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Neurocysticercosis (NCC) is a neglected parasitic disease that causes neurological symptoms. However, little is known about the long-term impact of this infection on health. We contacted participants from a randomized controlled trial on albendazole treatment for NCC in Ecuador 12 years after trial completion (14–16 years after NCC diagnosis) about their long-term health. We described the symptoms experienced post-trial and investigated if albendazole treatment, the presence of calcified NC cysts, and cysts in extraparenchymal locations at last imaging predicted symptoms. All analyses were standardized by adjusting for participant age and sex. In the 12 years post-trial, 52.1% reported some health problem, with 48.9% reporting neurological symptoms such as seizures (16.6% of participants) and headaches (26.6% of participants). At the end of the trial, 11 participants had complete NCC cyst resolution, of whom 3 (27.3%) reported seizures and 1 (9.1%) reported headaches post-trial. Twenty-four participants had only calcified cysts (residual calcification sometimes left after the parasite dies) by trial end, of whom 8 (33.3%) reported seizures and 9 (37.5%) headaches post-trial. None of the predictors examined were significantly associated with long-term symptoms. A high proportion of people diagnosed with NCC continue experiencing symptoms years after treatment, and while slightly fewer people experienced continued symptoms in the albendazole group, the difference was not statistically significant. Eleven participants with no live parasites at last imaging (8 with residual calcifications) had seizures post-trial, which may be unprovoked and an indication of epilepsy risk. Research is urgently needed to improve NCC treatment to mitigate long-term outcomes.
Neurocysticercosis is a poorly understood infection of the central nervous system with Taenia solium larva, and the treatment often fails to kill all the parasitic larva. Most research on this infection has used patient-level data, looking at summaries of the encysted parasitic cysticercus burden. Cyst-level analysis is needed to identify factors that impact individual cyst trajectories and how that may vary based on characteristics of the patient, infection and cyst being followed. We disaggregated data on 221 cysts from 117 patients who participated in a trial evaluating the impact of albendazole treatment to identify factors that impact cyst evolution over time from the active to the degenerating and calcified phases, and eventual resolution. We found that having calcified cysts at baseline was associated with a faster rate of transition from the degenerative phase to calcified phase or resolution. Age and sex were not associated with cyst evolution in the main effect analysis, but after stratifying on treatment we found that the direction of some associations by patient age and sex was reversed for patients in the albendazole arm compared to those in the placebo arm. These findings suggest that differences in host immune response by sex and age as well as by past exposure, potentially indicated by having calcified cysts together with active cysts at baseline, are important to cyst evolution and may be modified by treatment. Future research is needed to assess if these differences suggest distinct treatment recommendations.
Hidden consumption is a potential problem when consumers’ expenditure data from household surveys are used in demand analyses. A solution is to collect and use actual consumption data. This study compares demand estimation using consumption and expenditure data and evaluates meat demand in Nigeria. Data are from a nationally representative panel from Nigeria. The results show the elasticities estimated across both datasets were very similar; thus, if the only objective of data collection is to estimate elasticity using a demand system framework, collection of both types of data (consumption and expenditures) may be unnecessary. The elasticity estimates classify poultry, beef, and processed seafood as luxuries, while other meat and unprocessed seafood are classified as necessities. Own-price elasticities from both datasets indicated that poultry, beef, and processed seafood were price-elastic, and poultry was the most price-elastic.
