Mental Status Changes Research Articles

Antibiotic Overprescription for "Urinary Tract Infections" Is Associated With Poor Diagnostic Stewardship and Low Adherence to Guidelines.

While urinary tract infections (UTIs) are thought to be common among women, as many as 65% of UTI diagnoses may be inaccurate. To identify strategies to improve antibiotic stewardship, we sought to determine the clinical and laboratory factors associated with overdiagnosis and overtreatment of UTIs. Electronic health records identified patients bearing an isolated diagnostic code for UTI within a single healthcare system during July 2019. Demographic, clinical, and microbial data were collected by manual chart review. Regression analyses were utilized to determine factors associated with guideline non-concordant UTI diagnosis and treatment utilizing R statistical software (version 4.3.1). In patients diagnosed with UTI, 64% were treated with antibiotics despite only 28% having symptoms consistent with UTI diagnostic criteria. Of patients diagnosed with a UTI who were treated in an emergency room (ER) setting, 95% were given antibiotics compared with only 55% of patients in an outpatient setting. Even without any urinary symptoms, 95% of patients in the ER and 27% of patients in outpatient settings were treated with antibiotics. Patients who presented to the ER for non-localizing symptoms, such as mental status changes (MSC), were more likely to be diagnosed with UTI compared with those in an outpatient setting. The results of this study demonstrate that patients were frequently diagnosed with and treated for a UTI despite not meeting diagnostic criteria. This pattern of overdiagnosis leads to overtreatment, particularly in acute care settings, contributing to worsening antibiotic resistance in conjunction with incomplete evaluation of patients' primary complaints.

Impact of War on Ukrainian University Students and Personnel: Repeated Cross-Sectional Study

This study aims to discern significant shifts in the impact of war on university students and academic personnel, from the war’s onset (March–April 2022) to eight months later (November–December 2022). Our research questions focus on the individual experiences affected by warfare, changes in mental health status, and factors accounting for these observed changes. This research is a repeated cross-sectional survey, conducted in two waves, in March and November 2022. Findings revealed a significant increase in the general fear of war (t(1018.4) = −9.79, p < .001), emotional and physiological reactions to war remained stable overall but escalated among those with relatives in the armed forces and decreased in subsets not experiencing significant shifts in well-being and emotional reactions to war. Burnout levels increased (t(723.2) = 2.06, p = .040), but decreased among those reporting no change in well-being due to the war. Results also reveal a significant increase in: being in blockade and/or under shelling (χ 2(1) = 12.737, p < .001); lost (χ 2(1) = 11.644, p < .001) and dead relatives (χ 2(1) = 14.248, p < .001); worsening of chronic diseases (χ 2(1) = 11.838, p < .001); relatives in armed forces (χ 2(1) = 889.360, p < .001). Conversely, resilience did not significantly increase, although a trend toward its improvement over time was observed. Given the unpredictable and prolonged nature of the conflict and changes in the impact of the war, our study shows that more regular follow-up studies are needed.

Ensuring continuity of care in times of crisis: A longitudinal analysis of dementia care delivery during armed conflict.

Individuals with dementia are particularly vulnerable during emergency situations due to challenges with cognition, mobility, and daily functioning. However, little is known about how disruptive events may specifically impact the health of those with dementia. To evaluate changes in health outcomes for individuals with and without dementia surrounding the Israel-Gaza war in October 2023. Specifically, we analyzed and compared changes in mental health status, medication adherence, healthcare service utilization, and associated costs between individuals with dementia (Study Group) and those without dementia (Control Group) during the period surrounding the Israel-Gaza war in October 2023. A prospective cohort study compared outcomes between individuals with dementia (Study Group, n = 24,178) and without (Control Group, n = 250,652) before and after the crisis onset. The conflict precipitously threw national systems into disarray, recruited healthcare personnel to the war effort, and disrupted supply chains. Compared to baseline, analysis revealed alterations in patterns of dementia diagnoses, healthcare service utilization, medication adherence, and associated costs during the crisis period for both groups. However, the Study Group experienced comparatively larger declines. Findings provide insights into how humanitarian emergencies, through disruption of health systems and care networks, differentially impact continuity of dementia care. This underscores the need for tailored crisis response strategies to address the heightened vulnerabilities of patients with dementia.

