1,721,000 research outputs found
Novel experimental and early investigational drugs for the treatment of bipolar disorder
No full textIntroduction: The quest toward more effective treatments for bipolar disorder (BD) solicits novel drugs and further research on the underpinning neurobiology. The present review aims to critically appraise the existing evidence about the pharmacological treatment of BD toward the development of novel treatment avenues. Areas covered: The present review appraises animal and human studies concerning both the currently available psychotropic drugs, and the general medicine drugs which may represent a path toward the development of novel drugs for BD. PubMed and Scopus were last accessed on February 20th, 2021 for records indexed upon inception relevant to the pharmacological treatment of BD. Immune-modulating agents, anti-inflammatory agents, and glutamate antagonists represent the most intriguing potential targets for the development of new drugs for BD, thus receiving critical appraisal in the present text. Expert opinion: Regardless of the neurobiological pathways worthy of investigation toward the development of experimental drugs for BD, several unmet needs need to be addressed first. In particular, several biomarkers are altered in BD. However, it is the opinion herein expressed by the authors that it remains uncertain what comes first, that is peripheral changes or the disease
Systematic review of involuntary hospitalisation and long-term compliance
Full text linkIntroduction
Involuntary hospitalisation denies autonomy and freedom of decision-making and is frequent in psychiatric clinical practice. However, there is still a lack of knowledge of long-term compliance after Involuntary commitment.
Methods
We conducted a systematic review of published studies reporting people compliance after involuntary hospitalisation and people compliance after voluntary admission. Two investigators independently searched PubMed, PsycINFO, EMBASE and CINAHL up to December 17th, 2021 to identify eligible studies. The study is registered with PROSPERO number CRD42022299437.
Results
Ten independent studies analysing the main indicators of compliance, engagement with services and medication adherence, were included. Three studies show that compliance is worse in people that have been involuntary hospitalised and in the others no association is found. Just two of the ten studies show an association with improved compliance. Outcomes are assessed from the first follow-up appointment after discharge up to 96 months.
Conclusions
Although evidences carried out so far are weak, the data do not show a trend of improvements and do not seem to exclude the possibility of worse compliance after compulsory hospitalisation. More appropriate methodologies and reliable assessment are needed in future research to provide scientific evidence on involuntary admission health effects
The long‐term adherence following the end of Community Treatment Order: A systematic review
Full text linkTowards an evolutionary perspective of bipolar disorders: Is there a genetic link between bipolar disorders and non-pathological (adaptive) hyperactivity?
Full text linkThe new-developed Questionnaire for Adaptive Hyperactivity and Goal Achievement (AHGA), represents an innovative approach to hyperthymic features by embracing a broader concept of spectrum, which conceptualizes as a continuum the potential transition between pathological and adaptive aspects. The two basic components of the hyperthymic temperament that stand out are hyperactivity and goal achievement. This kind of temperament can be classified as abnormal only in the presence of chronic hypomanic symptoms or advanced mood disorders. In general, temperaments have been verified to belong to the domain of normality rather than the sphere of pathology, in accordance with their putative adaptive role. Commonly, achieving success, experiencing excitement and joy, and moving towards core life goals are moments of great importance in life. In this approach, goal and drive achievement demonstrates an adaptive and beneficial side of hyperthymia. It indicates the willingness to set high goals and spend energy pursuing them, which could help clarify the high rates of creative efforts among people with a hyperthymic temperament. However, the pathological scenery appears linked to variability in the adaptiveness with which people follow life goals and accomplishments. In the later stages of the study, this tool was very helpful in identifying older adults (60 years of age and older) with features of well-defined hyperactivity and novelty-seeking. The Questionnaire for Adaptive Hyperactivity and Goal Achievement (AHGA) measures the adaptive characteristics of hyperactivity and goal pursuit in contrast to the Biological Rhythms
Interview of Assessment in Neuropsychiatry (BRIAN) tool, which measures its pathological characteristics. According to the results regarding the investigated genetic variant (RS1006737) of the CACNA1C gene, an association was found with the characteristics of hyperactivity rather than just BD. Also, this genetic variant, recognized in the literature as associated with bipolar disorders, was found in well-adapted older adults without bipolar disorders and high hyperactivity traits with a similar frequency as in older adults with a diagnosis of bipolar disorders but higher than in older adults without bipolar disorders and without hyperactivity. This could led to the new interpretation and a new approach to supporting drug therapy in which the rediscovery of the adaptive potential resources would be central to the recovery of the individual who has suffered a bipolar disorder onset. Furthermore, the interpretation of the disorder not as the simple consequence of a genetic weakness could be an element against stigma and self-stigma. When comparing the biological material, although saliva and blood differ in composition and biological properties, sample type has no effect on the detection of a mutation in the genetic variant of interest. Blood and saliva can both be used as biological materials in later stages of this research.