Vortex shedding in the wake of a cylinder in uniform flow can be suppressed via the application of a porous coating; however, the suppression mechanism is not fully understood. The internal flow field of a porous coated cylinder (PCC) can provide a deeper understanding of how the flow within the porous medium affects the wake development. A structured PCC (SPCC) was three-dimensionally printed using a transparent material and tested in water tunnel facilities using flow visualisation and tomographic particle image velocimetry at outer-diameter Reynolds numbers of $Re = 7 \times 10^{3}$ and $7.3 \times 10^{4}$, respectively. The internal and near-wall flow fields are analysed at the windward and mid-circumference regions. Flow stagnation is observed in the porous layer on the windward side and its boundary is shown to fluctuate with time in the outermost porous layer. This stagnation region generates a quasi-aerodynamic body that influences boundary layer development on the SPCC inner diameter, that separates into a shear layer within the porous medium. For the first time via experiment, spectral content within the separated shear layer reveals vortex shedding processes emanating through single pores at the outer diameter, providing strong evidence that SPCC vortex shedding originates from the inner diameter. Velocity fluctuations linked to this vortex shedding propagate through the porous layers into the external flow field at a velocity less than that of the free stream. The Strouhal number linked to this velocity accurately predicts the SPCC vortex shedding frequency.
Cultural differences influence understanding and therapeutic adherence of migrant patients, therefore it is very important to acquire cultural competence.
Objectives
The objective of this paper is to study, from the following case, the effect of cultural competence in approach to psychosis in migrant patients.
Methods
A bibliographic search was performed from different database (Pubmed, TripDatabase) about the influence of culture on psychosis and its resolution. A 25-year-old Moroccan man who came to Spain two years ago fleeing his country and suffered violence in different countries until he arrived. He lived on the street until they offered him a sheltered house with other Moroccans. He felt lack of acceptance and loss of his roots. In this context, he developed a first psychotic episode in which he described “the presence of a devil”.
Results
He distrusted antipsychotic treatment and believed “that devil” was still inside him, being convinced that he needed a Muslim healer to expel him. We followed up with the patient and a cultural mediator, better understanding his cultural reality, uprooting and traumas, and he could feel understood and trust us. During the process, he decided to go to the Muslim healer who performed a symbolic rite for which he felt he “expelled the devil”, while accepting antipsychotics. With all this, the psychotic symptoms and their acculturation process improved.
Conclusions
It is very important that psychiatrists have cultural competence to understand the context of migrant patients, and to be able to provide them with the best treatment.
Psychotic symptoms are not exclusive to schizophrenia, they can be due to paranoid development and can be treated differently.
Objectives
The objective of this paper is to study, from the following case, the effect of psychotherapeutic treatment in patients with paranoid development.
Methods
A bibliographic search was performed from different database (Pubmed, TripDatabase) about psychological intervention for the improvement of paranoid symptoms. 20-year-old man, born into a family with marital problems, without difficulties in psychomotor development, socialization or academic performance, who began with behavioral alterations from the age of 5 that he had begun to suffer abuse from his father, showing aggressiveness towards other children and progressively worsening over the years: consuming cannabis, isolating himself, listening to protective voices and distrusting of people, to whom he responded aggressively believing that they wanted to harm him.
Results
Initially, he was treated with antipsychotics that were later suspended when acute psychotic symptoms were ruled out, diagnosing a paranoid development secondary to trauma, for which he had felt fear and defenselessness, and had learned to be alert and respond aggressively to everything he considered threatening, showing anger that he did not know how to express. During therapy, abstinence to drugs was worked on, therapeutic link, mentalization-based therapy, emotions, narrative techniques, trauma and systemic family therapy.
Conclusions
To conclude, we need to pay attention to development of pathologies like this so as not to rush with antipsychotics, when it may be due to a development secondary to trauma that needs to be treated psychotherapeutically.
