Acute Disorders Research Articles

Title: The ameliorative role of Camellia sinensis extract against spleenʼs extra-medullary hematopoiesis in acute myeloproliferative disorder model in rats: Histopathological study

Title: The ameliorative role of Camellia sinensis extract against spleenʼs extra-medullary hematopoiesis in acute myeloproliferative disorder model in rats: Histopathological study

A rare neurological complication of COVID-19: Pediatric Miller Fisher Syndrome. A case report

The SARS-CoV-2 pandemic has significantly transformed the world. While it was initially viewed as a respiratory virus, it has now been found to cause cardiovascular, gastrointestinal, and psychological complications. Moreover, the nervous system (NS) is also greatly affected. Research has identified dizziness, headaches, as well as disturbances in one's taste and smell abilities as the most frequent symptoms of NS involvement. Even more significant changes may occur in patients who get infected with SARS CoV-2, such as the development of acute cerebrovascular disorders (stroke), multiple sclerosis, acute disseminated encephalitis, Guillain-Barré syndrome, encephalitis, and myelitis. It is important to note these potential complications and monitor patients closely. A retrospective study conducted in Wuhan, China revealed that CNS (central nervous system) involvement occurred three times more frequently than PNS (peripheral nervous system) involvement. This emphasizes the critical importance of studying and describing CNS manifestations. This case report depicts Miller Fisher syndrome in a 5-month-old infant after SARS CoV-2 infection and explores literature on pediatric cases and potential pathogenic mechanisms.

USING INTRAVENOUS IMMUNOGLOBULIN IN A PATIENT WITH SEPTIC SHOCK AND MULTIPLE COMORBIDITIES: A REVIEW BASED ON A CLINICAL CASE

The review focused on managing sepsis and septic shock patients by administering intravenous immunoglobulins (IVIG). Treatment outcomes and survival prognosis of septic patients were discussed in view of different regimens and dosages of IVIG. The principles of determining the appropriate dosage of IVIG in different medical facilities were compared. Own clinical case of complex treatment of septic shock using IVIG was proposed. The patient experienced a septic shock after transurethral resection of the prostate to treat a prostate abscess. Additionally, the patient was diagnosed with acute cerebrovascular disorder and various cardiovascular ailments, including type 2 diabetes mellitus and stage 2 chronic kidney disease. This septic patient was diagnosed with immunodeficiency disorder with lymphopenia, hypoproteinemia, procalcitoninemia, and significant secondary autoimmune inflammatory disorders. Despite the expected unfavorable prognosis, after comprehensive treatment with early application of moderate doses of IVIG, the patient’s condition stabilized, and organ functions remained satisfactory. Therefore, early administration of intravenous immunoglobulin had a favorable clinical outcome in the treatment of septic shock, thereby indicating the need to utilize a multidisciplinary approach, including involving an immunologist, in managing septic conditions.

Thrombotic and hemorrhagic complications in COVID-19.

Background. In some cases, a new coronavirus infection demonstrates non-standard clinical manifestations, an integral characteristic of which is a tendency to thrombotic and hemorrhagic complication.Objective. To study the predisposing factors for the development of thrombotic and hemorrhagic complications in patients with COVID-19.Design and methods. The work was based on observations of 403 patients who were hospitalized for pneumonia of viral etiology (COVID-19). The features of comorbid pathology, markers of inflammation and coagulation, characteristics of the identified complications in the main group (75 people who had thrombotic and hemorrhagic complications) were prospectively collected in comparison with the control (328 patients), where no such consequences were detected.Results. There were no significant differences between the groups in terms of age and gender. In the main group, a large number of overweight patients were registered in comparison with the control. The levels of CRP, ferritin, and D-dimer in patients with complications significantly exceeded the reference values more often. Among the complications, spontaneous hematomas, gastrointestinal bleeding, acute cerebral circulatory disorders, acute myocardial infarction and venous thromboembolic complications were recorded.Conclusion. In patients with thrombotic and hemorrhagic complications of COVID-19, the level of markers of the inflammatory process (CRP, ferritin) increases. These negative consequences are most characteristic for patients with chronic kidney disease, severe hypertension, COPD and generalized atherosclerotic process (myocardial infarction, stroke).

