Lamotrigine is a commonly used agent for seizure control in epilepsy. There are limited data on the adverse effects of lamotrigine in overdose. We report a number of serious side-effects associated with a large overdose of lamotrigine. A 23-year-old female presented to the emergency department after taking an intentional overdose of 9.2 g of lamotrigine, 56 mg of chlorpheniramine, and 220 mg of citalopram. On admission, she had a reduced level of consciousness and electrocardiographic abnormalities; a widened QRS and a prolonged corrected QT (QTc) interval. Prompt treatment with early intubation, along with the use of magnesium for cardioprotection and administration of sodium bicarbonate may have aided in a quick recovery with a short intensive care stay and good outcome.

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There is currently a growing body of research examining environmental factors in the etiology of psychosis. Much recent interest has focused on the relationship between childhood trauma and the risk of developing psychotic experiences later in life. Numerous studies of psychiatric patients where the majority are diagnosed psychotic indicate that the prevalence of traumatic experiences in this group is high. This body of research now includes many large-scale population-based studies controlling for possible mediating variables, which together provide persuasive evidence of a dose-response association and are indicative of a causal relationship. Several psychological and biological models have been proposed which offer credible accounts of the processes by which trauma may increase risk of psychotic experience. Clinically it is imperative to routinely enquire about traumatic experiences, to respond appropriately and to offer psychosocial treatments to those who report traumatic life events in the context of psychotic experiences.

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A considerable body of research has demonstrated that women who are abused by their male romantic partners are at substantially elevated risk for the development of post-traumatic stress disorder (PTSD). This article reviews recent literature regarding intimate partner violence (IPV) and resultant PTSD symptoms. The article is intended to be an introduction to the topic rather than an exhaustive review of the extensive literature in this area. Factors that enhance and reduce the risk for PTSD, including social support, coping styles, and types of abusive behavior experienced, are described. In addition, the unique risks associated with IPV for women who have children are discussed. Prevention efforts and treatment are briefly reviewed.

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The preference for a son continues to be a prevalent norm in the traditional Indian household. This is evident from the declining sex ratio which has dropped to alarming levels, especially in the northern states according to Census 2001 reports. The proliferation and abuse of advanced technologies coupled with social factors contributing to the low status of women such as dowry, concerns with family name and looking up to the son as a breadwinner has made the evil practice of female feticide to become common in the middle and higher socioeconomic households, especially in the northern states. Despite the existence of the Prenatal Diagnostic Techniques Act, there is a dire need to strengthen this law since the number of convictions is despairingly low as compared to the burden posed by this crime. Moreover, it is necessary to gear efforts against the cultural, economic and religious roots of this social malady by woman empowerment and intensive Information, Education and Communication campaigns. The medical colleges and professional bodies have a vital role to play by sensitizing medical students who are the doctors of tomorrow.

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Child maltreatment is a significant public health problem associated with a broad range of negative outcomes in children and adolescents that can extend into adulthood. This review summarizes information about programs aimed at the prevention of child maltreatment evaluated by controlled trials, with a focus on home visitation programs. It does not include programs aimed at prevention of child sexual abuse, the subject of a separate review in this series. We discuss those programs that include one or more measures of child maltreatment and related outcomes (reports of abuse and neglect, injuries, hospitalizations and emergency room visits). Most programs targeting at-risk families have not shown evidence of effectiveness in preventing abuse or neglect. An important exception is the Nurse Family Partnership (NFP), a program provided by nurses to first-time socially disadvantaged mothers beginning prenatally that has undergone rigorous evaluation in three randomized controlled trials. It has shown consistent effects in reducing reports of maltreatment and associated outcomes as well as additional benefits in maternal and child health in high-risk families. A second exception is the promising Early Start program provided by nurses and social workers to at-risk families beginning postnatally. One randomized controlled trial of the program has shown reduced rates of parental reports of severe abuse and hospital attendance for injuries and poisonings, based on records. The characteristics of the NFP and Early Start programs are discussed with special emphasis on ways in which they differ from other home visitation programs.