NE contribution to rebooting unconsciousness caused by midazolam

The advent of midazolam holds profound implications for modern clinical practice. The hypnotic and sedative effects of midazolam afford it broad clinical applicability. However, the specific mechanisms underlying the modulation of altered consciousness by midazolam remain elusive. Herein, using pharmacology, optogenetics, chemogenetics, fiber photometry, and gene knockdown, this in vivo research revealed the role of locus coeruleus (LC)-ventrolateral preoptic nucleus noradrenergic neural circuit in regulating midazolam-induced altered consciousness. This effect was mediated by α1 adrenergic receptors. Moreover, gamma-aminobutyric acid receptor type A (GABAA-R) represents a mechanistically crucial binding site in the LC for midazolam. These findings will provide novel insights into the neural circuit mechanisms underlying the recovery of consciousness after midazolam administration and will help guide the timing of clinical dosing and propose effective intervention targets for timely recovery from midazolam-induced loss of consciousness.

NE contribution to rebooting unconsciousness caused by midazolam.

The advent of midazolam holds profound implications for modern clinical practice. The hypnotic and sedative effects of midazolam afford it broad clinical applicability. However, the specific mechanisms underlying the modulation of altered consciousness by midazolam remain elusive. Herein, using pharmacology, optogenetics, chemogenetics, fiber photometry, and gene knockdown, this in vivo research revealed the role of locus coeruleus (LC)-ventrolateral preoptic nucleus noradrenergic neural circuit in regulating midazolam-induced altered consciousness. This effect was mediated by α1 adrenergic receptors. Moreover, gamma-aminobutyric acid receptor type A (GABAA-R) represents a mechanistically crucial binding site in the LC for midazolam. These findings will provide novel insights into the neural circuit mechanisms underlying the recovery of consciousness after midazolam administration and will help guide the timing of clinical dosing and propose effective intervention targets for timely recovery from midazolam-induced loss of consciousness.

The impact of distance learning on the health in schoolchildren (literature review)

Distance learning (Dl) is widespread in educational institutions. The COVID-19 epidemic has led to the transfer of only Dl to students in most countries of the world. However, the use of Dl is associated with a number of health risk factors. The purpose of the review is to study the impact of Dl on the health in schoolchildren. A literature search was conducted using PubMed and eLIBRARY.RU search engines. The initial search allowed identifying 21,745 reports, after an independent assessment by two experts, there are still 36 full-text publications containing original data on the impact on the health of schoolchildren. The analysis of the topics of publications allowed establishing all publications to be devoted to the study of the impact of Dl on the health of students during the COVID-19 epidemic, which does not allow differentiating the impact of Dl on health from the influence of self-isolation and fear of covid disease. Most studies do not compare the detected changes in health status during traditional training. The main complaints of students during Dl were complaints of painful sensations in the eyes, decreased vision, headache, back and neck pain, sleep disorders, largely associated with hygienically irrational learning conditions. The revealed changes in mental status (anxiety, depressive manifestations) are largely determined not by the presence of Dl, but by the influence of self-isolation and fear of covid disease. The transition to Dl also led to an increase in body weight in a number of students, a decrease in physical fitness. More pronounced changes in the state of health were noted in schoolchildren of junior classes. Conclusion. The identified adverse changes in the state of health in students can be minimized by the use of Dl in combination with traditional learning and compliance with hygienic requirements for its management.

Abstract 4139117: Epidemiology of Patients Undergoing a Rapid Response within the First 24 Hours of Admission at an Urban Academic Center