Theoretical predictions and numerical simulations are used to determine the transition to bubble and conical vortex breakdown in low-Mach-number laminar axisymmetric variable-density swirling jets. A critical value of the swirl number $S$ for the onset of the bubble ($S^*_B$) and the cone ($S^*_C$) is determined as the jet-to-ambient density ratio $\varLambda$ is varied, with the temperature dependence of the gas density and viscosity appropriate to that of air. The criterion of failure of the slender quasi-cylindrical approximation predicts $S^*_B$ that decreases with increasing values of $\varLambda$ for a jet in solid-body rotation emerging sharply into a quiescent atmosphere. In addition, a new criterion for the onset of conical breakdown is derived from divergence of the initial value of the radial spreading rate of the jet occurring at $S^*_C$, found to be independent of $\varLambda$, in an asymptotic analysis for small distances from the inlet plane. To maintain stable flow in the unsteady numerical simulations, an effective Reynolds number $Re_{eff}$, defined employing the geometric mean of the viscosity in the jet and ambient atmosphere, is fixed at $Re_{eff}=200$ for all $\varLambda$. Similar to the theoretical predictions, numerical calculations of $S^*_B$ decrease monotonically as $\varLambda$ is increased. The critical swirl numbers for the cone, $S^*_C$, are found to depend strongly on viscous effects; for $\varLambda =1/5$, the low jet Reynolds number (51) at $Re_{eff}=200$ delays the transition to the cone, while for $\varLambda =5$ at $Re_{eff}=200$, the large increase in kinematic viscosity in the external fluid produces a similar trend, significantly increasing $S^*_C$.
There is debate in the political sphere regarding the level at which climate change will have an impact on the earth. In the scientific community there is little debate, but this thought does not necessarily trickle down to the average layperson. Many believe that this disconnect is due to misinformation campaigns through the late 1990s. Climate change is a vast social and health issue that affects communities all over the world differently. Different areas of the world with varied resources and support will fare differently as climate change continues to change the land, making climate change a social justice concern. However, it is possible to improve climate change by focusing resources on human behavior, psychology, and sustainability.
This chapter focuses on the consumer recovery movement. A brief history of key events that have supported the consumer recovery movement in the USA is provided. A definition of recovery is provided along with consideration of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) guiding principles for recovery. Mental health-related stigma is discussed as a barrier to the consumer recovery movement and the access and utilization of mental health services in general. An interview with the Director of The Carter Center’s Mental Health Program is provided to demonstrate programmatic examples of the consumer recovery movement in action. The chapter concludes with a discussion of key current policies and future directions for research and practice.
We present quantitative evidence that the mita introduced by the Spanish crown in 1573 caused the decimation of the native-born male population. The mass baptisms after the conquest of Peru in 1532 resulted in the assignation of surnames for the first time. We argue that past mortality displacement and mass out-migration were responsible for differences in the surnames observed in mita and non-mita districts today. Using a regression discontinuity and data from the Peruvian Electoral Roll of 2011, we find that mita districts have 47 log points fewer surnames than non-mita districts, and fewer surnames exclusive to one location.
Lattice Boltzmann simulations were carried out to investigate the noise mitigation mechanisms of a 3-D printed porous trailing-edge insert, elucidating the link between noise reduction and material permeability. The porous insert is based on a unit cell resembling a lattice of diamond atoms. It replaces the last 20 % chord of a NACA 0018 at zero angle-of-attack. A partially blocked insert is considered by adding a solid partition between 84 % and 96 % of the aerofoil chord. The regular porous insert achieves a substantial noise reduction at low frequencies, although a slight noise increase is found at high frequencies. The partially blocked porous insert exhibits a lower noise reduction level, but the noise emission at mid-to-high frequency is slightly affected. The segment of the porous insert near the tip plays a dominant role in promoting noise mitigation, whereas the solid-porous junction contributes, in addition to the rough surface, towards the high-frequency excess noise. The current study demonstrates the existence of an entrance length associated with the porous material geometry, which is linked to the pressure release process that is responsible for promoting noise mitigation. This process is characterised by the aerodynamic interaction between pressure fluctuations across the porous medium, which is found at locations where the porous insert thickness is less than twice the entrance length. Present results also suggest that the noise attenuation level is related to both the chordwise extent of the porous insert and the streamwise turbulent length scale. The porous inserts also cause a slight drag increase compared to their solid counterpart.
This study’s goal was to determine the perceived risks of infection as well as the perceived risks of hospitalization and death from COVID-19 in Ecuador and Kenya. It also assessed the factors associated with the risk-related perceptions.
Methods:
Cross-sectional studies with samples from the adult populations in both countries were conducted to assess the perceived risks of contracting COVID-19. Data were collected online using the Qualtrics platform (Qualtrics, Provo, Utah, United States) from samples of 1050 heads of households, aged 18 years or older, in each country. A total of 3 statistical analyses were conducted: summary statistics, correlation, and linear regression.
