Rational Therapy Research Articles

Рациональная антибиотикотерапия у пациентов с синдромом диабетической стопы

Введение. Синдром диабетической стопы (СДС) как одно из наиболее важных и частых осложнений у пациентов с сахарным диабетом (СД) характеризуется развитием гнойно-некротических изменений мягких тканей нижних конечностей, что повышает риск инвалидизации пациентов. Для повышения эффективности контроля инфекции необходим локальный мониторинг микрофлоры в каждом учреждении, занимающемся лечением СДС. Хирургическое лечение, применение разгрузочных повязок и коррекция гликемического профиля являются наиболее важными направлениями в купировании инфекционно-воспалительного процесса у пациентов с СДС, однако они могут оказаться неэффективными при неадекватной антибактериальной терапии. В связи с этим проблема рационального использования антибиотиков в комплексном лечении СДС остается актуальной и требует дальнейшей разработки. Цель. Изучить этиологическую структуру и антибиотикорезистентность микробной флоры у пациентов с СДС для разработки протокола рациональной эмпирической антибиотикотерапии. Материалы и методы. В исследование включены 66 пациентов с СДС, находившихся на стационарном лечении в отделении гнойной хирургии УЗ «Могилевская областная клиническая больница» с 2020 по 2022 г. Выполнен комплекс бактериологических исследований. Идентификация и определение чувствительности микроорганизмов к антибиотикам проводились с помощью тест-систем на биохимическом анализаторе Vitek 2 Compact (bioMerieux, Франция). Результаты. У пациентов с СДС из ран выделено 19 изолятов (28,8%) рода стафилококков, 18 изолятов (27,2%) семейства энтеробактерий, 8 изолятов (12,1%) P. aeruginosa, 5 изолятов (7,5%) А. baumannii, 5 изолятов (7,5%) энтерококков. Кроме того, идентифицировано 43 представителя облигатных анаэробов: 14 – рода Bacteroides (32,5%), из которых наиболее часто встречался B. fragilis – 13 штаммов (30,2%); по 9 представителей Peptococcus spp. (20,9%) и Peptostreptococcus spp. (20,9%), 5 изолятов Prevotella spp. (11,7%), 4 изолята Fusobacterium spp. (9,3%). Недифференцированные неспорообразующие грамположительные анаэробные палочки (ННГАП) выделены в 3 случаях (6,9%). Аэробная и факультативно-анаэробная микрофлора характеризовалась высоким уровнем устойчивости к антибактериальным лекарственным средствам. На основании полученных результатов разработан протокол эмпирической антибактериальной терапии СДС. Выводы: 1. Ведущая роль в этиологической структуре микроорганизмов у пациентов с СДС принадлежит стафилококкам, энтеробактериям и синегнойной палочке. Среди облигатных анаэробов лидирующие позиции занимает B. fragilis. 2. Представители аэробной и факультативно-анаэробной микрофлоры характеризуются высоким уровнем устойчивости к антибактериальным лекарственным средствам. 3. Разработанный протокол эмпирической антибактериальной терапии СДС характеризуется высокой клинической эффективностью. Introduction. Diabetic foot syndrome (DFS), as one of the most important and frequent complications in the patients with diabetes mellitus (DM), is characterized by the development of purulent-necrotic changes in the soft tissues of the lower extremities, which increases the risk of disability of patients. To increase the effectiveness of infection control, local microflora monitoring is necessary in each hospital that treats DFS. Surgical treatment, the use of discharge dressings and correction of the glycemic profile are the most important directions in the relief of the infectious and inflammatory process in patients with DFS, however, they may be ineffective with inadequate antibacterial therapy. In this regard, the problem of rational use of antibiotics in the complex treatment of DFS remains relevant and requires further development. Purpose. To study the etiological structure and antibiotic resistance of microflora in the patients with DFS for the development of a protocol of rational empirical antibiotic therapy. Materials and methods. The study included 66 patients with DFS, who were hospitalized in the department of purulent surgery of the Mogilev Regional Clinical Hospital from 2020 to 2022. A complex of bacteriological studies was performed. Identification and determination of the sensitivity of microorganisms to antibiotics was carried out using test-systems on the Vitek 2 Compact biochemical analyzer (BioMerieux, France). Results. In the patients with DFS, 19 isolates (28.8%) of Staphylococcus spp., 18 isolates (27.2%) of Enterobacteriaceae, 8 isolates (12.1%) of P. aeruginosa, 5 isolates (7.5%) of А. baumannii, 5 isolates (7.5%) of Enterococcus spp. were isolated from the wounds. 43 representatives of obligate anaerobes were identified: 14 – of the genus of Bacteroides (32.5%), of which 13 strains of B. fragilis were most common (30.2%); 9 representatives of Peptococcus spp. (20.9%) and Peptostreptococcus spp. (20.9%), 5 isolates of Prevotella spp. (11.7%), 4 isolates of Fusobacterium spp. (9.3%). Undifferentiated non-spore-forming gram-positive anaerobic rods (UNGAP) were isolated in 3 cases (6.9%). The aerobic and facultative anaerobic microflora was characterized by a high level of resistance to antibacterial drugs. Based on the results obtained, a protocol for empirical antibacterial therapy of DFS has been developed. Conclusions: 1. The leading role in the etiological structure of microorganisms in the patients with DFS belongs isolates of Staphylococcus spp., Enterobacteriaceae and P. aeruginosa. Among obligate anaerobes, B. fragilis occupies a leading position. 2. Representatives of aerobic and facultative anaerobic microflora are characterized by a high level of resistance to antibacterial drugs. 3. The developed protocol of empirical antibacterial therapy of DFS is characterized by high clinical efficacy.