Introduction: A Rapid Response Team (RRT) is an inpatient team that aims to resuscitate deteriorating patients in non-critical care settings and reduce inpatient morbidity and mortality. It is not well understood which patients are likely to deteriorate and need a rapid response (RR) within the first 24 hours of admission. Research Question: We sought to identify the most common characteristics for patients who had a RR within 24 hours of admission. Methods: We performed a descriptive analysis evaluating 176 patients who had a RR called within 24 hours of admission to North Shore University Hospital from February 2022 to August 2023. Demographic and clinical variables were assessed, including medical history, admitting diagnosis, and indication for RR. Results: The median age of the population was 73 years; 92 (52.3%) were male, and 91 (51.7%) were white. The most common comorbidities were hypertension (119, 67.6%), coronary artery disease (51, 28.9%), and heart failure (34, 19.3%). Amongst these patients, acute hypoxic respiratory failure (11.6%) was the most common admission diagnosis followed by sepsis (9.7%) (Table 1). The most common reason for the RR was acute mental status change (26.1%) followed by hypotension (25.0%). Average time spent in the ED prior to admission was 6 hours 41 mins. Intensive care unit (ICU) consultation prior to the RRT occurred in 36 patients (20.5%) and 52 patients (29.5%) were transferred to an ICU while 124 (70.5%) remained on the medicine floors. Regarding hospital utilization, 98 (55.7%) patients were admitted within the last year and 47 (26.7%) patients were hospitalized within the last month. 14 (7.9%) patients had an ICU admission in the past year. 38 (21.5%) patients died during the admission post RR. Conclusion: In our cohort of RRs within 24 hours of admission, we observed a high prevalence of cardiac comorbidities and recent hospitalizations, a low prevalence of ICU consults prior to RR, and discordance between admitting diagnoses and reasons for RR. Further studies involving a larger cohort are needed to develop a prediction model for determining patients most at risk of deteriorating after admission and requiring RRs.

Dengue Encephalopathy, its Presentations and Outcome, A Study on 200 Dengue Encephalopathy Patients in Tertiary Level Hospitals in Bangladesh

Background: Dengue encephalopathy represents a severe neurological complication of dengue infection, yet comprehensive data from Bangladesh remains limited despite the country's high disease burden. Objective: To analyze the clinical characteristics, laboratory parameters, neuroimaging findings, and outcomes of dengue encephalopathy cases in Bangladesh, and to identify prognostic factors for adverse outcomes. Methods: This prospective observational study examined 200 cases of dengue encephalopathy across five tertiary care centers in Bangladesh from January 2020 to December 2023. Diagnosis was confirmed through NS1 antigen and/or dengue-specific antibody testing. Clinical features, laboratory parameters, neuroimaging findings, and outcomes were analyzed using standardized protocols. Results: The cohort (59% male; mean age 34.6±15.3 years) showed neurological manifestations at a median of 5.2 days post-fever onset. Common presentations included altered consciousness (100%), seizures (43%), and focal neurological deficits (27%). Significant neuroimaging findings were observed in 56% of cases, predominantly cerebral edema (28.5%) and meningeal enhancement (17%). ICU admission was required in 43% of cases. The overall mortality rate was 12%, while 71% achieved complete neurological recovery. Multivariate analysis identified GCS &lt;8 at admission (OR: 3.8, 95% CI: 2.1-6.9), presence of shock (OR: 2.9, 95% CI: 1.8-4.7), and platelet count &lt;20,000/µL (OR: 2.4, 95% CI: 1.5-3.8) as independent predictors of poor outcomes. Conclusion: Dengue encephalopathy in Bangladesh presents with distinct clinical patterns and carries significant mortality risk. Early recognition of prognostic factors, standardized management protocols, and adequate critical care support are crucial for improving outcomes. The findings provide a framework for managing similar cases in endemic regions and highlight areas for future research.

TOXIC ALCOHOL POISONING: A CASE REPORT

During the COVID-19 pandemic, toxic alcohol poisoning, notably from methanol, has emerged as a significant concern due to increased consumption of illicit liquor amidst lockdown restrictions. We present a case of a middle-aged man who developed altered consciousness, metabolic acidosis, and shock two days after ingesting hospital spirit. Although initial qualitative tests only detected ethanol, subsequent MRI findings showed classical signs of methanol poisoning, including basal ganglia abnormalities. Prompt management with dialysis, ventilatory support, and adjunctive therapy successfully addressed the acute phase despite the patient remaining delirious for seven days. This case underscores the importance of considering methanol toxicity even in the absence of direct evidence, necessitating comprehensive diagnostic approaches. Awareness and incorporating point-of-care assessments such as arterial blood gas analysis and osmolar gap evaluation in suspected cases are crucial, especially in resource-limited settings. Recognizing unexplained high anion gap metabolic acidosis with a high osmolar gap and characteristic MRI findings can aid in the early diagnosis and management of toxic alcohol poisoning