Temporomandibular disorders: Definition and etiology

Temporomandibular disorders (TMDs) are a group of musculoskeletal conditions affecting the masticatory system and which are best defined based on symptoms and signs reflective of the underlying disease process. Etiology – the cause of disease – is best considered as risk determinants due to the complexity of TMDs in terms of the broad range of factors that place an individual at risk for initial development of a TMD and at risk for transition from an acute disorder to a chronic disorder. Identified risk determinants act together in unique patterns across individuals; notably, painful TMDs seldom occur in isolation of other risk determinants. While occlusal characteristics have been proposed as a primary etiology for TMDs, the evidence remains weak and unconvincing. In contrast, the evidence is strong for a wide range of intersecting factors to act as risk determinants for initial onset of a painful TMD, and which contribute further when pain becomes chronic due to bidirectional relationships between a primary pain condition and its risk determinants. These include overuse behaviors, pain sensitivity, psychological distress, injury, and the presence of other health and pain disorders. Overall, the evidence points to TMDs as system level disorders residing within a person at risk due to any of these identified risk determinants, and when more than one is present, the risk increases substantially. This complexity requires evolved standards of care for evaluation and treatment of the identified risk determinants based on available evidence.

NOVEMA® NIGHT (diphenhydramine + naproxen) in patients with pain and insomnia: results of a multicenter non-interventional observational study

Pain and sleep disorders are interrelated problems that significantly affect patients’ quality of life (QoL) and daily functioning.Objective: to evaluate the efficacy and safety of the use of the combination of diphenhydramine + naproxen (NOVEMA® NIGHT) in patients with acute pain syndrome or exacerbation of chronic pain syndrome and sleep disorders.Material and methods. The study included 4365 outpatients with acute pain (musculoskeletal pain, post-traumatic pain, headache) and sleep disorders who took naproxen 275 mg, 1 tablet in the morning and diphenhydramine 25 mg + naproxen 220 mg (NOVEMA® NIGHT) for 5 days before bedtime. Pain intensity, using a visual analogue scale (VAS), and sleep disorders were assessed before and after treatment; QoL was assessed after treatment using a five-point scale.Results. During treatment, a reduction or complete regression of pain was observed in 92% of cases (60 [50; 61] points on the VAS before treatment versus 10 [0; 20] after treatment; p<0.0001) and normalisation of sleep in most patients: faster falling asleep – in 81% (χ2=9650.2; p<0.0001), an increase in total sleep duration – in 75.5% (χ2=7351.2; p<0.0001), a decrease in the number of nocturnal awakenings – in 84% of patients (χ2=10,568; p<0.0001). At the end of treatment course, the majority of patients rated their quality of life as 4 out of 5 possible points (4 [4; 5]): 41% of patients – “high quality of life”; 48% – “above average”; 11% – “average”; 0.09% – “below average”). None of the patients had a low QoL. The therapy was well tolerated and no patient discontinued treatment due to adverse events (AEs).Conclusion. Short-term treatment (5 days) with naproxen 275 mg and a combination of diphenhydramine 25 mg + naproxen 220 mg (NOVEMA® NIGHT) at bedtime effectively reduces the pain syndrome associated with insomnia. This therapy significantly improves patients’ QoL and has a low risk of AEs, so that we can recommend NOVEMA® NIGHT as an additional analgesic for patients with concomitant sleep disorders.

Clinical Applications of Virtual Reality in Musculoskeletal Rehabilitation: A Scoping Review.

(1) Background: VR is based on a virtual world that creates sounds effects and videos that replace the real environment. Arising literature shows VR efficacy in the field of neurological rehabilitation (NR) and that its use is also taking a place in musculoskeletal rehabilitation (MSR), as a treatment of various disorders that cause disability and chronic pain. (2) Aim: We discuss the role of VR in MSR, presenting its use and development on acute and chronic musculoskeletal disorders, based on the most recent literature. (3) Design and Methods: Literature searches were conducted in the databases Pubmed and Medline up to 30 September 2023. The PRISMA-Scr Checklist was followed. (4) Results: A total of 51 records were included. The analysed studies were conducted within a variety of populations, musculoskeletal disorders, settings, and VR technologies. Only a few studies could statistically affirm the efficacy of VR in MSR, as mentioned for the rehabilitation of the upper limb. Nevertheless, the observed trend is an improvement of the global perceived effect compared to traditional rehabilitation. (5) Conclusion: VR allows for the personalisation of treatment with an adaptable treatment platform, which may improve the participation of the patient and increase acceptability and adherence to long-term rehabilitation programs. We provide recommendations and suggestions for future research and use of VR in musculoskeletal rehabilitation.