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Aims: The objective of this study was to determine the reliability and validity of the eight-item Short Form Health Survey (SF-36) questionnaire translated into Persian for use in Iranian patients with thalassemia major. Materials and Methods: Using a standard "forward-backward" translation procedure, the English language version of the questionnaire was translated into Persian. Two hundred patients with thalassemia major following up at the Thalassemia Center, Dastgheib Hospital, Shiraz, Iran, were enrolled in this study. Statistical Analysis: The reliability and internal consistency of the questionnaire were assessed by Cronbach's alpha coefficient and Spearman's correlation, respectively. Validity was assessed using convergent and discriminant validity. Results: The mean age of 200 subjects enrolled in the study was 19.81+/-4.07 years. Reliability analysis showed satisfactory results (Cronbach's a coefficient = 0.915). The factor analysis showed that all items were in the same groups as previous studies with the exception of role emotional and general health that had been substituted. Most of the patients were in lower range of normal for both mental and physical summary status. Conclusions: The study finding showed that the Persian version of SF-36 questionnaire has a good structural characteristic and is a reliable and valid instrument for measuring the quality of life of patients with thalassemia major.

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Background: Spousal violence has wide-ranging effects on the physical, reproductive, sexual and psychological health of women. There are few longitudinal studies that describe this association in developing countries. Aim: To test the hypothesis that spousal violence is an independent risk factor for a broad range of adverse health outcomes in women. Setting and Design: A population-based cohort study of women living in the catchment area of a primary health center in north Goa. Two thousand four hundred and ninety-four of 3000 randomly selected women were recruited of whom 1750 married women were included for this paper. Materials and Methods: Each participant was assessed at baseline with a structured interview for the assessment of exposure to spousal violence (verbal, physical, sexual) over two time periods (lifetime; recent in the past three months). The interview collected data on gynecological complaints and the Revised Clinical Interview Schedule was used for the diagnosis of depressive disorder. Laboratory tests for anemia and sexually transmitted infections (STI) were carried out. Longitudinal data was collected after six and 12 months on these outcomes. In addition, baseline measures for nutritional status and menstrual health were also obtained. Statistical Analysis: Univariate analyses were carried out on the cross-sectional and longitudinal data to assess the association between each type of spousal violence and each health outcome. Multivariate analyses adjusted for age, literacy, household per capita income. Logistic regression was used for all analyses in Stata (Version 10). Results: Lifetime spousal violence was reported by 290 (16.6%, 95%CI=14.9-18.4) women; recent violence was reported by 230 (13.0%, 95%CI=11.6-14.8). The cross-sectional data showed an association between violence and a range of self-reported gynecological complaints, low Body Mass Index, depressive disorder and attempted suicide. The longitudinal analyses confirmed these associations only for STI and attempted suicide. Conclusion: Spousal violence is specifically associated as an independent risk factor for two adverse women's health outcomes, viz., STI and attempted suicide. Public health and clinical programs targeting these outcomes must specifically address spousal violence.

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India is considered as a preferred site for conducting global clinical trials. Existence of a large treatment-naοve population, availability of English-speaking, skilled doctors, plenty of clinical material, and cost-savings are obvious advantages for carrying out clinical research in India. However, challenges exist at various levels. Lack of formal training in bioethics and research methodology, heavy burden of clinical duties and sub-optimal administrative support restrict investigators. Absence of oversight of functioning of ethics committees (ECs) and lack of mechanisms for ensuring quality of ethics review heighten societal concerns about safety of participants. Conducting research on issues not relevant to local needs and failure to ensure post-trial access further enhance society's cynicism. These issues need to be tackled through capacity building, training of investigators and EC members, strengthening of EC functioning and encouraging greater community participation.