Neutrophilic granulocytes in the patients with burn injury

Severe burn injury (BI) is accompanied by disturbed microcirculation, water-electrolyte and acidbase imbalance within 2-3 days after the accident, and the development of toxemia within 4-12 days. The severity of toxemia depends on the area and depth of the lesion, resorption of tissue decay products, and development of a systemic inflammatory response syndrome. In the patients suffering with deep BI sepsis, it develops in 15% of cases. Pathogenesis of critical conditions is related to the functional activity of myeloid cells, including neutrophilic granulocytes (NG). Тhe determination of NG’s dysfunctions in patients with BI is important, both for prediction of septic complications and administration of rational therapy. The aim of our work was to study the functions of neutrophils in patients with severe BI and to determine early predictors of burn-associated sepsis. The study involved 53 patients with severe BI at the mean age of 43 years (32 to 52); the area of damage was 43% (17 to 63) of the body surface, with deep-burn area of 17 (13 to 27) %. The severity of BI was assessed using the Frank index, at the average value of 74 conventional units (62 to 89). Тwo groups of patients were identified: 24 persons without sepsis, and 29 people with sepsis and severe sepsis. The studies were carried out upon admission, on the 1st, 3rd, 5th, 10th , and 20th day of the burn disease. We determined the numbers of NGs expressing CD18+, CD14+, defensin+; serum contents of soluble defensins (sDеf), IL-6, IL-8 levels (ELISA); procalcitonin, as well as luminol-mediated spontaneous аnd induced NG chemiluminescence. Тhe results of this study showed a relationship between the amounts of NGs containing antimicrobial peptides, contents of NGs expressing CD18+ adhesion molecules, activation of oxidative metabolism, IL-6 overproduction, and development of sepsis in patients with burn injury, as well as with severity of burn trauma.

Abstract 4160: Characterization of cytotoxic resilient T cells in patients with advanced cancers in response to salvage radiation therapy or chemotherapy

Abstract Although cancer burden in patients with advanced diseases results in T cell exhaustion and failed prior therapies, some of them achieved durable clinical responses to salvage therapy (chemotherapy or radiation therapy) implying a presence of tumor-reactive resilient T cells in them. However, the phenotype and functional features of resilient T cells have not been clearly defined. We found that CX3CR1+ CD8+ T cells with low mitochondrial membrane potential demonstrated features of resilient T cells: (a) their cytotoxic T cell function (degranulation/CD107a expression) recovered quickly after tumor burden has been reduced by radiation therapy or chemotherapy; (b) they maintain a low profile of glycolysis but produce optimal levels of ATP; (c) they express lower levels of PD-1 and TOX; (4) they share a feature of stem-like T cells (TCF1+PD-1+) that can be responsive to immunotherapy; (5) they avoid accumulation of a harmful level of cytosolic reactive oxygen species (ROS) that may cause T cell exhaustion; (6) they upregulate malic enzyme 1 (ME1) to balance glycolysis and ROS, and to expand cytotoxic effector T cells. These unique features of resilient T cells may not only be used as T cell biomarker to design rational combination therapy to control advanced cancers but can also be used to convey a resilient functional state to T cells in patients who lack them. Citation Format: Joanina K. Gicobi, Yiyi Yan, Hu Zeng, Sean Park, Haidong Dong. Characterization of cytotoxic resilient T cells in patients with advanced cancers in response to salvage radiation therapy or chemotherapy. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4160.