Targeting Dysregulated Neuroinflammation in CNS Disorders

A critical mechanism driving neurodegenerative disease progression is dysregulated brain inflammation. Neuroinflammatory repair processes are fundamental to CNS homeostasis, but inflammation that is inefficient, excessive, or prolonged can contribute to neurodegeneration. A specific aspect of neuroinflammation, stressor-induced proinflammatory cytokine overproduction from abnormally activated glia, has been linked to subsequent neurological damage and cognitive deficits in both acute and chronic CNS disorders. This cytokine/synaptic dysfunction axis (Fig. 1) has emerged as an attractive druggable target for neurodegenerative diseases. However, despite advances in our understanding of these molecular neuroinflammatory mechanisms, approved therapeutics that target this pathological process are lacking. To address this need, we used an integrated, recursive drug discovery platform (Fig. 2) to develop brain-penetrant, small molecule drug candidates that normalize cytokine levels and exhibit efficacy at low doses in multiple animal models of CNS disorders. The molecule design stage began with a pyridazine chemotype that was diversified using established chemistries to create a library of compounds. Compounds were screened for concentration dependence and selectivity using either a single molecular target approach or the historically successful functional/pathway-based approach. A pharmacology assessment stage was incorporated to assess compounds for drug-like properties, such as chemical and metabolic stability, CNS penetrance, and potential for safety. Prioritized compounds were then tested in relevant animal models, and the most promising drug candidates taken into formal IND-enabling preclinical testing. The platform yielded three clinical drug candidates, MW150, MW151, and MW189, that are all in human phase 1b/2a clinical trials.

Chronic kidney disease in patients with long-term type 1 diabetes mellitus

BACKGROUND: Patients with type 1 diabetes mellitus (T1D) have an earlier age of onset and a longer course of the disease, already by middle age they have the development of microand macrovascular diabetic complications that reduce the quality and duration of life.AIM: To evaluate the prevalence of chronic kidney disease (CKD) and other late complications of T1D depending on renal dysfunction in the population of patients with T1D with disease duration of 20 and more years, who underwent examination and treatment in Endocrinology Research Centre.MATERIALS AND METHODS: A one-stage single-center epidemiological non-randomised study was conducted using the database of Endocrinology Research Centre with the study of 500 patients’medical histories with long-term T1D (20 years and mores), without kidney damage and with CKD at different stages (CKD C1–C5, C5D, after transplantation), examined and treated from 2011 to 2023.RESULTS: Normal renal function was observed in 10.8% of patients (n=54). Terminal stage of CKD was reached in 28.0% (n=140), of which 12.4% were on renal replacement therapy with program hemodialysis (RRT-HD), and 12.0% after isolated kidney transplantation or combined kidney and pancreas transplantation, the rest were at different stages of CKD. Normoalbuminuria was observed in 15.4% (n=77) among 500 patients. The prevalence of late complications of DM among the examined patients was high and increasing with the progression of renal dysfunction: diabetic retinopathy was diagnosed in 96% of patients, distal symmetrical polyneuropathy — in 97% of patients, various forms of autonomic neuropathy — in more than half of patients. About 60% of patients had diagnosed arterial atherosclerosis in the legs, about one third — atherosclerosis of brachiocephalic arteries, 23% — confirmed coronary heart disease, and suffered cardiovascular events (myocardial infarction, acute cerebral circulation disorder) — 19% of patients, about half of whom had CKD of different severity. Factors for increased risk of cardiovascular disease: estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2, OR=7.1; 95% CI 3.6–8.4; p<0.001), eGFR <30 mL/min/1.73m2 OR=8.7; 95% CI 2.8–8.4; p<0.001), eGFR <15 mL/min/1.73m2 OR=14; 95% CI 6.3–31.3; p<0.001); albuminuria > 30 mg/g OR=2.4; 95% CI 1.6–3.6; p<0.001), dialysis OR=14.1; 95% CI 6.2–32.1; p<0.001), kidney transplant OR=11.7; 95% CI 5.4–24.9; p<0.001). Manifestation of T1D between 1996–2002 reduced the risk of developing CKD by 10.75; 95% CI 4.37; 27.03) vs manifestation of T1D earlier. Age of T1D debut 6–17 years increased the risk of reaching terminal CKD vs age of debut >18 years: OR=2.4; 95% CI 1.22; 5.022; p=0.012).CONCLUSION: Despite a significant reduction in the risk of developing CKD in individuals with T1D debut between 1996 and 2002, renal dysfunction is a frequent complication in patients with a long disease course, combining with other late complications and contributing to a high risk of terminal stage of CKD and cardiovascular events. Early age of T1D debut increases the risk of terminal CKD.

