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Implementing a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE)

Abstract

Objectives

Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.

Methods

This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.

Trial registration: ISRCTN 11913964

Open access
Atrial Flutter as the First Manifestation of Progressive Cardiac Conduction Disease in a Young Apparently Healthy Patient: А Case Report

Abstract

We reported a case of a twenty-one-year-old man with an atrial flutter as the first manifestation of progressive cardiac conduction disease. The patient was admitted to the cardiology department due to complaints of shortness of breath and a decrease in exercise tolerance, which had happened after physical exercises (running). During ambulatory ECG monitoring persistent AFL was observed with atrial rate 262-297 bpm and ventricular rate 26-136 bpm (average 56 bpm). AV conduction was very variable – 4:1-14:1. The results of ambulatory ECG monitoring during the whole period of recording indicated signs of atrioventricular conduction disturbances. After cardioversion sinus rhythm was restored additional rhythm and conduction disorders were revealed. Ambulatory ECG monitoring was performed two weeks after the initial one, and throughout this recording were registered sinus rhythm on the background of first-degree AV block; transient Mobitz I AV block; and type 2 second-degree sinoatrial block. Trans-esophageal electrophysiology study was performed. During pharmacological denervation of the heart, signs of slowing of the atrioventricular conduction and sinus node recovery time persisted. These changes along with right bundle branch block were regarded as a progressive cardiac conduction disease with an apparently hereditary cause.

Open access
The Incidence of Depression and the Decrease of Quality of Life in Patients with Moderate-Severe Inflammatory Acne

Abstract

Objective: to know the prevalence of depression in patients with moderate-severe acne vulgaris.

Hypothesis: the incidence of depression increases in patients with moderate-severe acne vulgaris and will therefore decrease the quality of life.

Background: acne is a very frequent dermatosis in the outpatient clinic, it is not considered a life-threatening disease. It has been associated with negative emotional status. Also, suffering from it for a long time has been associated with depression, anxiety and frustration. The complications of acne in the psychosocial aspect are related to academic or vocational performance, self-esteem and adolescents’ quality of life.

Materials and Methods: the type of study was retrospective cross-sectional descriptive observational study. The sampling was carried out at the facilities of the Popular Autonomous University of the State of Puebla, taking into account any person within the institutional organisation within the range of 12-20 years of age, with a total of 50 participants. The Hamilton assessment scale of depression and the Cardiff Acne disability index were applied to all patients with dermatological diagnosis of moderate-severe vulgar acne in a period between February-October 2019. Results: a total of 50patients were analysed, of which 28 were women aged 12 to 20 years and 22 men (28 women and 13 men) and severe acne in 9 patients, all over 17 years of age and male. According to the degree of depression, 28% (n = 14) of the patients were obtained without some degree of depression; 60% (n = 30) with minor depression; 12% (n = 6) with moderate depression. Regarding the quality of life: 40% (n = 20) of the patients showed good quality of life, 46% (n = 23) regular quality of life and 14% (n = 7) showed poor quality of life.

Conclusion: orderly study of the psychic impact of acne and other skin diseases on people suffering them is recent and is carried out through questionnaires that try to measure the impact the diseases have on the patients’ quality of life.

Open access
Methicillin-Resistant Staphylococcus Aureus in Community Settings: Spread of Drug Resistance and Uncontrollable Infections

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a major multidrug-resistant bacterial pathogen. The evolution of MRSA is dynamic posing an ongoing threat to humans. The evolution of MRSA includes horizontal gene transfer, which is mediated by mobile genetic elements, plasmids, and bacteriophages, and also mutations. In this review, we clarify the recent trends in MRSA from the perspectives of drug-resistance transfer and uncontrollable infections, particularly those occurring in community settings. We first address the role of MRSA as a disseminator of multidrug resistance. We have studied the cell-to-cell transfer of drug resistance, in which transfer frequencies range from 10-3 to 10-8. The mechanisms of drug-resistance transfers include the self-transmission of large plasmids, the mobilization of small nonconjugative plasmids, the generalized transduction of phages, and the transfer of transposons with circular intermediates. We then discuss uncontrollable infections. Although several anti-MRSA agents have been developed, uncontrollable cases of MRSA infections are still reported. Examples include a case of uncontrollable sepsis arising from a community-associated MRSA (CA-MRSA) with the ST8/SCCmecIVl genotype, and a relapsing severe invasive infection of ST30/SCCmecIVc CA-MRSA in a student athlete. Some of these cases may be attributable to unique adhesins, superantigens, or cytolytic activities. The delayed diagnosis of highly adhesive and toxic infections in community settings may result in CA-MRSA diseases that are difficult to treat. Repeated relapse, persistent bacteremia, and infections of small-colony variants may occur. To treat MRSA infections in community settings, these unique features of MRSA must be considered to ensure that diagnostic delay is avoided.

Open access
Mobile Ultrasound Systems as a Modern Tool for the Doctor

Abstract

Miniaturisation of ultrasound equipment in the form of a tablet- or smartphone-sized scanner is the result of rapid development of modern medical technology. Availability of mobile ultrasound devices has changed our approach to diagnostics of many cardiovascular diseases. Mobile visualisation can be performed at the patient’s bedside and is simple in use. The information obtained from mobile visualisation, despite being incomplete, is of undoubtable value for rapid diagnosis which leads to early treatment onset. These devices possess unique characteristics: low cost, wide availability, safety, and precision. These characteristics make them usable in different clinical scenarios by operators of different specialties and expertise. Visualisation and interpretation of the images is done fast and provides useful diagnostic, prognostic and treatment data for each situation. This review devotes main attention to the regulation of application of mobile ultrasound devices, the notion of “focus cardiac ultrasound” and its differences from emergency and elective expert echocardiography protocols as well as limitations and numerous advantages related to usage of mobile ultrasound systems.

Open access
Possible Deleterious Impact of Glyphosate and its Commercial Formulation in Reproductive Health of Fishes

Abstract

Glyphosate (GLY) is the active ingredient of Roundup® and it is the most utilized herbicide worldwide in the maintenance of conventional agricultural crops, and lawns in parks. A growing number of studies have associated environmental GLY to different pathologies such as obesity, diabetes, heart disease, Alzheimer’s disease, depression, and autism. Different fish species have been used for a long time as experimental biological models to measure the environmental impact of different substances. Therefore, the present study approached the possible association between the exposure to GLY / Roundup® and the ecotoxicological impact on fish reproductive health. With this goal, we performed a comprehensive analysis of the literature and its content by systematic review of international databases. Two independent electronic searches were performed on Medline / PubMed and Scielo for identifying relevant studies published in English up to September 2019. The application of inclusion / exclusion criteria settled the boundaries for this systematic review and after qualitative analysis of the data; we found evidences that suggest a link between the exposure to GLY / Roundup® with deleterious effects on reproductive health in eight different species of fish.

Open access
Editorial
Open access
Figure, Ground and the Notion of Equilibria in the Work of Gilbert Simondon and Gestalt theory

Summary

Based on Clausius’ phrasing of a “transformational content” and the resulting 2nd law of thermodynamics, I demonstrated that Gilbert Simondon’s On the Mode of Existence of Technical Objects is historically situated at the threshold of understanding open systems thermodynamics and the related concepts of balance. Furthermore, I showed that Gestalt theory, as represented by Wolfgang Köhler, at least reproduced, if not partially anticipated or even prepared this development of 20th century thinking. Finally, I gave some short examples of how Simondon applied the figure/ground distinction to human perception, memory, and a general theory of becoming and I introduced his proposal to analyse “the grounds” just as thoroughly as the laws of figuration.

Open access