Diabetic Ketoacidosis as a Debut and Immune-Mediated Complication Caused by Pembrolizumab: Case Report

Background/Objectives: Diabetic ketoacidosis (DKA) is an acute and potentially life-threatening complication characterized by the accumulation of ketone bodies in the blood, primarily occurring in patients with type 1 diabetes and occasionally in those with type 2 diabetes under certain conditions. DKA presents with symptoms such as polyuria, polydipsia, polyphagia, and, in severe cases, mental status changes. Identifying the triggering factor is crucial to prevent complications and effectively manage this medical emergency. Methods: This report describes the case of a 58-year-old male patient with stage IIIb nodular melanoma, diagnosed in November 2022. Results: After receiving five cycles of pembrolizumab, the patient developed de novo DKA, presenting with blurred vision, asthenia, adynamia, polyuria, and polydipsia. He was admitted to the emergency department with a blood glucose level of 764 mg/dL, confirming hyperglycemia and metabolic acidosis. He was transferred to the intensive care unit for fluid resuscitation and insulin infusion. After adequate clinical evolution and meeting the criteria for DKA resolution, possible autoimmune endocrinopathies secondary to immunotherapy were considered. Due to this complication, the oncological treatment was changed. Finally, the patient was discharged with the need to continue insulin therapy and oral hypoglycemic agents, along with thyroid hormone supplementation. Conclusions: The novelty of this case lies in the presentation of DKA as an immune-mediated complication induced by pembrolizumab, highlighting the importance of closely monitoring patients receiving immune checkpoint inhibitors to detect and manage emerging autoimmune endocrinopathies. It is essential to adjust oncological treatment according to the patient’s response and promptly manage autoimmune endocrinopathies to improve clinical outcomes and the patient’s quality of life.

Severe Neurological Complications With Influenza in Vietnamese Children.

Influenza is a common contagious respiratory virus that primarily causes respiratory tract infections. Neurological complications associated with influenza have also been reported, mainly in pediatric populations, and may be fatal. A descriptive study evaluated pediatric patients who were diagnosed with severe influenza-associated neurological complications at the Tropical Pediatrics Center-Vietnam National Children's Hospital from October 2022 to February 2024. In this study involving 20 patients, 80% of children were under 5 years old; 70% of patients had a history of good health. All patients had not received an influenza vaccination within 12 months. The median time from onset to neurological symptoms was 1 day. The most common neurological complication was encephalitis (16/20 patients) with symptoms included altered consciousness and seizures. Most patients had elevated levels of ALT (60%), AST (90%), LDH (94%), and ferritin (69%) in serum. The imaging of brain damage on MRI and CT scans varied in patterns and locations. There was no difference in the timing of methylprednisolone treatment within and after 48 h. The mortality rate was 20%, with 45% of patients experiencing severe sequelae. IANCs are severe with damage to both white matter and central gray matter and can occur in healthy children, emphasizing the importance of vaccination to reduce the risk.