EFFECTIVENESS OF PHYSIOTHERAPY FOR MUSCO-SKELETAL DISORDERS AND THE ROLE OF REMOTE PHYSIOTHERAPEUTIC INTERVENTIONS

For patients with musculoskeletal diseases, physiotherapy is a safe and efficient treatment option that can help them manage their symptoms and enhance their health. In primary care, physiotherapists aid in the diagnosis, cure, and manage of a broad spectrum of acute and chronic disorders, as well as promote physical exercise, mobility, and function. Physiotherapists in basic medical teams maximize patients’ mobility in accordance with their lifelong needs. This brief study emphasizes the significance of musculoskeletal disorders treatable with physiotherapy. Physiotherapy interventions, when delivered remotely through e-Health platforms, have gained prominence as accessible and effective tools for managing musculoskeletal conditions. These interventions provide patients with valuable resources for self-management, while greatly used to improve everyones quality of life. At the same time, helping to moderate the challenges that this load can create on healthcare systems. The use of telehealth in physiotherapy offers opportunities for personalized care, continuous monitoring, and the implementation of evidence-based interventions. The relevancy of this approach is mainly noticed when put in the context of the COVID-19 pandemic, where the need for remote healthcare delivery has become paramount. Telehealth allows patients to receive timely care and support while adhering to social distancing guidelines. The concept of adherence to eHealth technology in physiotherapy is crucial for ensuring the success of remote interventions. Understanding when and how patients engage with eHealth platforms can guide the development of more effective interventions. It is essential to explore factors that influence patient adherence to technology-driven physiotherapy interventions to optimize their benefits. As healthcare systems worldwide face increasing demands, the implementation of remote physiotherapeutic e-Health interventions can help alleviate the burden by offering scalable and cost-effective solutions. These interventions have the potential to reach a broader patient population and improve access to care for individuals with musculoskeletal disorders. The evaluation of the effectiveness of these remote interventions is essential to provide evidence-based guidance for their integration into clinical practice. By conducting systematic reviews and meta-analyses, researchers can contribute valuable insights into the outcomes and impact of telehealth-based physiotherapy on pain management and overall patient well-being.

Exosomal microRNAs: implications in the pathogenesis and clinical applications of subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) is a severe acute neurological disorder with a high fatality rate. Early brain injury (EBI) and cerebral vasospasm are two critical complications of SAH that significantly contribute to poor prognosis. Currently, surgical intervention and interventional therapy are the main treatment options for SAH, but their effectiveness is limited. Exosomes, which are a type of extracellular vesicles, play a crucial role in intercellular communication and have been extensively studied in the past decade due to their potential influence on disease progression, diagnosis, and treatment. As one of the most important components of exosomes, miRNA plays both direct and indirect roles in affecting disease progression. Previous research has found that exosomal miRNA is involved in the development of various diseases, such as tumors, chronic hepatitis, atherosclerosis, diabetes, and SAH. This review focuses on exploring the impact of exosomal miRNA on SAH, including its influence on neuronal apoptosis, inflammatory response, and immune activation following SAH. Furthermore, this review highlights the potential clinical applications of exosomal miRNA in the treatment of SAH. Although current research on this topic is limited and the clinical application of exosomal miRNA has inherent limitations, we aim to provide a concise summary of existing research progress and offer new insights for future research directions and trends in this field.