Abstract 6705: Molecular detection of circulating cancer cells with cancer stem cell or mesenchymal characteristics in esophageal squamous cell carcinoma

Abstract Esophageal squamous cell carcinoma (ESCC) is a clinically challenging disease that requires a multidisciplinary approach. Unfortunately, the scarcity of ESCC genomic data hinders the understanding of ESCC biology, disease progression and rational therapy design. Circulating tumor cells (CTCs), which are shed from the primary and metastatic tumors and then circulate within the peripheral vasculature, reflect the existing tumor heterogeneity. Here, we utilized the non-biased size-based CTC enrichment strategy in combination with the real-time RT-PCR to molecularly characterize the CTCs with cancer stem cell (CSC) or mesenchymal properties in ESCC. Comprehensive data from ESCC cell lines, mouse ESCC xenograft models and clinical ESCC peripheral blood samples emphasize the importance of TWIST1 (Twist Family BHLH Transcription Factor 1) in ESCC progression. Gain-of-function and loss-of-function analyses demonstrate that TWIST1 promotes cell migration, invasion and colony formation in ESCC cells. Moreover, positive TWIST1 expression is responsible for the chemoresistance of ESCC cells to Cisplatin and is correlated with poor overall survival in ESCC patients. In addition, we show that TWIST1 promotes malignant potential, including tumor growth, invasion and chemoresistance via the TWIST1-TGFBI-ZEB1 signaling pathway in ESCC. Meanwhile, the TWIST1-TGFBI-ZEB1 signaling pathway confers immunosuppressive conditions to the tumor microenvironment, which in turn contributes to EMT to promote tumor progression. Collectively, these findings indicate that TWIST1 has a novel role in ESCC carcinogenesis by regulating tumorigenicity and cancer stem cell properties that may be useful as a prognostic monitoring biomarker and a promising therapeutic target in clinical ESCC treatment. Citation Format: Zhen Tan, Josephine Mun-Yee Ko, Valen Zhuoyou Yu, Hoi Yan Ng, Simon Law, Maria Li Lung. Molecular detection of circulating cancer cells with cancer stem cell or mesenchymal characteristics in esophageal squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6705.

Distinctive features of A. Ellis' rational-emotional-behavioral therapy and A. Beck's cognitive therapy approaches in clinical practice and psychotherapy of emotional disorders

The object of this research is the theoretical and methodological features of the cognitive-behavioral direction of psychotherapy. The subject of the research is the comparative characteristics of rational–emotional-behavioral therapy (REBT) by A. Ellis and cognitive therapy (CT) by A. Beck in the context of diagnostic and therapeutic interventions. The authors investigate in detail the cognitive model of the formation of dysfunctional reactions, analyze the mutual determination of dysfunctional beliefs through the prism of both approaches, compare philosophical and cognitive solutions to the problem of emotional disorders, investigate the relationship of automatic thoughts and irrational beliefs, and also emphasize the differences between A. Beck's cognitive therapy and A. Ellis' rational-emotional-behavioral therapy. If in A. Beck's cognitive therapy cognitive restructuring is implemented on a descending principle, consistently affecting the levels of automatic thoughts, intermediate beliefs (cognitive distortions) and self-concept (deep beliefs), then in A. Ellis' rational-emotional-behavioral therapy the procedure of disputing (challenging) irrational beliefs is carried out on an ascending principle, moving from the modification of imperative and derived evaluative beliefs to change automatic perceptions and conclusions. The scientific novelty of the research also consists in clarifying the categorical framework of cognitive behavioral therapy in terms of clarifying the content and correlation of the concepts of "irrational belief", "dysfunctional attitude" and "cognitive distortion". The research also outlines the prospects for the integration of A. Beck's cognitive therapy and A. Ellis' rational-emotional-behavioral therapy.

Can Rational-Emotive Behavior Therapy (REBT) Reduce Academic Anxiety in High School Students?