Results:
The average perceived risks of COVID-19 infection, hospitalization, and death in the Kenyan sample were 27.1%, 43.2%, and 17.2%, respectively, and the values for the Ecuadorian sample were 34%, 32.8%, and 23.3%, respectively. The Pearson’s correlation coefficients between the risk measures in each country were less than 0.38. Risk measures were associated with several sociodemographic variables (e.g., income, gender, location), but not with age.
Conclusions:
The perceived risks of COVID-19 infection, hospitalization, and death in Kenya and Ecuador were significantly higher relative to the statistics reported; however, no strong association existed between perceived risk and age, which is a key factor in adverse health outcomes, including death, among COVID-19 infected individuals.
We know the coexistence of traumatic factors (loss of affective relationships, experiences of abuse, extreme risk situations, etc.) is common in psychiatric pathologies in which level of stress experienced exceeds normal capacity of the person, favoring the appearance of dissociative or excision mechanisms. A common mistake is to pathologize them and try to eliminate them.
Objectives
The objective of this paper is to study trauma and defense mechanisms involved, in order to carry out a better approach.
Methods
A bibliographic search was performed from different database (Pubmed, TripDatabase) about trauma, mechanisms involved and the construction of identity.
Results
We know neural pathways mature asymmetrically in evolutionary development (functions related to attention, concentration and executive function having special importance) and thus, traumas occurred in moments of greatest vulnerability such as early childhood, can damage and interfere with the correct integration of neural processes, producing disproportionate and unnecessarily maintained alert responses (common basis for many pathologies such as borderline personality disorder or traumatic psychosis). In response to this, reactive mechanisms are produced (such as dissociation or cleavage) that are not necessarily pathological and therefore, we should not always intervene by eliminating them because they often function as a protective factor, allowing to preserve functioning and favoring recovery.
Conclusions
In conclusion, we need a better understanding of mechanisms involved in trauma, executive function and the alarm system beyond anxiety reactions, trying to understand the function of symptom without eliminating it, but evaluating whether there are healthier alternatives can be promoted for the complete recovery of the patient.
Thanks to advances in medicine, more diseases are being cured, but this benefit can become a problem when it causes a worsening of quality of life.
Objectives
The objective of this paper is to analyze, regarding the following case, the convenience of treating or to limit the therapeutic effort (LTE) in psychiatric patients who are in situations at the end of life.
Methods
62-year-old woman begins with depressive symptoms from financial problems. In 4 months ago she makes four suicide attempts (drug overdose, cuts, self-stabbing, and precipitation), being hospitalized in ICU after latter because of multiple trauma and shock. During that time, she had a bad evolution with several complications that made LTE be evaluated. A bibliographic search was performed from different database (Pubmed, TripDatabase) about LTE and ethical implications.
Results
Trying to prolong life by disproportionate means in a patient with a poor prognosis or poor quality of life is bad practice. We must assess the severity, quality of life, capacity and preferences of the patient to decide to treat or not, thus guaranteeing the principle of beneficence. It is also important to respect the principle of autonomy, accepting patients can refuse treatment. All this is equally applicable to psychiatric patients, whom we should not stigmatize but rather evaluate their ability to decide, as in any person.
Conclusions
In conclusion, in situations of high suffering and near death, it is necessary a complete evaluation of the patient (psychiatric or not) is carried out in order to act in the most ethical way.
There are many authors that follow and develop Pinel-hypotheses about unitary psychosis, joining recent discoveries in neuropathology and neurochemistry, supporting the vision of mental illness as neurodevelop disorders. The classification they suggest, distinguishes early, late neurodevelop disorders, and those related to traumatic factors, what determine an evolutive vision of this pathology. In terms of anxiety symptoms/disorders, they have been usually associated with categorical pathology, and treated focus on symptoms,unfortunately relapses are very frequent.