The combination of the new questionnaire tool (Questionnaire for Adaptive Hyperactivity and Goal Achievement) with the genetic analysis appears to be an innovative, practicable, and original approach. The following development of this study will include more genetic variables with higher susceptibility for bipolar disorders (ANK3, NCAN, ODZ4, SYNE1, and
TRANK1 genes) and obviously more numerous target and control samples
Adaptive Hyperactivity and Biomarker Exploration: Insights from Elders in the Blue Zone of Sardinia
Full text linkBackground/Objectives: Adaptive hyperactivity characterized by increased activity levels and novelty-seeking traits without mood disorders is prevalent among older adults in Sardinia’s “blue zone,” an area with high longevity. This study aims to evaluate the adaptive nature of hyperactivity concerning quality of life, social rhythms, and mood symptoms in individuals from this region, particularly among elderly adults over 80. Methods: This observational cross-sectional study included adults and older adults over 80 from Sardinia’s blue zone. This study included a sample of patients followed at the Center for Consultation Psychiatry and Psychosomatics for Bipolar Disorder of the University Hospital of Cagliari and a homogeneous comparison sample of patients without psychiatric pathologies, referred to the Dermatology Clinic of the same hospital, for a period of 6 months, from February to August 2024. The general sample, divided into two parts—cases, represented by patients with psychiatric pathology, and controls, patients without psychiatric pathology—was divided in turn into three sub-groups: “adults” (18–64 years), young elders (65–79), and old elders (over 80 years). The participants underwent psychiatric interviews and completed the Mood Disorder Questionnaire (MDQ), Patient Health Questionnaire (PHQ-9), SF-12, and Brief Social Rhythm Scale (BSRS). Data were compared with national and regional normative data. Results: Older adults in the blue zone demonstrated higher MDQ positivity (22.58%) compared to the national averages (0.87%), without corresponding increases in dysregulated rhythms, depressive symptoms, or reduced quality of life. Younger old persons (65–79 years) showed increased rhythm dysregulation (BSRS score: 20.64 ± 7.02) compared to adults (17.40 ± 6.09, p = 0.040), but this trend was not observed in the oldest group (80+ years). No significant differences were found in the CH3SH and (CH3)2S levels between groups. Conclusions: The hyperactivity observed in older adults from Sardinia’s blue zone appears adaptive and not linked to social rhythm dysregulation, depressive symptoms, or a diminished quality of life, suggesting resilience factors which may contribute to longevity. These findings support the potential classification of such hyperactivity as beneficial rather than pathological, warranting further research into biomarkers and psychoeducational interventions to prevent the onset of bipolar disorders in predisposed individuals
The Effects of Tyrosine Kinase Inhibitors (TKIs) in Monotherapy and with Add-on Treatments on Health-related Quality of Life of People with Chronic Myeloid Leukemia: A Systematic Review of Randomized-Controlled Trials
Full text linkBackground: The era of establishing tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) changed the outcome and the course of this life threatening malignancy. People suffering from CML have now a better prognosis and a longer life expectancy due to the development of TKIs, even if it requires long-term, often lifelong, treatments that are nonetheless associated with improved Health-related Quality of life (HRQoL). However, data on the effects of TKIs on HRQoL are not always systematic; sometimes the data have been obtained by studies different from RCTs, or without a clear definition of what HRQoL is. The main purpose of this systematic review is to summarize all randomized-controlled trials (RCTs) including HRQoL as main or secondary outcome in patients with CML treated with TKIs or with TKIs plus an add-on treatment.