Beyond Glasgow Coma Scale: Prehospital prediction of traumatic brain injury

IntroductionEarly identification of traumatic brain injury followed by timely, targeted treatment is essential. We aimed to establish the ability of prehospital Glasgow Coma Scale score alone and combined with vital signs to predict hospital-diagnosed traumatic brain injury. MethodsThis study included adults from the 2017–2020 Trauma Quality Improvement Program data set with blunt mechanism. We calculated test characteristics of prehospital Glasgow Coma Scale score ≤12 alone and Glasgow Coma Scale score combined with heart rate and systolic blood pressure for predicting (1) any traumatic brain injury and (2) moderate to severe traumatic brain injury. Diagnostic performances were calculated in all patients and older adults (≥55 years). We used decision curve analysis to determine the net diagnostic benefit of prehospital Glasgow Coma Scale score combined with heart rate + systolic blood pressure over Glasgow Coma Scale score alone. ResultsOf 1,687,336 patients, 39.1% had any traumatic brain injury, 3.7% had moderate to severe traumatic brain injury, and 9.1% had a prehospital Glasgow Coma Scale score ≤12. Prehospital Glasgow Coma Scale score ≤12 alone had a sensitivity 83.1%, specificity 93.7%, negative predictive value 99.3%, and positive predictive value 33.7% for predicting moderate to severe traumatic brain injury. Adding prehospital heart rate <65/min and systolic blood pressure >150 mm Hg to Glasgow Coma Scale score ≤12 improved the positive predictive value for moderate to severe traumatic brain injury (55.3%), with a preserved negative predictive value of 96.4%. Decision curve analysis showed the traumatic brain injury prediction model including prehospital heart rate and systolic blood pressure had the greatest net benefit across most threshold probabilities. ConclusionLess than a third of adult blunt trauma patients with a prehospital Glasgow Coma Scale score ≤12 have moderate to severe traumatic brain injury. Supplementing Glasgow Coma Scale score with prehospital vital signs improves diagnostic accuracy, potentially by filtering out patients with altered consciousness due to shock. Future work should better identify patients for traumatic brain injury–specific treatments in prehospital settings, including triage destination.

Holohemispheric Hemorhhage in Infantile Acute Subdural Hematoma: Serial Neuroimaging Analysis

Background: An acute subdural hematoma (ASDH) in infants without any external sign of trauma is differently recognized as shaken baby syndrome (SBS) / abusive head trauma (AHT) in the United States or as infantile acute subdural hematoma (IASDH) due to minor head trauma in Japan. The present case report aimed to demonstrate that IASDH can occur after a mild head impact if the dural border cell layer is disrupted in an infant with cranio-cerebral disproportion (CCD). Case description: A 5-month-old, male patient fell from a baby bed and struck his occiput against a mat. He began to cry and soon thereafter demonstrated signs of altered consciousness. He was taken to a pediatric hospital where computed tomography (CT) revealed a thin subdural hematoma (SDH) surrounding the entire right cerebral hemisphere. Fundoscopy found a right-sided retinal hemorrhage. Magnetic resonance imaging (MRI) on hospital day 4 revealed a thin, high-intensity ASDH surrounding the entire, cerebral convexity on the right side. In addition, benign enlargement of the subarachnoid space (BESS) and large sylvian fissure (LSF) were noted. On hospital day 12 and 18, follow-up MRI revealed a residual SDH with minimal reduction. The patient had an uneventful clinical course and met all the normal, developmental milestones as of his current age of 3 years. Conclusion: The present case is invaluable because it demonstrates that ASDH can occur as a result of a mild, occipital impact. Particularly relevant here is the thin, holohemispheric appearance of the hematoma on neuroimaging studies, which has been suitably termed, holohemispheric subdural hematoma (HHSDH). Also noteworthy is the long-term presence of the HHSDH with minimal reduction of the SDH. The HHSDH may be caused by entrapment of the hematoma in the dural border cell layer in the absence of any communication with the surrounding structures.

Transforming Subdural Hematoma Treatment in the Elderly: Insights from an Endoscopic Case Series.

Subdural hematoma (SDH), a critical brain condition, significantly affects the elderly, making traditional surgeries risky due to their length and potential for blood loss. Endoscope-assisted evacuation offers a safer, less invasive alternative by reducing operation time and minimizing damage, providing an effective solution for older patients. This study evaluated six patients treated with endoscopic evacuation for different stages of SDH from August 2019 to July 2023. Selection criteria were based on altered consciousness, lack of severe brain contusion, SDH thickness over 1 cm, or midline shift over 0.5 cm. The technique used a burr hole and rigid lens endoscope for hematoma removal, focusing on shorter surgery times and better outcomes. Patients aged between 63 to 84 years showed no surgical fatalities, with all recovering well by discharge. Hematoma clearance rates were 76.9% at three days, improving to 96.8% after one month. Endoscope-assisted evacuation is a safe, efficient treatment for elderly patients with various stages of SDH, offering a less invasive option with potential for better outcomes. It supports the trend towards minimally invasive neurosurgery, with further research needed to optimize patient selection and understand long-term benefits.