Teenagers experience rapid development and growth during high school. During this phase, adolescents experience many challenging changes, including changes in emotional and physical development. If these changes are not properly managed, they can lead to problems such as anxiety. One of the sources of teenage anxiety is their academic problems. "Academic anxiety" is what this form of anxiety is called. It can be a challenge for students to focus, learn, and feel confident. Interventions are needed to assist students in controlling their anxiety so that they can be successful in achieving their academic endeavours. The purpose of this study was to assess the effectiveness of the Rational Emotive Behavior Therapy (REBT) method in reducing high school students' academic anxiety levels. The participants in this study were 17-year-old high school students. The method used is a single case experimental design in which this single case refers to one individual within a certain scope. The results showed that REBT can reduce high school students' academic anxiety levels. Based on their experience of carrying out activities during the intervention, students are aware of irrasional thoughts that lead to behavior and feelings and replace them with rational thoughts by confronting these irrasional thoughts.Remaja mengalami perkembangan dan pertumbuhan yang pesat selama masa sekolah menengah atas. Pada fase ini remaja mengalami banyak perubahan yang menantang, termasuk perubahan perkembangan emosi dan fisik. Jika perubahan ini tidak dikelola dengan benar, maka dapat menimbulkan masalah seperti kecemasan. Sumber kecemasan remaja salah satunya ialah persoalan akademik mereka. "Kecemasan akademis" adalah sebutan yang diberikan untuk bentuk kecemasan ini. Hal ini dapat menjadi tantangan bagi siswa untuk fokus, belajar, dan merasa percaya diri. Intervensi diperlukan untuk membantu siswa dalam mengendalikan kecemasan mereka sehingga mereka dapat berhasil dalam mencapai usaha akademis. Tujuan dari penelitian ini adalah untuk menilai efektivitas Rational Emotive Behaviour Therapy (REBT) dalam menurunkan tingkat kecemasan akademis siswa sekolah menengah atas. Partisipan penelitian ini adalah siswa sekolah menengah atas yang berusia 17 tahun. Metode yang digunakan adalah single case experimental design yang dimana single case ini mengacu pada salah satu individu didalam suatu lingkup tertentu. Hasil penelitian menunjukkan bahwa REBT dapat menurunkan tingkat kecemasan akademis siswa SMA. Berdasarkan pengalaman mereka melakukan aktivitas selama intervensi, siswa menyadari pemikiran irasional yang mengarah pada perilaku dan perasaan dan menggantinya dengan pemikiran rasional dengan cara mengkonfrontasi pemikiran yang irasional tersebut.

Application of Rational and Emotional Therapy Techniques and Cognitive Re Signification in a Case of Jealousy

Deterioration and Reorientation of the lifestyle of "Carlos" Carlos, like many university students his age, used to have a "normal" life; his existence was spent between school responsibilities and social relationships, his family was middle class, and both parents worked; Carlos was the eldest of four siblings of two of which are men, and two are women, they were in the middle of the two brothers, therefore the relationship between male brothers. However, it was harmonious; there was not much attachment between the two, probably the chronological distance influenced this situation. Carlos's parents worked in very different fields from each other, he had his own business, and it demanded a lot of time and effort, and a good part of his activity involved checking engines and parts full of oil and grease; this meant that his personal grooming It was commensurate with his activity. On the contrary, she worked in an office, and her work forced her to be more careful with her personal grooming. The difference in occupations somehow impacted the couple's relationship since the relationship, although not very close, was not conflictive either. She somehow solved the need for communication through her son Carlos, she shared many hopes with him, and both complemented each other in mutual expectations, which meant that any situation, no matter how small, was enough to start a dialogue.

Depression, suicide ideation, and irrational beliefs: Explanatory models in psychology students

Introduction. In rational emotive behavioral therapy, irrational beliefs are significant in mental health since their presence leads to conditions such as depression and suicidal ideation. Since these conditions have been increasing worldwide, it is essential to explore the factors that contribute to their understanding. Objective. To design explanatory models for depression and suicidal ideation based on irrational beliefs in psychology students. Method. Quantitative, non-experimental, cross-sectional study with multivariate analysis. Results. Two explanatory models were designed: one for depression and the other for suicidal ideation. Thirty-nine per cent of depressive symptomatology can be explained by the presence of irrational beliefs concerning perfectionism, avoidance of responsibilities, concern over the future, and the determinism of the past. At the same time, 54% of suicidal ideation can be explained by the presence of beliefs centering on perfectionism, avoidance of responsibilities, external locus of control, and the determinism of the past. Discussion and conclusion. Depression and suicidal ideation in psychology students can partly be explained by irrational beliefs concerning perfectionism, external locus of control, concern over the future, avoidance of responsibilities, and the determinism of the past. Clinical care approaches can modify these beliefs to reduce symptoms and promote mental health.

