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Biomedical subjects

R Mahendran

Publications and source records attributed to R Mahendran.

At least 19 recordsLinked to original sources
PubMed2006

Co-sleeping and clinical correlates in children seen at a child guidance clinic.

INTRODUCTION: Co-sleeping or bed-sharing is a common practice that has been little researched. While often viewed as being "cultural" in nature, there is a suggestion that it may be a parental response to sleep problems. Some studies link co-sleeping with behavioural and temperamental difficulties. The objectives of the current study were to determine the prevalence of co-sleeping and how they relate to sleeping problems among a cohort of children and adolescents seen in a child guidance clinic. METHODS: Parents or guardians of all new patients seen at the child guidance clinic were asked to complete a questionnaire upon their consent to participate in the study. The questionnaire included socio-demographical data and frequency of sleep problems in the past six months. A list of nine common sleep problems was included. RESULTS: The prevalence of co-sleeping was found to be 72.7 percent. The children who co-sleep were significantly younger and there was a decrease in the practice with increasing age. Sleep starts and nightmares were significantly more among those sleeping alone. CONCLUSION: Co-sleeping was not associated with significant sleep problems in our cohort. Co-sleeping may have been initiated in response to an existing sleep problem but eventually resolved the problem. If co-sleeping is not permitted, the sleep problem could be compounded, giving rise to a higher prevalence of sleep starts and nightmares among those in our cohort who slept alone.

Adolescent↗
PubMed2005

An evaluation of the role of a store-and-forward teledermatology system in skin cancer diagnosis and management.

There is currently much interest in the potential role of telemedicine in improving the delivery of dermatological care in the UK. The two teledermatology systems available at present are divided into live video and store-and-forward technology. We investigated the value of a store-and-forward teledermatology system in the diagnosis and management of lesions suspicious of skin cancer. A total of 163 store-and-forward referrals of patients with one lesion each were assessed independently by a Consultant and a third-year trainee dermatologist. The accuracy of diagnosis and appropriateness of management from these assessments was compared to a subsequent face-to-face consultation with the Consultant. Analysis of the Consultants' diagnoses showed that 48% were identical for teledermatology and conventional face-to-face consultations. A further 17% of teledermatology diagnoses included the actual clinical diagnosis as a possibility but 20% were either incorrect or a diagnosis could not be made. In the remaining 15% of cases the digital image was of insufficient quality for assessment. Of the trainee's reports, 44% were identical to the clinical diagnoses and another 20% included the clinical diagnosis as a possibility. The management plan was appropriate in 55% of the total teledermatology referrals assessed by the Consultants and in 52% assessed by the trainee when compared with the conventional consultation. This study illustrates that the store-and forward type telemedicine system has limited diagnostic accuracy for skin lesions. However, our results suggest that store-and-forward teledermatology may be suitable and safe for screening out clearly benign lesions but the study casts doubt on its efficiency.

Clinical Competence↗
PubMed2005

Clinical practice guidelines for depression.

The Ministry of Health Clinical Practice Guidelines for Depression were prepared and distributed to all doctors in Singapore in early 2004. This article highlights salient points and discusses pharmacotherapy, psychotherapy and psychoeducation in managing cases of depression. Assessment of suicide risk is elaborated upon, although this was not discussed in the guidelines. The learning points will be enhanced if this article is reviewed together with the Ministry of Health Clinical Practice Guidelines.

Antidepressive Agents↗
PubMed2004

Survey of the practices of laser users in the UK in the treatment of port wine stains.

