The right nostril was partially occluded with dried crusty material cheap xeloda 500mg overnight delivery, and the area around the nostril was hyperemic; the left nostril shown in this view is relatively normal discount xeloda 500mg online. Once the margins of the mass are clearly identified order xeloda 500 mg with amex, a slightly thicker metal spatula may be used to finish the dissection. Fragments may fall caudally into the nasal cavity and must be flushed from their resting place behind the turbinates. Once the rhinolith is removed, the lining of the nasal cavity should be swabbed and evaluated cytologically and by culture for mycotic and bacterial pathogens. The nares should be flushed with dilute chlor- hexidine, and any fungal or bacterial component should be treated systemically with appropriate an- timicrobial medications. Infraorbital Sinusitis Infraorbital sinusitis in birds may lead to secondary lacrimal and conjunctival infections, chronic rhinor- rhea and other upper respiratory problems. Fre- quently, nutritional problems such as hypovitami- nosis A predispose a bird to secondary infections with bacteria, yeast and fungi. A sinus flush technique can be used to obtain samples for cytology and cultures (see Chapters 10 and 22). If untreated, mild infraorbital sinusitis may progress to abscessation that requires surgical exploration and curettage (see Color 22). Clinical signs may in- clude sneezing, rhinorrhea, swollen eye, other ocular diseases, periorbital swelling and conjunctivitis. In some cases, purulent material can be visualized be- low the conjunctiva of the eyelid or the globe itself (Figure 41. The infraorbital sinus is initially opened in the same location described for sinus flushing (see Chapter 10). This area is highly vascular, and laser, if avail- able, is best for providing hemostasis. Bipolar radio- surgical units on higher coagulation settings may also be effective. Pressure may be applied to the area with a cotton-tipped applicator to allow visualization of the vessels. Its major disadvan- sinus that cannot be accessed using nasal flushes and tage is the risk of ocular injury. This pro- cedure is repeated so that each of the four sutures To create an opening in the supraorbital sinus, the passes through the skin, one hole of the stent, dou- skin is incised exposing the frontal bone. Holes are bles back, passes through the other hole of the stent made in the bone with a sterile rotary toolf about and exits the skin. The four sutures should be placed one-half to two-fifths the distance between the ros- one on each of the four sides of the incision. Cortical bone is removed problem is a transient occlusion of the stent with until the cancellous bone above the supraorbital si- dried tissue fluids, which is easily resolved using a nus is visualized. Samples for cytology and culture are This syndrome has also been treated in an Amazon obtained, and the sinus is flushed with irrigation parrot using a one-way valve connecting the cervico- solution. The passage of irrigation solution through cephalic air sac to the clavicular air sac. The ap- the choana and into the oral cavity confirms that the proach is through the left lateral thoracic inlet, and hole is properly placed. It bulge when fluids are introduced, and these tissues is then directed caudally along the esophagus, should not be over-distended. If indicated, this proce- through the thoracic inlet and into the cranial aspect dure may be performed bilaterally in some Passeri- of the clavicular air sac. The tube is sutured to the formes, whereas a single trephination site is suffi- longus coli muscles to prevent migration. No attempt cient in Psittaciformes in which the infraorbital is made to suture the air sac around the tube. The trephination sites may be irrigated as often as Thoracic Surgery indicated with appropriate antimicrobial solutions. The incisions heal rapidly and may need to be opened Tracheal/Syringeal Obstruction periodically. When therapy is no longer indicated, the 9,19 Seed or other foreign body aspiration, fungal trephination sites heal with minimal scarring. Some birds present with no premoni- This condition is thought to occur secondary to trauma, tory signs, while others have a history of voice change but the location of leakage of air into the subcutaneous and a more gradual onset of dyspnea. Generalized subcu- taneous emphysema usually occurs in small birds, Therapy depends upon the size of the patient and the while in larger species the emphysema is generally configuration of the trachea. A birds such as swans and cranes is coiled and encased procedure for surgically implanting a cutaneous stent within the sternum, making retrieval of distal tra- at the poll of the head to allow the air to escape (in a cheal foreign bodies extremely difficult (see Figure location where the bird cannot remove the device) has 12. In a that allows the skin to be placed under its edge to Sarus Crane, a 22 ga spinal needle was passed trans- prevent the dermis from closing over the opening, is versely through the trachea to prevent a kernel of used for the procedure. Sutures are pre-placed through generally cartilaginous, although calcified rings