tip to the "available" Cl group and lift-up of the molecule while it is anchored to the surface via an O atom. The asymmetric bonding motifs of the molecule to the electrodes allow for reversible control of the junction.

Sexual Pain Disorder with Anxiety and Depressive Psychopathology as Complication: A Case-Report

Vaginismus is a sexual dysfunction which results from vaginal musculature spasm and makes the penetration almost impossible. It is commonly associated with significant emotional distress. On several occasions, fear of pain during sexual intercourse may perpetuate the sexual dysfunction. We report a case of primary vaginismus that was associated with psychiatric squeale of anxiety and depression psychopathology. It suggests that psychological problems related to a mentalhealth problem in vaginismus should be dealt adequately for a holistic approach. A combination of behavioural, psychological and pharmacological treatment is important to ensure a good prognosis outcome.

Is Electroconvulsive Therapy Safe for Patient with Very Low BMI? A Case Report

A case of rapid stabilization using electroconvulsive therapy (ECT) for a major depressive disordered (MDD) patient with life-threatening low body mass index (BMI) is reported. This case report focuses on a 55-year-old Malay housewife with underlying hyperthyroidism in a euthyroid state who presented with MDD with mood congruent psychotic features, which were precipitated by the death of her husband. Her BMI was only 11 kg/m2 due to severe anorexia, and she was highly suicidal. Peripheral total parenteral nutrition was started and ECT was commenced for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout admission. The patient was discharged at BMI of 13 kg/m2 with good appetite. ECT was safe for very low BMI MDD patient.

Controlling single-molecule junction conductance by molecular interactions.

For the rational design of single-molecular electronic devices, it is essential to understand environmental effects on the electronic properties of a working molecule. Here we investigate the impact of molecular interactions on the single-molecule conductance by accurately positioning individual molecules on the electrode. To achieve reproducible and precise conductivity measurements, we utilize relatively weak π-bonding between a phenoxy molecule and a STM-tip to form and cleave one contact to the molecule. The anchoring to the other electrode is kept stable using a chalcogen atom with strong bonding to a Cu(110) substrate. These non-destructive measurements permit us to investigate the variation in single-molecule conductance under different but controlled environmental conditions. Combined with density functional theory calculations, we clarify the role of the electrostatic field in the environmental effect that influences the molecular level alignment.

Validation Study of the Malay version of the Neuropsychiatric Inventory.

OBJECTIVES: There is a lack of local instruments to assess behavioural and psychological symptoms of dementia (BPSD). This 2-stage cross-sectional study was aimed at validating a Malay translated version of the Neuropsychiaric Inventory (MvNPI). MATERIALS AND METHODS: It was conducted on a selected group of 138 elderly outpatients with dementia and their caregivers in Hospital Pulau Pinang. Severity of dementia was assessed using the Malay-translated version of Mini Mental State Examination (MMSE). The original NPI was translated and then back-translated before it was pilot-tested. The MvNPI was administered twice, a week apart on the same caregiver by the same investigator. RESULTS: The individual items and total scale score of MvNPI had high internal consistency, with Corrected Item-Total Correlation ranging from satisfactory to good (0.41 to 0.77). The Cronbach's alpha for all the NPI domains showed high internal consistency (0.83), and subtotal for severity and distress scores were perfect (0.998 to 1.00). There was no significant difference between test-retest mean scores (p>0.05) and their correlations were perfect (0.996 to 1.00). Content validity indicated mild and inverse relationship between MMSE scores and severity, and distress score (-0.281 and -0.268, respectively, with p<0.001). Discriminant validity calculated using Mann-Whitney U test was found to be significant (p<0.001) in differentiating severity of cognitive impairment. Factor analysis revealed four possible components existed in MvNPI. CONCLUSIONS: The MvNPI is a valid and reliable tool for assessing BPSD among Malay speaking populations of Malaysia and its neighbouring South East Asian countries.

Formation of unique trimer of nitric oxide on Cu(111).