Impact of agitation status during intensive care on functional outcomes and mortality in patients with cardiovascular disease

Abstract Background Agitation in patients during intensive care is a frequent complication. Several studies have reported that restlessness and agitation are risk factors for prolonged intensive care unit (ICU) stay and poor prognosis. Since patients with cardiovascular disease (CVD) requiring intensive care are ageing and thereby easily affected by responses, including changes in mental status, optimal management of sedation and agitation statuses during ICU stay is considered crucial. However, the influence of different agitation levels during CVD treatment in the ICU on clinical outcomes after ICU discharge is still unclear. Purpose To investigate the associations of the agitation level during ICU stay with mortality after ICU admission and functional outcomes at hospital discharge. Methods We studied 2236 patients (mean age 67.8±0.3 years) who were admitted to the ICU of a university hospital for CVD treatment and whose highest Richmond Agitation-Sedation Scale (RASS) ≥0, measured daily during ICU stay. In addition to clinical characteristics, we investigated the incidence of all-cause mortality during hospitalization and after hospital discharge. We also measured functional outcomes at discharge among 1625 patients, including 6 minutes walk distance (6MWD), Mini-Cog test, and Patient Health Questionnaire-2 (PHQ-2) as physical, cognitive, and mental functions, respectively. In statistical analysis, patients were divided into three groups based on the highest RASS levels during ICU stay in each patient (Calm: RASS=0, Restless: RASS=1, Agitation: RASS≥2). Kaplan-Meier analysis with a log-rank test and the multivariate Cox proportional hazard model were used to clarify whether higher agitation levels were associated with all-cause mortality. Moreover, the differences between the agitation levels and functional outcomes at hospital discharge were compared using the analysis of covariance. Results During the median follow-up of 1.9 years, all-cause death occurred in 280 patients (12.5%), with an incidence rate of 5.57/100 person-years. The Restless and Agitation groups showed higher mortality than the Calm group (P&amp;lt;0.001), and higher agitation levels in the ICU were significantly associated with a higher rate of all-cause mortality (adjusted hazard ratio: 1.37, 95% confidence interval: 1.19–1.57, P&amp;lt;0.001). Furthermore, as compared with the Calm group, the Restless and Agitation groups showed significantly lower levels of 6MWD (all P&amp;lt;0.001) and Mini-cog (P=0.004 and P&amp;lt;0.001, respectively) and a higher PHQ-2 (all P&amp;lt;0.001), even after adjusting for clinical confounders. Conclusions Agitation during ICU stay in CVD patients was associated with low functional outcomes at hospital discharge and high mortality rate after discharge, irrespective of agitation level. Detailed information on the agitation status during intensive care may be an important indicator in developing management and treatment strategies for patients with CVD admitted to ICU.

Meningeal Dissemination and Drop Metastasis From Glioma Presenting With Non-Epileptic Myoclonus and Minipolymyoclonus.

We describe the case of a 36-year-old woman with a past medical history of low grade right frontal lobe glioma and focal epilepsy presenting with subacute, progressive, multifocal myoclonus and neck and back pain. Unlike her typical seizures, the myoclonus exhibited a distinct semiology, involving both positive and negative muscle jerks affecting multiple limb muscles while sparing the face. In addition, neurological examination revealed low-amplitude, arrhythmic movements of the hands and fingers, resembling minipolymyoclonus. There were no other neurological exam findings, including mental status changes, extrapyramidal signs or signs of myelopathy. Brain and spine MRI indicated leptomeningeal and spinal "drop" enhancing lesions, suggesting likely malignant evolution of the glioma. EEG ruled out a cortical origin of the myoclonus. Pharmacological trials with benzodiazepines and other antiepileptic medications were ineffective. The patient's myoclonus was most likely spinal segmental in origin from meningeal spread of glioma. The spinal roots or anterior horns of the spinal cord may have represented a focus of hyperexcitability responsible for generating minipolymyoclonus. Our case expands the etiological spectrum of non-epileptic myoclonus and minipolymyoclonus to encompass meningeal carcinomatosis and drop metastases from glioma. These cases may occur even without overt signs of myelopathy. Recognizing such presentations holds significance due to the poor prognosis associated with meningeal spread of glioma and the limited response of non-epileptic myoclonus to symptomatic treatments.