ROLE OF MICROBIOLOGICAL MONITORING IN ALMATY MULTIDISCIPLINARY HOSPITAL

Microbiological monitoring is the most important component of the epidemiological safety of the medical and diagnostic process, an integral part of the process of providing epidemiological surveillance for infections associated with the provision of medical care [1].
 Purpose. Determine the effectiveness of microbiological monitoring of patients, study the microbiological spectrum and resistance of microflora to antibiotics with the study of the antibiotic graph.
 Materials and methods. Data on antimicrobial sensitivity of microorganism strains isolated from the wound compartment (55 patients) and sputum (258 patients) were retrospectively analyzed. The microbial landscape was studied, based on the results of records in disease histories for six months (October 2021 - April 2022). Microbiological studies were performed on the basis of the City Clinical Hospital No. 4 in Almaty according to the approved regulatory documents [5]. Results. Thus, the results of our study showed a high percentage of excretion of gram-positive flora in sputum and wound separation. In most cases, microflora was sensitive to moxifloxacin, levofloxacin and gentamicin with different degrees of severity. There was a difference in the resistance of the sputum flora to erythromycin, and the microflora of the wound secretible to oxacillin. This indicates the need to make changes in the tactics of administering and treating these patients in accordance with the principles of rational use of antimicrobials [6].
 Conclusion. Rational antimicrobial therapy can be carried out with timely and guaranteed receipt of information on the sensitivity of microorganisms to antimicrobial drugs. The spread of antibiotic-resistant microorganisms in medical organizations significantly reduces the effectiveness of antibacterial therapy and is associated with the threat of the spread of ubiquitous strains. Targeted observations of the resistance of infectious agents to these drugs represent one of the effective ways to prevent antibiotic resistance [1].

Rational Emotive Behavior Therapy (REBT) And Tawakkal Concept Elaboration To Encounter Anxiety As The Impact of COVID-19

The anxiety and worriness are experienced by most of the parents who stay in distance with their children due to corona virus disease pandemic (covid-19). The anxiety and worriness can cause irrational behavior, such as: frequently crying, restless, moody, and lost appetite. This situation is keep going on even though their children have given news that they are just doing well. This research discusses about the implementation of Rational Emotive Behavior Therapy (REBT) to overcome anxiety and negative thinking toward parents whose children are living in the area which vulnerablea to covid-19. REBT therapy implementation with tawakkal concept elaboration is aimed to improve an individual point of view toward problem encountered. This is an action research. The researchers provide therapy toward three parents who live far away from their children in which those children cannot return home yet due to covid-19. Those parents live in Kampung Karang Tangah Pesisir Selatan West Sumatera. There are 3 stages in this research: (a) empathy with client condition; (b) provide catharsis nuance; (c) ask the client to fight against the negative feeling; (d) provide suggestion through tawakkal concept; and (e) contract making. The research result revealed that clients started to realize that their action is not appropriate since it solves nothing. Hence, the implementation of REBT concept which combined with obedience concept may change clients’ point of view toward their problems as the impact of covid-19.

Using Rational Emotive Behavior Therapy to Improve Psychological Adaptation among Future Coaches in the Post-Pandemic Era

This study aims to demonstrate that applying rational emotional behavior theory (REBT) concepts can help to improve the psychological adaptation of future coaches in the post-pandemic era. The current research utilizes a qualitative approach with a sample of 14 future coaches, namely, students of the study program "Training systems" at Lithuanian Sports University. These students are also active athletes (basketball players). Interview questions were developed based on the ABC(DE) model, and answers were analyzed following the methodology of content analysis. In general, our findings fit the ABC(DE) framework. However, there are several important exceptions. During discussions, participants presented their basic beliefs in the form of statements rather than demands. The ABC(DE) framework predicts the latter. Furthermore, participants' automatic thoughts are not logical derivatives of their basic beliefs, contrary to the REBT theory. However, it is possible to interpret basic beliefs as an explanation for automatic thoughts, meaning that this interpretation seemingly does not contradict the theoretical principles of REBT. As such, REBT appears to be helpful for better understanding the psychological adaptation problems that arose during the pandemic and are relevant in the post-pandemic era.