Methods:
A systematic review has been conducted by searching the relevant papers in PubMed/Medline and Web of Science with the following keywords: “quality of life” OR “health-related quality of life” OR “QoL” OR “HRQoL” OR “H-QoL” AND “chronic myeloid leukemia”. Interval was set from January 2000 to December 2020.
Results:
40 papers were identified through the search. Out of them, 7 RCTs were included. All the studies used standardized measures to assess HRQoL, even not always specific for CML. 5 RCTs randomized subjects to 2 or 3 arms to evaluate the effects of TKIs of the first, second and third generation in monotherapy. 2 RCTs randomized subjects to TKI therapy plus an add-on treatment versus TKI therapy as usual. The results of all these trials were examined and discussed.
Conclusion:
All the included RCTs pointed out significant findings regarding the positive effects of TKIs on HRQoL of people with CML, both when they were used in monotherapy or, notably, with an add-on treatment to enhance TKIs effects
Visceral leishmaniasis in a patient with aortic coronary bypass transplant and hepatitis case report
Full text linkAims: Visceral leishmaniasis (cala-azar) caused by
the protozoal parasite Leishmania donovani, is one
of the major causes of worldwide morbidity and
mortality. In this case report, we present a female
patient, who had been diagnosed with Visceral
Leishmaniasis.
Case report: A 56-year-old woman from Skopje,
Republic of Macedonia, who was in Barcelona and
Istanbul a year ago, was taken to the state hospital
because of fever and hepatosplenomegaly. The
diagnosis is made with bone marrow biopsy. The
patient had previously an aortic coronary bypass
transplant. During the stay of the Intensive Care and
Therapy Department at the Clinic for Infectious
Diseases and Febrile Conditions in Skopje, Hepatitis
C virus has been laboratory diagnosed.
Unfortunately, the patient ended with death.
Conclusion: We hope that with the presentation of
this case, we will increase the need for further
exploration of geographical changes,
epidemiological characteristics and interconnections
between leishmania parasites.
Keyword: leishmaniasis, protozoa, Hepatitis C
1.INTRODUCTION
Visceral leishmaniasis (cala-azar) caused by the
protozoal parasite Leishmania donovani, is one of the
major causes of worldwide morbidity and mortality (1).
Leishmaniasis is an inflammatory, chronic disease that
affects the skin, mucous membranes and visceral
organs, caused by intracellular parasites that are
transmitted by infected sand flies of the genus
Flebotomus. The life cycle of Leishmania takes place in
two phases, the promastigote which lives extracellularly
in the infected phlebotomes and the amastigote, which
lives and reproduces intracellularly in the host's
reticuloendothelial cells (2). Mammals, including foxes,
rodents and dogs are infection reservoirs (3). The
amastigotes from Leishmania species have a particular
affinity for replication in the liver, spleen, bone marrow
and lymph nodes causing fatal lesions. (4). We present a
complex case of a 56 year old woman from Skopje,
Republic of Macedonia with three independent types of
morbidities, as follows: aortic coronary bypass
transplant, Hepatitis C and visceral leishmaniasis.