have the four pairs of holes in the flange of the stent such been reported in adult Amazon parrots and adult that the suture enters one hole from the external 19 40 cranes. Once all four sutures are cartilage) may be present, providing an additional placed, the stent is implanted. Place- moval of tracheal or syringeal foreign bodies (Figure ment of an air sac cannula will allow the patient to 41. The patient is positioned in dorsal recumbency ventilate through an alternate airway until the ob- on a surgical restraint board. It may be beneficial to in the esophagus to allow for its easy identification to place the bird in an oxygen-enriched environment prevent iatrogenic trauma. The skin is incised from prior to manipulating the patient for placement of the right clavicular/sternal junction to the clavicu- the air sac cannula. The skin is elevated from the crop, and the right lateral aspect In small birds (cockatiels and smaller), the tracheal of the crop is gently dissected from surrounding tis- diameter (approximately 1. Major blood vessels are easily avoided using cludes use of an endoscope to retrieve a foreign body blunt dissection. If the obstruction is the result of a vicular attachments, it should be reflected to the granuloma or inspissated cells and mucus, a suction right. The trachea is identified by its complete carti- tube (urinary catheter) slightly smaller than the di- lage rings. The sternotracheal muscles are identified ameter of the trachea may be utilized to remove traversing obliquely to their caudolateral attach- material from the trachea and syrinx (see Chapter ments, and both sets of sternotracheal muscles are 22). A large blood vessel between the muscle cannula, the trachea may be occluded with the suc- bellies should be coagulated prior to transection of tion tube without compromising respiration. A small canine vaginal speculum may squamous metaplasia secondary to hypovitaminosis aid in visualization. A is suspected, dietary modification and vitamin A supplementation should be instituted. The restraint board should be elevated In medium to large birds, a rigid or flexible endoscope at the cranial end such that the operating microscope can be used to evaluate the cause of an obstruction can be used to visualize the structures deep in the and potentially aid in its removal. It may take some time and patience to endoscope may allow visualization of the object, but achieve proper positioning and focus, but this tech- the tracheal diameter may be too small to use a wire nique allows the surgeon to visualize critical structures basket or grasping forceps to remove the object. In Amazon samples obtained from the suction tube, or the end of parrots, small macaws and smaller birds, this proce- the endoscope, may be used to determine the identity dure may result in avulsion of the bronchi from the of an etiologic agent. For these patients, a left lateral approach to the patient should be treated using nebulization, intra- syrinx is recommended as a last desperate attempt.
In present study purchase 500 mg xeloda, plant samples were collected from Thar Du Kan generic xeloda 500 mg otc, Shwe Pyi Thar Township buy xeloda now, Yangon Division. Its habits, morphological characters were documented in this thesis for the plant authenticity purpose. Physicochemical and phytochemical studies were also conducted by using appropriate references and methods. Tests for the absence of pesticide residues, heavy metals, aflatoxins were performed. Dried rhizome powder was tested with the various doses of 2, 4 and 8g/kg for acute toxicity study. In sub-chronic toxicity study, there were no significant differences in the average organ weights of brain, lungs, heart, small intestine, colon, stomach, liver, spleen and kidney of between the rats treated with the dried rhizome powder of P. There were no significant differences in haematological parameters between the rats treated with 1g/kg of dried rhizome powdwe of this plant and control group. But, higher dose 2g/kg of rats total serum bilirubin showed slightly higher than normal range. A study on anthelimintic properties of Holarrhena antidysenterica (Let-htoke-kyi). Helminthiasis especially ascariasis is common in Myanmar and its impact on health and economic status of the country is considerable. Although a lot of anthelmintics are available, some more addition from the indigenous source is highly desirable. It will be highly more so, if the indigenous drugs are proved to be safe and more effective than the currently used anthelmintics. The anticholinesterase activity of alcoholic extract of Let-htoke-kyi was found to be 802u/gm. The attempt to elucidate its mechanism of action on the ascaris was carried out by camparing with other known anthelmintic drugs such as piperazine, pyrantel and levamisole. The toxicity study using the oral route was limited because the dose used cannot go larger than 15. Study on chemical constituents and bioactivity of the tubers of Asparagus racemosus Willd. The tubers of this plant have many activies such as diuretic, antidysentery antibacterial, antioxidant and antidiarrheal activities. The tubers of this plant are used in traditional medicine for