A Prospective Study On Corticosteroids Utilization Pattern In Dermatology Department Of A Tertiary Care Teaching Hospital, Bangalore, India

Corticosteroids are widely prescribed in dermatology department and a rational prescribing lead to maximum benefit and minimum untoward effects. The objectives of this study were to assess the corticosteroid prescribing pattern for various skin diseases and to identify, monitor and assess any drug interactions and adverse reactions if any associated with their use. A prospective cross-sectional study on corticosteroid utilization pattern in dermatology department of a tertiary care teaching hospital was done by reviewing 205 inpatient cases for a period of 6 months. The data was collected with respect to demographics, medical and medication history, laboratory data and drugs prescribed during hospitalization and at discharge. A descriptive statistical analysis was performed to report the findings in terms of number and percentage. Corticosteroids were prescribed in 129 cases with 72male patients most in 51-60-year age group and 57female patients with 28% in 31-40-year age group. The common indications were psoriasis, dermatitis, and pemphigus. Prednisolone (27.4%) followed by clobetasol (22.04%) were most commonly prescribed. 48.6% therapy was by topical route, 28.2% by oral and 23.03% parenteral route. At discharge prednisolone and clobetasol were mostly prescribed and topical route was the most preferred route. Drug interactions involving drugs like betamethasone, triamcinolone, dexamethasone, and prednisolone were observed but no adverse reactions were reported. With a wide choice of corticosteroids and dosage forms available to treat dermatological conditions the rational therapy should consider the appropriate choice of drugs, potency, effectiveness and the cost.

Pharmacometrics: A New Era of Pharmacotherapy and Drug Development in Low- and Middle-Income Countries.

Pharmacotherapy, in many cases, is practiced at a suboptimal level of performance in low- and middle-income countries (LMICs) although stupendous amounts of data are available regularly. The process of drug development is time-consuming, costly, and is also associated with loads of hurdles related to the safety concerns of the compounds. This review was conducted with the objective to emphasize the role of pharmacometrics in pharmacotherapy and the drug development process in LMICs for rational drug therapy. Pharmacometrics is widely applied for the rational clinical pharmacokinetic (PK) practice through the population pharmacokinetic (popPK) modeling and physiologically based pharmacokinetic (PBPK) modeling approach. The scope of pharmacometrics practice is getting wider day by day with the untiring efforts of pharmacometricians. The basis for pharmacometrics analysis is the computer-based modeling and simulation of pharmacokinetics/pharmacodynamics (PK/PD) data supplemented by characterization of important aspects of drug safety and efficacy. Pharmacometrics can be considered an invaluable tool not only for new drug development with maximum safety and efficacy but also for dose optimization in clinical settings. Due to the convenience of using sparse and routine patient data, a significant advantage exists in this regard for LMICs which would otherwise lag behind in clinical trials.

Cure of Alzheimer's Dementia Requires Addressing All of the Affected Brain Cell Types.

Multiple genetic, metabolic, and environmental abnormalities are known to contribute to the pathogenesis of Alzheimer's dementia (AD). If all of those abnormalities were addressed it should be possible to reverse the dementia; however, that would require a suffocating volume of drugs. Nevertheless, the problem may be simplified by using available data to address, instead, the brain cells whose functions become changed as a result of the abnormalities, because at least eleven drugs are available from which to formulate a rational therapy to correct those changes. The affected brain cell types are astrocytes, oligodendrocytes, neurons, endothelial cells/pericytes, and microglia. The available drugs include clemastine, dantrolene, erythropoietin, fingolimod, fluoxetine, lithium, memantine, minocycline, pioglitazone, piracetam, and riluzole. This article describes the ways by which the individual cell types contribute to AD's pathogenesis and how each of the drugs corrects the changes in the cell types. All five of the cell types may be involved in the pathogenesis of AD; of the 11 drugs, fingolimod, fluoxetine, lithium, memantine, and pioglitazone, each address all five of the cell types. Fingolimod only slightly addresses endothelial cells, and memantine is the weakest of the remaining four. Low doses of either two or three drugs are suggested in order to minimize the likelihood of toxicity and drug-drug interactions (including drugs used for co-morbidities). Suggested two-drug combinations are pioglitazone plus lithium and pioglitazone plus fluoxetine; a three-drug combination could add either clemastine or memantine. Clinical trials are required to validate that the suggest combinations may reverse AD.