Objectives
Proving that the evolutive vision may ease a change on the intervention of anxiety disorders, that would propound different therapeutic alternatives.
Methods
A bibliographic search was performed from different databases, showing throw aspects related to main etiopathogenic theories about anxiety disorders from an evolutive vision.
Results
Evolutive-Psychology raises that anxiety is a concomitant process to development, that grows progressively and is necessary to induce changes in it. However a high level of anxiety might block that process or causes alterations. In that sense, anxiety-disorders may be related to an excess of anxiety that provoke a fault in present handling mechanisms. According to classic dynamic-theories, these mechanisms are associated with defence concept, but now we can link them to neurobiological development. From this point, there exists an asymmetric neurological maturation through childhood-adolescence that translates different manifestations of anxiety along development, initially more related with external contemption and relationship with caregiver, but later with hormonal pulses, physical changes and separation from family.
Conclusions
The evolutive vision allows to understand development fluctuation of anxiety symptoms along the growth process, more accurately than categorical classic tendency.
Concomitant presence of obsessive-compulsive symptoms(OCS)is relatively frequent in psychotic patients and there are different hypotheses trying to explain the origin of them as pathology evolution,comorbid disorder,defence mechanism,or even a medication side-effect,but it is difficult to make a precise evaluation of these symptoms and the mechanisms involved.SometimesOCS are the first manifestation toappear without any other areas affected,and psychotic disorder comes later with initial symptoms in that domain.
Objectives
Evaluate the association between OCS and psychosis to document pathogenia of both entities.
Methods
A bibliographic search was performed about this topic.We present two cases of patients that have been referred to our unit: A34year old man, a usual consumer of cannabis,who shows checking and organizing compulsions that interfere significantly with their life.Consumptions grew progressively until they became daily,trying to decrease partly this behaviour. He comes to an addiction unit where he achieves abstinence,but immediately shows an important functional-impairment, adding to the previous compulsions new ones,and also thought blocking,social retraction and personality change. He starts taking antidepressant and benzodiazepines to reduceOCS, and weeks later begins a manic episode with delusions as a bipolar-disorder debut. A29year old man, with a history of familiar obsessive personality,that begins to worry about physical appearance and starts compulsive behaviour focused on exercise preventing him from daily activities.No response to antidepressants, he started antipsychotics and develop referential-symptoms.
Results
Both are atypical presentations of bipolar and schizophreniform disorders withOCS,where the beginning of treatment causes psychosis-symptoms not previously developed.
Conclusions
Frequent doubts are what factors determine the eclosion.The triggers are not clear and neither the related-pathology.
The need for preventive mechanisms in psychiatric pathology has been raised, therefore authors talk about primary, secondary and tertiary prevention. However, this emphasis on those preventive aspects has tended to ignore an essential part: quaternary prevention.
Objectives
Reflecting the importance of avoiding ignoring iatrogenic forms of psychopathology by studying a clinical case and reviewing available literature.
Methods
We will present a clinical case of a patient with residual schizophrenia who undergoes an escalation of pharmacological interventions that lead to functional deterioration after initiating behavioral alterations. We will also review available literature about quaternary prevention.
Results
M. is an institutionalized patient who was taking a combination of three neuroleptics, anxiolytics and stabilizers for the treatment of behavior problems such as heteroaggressiveness. When the patient was referred to psychiatry consultations after being hospitalized, he could not move, had lost sphincter control and had serious communication problems. However, treatment was suspended and only one neuroleptic was maintained. The patient regained sphincter control and kept a residual but communicative delusional speech.
Conclusions
It is important to see how sometimes we can get into therapeutic escalation without correcting the underlying problem by focusing on a symptom, because behavioral alterations will persist regardless of pharmacological treatment changes. Sometimes clinical fluctuations make us confuse basal state and decompensation, ignoring the fact that we lack the way to modify the course. Authors believe that a rational approach to treatment should take into account the balance between potential benefits and side effects applied to an individual patient.