cough, gastric ulcers, and blood diseases and for general tonic in local regions. It has has not yet been scientifically sutidied of its anti-diarrheal activity in Myanmar. In the examination of nutritional values, carbohydrate was found to be high content in the sample. Before the investigation of anti-diarrhea activity, antimicrobial activity was formally done in order to make sure that the sample may have positive effect on microorganisms, especially diarrhea causing microorganisms. Acute toxicity test was done before investigating anti-diarrhea activity because the extracts were taken orally for this activity. The acute toxicity effect of 70% ethanol and the aqueous extract of the tubers of Asparagus racemous Willd. In vivo anti-diarrhea effect of the aqueous extract was studied on castor oil- induced diarrhea mice model. The investigation was conducted by castor oil-induced diarrhea test, castor oil-induced enterpooling test and castor oil-induced intestinal transit test. From the results, it can be inferred that the tubers of Asparagus racemosus Willd. Myat Myat Ohn Khin; Aye Than; Thidar Swe; Mu Mu Sein Myint; Myint Oo; Cho Cho Yee. There is a very long history of health care system using herbal medicine in Myanmar. In the past decades, the knowledge of herbal drugs is directly utilized by Myanmar people. The authors chose the plant seed kernel to investigate whether the seed kernel of the plant possess hypoglycemic activity. The percentage inhibition of blood glucose levels were 38% in adrenalin-induced method and 25% in the glucose-loaded method respectively. It had transient lowering activity on blood glucose level in two induced diabetic rabbit models. Investigations were carried out to determine whether the extract of Tinospora cordifolia possesses oral hypoglycemic activity. The ability of alcoholic extract of Tinospora cordifolia to lower the fasting blood glucose level was investigated using albino rats as experimental diabetes models. The results indicate that the extract of Tinospora cordifolia capable of significantly lowering the fasting blood glucose level. Central nervou system depression and cardiomyotoxic effects were observed in acute toxicity study with lethal dosage. The site of action was on the beta cells of the pancreas and mechanism of action could be stimulation of endogenous insulin secretion. Thaw Zin; Nwe Nwe Win; Thein Han Oo; Hlaing Aung; Soe Moe; Soe Soe Yin; Khin Aye Than; Tin Mi Mi Naing; Cho Cho Yee; Aung Naing; Maung Maung Wint. Although Myanmar has a well-developed allopathic health care system with highly trained medical professionals, many rural areas still remained underserved by the existing health care facilities and pharmaceuticals are in short supply. With the aim to compare the availability, accessibility care facilities among urban and rural areas, a health systems research was conducted in 5 areas of Taikkyi Township, defined according to the accessibility of different health care facilities. Community based knowledge; attitude and practice study was also conducted on randomly selected 1215 respondents and 20 traditional medicine practitioners so as to identify the factors that influence the pattern of decision-making by patients in choosing different healing practices. Results indicated that despite the extremely low availability and accessibility of traditional medicine health centre and practitioner, majority of the population still prefer and use traditional medicine above others. In addition, local traditional medicine practitioners and herbal remedies were found to play a much more important role than government provided traditional medicine dispensaries and traditional medicine formulations. The morphology and taxonomy of their vegetative and reproductive parts have been studied and identified by using the standard methods used in Botany Department of Yangon University. These plant materials were washed and dried at room temperature for 3 days and then crushed and powdered by using grinding mill. They were also extracted by using pet-ether (60-80) ºC and 95% ethanol successively. These pet-ether extracts were studied for the presence of total steroids and then the estradiol present in the pet-ether extracts of Butea frondosa Roxb. The remaining 95% ethanolic extracts were further studied for the presence of total alkaloids. The presence of flavonoids in all the plant species were conducted by using the aqueous extracts of the powder. The diosgenin have been extracted from the five species of Asparagus racemosus Willd. The alkaloid trigonelline was also isolated from the powder of Trigonella foenum-graeum Linn. The isolated estradiol and diosgenin were tested with animal model to find out the rejuvenating effect of uterus activity.