BACKGROUND: Laser treatment for the management of port wine stains (PWS) is well established but there are some variations in practices amongst clinicians in the UK. OBJECTIVES: To identify areas of consensus and highlight issues where sufficient variation existed to warrant further debate or clinical research using a postal questionnaire survey of clinicians carrying out laser treatments for PWS in the UK. METHODS: A 29-item questionnaire was constructed regarding the laser treatment of PWS and was sent to 55 members of the British Skin Laser Study Group in 2000. The questions related to the usual clinical practice of the respondents and facilities available. RESULTS: Completed questionnaires were returned from 45 clinicians (28 dermatologists, 14 plastic surgeons, two maxillofacial surgeons and one ENT surgeon) at 36 laser centres. The following areas of consensus were identified. The majority of centres used a pulsed dye laser (PDL) for the treatment of PWS, either alone or in conjunction with a KTP laser, and medical personnel assessed and treated patients. Written information and consent was obtained in 89% of centres before starting treatment. Test areas were usually performed before embarking on a full treatment by 98% of the clinicians. The majority of respondents (84%) considered 2-3 months as the optimum interval between treatments. All the clinicians were prepared to treat patients with skin types I-IV, but skin type VI was often not treated. The vast majority of laser users treated most PWS affecting the face, neck and upper limb. The majority of clinicians used local or topical anaesthesia frequently or sometimes in the treatment of PWS and 81% of the respondents used general anaesthesia, especially when treating children. When using the PDL, 91% of respondents selected an initial fluence based on experience and/or the appearance of the skin immediately after the laser pulse. Postoperatively, most clinicians advised patients to avoid the sun, avoid injury and use an emollient. Areas of variation in practice included some centres using non-medical in conjunction with medical staff to review and treat patients. The earliest age at which the clinician thought it appropriate to treat PWS varied from newborn to 8 years old; 25% of the clinicians who treat children would treat from the age of 2-3 months old and 34% would only treat patients over 1 year old. There was considerable variation in the initial fluence selected. The usual number of treatments given to each area of the PWS varied from 3 to 16. CONCLUSIONS: This survey has demonstrated a number of areas where there appears to be a consensus of opinion about laser treatment of PWS. However, issues where there are significant variations in practice have also been identified and require further evaluation to help direct further clinical research.

Child↗
PubMed2004

Psychiatric comorbidity in first episode psychosis: the Early Psychosis Intervention Program (EPIP) experience.

OBJECTIVE: To determine the prevalence rates of psychiatric comorbidity in a hospitalized Asian patient group with first episode psychosis and examine its clinical correlates. METHOD: Seventy-nine consecutively admitted patients with first episode psychosis were assessed using the Structured Clinical Interview for DSM-IV-axis I disorders (patient edition), Positive and Negative Symptom Scale (PANSS), Scale to assess Unawareness of Mental Disorders (SUMD) and Global Assessment of Functioning (GAF) scales. RESULTS: Psychiatric comorbidity was present in 36.7% (n = 29) of the patients. Patients with psychiatric comorbidity were younger (P < 0.05), had an earlier onset of illness (P < 0.05) and better insight on social consequences and flat affect items (P < 0.05) on the SUMD. No significant differences were found between the two groups with and without psychiatric comorbidity in gender, ethnicity, marital status, length of education, employment status, living arrangements, duration of hospitalization and untreated psychosis as well as total PANSS and GAF scores. CONCLUSION: Psychiatric comorbidity is common thus calling for a greater awareness in clinicians of these conditions, which are often under-recognized, under-diagnosed and untreated.

Adult↗
PubMed2004

Interleukin-2 levels in chronic schizophrenia patients.

INTRODUCTION: Most research in interleukin activity in schizophrenia has been in Caucasian populations. We examined interleukin-2 (IL-2) levels and their relation to the duration of the illness, psychopathology and treatment effects, in chronic schizophrenia patients of Asian origin. MATERIALS AND METHODS: Thirty chronic schizophrenia patients were recruited for the study and their demographic data and medication dosage were noted. Symptom severity was scored on the Positive And Negative Syndrome scale for Schizophrenia (PANSS) and blood sampling done. Ten healthy Chinese males were recruited as controls. Phytohaemagglutinin-stimulated production of serum levels of IL-2 were measured by enzyme-linked immunosorbent assay. RESULTS: IL-2 levels (1327 +/- 596.2) of all 30 patients were significantly lower than that of the Chinese controls (2420 +/- 342.5). This effect was noted throughout the entire duration of the illness. Ethnic and age differences in IL-2 levels were not found. There was, however, a negative correlation with the duration of the illness and a positive correlation with the dosage of medication. CONCLUSIONS: The results of this study of a population of mostly Chinese patients with schizophrenia replicate an important finding. Data such as this has not been reported previously on Asians of this racial group.