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Nicolau syndrome (NS) is a rare complication of an intramuscular injection characterized by severe pain, skin discoloration, and varying levels of tissue necrosis. The case outcomes vary from atrophic ulcers and severe pain to sepsis and limb amputation. We describe a case of a seven-year-old boy with diagnosis of NS after intramuscular benzathine penicillin injection to the ventrolateral aspect of the left thigh. Characteristic violaceous discoloration of skin and immediate injection site pain identified it as a case of NS. The case was complicated by rapid progression of compartment syndrome of the lower limb, proceeding to acute renal failure and death. Associated compartment syndrome can be postulated as a poor prognostic factor for NS.

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Background: In developing countries, gender-based treatment disparities in cardiovascular preventive therapy have received little attention. Aims: To evaluate the gender-based differences in cardiovascular disease risk profile, drug prescribing pattern, and blood pressure (BP) and glycemic control rates in diabetic hypertensives treated at primary care setting in Bahrain. Settings and Design: A retrospective study at primary care setting. Materials and Methods: An audit of the medical records of 392 diabetic hypertensives (127 men, 265 women). Results: BP and glycemic targets were achieved in <10% and <13% of diabetic hypertensives, respectively. Angiotensin converting enzyme inhibitors monotherapy was more often prescribed in males. Apart from this, no significant differences in prescribing pattern were observed between male and female diabetic hypertensives treated with either antihypertensive mono or multidrug therapies. With the exception of insulin which was more often prescribed to females, a similar prescribing pattern and rank order of antidiabetics, either as monotherapy or combinations, was observed in both genders. The majority of diabetic hypertensives were at high cardiovascular risk. The body mass index and total cholesterol level were greater in females. Prescribing lipid-lowering drugs and aspirin were suboptimal; aspirin was more often prescribed to males. There was no gender-based difference with regard to the use of lipid-lowering drugs. Conclusions: BP and glycemic controls were suboptimal in both male and female diabetic hypertensives treated by primary care physicians. Cardiovascular disease preventive strategies have received little attention regardless of gender or other risk factors. Gender-based treatment inequities also need to be addressed.

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Background: Previous studies have demonstrated a strong association of hypertension and renal disease with gout. Nevertheless, controversy remains concerning serum uric acid concentration as an independent factor of hypertension. Aim: To explore the relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with serum uric acid levels. Settings and Design: An observational study. Materials and Methods: A total of 5,564 subjects from the Armed Forces Research Institute of Medical Sciences were included in the study. Statistical Analysis: ANOVA tests, Chi-square test, correlation coefficients, and multiple regression analysis were performed. Results: Of the total subjects, 4,099 (73.7%) were male. Mean SBP and DBP were 128.73±17.06 and 81.62 ± 11.58 mm Hg, respectively. The mean serum uric acid level was 6.54 ± 1.71 mg/dL. A significant and positive correlation was found both between serum uric acid and SBP (r=0.186, P < 0.001) and between serum uric acid and DBP (r=0.255, P < 0.001). After multiple regression analysis of various clinical variables, serum uric acid levels were correlated with the severity of both SBP and DBP, increased age, increased body mass index, decreased glomerular filtration rate, increased serum cholesterol, and male gender. Conclusions: In this study, we suggest that serum uric acid be used to correlate with levels of blood pressure in the general population. Further investigation is required to establish the treatment for hyperuricemia in hypertensive patients.

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Background: Laparoscopic dismembered pyeloplasty has become the "gold-standard" procedure for pelviureteric junction (PUJ) obstruction but consists of a steep learning curve especially via the retroperitoneal route. Aims: To examine the feasibility and safety of introducing this technique via the retroperitoneal approach to a laparoscopic naοve center. Settings and Design: A retrospective data analysis of a single surgeon's (NEO) series from a large UK teaching hospital. Materials and Methods: The notes and imaging of all patients who underwent pyeloplasty for PUJ obstruction by NEO during a five-year period were reviewed. Statistical Analysis: Parametric and nonparametric data are presented analyzed with Excel XP (Microsoft, Redmond, WA, USA). Results: Our series consists of 67 patients. Three ports were used in 47/57 (82%), and the antegrade technique for stent insertion was utilized in 41/67 (61%). Median time to drink, eat, and mobilize was one day (range one to two), and to discharge three days (range three to four). Two patients required conversion to an open procedure, and two developed intraoperative complications. Postoperative complications at 30 (three major, seven minor) and 90 days (three major, three minor) are presented. With median follow-up of 15 months 61/65 (94%) patients were unobstructed, and 57/63 (90%) of patients were pain-free. Two patients re-obstructed requiring further surgery. Conclusions: Analysis of our series of patients illustrates that adopting a policy of retroperitoneal laparoscopic pyeloplasty for primary PUJ obstruction is feasible without compromising patient safety or functional results. There is no need to breach the peritoneum to facilitate the learning curve.