Uterine Prolapse Uterine prolapse containing an egg is common cheap xeloda 500mg with visa, par- ticularly in budgerigars xeloda 500 mg visa. A firm mass was palpable in the result from constant straining coupled with muscle caudal abdomen and an egg could be visualized through the weakness due to nutritional deficiencies or physical urodeum using a small otoscope cone xeloda 500 mg overnight delivery. One hour later, the bird was re-evaluated and had The bird is anesthetized with isoflurane to allow not improved. The egg was gently pinched into the cloaca, the egg careful examination of the prolapsed tissue. The bird had returned to normal and was eating bacteriocidal antibiotic are administered. The ureters, rectum and If the egg has not passed in 24 hours, or if the bird cloaca will sometimes prolapse with the uterus. The appears to be weakening, two nonsurgical techniques prolapsed tissue should be flushed with sterile saline can be considered. The first works best if the egg is and replaced with a lubricated blunt probang, sterile low in the abdomen. With the bird under isoflurane swab or other sterile, blunt instrument (see Color anesthesia to achieve full relaxation, the egg may be 29). Fluid drain- the open end of the prolapse should be identified and age can be attempted from several sites, choosing the egg contents aspirated with a needle to gently avascular areas of skin. More than to the fine, transparent uterine tissue, which should one abdominocentesis may be necessary. A erinarians prefer to place a Penrose drain to allow a moist, sterile swab will help gently peel the uterine continuous port for fluid removal. Increased ossification in the long The prognosis for recovery depends on the extent of bones suggests that calcium is being stored for im- tissue trauma. Parenteral fluids, a broad-spec- respond well to therapy even if the replaced uterine trum antibiotic and an anti-inflammatory dose of tissue appears severely desiccated or inflamed. The necrotic areas are sutured with conjunction with antibiotics appears to be beneficial 4-0 or 5-0 absorbable suture material, being careful in birds with egg-related peritonitis. After the bird is stable, a and abdominal lavage may be necessary in birds with hysterectomy may be necessary to prevent future severe or non-responsive egg-related peritonitis (see egg-related problems. Egg-related Peritonitis Renal Failure Egg-related peritonitis is thought to occur because of Renal failure is uncommonly diagnosed in avian a failure of the ovum to enter the infundibulum. Possible causes include peritonitis that occurs is usually sterile, but may be some toxicities, ureteral obstruction and trauma complicated by secondary bacterial infection. The (such as occurs with egg binding) and bacterial, viral, condition is seen most commonly in cockatiels, love- fungal or parasitic infections. Clinical signs include polyuria, polydipsia, inappe- The history usually includes a gradual onset of leth- tence, depression and dehydration. Uric acid deposits argy, weakness, inappetence, tachypnea and dysp- may be visible on joint surfaces. Uric acid deposits are radiolucent but clinical presentation of egg-related peritonitis varies renal mineralization will be visible on radiographs. Emergency treatment consists of subcutaneous or intravenous fluids, antibiotics and a multi vitamin On physical examination, the bird is found to have a injection. If the bird is dysp- pervitaminosis is suspected (eg, vitamin D toxicosis neic, it should be placed in an oxygen-rich environ- in macaws). Abdomino- centesis is performed with a 23 or 25 ga butterfly Respiratory System catheter or an appropriately sized needle and syringe (see Chapter 10). Only a sufficient volume of fluid to Dyspnea relieve the dyspnea should be removed. The needle is Dyspnea in birds is characterized by open-mouthed passed into the abdomen just below the end of the breathing, prominent abdominal excursions and tail- keel. A 23 to 25 ga butterfly catheter or fine- ease occurs in the trachea, lungs or air sacs and may gauge needle and syringe are used to aspirate from be caused by viral, bacterial, fungal, parasitic, several sites through areas of avascular skin. Extra-respiratory dis- A tracheal wash should be performed just before the eases can cause dyspnea by interfering with normal bird recovers from anesthesia. A sterile catheter or air flow patterns through the respiratory tree or by tube is passed into the tracheal opening. This bird held parallel to the floor, sterile saline (up to category includes thyroid enlargement, abdominal 10ml/kg) is infused into the trachea and immediately masses, abdominal fluid and oral masses such as aspirated. Birds with severe rhinitis, impacted can be used to evaluate the aspirated material. Anemia may also tered according to the patient’s ability to withstand induce dyspnea (see Chapter 22). Specific therapy is given according to the A thorough history should include questions regard- differential diagnosis (see Chapter 22). Before a dyspneic bird is usually due to one of three causes: 1) inhalation of is handled, it should be carefully observed for con- a toxin, 2) plugging of the trachea by dislocation of an junctivitis, swollen sinuses, nasal discharge and res- infectious plaque from the choana or tracheal bifur- piratory sounds. Budgerigars with goiter may have a cation or 3) inhalation of a foreign body such as seed high-pitched voice or a squeak with each respiration. Inhalation of small seeds by These birds are also prone to crop-emptying prob- cockatiels is common. Birds with infec- When a blockage of the upper respiratory tract is