Changes in mental health and illness perception in patients with hypertrophic cardiomyopathy referred to hybrid cardiac telerehabilitation in comparison to usual care - a randomised-control trial

Abstract Purpose Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, that influences patients' physical capacity and quality of life, as well as the risk of sudden cardiac death (SCD). Patients with HCM often experience emotional distress due to the uncertainty of their condition and have a threatening illness perception (the way individuals make sense of their illness, which can have a significant impact on adherence to treatment). Current studies suggest that some HCM patients could benefit from hybrid cardiac telerehabilitation (HCTR) in terms of somatic and psychological status. This study is part of a research project investigating the safety and effectiveness of hybrid cardiac telerehabilitation for HCM patients. The specific focus of this part is to evaluate the changes in mental health status and illness perception of HCM patients who have been referred for cardiac telerehabilitation compared to those receiving usual care. Methods An RCT study was conducted, with the inclusion criteria for the study of being above 18 y.o., HCM without LVOT obstruction, NYHA Class II or III, LVEF ≥ 50%, and having CIED. The study involved telerehabilitation (HCTR) and control (CG) groups. Both groups were completing questionnaires assessing illness perception (Brief IPQ) and overall psychosocial distress (GHQ-28) with its 4 domains: somatic symptoms, anxiety, social impairment, and depression. Psychological assessment was performed at the beginning and at the end of telerehabilitation/outpatient care, and at 3, 6 and 12 months after the end of care (T1/T2/T3/T4/T5). Results There was a significant improvement in the overall distress level in the HCTR group (p=0.003) but not in the CG (p=0.559). It remained significant in the HCTR group for the T2 (p&amp;lt;0.001), T3 (p=0.008), and T4 (p&amp;lt;0.001). The positive change was observed in somatic symptoms only in the HCTR group: for T2 (p=0.025) and T3 (p=0.032) compared to the T1. The gradual decrease in anxiety level was observed in the HCTR group, but not in the CG, with a significant difference for T4 (p=0.013) compared to T1. Although there was an improvement in social impairment in both groups (p=0.049 for the CG, and p=0&amp;lt;0.001 for the HCTR group), only in the HCTR group it held a stable pattern after the intervention (p&amp;lt;0.001 for T2; p=0.013 for T3; p=0.032 for T4). There were no changes in the level of depressive symptoms in either of the compared groups. There were also no significant differences in the illness perception (p=0.200 for the HCTR group and p=0.090 for the CG), although the HCTR group showed short-term improvement after three months of HCTR (T2) (p=0.032). Conclusions There are significant benefits of hybrid cardiac telerehabilitation for mental health, level of distress, and illness perception in HCM patients. It is worth noticing that this improvement is short-term, and prolonged effects might require providing additional support during extended care.overall distress in HCTR vs CGsubscales of GHQ_28 in HCTR vs CG

An exploratory study of alternative life experiences in comparison to transcendental near‐death experiences

AbstractThe term near‐death experience (NDE) generally refers to a state of altered consciousness that can occur during real or presumed near‐death circumstances and/or life‐threatening incidents. The NDE usually includes the impression of being conscious while out of and/or away from the physical body, often accompanied by other specific features. Furthermore, when the experient has the impression of being in a perceived locality that transcends the observable physical Earth, it is referred to by researchers as a transcendental NDE. Whereas transcendental NDEs have been widely studied, there is also another type of experience that can occur under similar life‐threatening conditions that I refer to as an alternative life experience (ALE), which consists of a perception of living another alternative life where the experient is aware of the self, but does not believe at the time of occurrence that they are either out of or away from their physical body. After providing a total of 15 examples, I note some similarities and differences between ALEs and transcendental NDEs while providing some qualitative and quantitative results, suggesting that ALEs might be similar to some aspects of transcendental NDEs despite their neglect in the study of altered states of consciousness during near‐death circumstances. I further postulate that ALEs might be subjective psychological experiences of dissociation and/or absorption. It is then pointed out that symptoms of derealization are a common ALE aftereffect and so an awareness of that association is stressed as having therapeutic importance.

