Patients who present with subjective memory complaints and are over the age of 61 years are at high risk of cognitive decline and warrant an in-depth assessment and follow-up.

The most common offending allergen in our study was the dust mite. Identification of specific allergens for a particular geographical area aids patient education and enables allergen-specific immunotherapy.

BackgroundSericulture plays an eminent role in development of rural economy in India. Silk filature is a unit where silk is unwound from the cocoons and the strands are collected into skeins. During the process workers are exposed to the high molecular weight proteins like Sericin and Fibroin which are potent allergens leading to sensitization over a period of time and subsequently occupational related health disorders.ObjectiveTo identify and compare the magnitude of silk allergen sensitization in workers of silk filatures.MethodsA community based comparative descriptive study was conducted for a period of 1 year at Ramanagara in south India. One hundred twenty subjects working in the silk filatures formed the study group. For comparison, 2 types of controls were selected viz.120 subjects who were not working in the silk filatures but resided in the same geographical area (control A) and 360 subjects who were not working in silk filatures as well not residing in the same geographical area (control B). Skin prick test was used to identify the silk allergen sensitization.ResultsMean age was 34.14 ± 2.84 years in the study group. Mean age was 40.59 ± 14.40 years and 38.54 ± 12.20 years in control A and control B, respectively. There were 35 males (29.16%) and 85 females (70.84%) in the study group. There were 58 (48.34%) males and 62 (51.66%) females and 152 (42.2%) males and 208 females (57.8%) in control A and control B, respectively. Sensitization to silk allergen was 35.83% in the study group and 20.83% in the control group A and 11.11% in control group B. There was difference in the allergen sensitivity between the study group and control groups and it was statistically significant (chi-square = 38.08; p < 0.001).ConclusionThere is high burden of silk allergen sensitization among silk filature workers.

Aims and methodTo investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013.ResultsThirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers.Clinical implicationsApproximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking after transfer. Monitoring of clozapine serum levels and assessment of mental state in the immediate period after a change in smoking status is indicated.