tious respiratory conditions often have conjunctivi- suspected, an air sac tube will provide immediate tis, swollen sinuses or nasal discharge. The bird can be anesthetized by and toucans may develop cardiomyopathy or iron- administering isoflurane through the air sac tube, storage hepatopathy, resulting in ascites and dysp- making it possible to examine the trachea endoscopi- nea. In smaller birds, transillumination of the tra- considered as a cause of dyspnea if the bird has a chea may be used to identify tracheal foreign bodies. The bird should be placed in an Radiographs often demonstrate the site of obstruc- oxygen-rich environment while diagnostic and treat- tion and will also allow for evaluation of the lungs ment plans are being formulated. Removal of a tracheal foreign body is accomplished using suction or a biopsy forceps. In Some birds may benefit from immediate placement some cases it may be necessary to perform a trache- of an air sac tube (see Figure 15. The foreign body is retrieved sacculitis is likely, antibiotics may be administered with biopsy forceps or pushed up and out of the by nebulization in order to minimize handling. Birds clinical appearance is quite alarming to owners, the with ascites or egg-related peritonitis will often im- problem is rarely a true emergency. Early in cervicocephalic air sac in small birds is most com- the course of therapy, enough fluid should be with- mon. The rupture is usually acute, but gradual onset drawn to relieve dyspnea and provide a diagnostic is seen also. In theory, sudden withdrawal of too much 11,19 normal and the cause of the rupture is not identified. The swelling will involve the head and neck permanent if the injury is several days old and no region when the cervicocephalic air sacs are involved. A small needle and syringe can be used to aspirate Long-term corticosteroid therapy should be avoided some air and confirm the diagnosis.
In civil proceedings in England and Wales proven 500 mg xeloda, matters are now governed by the Civil Procedure Rules and by a Code of Practice approved by the head of civil justice cheap xeloda american express. Any practitioner who provides a report in civil proceedings must make a declaration of truth and ensure that his or her report complies with the rules buy discount xeloda 500 mg. Additionally, the doctor will encounter the Coroners Court (or the Procurators Fiscal and Sher- iffs in Scotland), which is, exceptionally, inquisitorial and not adversarial in its proceedings. A range of other special courts and tribunals exists, from eccle- siastical courts to social security tribunals; these are not described here. The type of court to which he or she is called is likely to depend on the doctor’s practice, spe- cialty, and seniority. The doctor may be called to give purely factual evidence of the findings when he or she examined a patient, in which case the doctor is simply a professional witness of fact, or to give an opinion on some matter, in which case the doctor is an expert witness. Usually the doctor will receive fair warning that attendance in court is required and he or she may be able to negotiate with those calling him or her concerning suitable dates and times. Many requests to attend court will be made relatively informally, but more commonly a witness summons will be served. A doctor who shows any marked reluctance to attend court may well receive a formal summons, which compels him or her to attend or to face arrest and proceedings for contempt of court if he or she refuses. If the doctor adopts a reasonable and responsible attitude, he or she will usually receive the sympathetic understanding and cooperation of the law- yers and the court in arranging a time to give evidence that least disrupts his or her practice. However, any exhibition of belligerence by the doctor can induce a rigid inflexibility in lawyers and court officials—who always have the ability to “trump” the doctor by the issuance of a summons, so be warned and be reasonable. A doctor will usually be allowed to refer to any notes made contemporaneously to “refresh his memory,” although it is courteous to seek the court’s agreement. Demeanor in Court In the space available, it is not possible to do more than to outline good practice when giving evidence. Court appearances are serious matters; an individual’s liberty may be at risk or large awards of damages and costs may rely on the evidence given. The doctor’s dress and demeanor should be appro- priate to the occasion, and he or she should speak clearly and audibly. As with an oral examination for medical finals or the defense of a writ- ten thesis, listen carefully to the questions posed. Think carefully about the reply before opening your mouth and allowing words to pour forth. Answer the question asked (not the one you would like it to have been) concisely and carefully, and then wait for the next question. There is no need to fill all silences with words; the judge and others will be making notes, and it is wise to keep an eye on the judge’s pen and adjust the speed of your words accordingly. Pauses between questions allow the judge to finish writing or counsel to think up his or her next question. If