Predictors of transition to schizophrenia and other long-lasting non-affective psychoses in first-episode patients with acute and transient psychotic disorders: A validation study

Background and objectivesAlmost half of the individuals with a first-episode of psychosis who initially meet criteria for acute and transient psychotic disorder (ATPD) will have had a diagnostic revision during their follow-up, mostly toward schizophrenia. This study aimed to determine the proportion of diagnostic transitions to schizophrenia and other long-lasting non-affective psychoses in patients with first-episode ATPD, and to examine the validity of the existing predictors for diagnostic shift in this population. MethodsWe designed a prospective two-year follow-up study for subjects with first-episode ATPD. A multivariate logistic regression analysis was performed to identify independent variables associated with diagnostic transition to persistent non-affective psychoses. This prediction model was built by selecting variables on the basis of clinical knowledge. ResultsSixty-eight patients with a first-episode ATPD completed the study and a diagnostic revision was necessary in 30 subjects at the end of follow-up, of whom 46.7% transited to long-lasting non-affective psychotic disorders. Poor premorbid adjustment and the presence of schizophreniform symptoms at onset of psychosis were the only variables independently significantly associated with diagnostic transition to persistent non-affective psychoses. ConclusionOur findings would enable early identification of those inidividuals with ATPD at most risk for developing long-lasting non-affective psychotic disorders, and who therefore should be targeted for intensive preventive interventions.

Analysis and treatment workflow of modified seven-step approach for acute respiratory and circulatory disorders

Acute respiratory and circulatory disorders are the most common critical syndromes, the essence of which is damage to the organs/systems of the heart and lungs. These comprise the essential manifestation of disease and injury progression to the severe stage. Its development involves the following components: individual specificity, primary disease strike, dysregulation of the host's response, and systemic disorders. Admission for acute respiratory and circulatory disorders is a clinical challenge. Based on a previously proposed flow, a critical care ultrasound-based stepwise approach (PIEPEAR) as a standard procedure to manage patients with acute cardiorespiratory compromise and practical experience in recent years, a modified seven-step analysis and treatment process has been developed to help guide clinicians with rational thinking and standardized treatment when faced with acute respiratory and circulatory disorders. The process consists of seven steps: problem-based clinical analysis, intentional information acquisition, evaluation of core disorder based on critical care ultrasound, pathophysiology and host response phenotype identification, etiology diagnosis, act treatment through pathophysiology-host response and etiology, and re-check. The modified seven-step approach is guided by a "modular analysis" style of thinking and visual monitoring. This approach can strengthen the identification of clinical problems and facilitate a three-in-one analysis. It focuses on pathophysiological disorders, body reactions, and primary causes to more accurately understand the condition's key points, and make treatment more straight forward, to finally achieve the aim of "comprehensive cognition and refined treatment".

Diagnosing and treating acute myelopathies in dogs and cats

Background: A variety of acute spinal cord disorders (myelopathies) can occur in dogs and cats. Understanding the typical clinical presentation and examination findings of the most common acute myelopathies is the key to formulating an accurate diagnostic and treatment pathway in clinical veterinary practice.Aim of the article: This article describes the characteristic clinical features for the most common acute myelopathies in dogs and cats, as well as outlining a diagnostic approach and important treatment considerations to achieve a successful outcome.

MORPHOLOGICAL ASPECTS OF STATIC-LOCOMOTOR FUNCTION DISORDERS IN CHRONIC CEREBRAL ISCHEMIA

In our studies, the predominance of the proportion of chronic vertebral-basilar insufficiency in women was found. Men were significantly more likely to have acute brain disorder in the vertebral-basilar sistem. In persons younger than 50 years, no ischemic strokes were detected in 87% of cases, this indicator decreased by half at the age of 50 to 60 years and remained in persons older than 60 years. Thus, the most vulnerable age period in relation to the development of stroke is the age over 52.6 years. According to WHO statistics, more than 15 million cases of stroke are registered annually in the world, of which more than 30% die within a year, more than 80% become disabled.

How potentially inapropriate are psychotropic drugs prescribing in acute psychiatric unit for the elderly? Results from a large multicentric audit in France