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Background and Aims: Every year between 1.5 and 4 million women are abused by a partner in the United States and many abused women turn to the Emergency Department (ED) as their first source of care. Even though the vast majority of patients would feel comfortable disclosing intimate partner violence (IPV) to their physician, identification and referral is inconsistent . Aims: The aim of this paper was to discuss prevalence statistics of IPV, current screening recommendations and practices in ED settings, and future directions to improve the screening and identifying of victims of IPV that present to the ED. Material and Methods: The authors conducted a Medline search for articles discussing IPV screening in the ED. Results: Intimate partner violence results in approximately 1,300 deaths and 2,000,000 injuries annually among women and up to a third of ED patients have a history of IPV. Despite patients' reported willingness to disclose this information, identification of IPV by healthcare practitioners remains very low, with some estimates ranging between 4-10%. Conclusions: If we do not identify victims of IPV in the ED, this may result in continuation of the abuse, routine returns to the ED for treatment of injuries, and possibly even death.

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Background and Aims: Dysarthria affects linguistic domains such as respiration, phonation, articulation, resonance and prosody due to upper motor neuron, lower motor neuron, cerebellar or extrapyramidal tract lesions. Although Bengali is one of the major languages globally, dysarthric Bengali speech has not been subjected to neurolinguistic analysis. We attempted such an analysis with the goal of identifying the speech defects in native Bengali speakers in various types of dysarthria encountered in neurological disorders. Settings and Design: A cross-sectional observational study was conducted with 66 dysarthric subjects, predominantly middle-aged males, attending the Neuromedicine OPD of a tertiary care teaching hospital in Kolkata. Materials and Methods: After neurological examination, an instrument comprising commonly used Bengali words and a text block covering all Bengali vowels and consonants were used to carry out perceptual analysis of dysarthric speech. From recorded speech, 24 parameters pertaining to five linguistic domains were assessed. The Kruskal-Wallis analysis of variance, Chi-square test and Fisher's exact test were used for analysis. Results: The dysarthria types were spastic (15 subjects), flaccid (10), mixed (12), hypokinetic (12), hyperkinetic (9) and ataxic (8). Of the 24 parameters assessed, 15 were found to occur in one or more types with a prevalence of at least 25%. Imprecise consonant was the most frequently occurring defect in most dysarthrias. The spectrum of defects in each type was identified. Some parameters were capable of distinguishing between types. Conclusions: This perceptual analysis has defined linguistic defects likely to be encountered in dysarthric Bengali speech in neurological disorders. The speech distortion can be described and distinguished by a limited number of parameters. This may be of importance to the speech therapist and neurologist in planning rehabilitation and further management.

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Echinococcal cysts usually involve the liver; extrahepatic localization is reported in 11% of all cases of abdominal hydatid disease. We report a case of a prevesical hydatid cyst. A 53-year-old man was admitted with a large suprapubic mass. Ultrasonography and computed tomography revealed a cystic mass situated in front of the urinary bladder. There were no cysts in any other location. Serological tests were positive for Echinococcus. The patient was operated on and the cyst was completely excised. The pathologic examination confirmed the diagnosis of Echinococcosis. Isolated hydatid cyst situated in front of the urinary bladder has never been described in the literature. Hydatid cyst should always be considered in the differential diagnosis of abdominopelvic masses in endemic regions, before any procedure like puncture, biopsy or cystectomy, in order to avoid dissemination of the cystic contents or an anaphylactic shock.

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