Adult↗
PubMed2004

Medical students' behaviour, attitudes and knowledge of sleep medicine.

INTRODUCTION: A seminar on sleep disorders was recently introduced for third, fourth and final year medical students rotating through the psychiatry posting in the Institute of Mental Health. This survey was conducted to assess the attitudes as well as knowledge of medical students towards sleep medicine. METHODS: Verbal consent was taken from the students who were willing to take part in the survey. The MED Sleep Survey, which is an inventory to assess behavior, attitudes and knowledge about sleep, was used to assess the same in the students. RESULTS: A total of 240 medical students completed the survey. There were 149 male and 91 female medical students. In terms of their basic sleep knowledge, 46.7 percent scored between 1 and 10 points, 51.7 percent scored between 11 and 20 points, and 1.7 percent scored between 21 and 30 points. There was no significant difference between the different groups in their scores on basic sleep knowledge. CONCLUSION: Most of the medical students scored between 1 and 20 points on basic sleep knowledge items in part III of the survey. Of these, almost one-half had scores between 1 and 10 points. Education is clearly important, and the introduction of the teaching programme on sleep medicine is timely and necessary.

Adult↗
PubMed2002

Risperidone and megacolon.

Risperidone is an atypical anti-psychotic medication with both 5HT2 receptor and D2 dopamine receptor antagonism. Its use has been reported to be generally safe with very few gastro-intestinal (GI) adverse or side effects. In this paper, we describe a case of megacolon associated with the use of risperidone. A 44-year-old man suffering from schizophrenia was treated with risperidone and developed gross abdominal distension after twenty-five days. Abdominal X-ray and colonoscopy showed megacolon. He improved following a surgical decompression and a reduction of risperidone dosage. We discuss the neuro-electro-physiological mechanisms of gastro-intestinal motility and conclude that the risperidone-associated megacolon may be dose-related and that there should be a heightened awareness of such possible GI complication when using risperidone.

Adult↗
PubMed2001

Susceptibility to neuroleptic-induced tardive dyskinesia and the T102C polymorphism in the serotonin type 2A receptor.

BACKGROUND: Genetic factors have been implicated in the pathophysiology of the movement disorder tardive dyskinesia, which may involve dopamine-serotonin interaction. Case-control association studies have identified the T102C polymorphism of the 5-HT2A receptor gene as being associated with schizophrenia and responsiveness to clozapine. In this study, we examine the association of this polymorphism in the 5-HT2A receptor gene as a risk factor for developing schizophrenia and tardive dyskinesia from prolonged treatment with neuroleptics. METHODS: Ninety-seven healthy control subjects with no history of mental illness and 221 schizophrenic patients (87 with tardive dyskinesia, 134 without) were genotyped by PCR-RFLP. RESULTS: Comparison between cases and control subjects revealed no significant association between the C allele and schizophrenia. There was significant difference in allele frequency (p = .044, OR = 1.54 95% CI = 1.02-2.33) between patients who developed tardive dyskinesia and those who did not. Significant difference remains even after adjusting for age and neuroleptic dosage (p = .041) with the odds ratio at 1.64 (95% CI = 1.02-2.62). CONCLUSIONS: A genetic variant of the 5-HT2A receptor may be associated with neuroleptic-induced tardive dyskinesia in schizophrenia. Further studies are needed to replicate the finding. The role of 5-HT2A receptor in the etiology of tardive dyskinesia or treatment-resistant schizophrenia should be further investigated.