Adverse drug reactions (ADRs) are a major public health issue, especially when it comes to the elderly. Potentially inappropriate prescribing (PIP) are one of the causes of ADRs in older people. A PIP can be defined as a prescription for which the benefit/risk ratio is unfavourable compared to other therapeutic alternatives. Psychotropic drugs are the second highest risk class for ADRs in the elderly. In order to reduce the prevalence of PIP, prescription assistance tools have been created. An inventory of PIP of psychotropic drugs in older patients hospitalized in psychiatry units was carried out in a French regional setting in 2019. A criteria grid was established based on 2 tools: STOPP/START criteria and Laroche's list adapted to French practice. This grid targeted each class of psychotropic drugs, drugs with a high anticholinergic burden and non-recommended combinations of psychotropic drugs. Three hundred forty-seven patients were included. A high prevalence of PPI was found for each class of psychotropic drugs. The highest prevalence of PPI was found among benzodiazepines (90.3%): long-term prescription, long half-life drugs, respiratory insufficiency or cognitive impairment condition. 56.5% of the subjects had a not-recommended combination of psychotropic drugs (prescription of drugs of the same pharmacotherapeutic class), 26% had a PIP of antipsychotics: prescription for insomnia, use of phenothiazine, 11.8% of drugs with anticholinergic properties and 7.4% of antidepressants: especially prescription of tricyclic drugs. These results obtained on a large population underline the interest of considering the specificities of prescriptions in the elderly. It shows both the interest and the limits of the current criteria defining the PIP in the context of a hospitalization in psychiatry for an acute disorder in elderly subjects.

Multipotent mesenchymal stromal cells of various origins reduce reactive gliosis in the hippocampal CA1 area during acute ischemia-reperfusion of the rat brain

Neuroprotective therapy in acute cerebrovascular disorders is directly aimed at preserving neurons in the penumbra zone, but it also emphasizes the importance of gliogenesis in the affected area. Glial cells exhibit rapid reactivity and are highly sensitive to cerebral ischemic damage. Recent experimental studies have demonstrated the successful application of multipotent mesenchymal stromal cells (MMSCs) in stroke to modulate microglial activation. The aim of the study was to investigate the impact of MMSCs of different origins, MMSC lysate, and citicoline on glial components in a model of cerebral ischemia-reperfusion in rats. Materials and methods. The experiments were conducted on 190 male Wistar rats aged 4 months, weighing 160-190 g. After modeling cerebral ischemia-reperfusion through bilateral 20-minute occlusion of the internal carotid arteries, rats were intravenously administered MMSCs derived from human Wharton’s jelly, human adipose tissue, and rat Wharton’s jelly at a dose of 106 cells per animal. Other groups received fetal rat fibroblasts (106 cells/animal in 0.2 ml of physiological solution) and lysate from human Wharton’s jelly at a dose of 0.2 ml per animal. Control animals received 0.2 ml of physiological solution intravenously. The last group of rats received a single dose of the reference drug citicoline at a dose of 250 mg/kg. On the 7th and 14th days, the area and fluorescence intensity of cells expressing markers of astrocytes (GFAP), microglia (Iba1), and oligodendrocytes (Rip) were quantitatively assessed in CA1 hippocampal region slices using immunohistochemical examination and confocal microscopy. Results. On the 7th and 14th days after cerebral ischemia-reperfusion in rats, the intensity of fluorescence of GFAP-positive astrocytes and Iba1-positive microglial cells increased, indicating pronounced reactive astrogliosis and microglial activation in the CA1 region of the hippocampus. Meanwhile, ischemia-reperfusion had a significant impact on the content of Rip-positive oligodendrocytes in brain slices. The application of all treatments (transplantation of MMSCs of different origins, their lysate, or the reference drug citicoline) had a cytoprotective effect, reducing reactive astrogliosis and microgliosis both on the 7th and 14th days after injury. The best result was demonstrated with the treatment using MSCs from human Wharton’s jelly.s. Conclusion. Cerebral ischemia-reperfusion induces reactive gliosis through the activation of GFAP- and Iba1-positive glial cells in all layers of the hippocampus. The application of MSCs from human Wharton’s jelly and fetal rat fibroblasts significantly reduces its intensity on both the 7th and 14th days after injury modeling.

Descriptive Epidemiology of Mental Illness and Epilepsy at the Psychiatric Hospital of Bouaké (Ivory Coast)

Mental illness is a public health problem worldwide. As in some African countries, epidemiological data are insufficient in Côte d'Ivoire. After more than ten years of socio- political crisis, an update of the data was necessary for a better psychiatric assistance in the region of Gbêkê strongly impacted during this period. Objective: The objective of this work was to study the mental disorders observed at the Psychiatric Hospital of Bouaké. Materials and method: This was a retrospective study with a descriptive aim, involving 550 files. Results: We noted a predominance of females (51%) residing in Bouaké with an age range between 15 and 34 years (52.9%), mostly single (56.9%). 61.3% of our sample was composed of subjects with a level of education lower than secondary school and who were not in employment (37.5%). As for psychiatric pathologies, depression was the most common (21.6%), followed by acute and transient psychotic disorders (18.4%), then schizophrenia (13.1%) and epilepsy (12.2%). These results prompted a study on the evaluation of the therapeutic management of mental patients at the psychiatric hospital in Bouaké.