Most mental disorders tend to relapse (severe or mild pathologies such as anxiety or dystima disorders), which are potentially recoverable and yet, tend to evolve poorly, persisting residual symptoms without achieving a complete recovery.
Objectives
The objective of this paper is to analyze the factors that influence process of recurrence and chronification, among which are our own therapeutic interventions.
Methods
A bibliographic search was performed from different database (Pubmed, TripDatabase) about the iatrogenic potential of our intervention (psychopharmacological or psychotherapeutic), analyzing influence and mechanisms involved, and the way to prevent them.
Results
Anxiety is a necessary element for the development of people, both from a biological perspective (natural and adaptive psychological response that allows us to respond adequately to possible threats); as an evolutionary psychological (element involved in conflict resolution, in turn necessary for personal development). It would be a mistake to consider it as pathological and try to eliminate it through medication or psychotherapy, since we could interfere with the natural recovery processes, contributing to its chronification and preventing possibility of change. At times, anxiety can be pathological when it occurs disproportionately and exceeds ability to adapt, but we must not eliminate it but to study origin and factors involved, to achieve complete resolution.
Conclusions
In conclusion, we must consider possible iatrogenesis of our therapeutic interventions in process of chronification of mental disorders and try to avoid them by adequately studying individual factors and characteristics, before intervening.
In order to understand etiopathogeny of any mental illness, it is important to be aware of the sequential emergence of symptoms, having presentations, that appear before, after or simultaneously. We could understand mental pathology as the sumatory of different factors and vulnerable cerebral substrates. Adverse external factors influence over them, causing relapses, that would lead to the evolution of diagnosis through time. However,patients usually come when pathology is already developed. Interventions are delayed, what is insufficient to modify the course of the illness.
Objectives
Proving that replacing classic clinical evaluation by an open access/multiintervention model, would determine a better prevention and reduction of relapse tendency.
Methods
We have arranged a prospective descriptive study of 124 users along 2 years. The idea was to test a first sample which let us check the viability of our project. We adopted a qualitative approach, linking practice and research, which have implied to perform a structured clinical process based on a dynamic reevaluation performed for different professionals in various stages using Rodman’s model.
Results
MultiIntervention model reduces the prognosis factor of delayed treatment thanks to reaching a high risk group in the early stages. That model allows us to determine the way each factor relates to each other, what facilitates multiple-intervention that tries to eliminate the symptom and also the relapse.
Conclusions
Late adolescence and early adulthood are stages in which many mental disorders start, however treatment delays some years. Rothman’s model may be a useful tool, what means a multiintervention treatment that mixes biological and psychosocial interventions.
SARS-CoV-2 is having an important direct impact, and also due to treatments used such as corticosteroids. Among its effects, we have focused on psychosis.
Objectives
The objective of this paper is to study, from following case, incidence of steroid-induced psychosis in context of COVID-19.
Methods
A bibliographic search was performed from different database (Pubmed, TripDatabase) about psychiatric symptoms associated with use of corticosteroids during pandemic. 64-year-old woman with no psychiatric history, who is hospitalized for pneumonia secondary to SARS-Cov2 and treated with antibiotics, bronchodilators, and corticosteroids. At 4 days she began with injury and nihilistic delusions. The corticosteroids were progressively reduced, adding 2.5 mg Risperidone, resolving after ten days.
Results
Corticosteroids are currently being used to treat the systemic inflammatory response associated with COVID-19, but they can produce other effects such as psychiatric symptoms (3-6%): 75% affective (mainly hypomanic symptoms); and 25% psychotic. Steroid-induced psychosis are characterized by confusion, delusions, and hallucinations, and they usually begin 3-4 days after onset, and resolve within a week. They are associated especially with oral systemic steroids and high doses: 1.3% with 40mg of prednisone, and 18% with 80mg; increased this incidence due to the greater use that is being made to treat COVID-19 and the higher doses used in severe cases (up to 120 mg).
Conclusions
To conclude, we need to know characteristics of these episodes in order to be able to prevent and treat them properly (minimum effective dose and less time), since they will probably occur more frequently at this time.