A study on the manifestation and treatment of hysteria among the unemployed due to economic recession under the impact of the COVID-19

BackgroundThe constant mutation of the coronavirus during the COVID-19 caused enough anxiety and panic, as well as a decline in an otherwise healthy economy. As the economy continued to decline, more and more people had to face the risks and anxiety associated with unemployment. Dysthymia, also known as dissociative disorder, is a complex group of psycho-physical disorders in which, during the course of the illness, the patient manifests involuntary and intermittent loss of the ability to integrate some or all of the psycho-physical functions and is unable to achieve unity in the areas of perception, memory, emotion, behavior and self-awareness.Subjects and MethodsA series of research studies were conducted to investigate the manifestation and treatment of hysteria among the unemployed as a result of the economic recession in the wake of the COVID-19. Rational Emotive Behavior Therapy was used to treat the hysterical condition of the unemployed. A self-administered questionnaire was used to investigate the mental health of the unemployed in a region before and after the epidemic. 56 valid questionnaires were returned, excluding those that were not standardized. The 56 individuals were randomly divided into two equal groups and the subjects in the experimental group were treated with rational emotive behavior therapy, while the subjects in the control group were treated with general psychotherapy. A self-administered psychological assessment scale was used to score the mental health of the subjects before and after the treatment. The scale included indicators of perception, memory, emotion, behavior and self-awareness.ResultsThe degree of self-awareness retained by the two groups of subjects under the self-awareness index was selected for analysis before and after the experiment. The results in Table 1 show that the number of subjects in the experimental group with high, low and no self-awareness were 0, 9 and 19 respectively before the rational emotive behavior treatment; after the treatment, their numbers changed to 5, 21 and 2. On the contrary, the number of subjects in the control group before the general psychotherapy was 0, 7 and 21; after the treatment, their numbers changed to 1, 15 and 12.Table 1.The degree of retention of self-awareness in the two groups of subjects before and after the experimentGroupHigh self-awarenessLow self-awarenessNo self-awarenessExperimental groupBefore treatment0919After treatment5212Control groupBefore treatment0721After treatment11512ConclusionsThrough questionnaires and a comparative experimental setup, it was demonstrated that the hysteria of unemployed people caused by the economic recession in the context of the COVID-19 manifested itself in the areas of perception, memory, emotion, behavior and self-awareness. The use of rational emotive behavioral therapy was able to treat their hysteria phenomenon and alleviate their psychological state of low or even no self-awareness.

Rational inhalation therapy in COPD in India: Hope or hype!

Chronic obstructive pulmonary disease (COPD) is common chronic lung disease usually treated in all health care settings as per knowledge of disease, availability of medicines and affordability of patients in India. COPD is second leading cause of death in list of all cause of mortality. COPD is under evaluated and half-heartedly treated with irrational oral medicines in spite of rational inhalation therapy in primary to tertiary care settings. More than half of the cases died due to cardiovascular causes are having underlying COPD as precipitating factor. More disease awareness regarding use of spirometry in health care professionals for proper diagnosis of COPD with more emphasis on rational inhalation treatment is must to prevent morbidity of mortality of this treatable disease.

ДИАГНОСТИКА И ЛЕЧЕНИЕ ХРОНИЧЕСКОГО ГАНГРЕНОЗНОГО ПУЛЬПИТА ПРИ ВЫЯВЛЕНИИ МИКОТИЧЕСКОЙ ФЛОРЫ ПОСЛЕ ПЕРЕНЕСЕННОЙ КОРОНОВИРУСНОЙ ИНФЕКЦИИ