We report that NO molecules unexpectedly prefer a trimeric configuration on Cu(111). We used scanning tunneling microscopy (STM) at 6 K, and confirmed that the NO molecule is bonded to the face-centered-cubic hollow site in an upright configuration. The individual NO molecule is imaged as a ring protrusion, which is characteristic of the doubly degenerate 2π(*) orbital. A triangular trimer is thermodynamically more favorable than the monomer and dimer, and its bonding structure was characterized by STM manipulation. This unique behavior of NO on Cu(111) is ascribed to the threefold symmetry of the surface, facilitating effective mixing of the 2π(*) orbitals in a triangular configuration.

Effects of gate stack structural and process defectivity on high-k dielectric dependence of NBTI reliability in 32 nm technology node PMOSFETs.

We present a simulation study on negative bias temperature instability (NBTI) induced hole trapping in E' center defects, which leads to depassivation of interface trap precursor in different geometrical structures of high-k PMOSFET gate stacks using the two-stage NBTI model. The resulting degradation is characterized based on the time evolution of the interface and hole trap densities, as well as the resulting threshold voltage shift. By varying the physical thicknesses of the interface silicon dioxide (SiO2) and hafnium oxide (HfO2) layers, we investigate how the variation in thickness affects hole trapping/detrapping at different stress temperatures. The results suggest that the degradations are highly dependent on the physical gate stack parameters for a given stress voltage and temperature. The degradation is more pronounced by 5% when the thicknesses of HfO2 are increased but is reduced by 11% when the SiO2 interface layer thickness is increased during lower stress voltage. However, at higher stress voltage, greater degradation is observed for a thicker SiO2 interface layer. In addition, the existence of different stress temperatures at which the degradation behavior differs implies that the hole trapping/detrapping event is thermally activated.

Configuration change of NO on Cu(110) as a function of temperature.

The bonding structure of nitric oxide (NO) on Cu(110) is studied by means of scanning tunneling microscopy, reflection absorption infrared spectroscopy, and electron energy loss spectroscopy at 6-160 K. At low temperatures, the NO molecule adsorbs at the short bridge site via the N end in an upright configuration. At around 50 K, this turns into a flat configuration, in which both the N and O atoms interact with the surface. The flat configuration is characterized by the low-frequency N-O stretching mode at 855 cm(-1). The flat-lying NO flips back and forth when the temperature increases to ~80 K, and eventually dissociates at ~160 K. We propose a potential energy diagram for the conversion of NO on the surface.

Sexual dysfunction among postmenopausal women.

INTRODUCTION AND OBJECTIVE: Female sexual dysfunction (FSD) has a major impact on interpersonal relationships and quality of life. For many women it has been emotionally distressing, physically disconcerting, and socially disruptive. To determine the prevalence and factors that contribute to female sexual dysfunction (FSD) and to evaluate the different sexual domains that influence sexual function amongst post menopausal women. MATERIALS AND METHODS: This was a cross-sectional study among postmenopausal women attended the Menopause Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). It was conducted over a period of one year. A validated English and Malay Version of the Female Sexual Function Index (FSFI) were used to assess female sexual function. RESULTS: The median age of menopause in this study population was 50 years and majority of these patients was on hormonal therapy (58.2%). The prevalence for sexual dysfunction was high (85.2%). The most affected sexual domains were: dissatisfaction (89.0%), arousal (67.0%) and desire (62.4%). Factors associated with sexual dysfunction among post menopausal women that were statistically significant were age more than 60 (p=0.033), lower educational level (p<0.001), and type of menopause (p=0.029). Women with naturally occurring menopause were found to be 2.5 times more likely to have sexual dysfunction. CONCLUSIONS: The prevalence of sexual dysfunction among post menopausal women was high. The most affected domains were satisfaction, desire and arousal. The associated factors were older age, lower education level, and type of menopause.

Comparative study of phenol and thiophenol adsorption on Cu(110).