2.CASE REPORT
56-year old woman from Skopje, Republic of Macedonia
of Albanian nationality was referred to University Clinic
for Infectious Diseases and Febrile conditions in Skopje
for management of visceral leishmaniasis. This patient
10 years ago was admitted to the Clinic “Filip II” because
of a heart attack. An aortic coronary bypass transplant
was made. She regularly went to controls for the
examination of cardiac function and control of current
therapy. She has been advised on several occasions
COVID-19 from a Perspective of Neuromuscular Diseases: Meeting the Challenges
Full text linkDear Editor,
The new SARS-CoV-2 epidemic is imposing immense strain on the health systems in several countries. The growth of the epidemic has led the WHO to declare the 2019-nCoV disease as a global pandemic (1). COVID-19 pandemic has the potential to affect patients with neuromuscular diseases. The evaluation of the overall risk of COVID-19 in patients with neuromuscular diseases depends on several factors: the specificity of the neuromuscular disease, the general condition, the presence of other comorbidities, age, and the type of immunosuppressive treatment they receive. It is important to emphasize the fact that most patients with neuromuscular disease are not expected to suffer from severe complications due to coronavirus infection. Corona infections can affect certain myopathies. In a recent study published in China, related to COVID-19 is shown that hospitalized patients experienced fatigue and myalgia (44-70%), and increased creatine kinase (33%) in the serum (2). Apart from this, a third of hospitalized patients infected with the coronavirus had rhabdomyolysis (3). All of this points to the fact that coronavirus infection may be responsible for viral myositis. In addition, is the finding that some of the critical cases have developed polyneuropathy or myopathy (4). On the other hand, it is well known that infection is a trigger for exacerbation of certain neuromuscular diseases. There is no data that measured the risk of exacerbation as a result of coronaviruses infection for neuromuscular disorders. However, in one retrospective study, COVID-19 infection was a leading reason for the exacerbation of myasthenia gravis (5). As a result of this, an increased incidence of exacerbations of certain neuromuscular diseases should be expected, as well as the appearance of new clinical presentations during this pandemic. It is important to note that there are still no neuromuscular diseases-specific recommendations for patients who are infected with the coronavirus. Observation is recommended in patients at high and medium risk, especially in those patients where there is a possibility of a decrease in respiratory function. Last but not least, we would like to emphasize the need for reorganization of clinical care for these patients (6). The goal is to reduce exposure of patients to areas where the coronavirus could be found. Moreover, non-urgent or outpatient care is remarkably reduced. In conclusion, we must learn to apply our clinical practices in order to reduce the complications that may occur in patients with neuromuscular disease due to COVID-19. The primary goal is to develop evidence-based medical practices in order to reduce morbidity and mortality. Collaboration among institutions worldwide will be able to give us the data needed for planning management for neuromuscular disorders with COVID-19 and maintain clinical research against strong challenges.
 
Висцерална лајшманијаза кај пациентка со аортокоронарен бајпас трансплант и хепатитис Ц
Full text linkВовед: Висцералната лајшманијаза предизвикана од паразитот Leishmania Donovani е важна причина за морбидитет и морталитет во
светски рамки.
Приказ на случај: 56 годишна жена од Скопје беше упатена на Универзитетската клиника за инфективни болести и фебрилни
состојби за менаџирање на висцерална лајшманијаза. Оваа пациентка пред 10 години била примена на Клиниката „Филип Втори"
поради срцев удар. Бил вграден аортокоронарен бајпас трансплант. Пациентката почнала да се жали на силни главоболки, кахексија
и печење при мокрење. Потоа, имала висока температура која не се симнувала со антипиретици и антибиотици. Обично,
температурата се зголемувала и намалувала за половина до еден степен. По неколку дена, пациентката се жалела на болка во
абдоменот, особено изразена под ребрата од обете страни. Почнале да се појавуваат и петехии. Претходно, има дадено податоци
дека била една година во Истанбул и Барселона. Биопсијата на коскената срцевина довела до сознание за изобилство на
амастиготни форми на Leishmania donovanani. На општ физикален преглед пациентката имала иктерус, цијаноза и лимфаденопатија.