Antipsychotic Agents↗
PubMed2001

Transfection of urothelial cells using methyl-beta-cyclodextrin solubilized cholesterol and Dotap.

the murine urothelial cell line, mb49 was transfected with the reporter gene pcmvlacz using a number of commercial transfection agents. the transfection efficiency of these agents, as determined by beta-galactosidase activity, is in the order of dotap>superfect>Fugene. The addition of methyl-beta-cyclodextrin solubilized cholesterol (MBC) to Dotap and Superfect further improved their transfection efficiency by 3.8-fold and 2.6-fold, respectively. beta-Galactosidase activity was detectable within 1 h of transfection and peaked at 48 h. Nuclear and cytoplasmic separation showed that with Dotap + methyl-beta-cyclodextrin solubilized cholesterol (DMBC), the DNA plasmid complex was found in both the nucleus and the cytoplasm. In vivo, murine bladders were transfected with an intravesical instillation of DMBC + DNA for 2 h. Two days later the bladder, lungs, liver, spleen and heart were assayed for the presence of the beta-galactosidase gene by staining and PCR. Expression of the gene was confined to the bladder. Both in vitro and in vivo expression was observed after as little as a 15 min exposure to DMBC:DNA. Expression of the marker gene was present up to 30 days after transfection in vivo. From our data it appears that DMBC is the best nonviral agent for the transfection of urothelial cells in vitro and in vivo.

Animals↗
PubMed2001

Mental health literacy survey of psychiatrically and generally trained nurses employed in a Singapore psychiatric hospital.

Mental health literacy studies consider the capacity of respondents to recognize certain psychiatric disorders, judge the comparative utility of a range of interventions, and make estimates about outcome and prognostic issues. We report such a study involving a sample of nursing staff employed at a large psychiatric institution in Singapore, and who were provided with separate brief vignettes of mania, schizophrenia and depression. Subjects were highly accurate in 'diagnosing' schizophrenia, less accurate for depression and even less accurate in diagnosing mania. Depression was alternately diagnosed as stress, mania was most commonly misdiagnosed as schizophrenia, and for both psychotic conditions, a percentage returned non-psychotic diagnoses. In terms of treatment options, staff distinctly favoured a 'medical model' and viewed traditional and alternative healing options as distinctly harmful. Analyses contrasted psychiatrically trained and generally trained nurses, but identified few significant differences. Such information has the potential to shape the education and training of mental health professional staff, as well as provide important insights about how nurses may diagnose, view and favour alternative treatments and strategies to assist those with common psychiatric disorders.

Data Collection↗
PubMed2001

Awareness of tardive dyskinesia in Asian patients with schizophrenia.

While ethnocultural differences in risk of tardive dyskinesia (TD) have been suggested, no previous studies have examined whether this factor also plays a role in lack of awareness of TD. This study examined this question in an Asian population with schizophrenia. Six hundred seven patients in a state mental hospital in Singapore were assessed using the Abnormal Involuntary Movement Scale (AIMS) and the Simpson-Angus Rating Scale. Of the 607 patients, 242 (39.9%) met criteria for TD, and 163 (67.4%) patients were not aware of the presence of TD. No significant differences in terms of age, gender, and duration of illness were found between those aware of their TD and those not aware. Daily neuroleptic doses and scores for the AIMS and Simpson-Angus Rating Scale were significantly different, although after logistic regression, only the Simpson-Angus Rating Scale scores remained significant. The finding that a large proportion of our patients lacked awareness of their TD is consistent with other reports in the West and provides evidence that this feature is characteristic of the illness rather than of a specific ethnocultural group. We found an association between lack of awareness and greater severity of extrapyramidal symptoms (EPS), suggesting that there may be a subtype of TD in which lack of awareness and greater vulnerability of developing EPS are features.

Adult↗