anything you have said is unclear or more is wanted from you, be assured that you will be asked more questions. Be calm and patient, and never show a loss of temper or control regard- less of how provoking counsel may be. An angry or flustered witness is a gift to any competent and experienced counsel, as is a garrulous or evasive wit- ness. Stay well within your area of skill and expertise, and do not be slow to admit that you do not know the answer. Your frankness will be appreciated, whereas an attempt to bluff or obfuscate or overreach yourself will almost certainly be detrimental to your position. Doctors usually seek consensus and try to avoid confrontation (at least in a clinical setting). They should remember that lawyers thrive on the adversarial process and are out to win their case, not to engage on a search for truth. Thus, lawyers will wish to extract from witnesses answers that best sup- port the case of the party by whom they are retained. However, the medical witness is not in court to “take sides” but rather to assist the court, to the best of the expert witness’ ability, to do justice in the case. Therefore, the witness should adhere to his or her evidence where it is right to do so but must be prepared to be flexible and to make concessions if appropriate, for example, because further evidence has emerged since the original statement was pre- pared, making it appropriate to cede points. The doctor should also recall the terms of the oath or affirmation—to tell the truth, the whole truth, and nothing but the truth—and give evidence accordingly. The essential requirements for experts are as follows: • Expert evidence presented to the court should be seen as the independent product of the expert, uninfluenced regarding form or content by the exigencies of litiga- tion (30). If the expert cannot assert that the report contains the truth, the whole truth, and nothing but the truth, that qualification should be stated on the report (32). In England and Wales, new Civil Procedure Rules for all courts came into force on April 16, 1999 (34), and Part 35 establishes rules governing experts. The expert has an overriding duty to the court, overriding any obliga- tion to the person who calls or pays him or her. An expert report in a civil case must end with a statement that the expert understands and has complied with the expert’s duty to the court. The expert must answer questions of clarifica- tion at the request of the other party and now has a right to ask the court for Fundamental Principals 57 directions to assist him in conducting the function as an expert. The new rules make radical changes to the previous use of expert opinion in civil actions. Most pit- falls may be avoided by an understanding of the legal principles and forensic processes—a topic of postgraduate rather than undergraduate education now. The normal “doctor–patient” relationship does not apply; the forensic physi- cian–detained person relationship requires that the latter understands the role of the former and that the former takes time to explain it to the latter. Meticulous attention to detail and a careful documentation of facts are required at all times. You will never know when a major trial will turn on a small detail that you once recorded (or, regrettably, failed to record). Your work will have a real and immediate effect on the liberty of the individual and may be highly influential in assisting the prosecuting authorities to decide whether to charge the detained person with a criminal offense. You may be the only person who can retrieve a medical emergency in the cells—picking up a subdural hematoma, diabetic ketoacidosis, or coro- nary thrombosis that the detaining authority has misinterpreted as drunken- ness, indigestion, or simply “obstructive behavior. Get it wrong, and you may not only fail to prevent an avoidable death but also may lay yourself open to criminal, civil, and disciplinary proceedings. You clearly owe a duty of care to those who engage your services, for that is well-established law. The issue of whether a forensic physician owes a wider duty to the victims of alleged crime was decided in the English Court of Appeal during 1999 (35). On December 20, the judge accepted a defense submission of no case to answer and directed the jury to return a verdict of not guilty. She claimed to suffer persistent stress and other psychological sequelae from fail- ing to secure the conviction of her alleged assailant and knowing that he is still at large in the vicinity. The claimant did not contend that there was any general duty of care on the part of a witness actionable in damages at the suit of another witness who may suffer loss and damage through the failure of the first witness to attend and give evidence in accordance with his or her witness statement. When the case came before the Court of Appeal, Lord Justice Stuart- Smith stated that the attempt to formulate a duty of care as pleaded, “is wholly misconceived. If a duty of care exists at all, it is a duty to prevent the plaintiff from suffering injury, loss or damage of the type in question, in this case psychiatric injury.
By I. Eusebio. Philadelphia Biblical University.