COVID-19 is an extremely severe acute respiratory infection caused by the SARS-CoV-2 coronavirus. This virus infects various organs both through direct infection and through the body's immune response. The presence of a patient in a state of immunosuppression contributes to the development of diseases that can be caused by opportunistic viruses, bacteria or fungi, which under normal conditions do not cause pathology in healthy people without damage to the immune system. The results of examination of the oral cavity in dental patients who have undergone COVID-19 demonstrate a variety of manifestations of dental diseases in the oral cavity. At the moment, there is no direct evidence of what exactly the underlying factor in the development and exacerbation of chronic diseases in the oral cavity after is suffering a coronavirus infection. This may be the virus itself, as well as drugs that patients took during treatment. Due to the widespread spread of COVID-19, the number of dental patients with various diseases of the oral cavity that developed against the background of a new coronavirus infection is steadily growing, among which there are various lesions of the dental pulp, including chronic gangrenous pulpitis. Actual is the problem of effective diagnosis and rational drug therapy in the treatment of this form of pulpitis. One of the reasons causing complications in the treatment of chronic gangrenous pulpitis is the lack of therapeutic complexes that can completely eliminate the inflammatory process. Treatment of pulpitis according to the standard method and only with antimicrobial drugs does not provide sufficient efficiency, therefore, in medical complex, along with etiotropic, it is necessary to use medicinal substances of pathogenetic influence. In the work, based on research, the diagnosis and treatment of chronic gangrenous pulpitis was carried out in 58 patients who had previously undergone COVID-19. Pulposcopic examination revealed elements of Candida yeast-like fungi. The data obtained substantiate the necessity and expediency of introducing an antifungal drug in the treatment of chronic gangrenous pulpitis, as one of the components at the stage of temporary root canal filling during endodontic treatment of a tooth.

Impact of Obsessive- Compulsive Disorder in term of Rational Emotive Behaviour Therapy (REBT) on Economic Wellbeing of Tribal Women at Kodaikanal Hills

To study aimed to examine the impacts of rational emotional behavioural therapy on obsessive compulsive disorder of women working in coffee plantations of Kodaikanal. The case study is based on the ten tribal women working in the coffee plantations of the Kodaikanal. The tribal women are undergoing significant psychological and physical issues based on the OCD. The obsessive compulsive disorder is examined with “The Padua Inventory Scale by Ezio Sanavio” which measures their OCD level of tribal women working in the coffee plantations. The study involved ten tribal women segmented into two groups and these two groups were subjected to counseling based on the REBT methods. The Padua Inventory Scale by Ezio Sanavio” was used for assessing the OCD of tribal women. The before and after effects of the counseling therapy was examined using the paired t-test. The analysis was done based using the statistical software of SPSS – 20. The study found that effort of REBT was initiated by the researcher which is found to successful among the very low group which found the therapy is significant effect in returning to normalcy. The OCD is considerably declined among the tribal women workers in the study area based on the therapies given under the REBT regime. The implementation of this regime will improve psychological well being of the workers in the coffee plantation and also improve their efficiency at workplace.

Examining the impact of randomized control intervention on depressive symptoms in schoolchildren with atypical behaviors.

The need to investigate depression among disadvantaged groups motivated this study. This study investigated the impacts of rational emotive behavior therapy (REBT) on depressive symptoms in schoolchildren with atypical behaviors in Enugu State Nigeria. A group randomized controlled design was used to assign 37 schoolchildren to the intervention group and 37 schoolchildren to the waitlisted control group. These people were evaluated at three times (pretest, post-test, and later test) using a dependent measure. The outcome demonstrated that there was no discernible difference between the participants in the treatment group and those in the waitlisted control group at the time of the pretest. The post-treatment test results revealed a considerable improvement among participants as a result of REBT therapy. The later test result revealed that the treatment's significant improvement was maintained in favor of the REBT group. The outcome of REBT treatment was not moderated due to location. The data showed a significant interaction impact on participants' depression levels in relation to the interaction between groups and gender during therapy. Following the outcomes, we concluded that REBT is a long-term efficacious intervention for treating depressive symptoms in schoolchildren with atypical behaviors in Enugu State Nigeria regardless of location and gender.

Diabetic foot infection - diagnosis and treatment.

Diabetic foot (DF) is one of the most serious complications of diabetes, leading to high morbidity and mortality in patients with diabetes, significantly affecting their quality of life and placing a huge burden on the healthcare system. Diabetic foot infection (DFI) is a major factor in the non-healing of diabetic ulcerations of the lower limbs, increases the number of hospital admissions, prolongs their duration and is a frequent cause of increased number of amputations. The most serious form of foot infection is osteomyelitis. Management of infection in SDN includes proper diagnosis, including obtaining appropriate specimens for culture, indication of rational antimicrobial therapy or early surgical intervention, and provision of all other necessary wound care and overall patient care to prevent recurrence of DFI.