Emerging Novel Diagnostic Measure: Prothrombin Fragment 1+2

One potential useful tool for diagnosing thrombosis is the prothrombin fragment 1+2 (PF1+2) that is generated when factor Xa cleaves prothrombin. The realisation that thrombosis plays a critical role in the genesis of vascular diseases has generated growing interest in the relationship between PF1+2 and clinical characteristics. The goal of the current review is to stimulate more translational and clinical research on this topic by offering an up-to-date update on the studies investigating whether PF1+2 measurements may be utilised as a diagnostic technique for vascular disorders. Hence; we performed a comprehensive review to describe the reports of elevated PF1+2 levels in venous thromboembolism, inflammation, cancer, sepsis, acute coronary syndromes, stroke, atrial fibrillation, rheumatoid arthritis, liver and kidney disorders, and in the post-operative period. Systematic searches in the English language were conducted in the Pubmed database. It may also be useful in assessing the efficacy of different treatments, in addition to its potential prognostic and diagnostic value. Although, elevations occur in the presence of overt thrombosis as well as the hypercoagulable state. However, to date, little is known about the diagnostic accuracy of the cut-off level to be employed for the definition of elevations. Therefore, additional research is necessary to develop a non-invasive technique for the evaluation of PF1+2 levels in the laboratory in order to predict prognosis in a variety of vascular disorders. This review comprises the clinical application of PF1+2 in hemorrhagic and cardiovascular diseases.

Increasing Palliative Care Team Involvement in Pediatric Hematopoietic Stem Cell Transplant Patients

Background/Objectives: Palliative care facilitates communication, helps with physical and psychological symptom management, and assists in goals of care and advance care planning discussions. Multiple organizations including the World Health Organization, American Academy of Pediatrics and the American Society of Clinical Oncology encourage palliative care involvement. Palliative care involvement with hematopoietic stem cell transplant (HSCT) patients has been shown to be beneficial as HSCT is associated with a high degree of morbidity and possible mortality. We sought to increase the frequency of palliative care consultations for patients planning to undergo HSCT for targeted diagnoses. The outcome measure was percentage of patients who underwent HSCT for a targeted diagnosis who had a Palliative Care Team (PaCT) consult. Baseline data revealed 48 patients underwent HSCT from July 2020 to July 2022, 25 of whom had a targeted diagnosis. PaCT met 12 of the 25 patients (48%). Our goal is to increase the number of PaCT consults for patients receiving HSCT for our targeted diagnoses from 48% to 75% by December 2023. Methods: Chart review was conducted for patients who underwent HSCT from July 2020 to July 2022. Demographics documented included reason for HSCT, if PaCT was consulted, date of transplant, date of PaCT consult and living status. A targeted diagnosis list was compiled based on which patients were felt to benefit most from palliative care involvement: relapsed or refractory leukemias and lymphomas, myelodysplastic syndrome, high risk acute myeloid leukemia and metabolic disorders, such as Hurler syndrome. The first plan-do-study-act (PDSA) cycle included discussion of the project at division meetings, posting flyers in the clinic provider workrooms, and education regarding palliative care and evidence of its involvement in HSCT patients. The second PDSA cycle implemented involved revision of the HSCT referral form to include the question “Is PaCT consulted.” If the provider answers “no,” further elaboration is requested. Results: From 1/1/23 to 7/31/23 ten patients with a targeted diagnosis underwent HSCT. Five patients (50%) received a PaCT consult prior to HSCT. Conclusions: Palliative care involvement in pediatric oncology is well established, but its role in HSCT patients continues to be explored. As HSCT patients receive more intense therapy, have frequent deaths in intensive care units and can have limited opportunity for end of life planning due to rapidly changing clinical courses, early integration of PaCT could allow for decreased symptom burden and distress for both patients and families. Future PDSA cycle interventions include adding PaCT consultation to the transplant evaluation order set in the electronic medical record and review of the comments on the completed HSCT referral forms to identify possible barriers in the PaCT consultation process.