На абдоминален преглед, црниот дроб и слезината биле зголемени паралелно со петехијални крварења на градите и стомакот.
Следните патолошки наоди беа забележани на контрасна КТ: асцит, 2-3 значително зголемени лимфни жлезди, мноштво проширени
лимфни јазли во областа околу coeliac trunk и во параоорталната област, зголемен црн дроб, плеврален излив од десната страна.
Дијагнозата на лајшманиозата претставува предизивик. Диференцијално дијагностичката палета вклучува болести како: маларија,
тифусна треска, тифус и шистозомијаза. Дијагнозата треба да биде потврдена со микроскопска идентификација на паразитот од
земено биоптично ткиво на црниот дроб, слезината или коскената срцевина или преку откривање на ДНК на Leishmania во крвта со
PCR. Таа веднаш била ставена на терапија со петовалентен антимон (Amphotericin B). Забележано е и мозочно крварење.
Пациентката егзитирала после четири недели.
Резултати: Следниве патолошки вредности беа забележани при лабораториските испитувања: СЕ 37 mm/h; триглицериди 2.77
mmol/l; AST 140,0 U/L; ALT 71,0 U/L во меѓувреме и лабораториски позитивен резултат за присуство на Хепатит C вирусот.
Хематолошките испитувања покажаа панцитопенија и нивото на хемоглобин од 7 g/dl (тешка анемија);
Заклучок: Затоа, овој случај го пријавуваме како многу ретка презентација која наложува понатамошно истражување на оваа тема.
Клучни зборови: лајшманијаза, протозоа, хепатитис Ц
The impact of social determinants on growth and health in preschool children
Full text linkIntroduction: It is worldwide known that social, cultural, political, and economic environment has a direct impact on the preschool children's health and growth. Although, there is a significant rate of preschool child morbidity and mortality in Macedonia, and there is not precise data about the impact of social determinants on health and growth of preschool children yet.
Aim of the study: The purpose of this thesis is to gain insight into the causal link between the common social determinants and the health and growth of preschool children, on the other hand. The results should serve to improve prevention and develop local programs to promote a sustainable system for improving children's health, with the help of reliable data.
Material and methods of work: As a material, it was used health documentation from the parent pediatric institutions from Public Health Center – Zeleznicar (Skopje), and from outpatient clinic in municipality of Butel (Skopje). Statistically, there were processed 50 health documents randomly selected from both institutions, a total of 100, in the period of 2013 - 2017.
Results: With the help of this paper, it will be possible to identify the link between social determinants and health with growth in children under five years of age. Of the group of mothers with primary education, 71% had a newborn with low birth weight, of the mothers with secondary education 18% had a newborn with low birth weight and a group of mothers with a university education, 2% had a newborn with low birth weight. In the study, one congenital anomaly was observed in a mother of age 36. That was congenital non – neoplastic nevus. In families where there are no employees 100% of the pre-school children had chronic infections, in families with 1 employee 87% of pre-school children had chronic infections and in families with 2 employees 77% of pre-school children had chronic infections. In children who only had healthy drinking water, there was no episode of diarrhea coming from contaminated drinking water, while pre-school children who came in contact with, in 100% there was diarrhea caused by contaminated drinking water. In the group of pre-school children living in homes with sanitary conditions, 100% are absent digestive disorders caused by unsecured sanitation in the home. In the group of pre-school children living in homes where no sanitary conditions are provided, 100% of them were digestive diseases where unsecured sanitation appeared as an aetiological moment.
Conclusion: Determining levels of inequality is essential for improving the health and nutrition of the poor. This does not mean only a set of solutions that involve multiple institutions, but also their effective dealing with all levels of determination. The social determinants of health are not vacuumed. Their quality and accessibility to the population are usually the result of public policy decisions made by the authorities.
Keywords: social determinants, preschool children, health, growth
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