Intradural Repair of Temporal Bone Encephalocele and Cerebrospinal Fluid Leak: Results from a Single Institution

Abstract Background Lateral temporal bone encephaloceles incidence is increasing with obesity rates. Middle fossa (MF) craniotomy, transmastoid (TM), or combined MF + TM access can be used for repair. Methods Retrospective review of MF or MF + TM repair with an intradural graft. Sex, age, and body mass index (BMI) were collected. Pre/postoperative audiometric results were included. Postoperative complications were reported. Results A total of 49 patients (50 repairs) were included. In addition, 74% were women (p &lt; 0.05). Ten patients had a history of chronic otitis media and surgery. Average BMI was 35.8, and average age was 59. Furthermore, 54% had multiple skull base defects; 18 (36%) patients had a MF approach. In total, 32 (64%) patients had a MF + TM approach for repair; 13 (40.1%) of these patients had a concurrent tympanoplasty. Hearing improved for 74%. Air conduction pure-tone average improved by an average of 5 dB (p 0.27). No differences in hearing outcomes were observed between the MF and MF + TM groups. Two patients (6%) had hearing decline. Eight complications were reported (1 (2%) skin infection, 4 (8%) recurrent/persistent cerebrospinal fluid [CSF] leaks requiring lumbar drain or shunt, and 3 (6%) episodes of aphasia or mental status change). Age &gt;65 years was not associated with risk of postoperative complication. Conclusion Intradural repair of encephalocele and CSF leak is a safe and effective surgical approach. Intradural reinforcement along the entire MF floor is beneficial for multiple areas of dehiscence and thin dura. Complication rates including recurrent/persistent CSF leak and aphasia related to temporal lobe retraction were similar to previously published reports and not associated with older patient age. Hearing was stable or improved in 94% with no difference noted between MF and MF + TM repair.

DISSOCIATION, SPLITTING AND COMPARTMENTALIZATION IN TRAUMA-RELATED DISORDERS

The article is devoted to the analysis of actual scientific views and theoretical research on the participation of the phenomena of dissociation, splitting, and compartmentalization in disorders associated with mental trauma, in particular, PTSD and addictions. It is shown that the understanding of the concepts of dissociation and splitting developed in parallel and that both concepts emerged from research on trauma. Empirical studies show a clear correlation between dissociation, splitting, and compartmentalization with trauma-related disorders. However, there is considerable confusion in the differentiation of these concepts: some authors use them as synonyms, other authors consider dissociation to be a more basic process underlying splitting, and some distinguish two separate types of dissociation - separation, and compartmentalization. In this article, the concept of dissociation and splitting into separate independent phenomena is chosen, where dissociation is defined as the separation of mental processes or mental systems from consciousness, and splitting is defined as the division of consciousness itself into several independent centers of self-consciousness, with the phenomenon of compartmentalization referring to a shallow level of splitting. Both dissociation and splitting can exist in the spectrum from normal to deep pathology of the (sub)psychotic level. The article analyzes how dissociation and splitting can participate in the formation of trauma-related disorders such as PTSD and addiction. In the formation of PTSD, a part of the human psyche system associated with traumatic experiences is detached from consciousness as a result of protection from unbearable experiences (dissociation). Further, due to unsuccessful attempts to integrate the trauma, a negative self-concept with feelings of shame/guilt is formed, which splits off from the core self (splitting). As a result, a triadic structure is formed: the normative Ego-state, the split traumatic Ego-state, and the dissociated traumatic Self-state. When addiction is formed based on early trauma, a dissociated self-state exists since childhood, but while using psychoactive substances, it is integrated with a state of altered consciousness, which is why a person is experiencing a state of high, similar to a miracle. In this case, a system is formed of a normative Ego state, a dissociated traumatic Self-state, and a detached addictive Ego state, which is activated exclusively in a state of altered consciousness, and during activation, integration with the dissociated Self-state occurs. This addictive integration is the real motive for the use of this group of addictive drugs. The proposed concept can be used in the psychotherapy of trauma-related disorders as a conceptualization of cases and conceptualization of loci of therapeutic contact. Keywords: dissociation, splitting, compartmentalization, mental trauma, PTSD, addiction