Adsorption of phenol and thiophenol (benzenethiol) on Cu(110) is investigated by a scanning tunneling microscope and electron energy loss spectroscopy. Phenol adsorbs intact and forms a cyclic trimer at 78 K. It is dehydrogenated to yield a phenoxy (C6H5O) group at 300 K. On the other hand, thiophenol is dehydrogenated to a thiophenoxy (C6H5S) group even at 78 K. Both products are bonded via chalcogen atom to the short-bridge site with the phenyl ring oriented nearly parallel to the surface. The C6H5O and C6H5S groups are preferentially assembled into the chains along the [001] and [112] directions, respectively. Dipole-dipole interaction is responsible for the chain growth, while the chain direction is ruled by the steric repulsion between chalcogen atoms and adjacent phenyl ring. This work demonstrates a crucial role of chalcogen atom of phenol species in their overlayer growth on the surface.

Effects of Selective Serotonin Reuptake Inhibitors (SSRIs) therapy on the female sexual response cycle of women with major depression.

OBJECTIVE: Depression and its treatment may influence all aspects of the female sexual function from desire to sexual satisfaction. This study aimed to examine the components of the female sexual response cycle (SRC) of women with major depression treated with Selective Serotonin Reuptake Inhibitors. MATERIALS AND METHODS: The correlations structure of the items of the SRC's phases (i.e. desire, arousal, orgasm, satisfaction and pain) in a validated Malay version of Female Sexual Function Index (FSFI) was determined using principal component analysis (PCA), with varimax rotation method. The number of factors obtained was decided using Kaiser's criteria. Factor loadings using PCA with varimax rotation divided the sexual domains into three components based on Kaiser's criteria. RESULTS: Sexual desire, sexual arousal, lubrication and orgasm were highly correlated, to form a "sexual drive" construct. Sexual satisfaction and pain made up the second and third components, respectively. SSRIs may affect the components of the SRC causing highly overlapping constructs of sexual drive including orgasm. Recognizing this helps strategizing the treatment approach of female sexual dysfunction in depression particularly in relation to the role of SSRIs.

A metallic surface state with uniaxial spin polarization on Tl/Ge(111)-(1 × 1).

We show that a metallic surface state is formed on Tl/Ge(111)-(1 × 1). The surface state forms electron pockets around K of the surface Brillouin zone. A first-principles calculation reveals that the electron pockets are composed of a single branch of a spin-split surface-state band. The spin quantization axis is along the surface normal and inverts according to the time-reversal symmetry. Since this spin-split branch is the unique metallic band on this surface, the surface conductivity should be governed by this spin-split branch, suggesting a possible spin-polarized electric current.

Vaginismus and subfertility: case reports on the association observed in clinical practice.

OBJECTIVE: To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms. METHOD: We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety. CONCLUSION: The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.

Associated risk factors to Non-compliance to Methadone Maintenance Therapy.

The escalating problem of opiate dependence in Malaysia and the limitations of regimental approach of forced admission to rehabilitation centres had triggered the government to expand the methadone maintenance therapy to become a national programme. This study aimed to evaluate the short-term outcomes of the Methadone Maintenance Therapy programme in one of the busiest hospital in east coast Malaysia. We also explored the prevalence on non-compliance and factors associated to it. A total of 172 patient case notes at Methadone Clinic Hospital Tengku Ampuan Afzan (HTAA) were retrieved for relevant data. A short survey was also conducted to determine the subjects' current employment and marital status. The programme's retention rate was 62% and factors associated with poor compliance were unemployment, low quality of life scores and low dose of methadone. A special attention on the patients with these three risk factors may improve their compliance to MMT. The short-term evaluation of MMT at HTAA revealed favourable findings.

Sexual Dysfunction amongst Women with Benign Gynaecological Disease

There was no difference in female sexual dysfunction amongst women with and without benign gynaecological disease.

Sexual Dysfunction among Post Menopausal Women

The prevalence of sexual dysfunction among post menopausal women was high. The most affected domains were satisfaction, desire and arousal. The associated factors were older age, lower education level, and type of menopause.