Severe Health Condition Research Articles

Influence of postpartum depression on maternal-infant bonding and breastfeeding practices among mothers in Abeokuta, Ogun state

BackgroundPostpartum Depression (PPD) is a severe mental health condition that adversely affects mothers and their infants. The influence of PPD on maternal-infant bonding and breastfeeding practices has been scarcely reported in Nigeria. Therefore, we examined the prevalence of PPD, the associated factors, and the relationship with maternal-infant bonding and breastfeeding practices in Abeokuta, Nigeria.MethodA descriptive cross-sectional survey was conducted among 600 mothers within the extended postpartum period (≤ 1 year) from three government-owned immunisation clinics at primary, secondary, and tertiary health facilities in Abeokuta, Ogun State. PPD was assessed using the Edinburgh postnatal depression Scale (EPDS ≥ 13), and maternal-infant bonding was evaluated using the Postpartum Bonding Questionnaire (PBQ ≥ 50). We also examined breastfeeding practices (i.e. the time to initiation by 30 min, exclusive breastfeeding for 6 months and early commencement of complementary feeding by 2 months). Data was analysed using chi-square and logistics regression models at a 5% significance level.ResultsThe prevalence of PPD was 21.8%, 95% CI (18.7–25.3). Factors associated with PPD were maternal age: 25–34 years [AOR = 0.52; 95% CI (0.29–0.90)]; ≥ 35 years [AOR = 0.44; 95% CI (0.20–0.96)], being married [AOR = 0.43; 95% CI (0.21–0.85)], perceived stress increased the odds of PPD: moderate stress level [AOR = 8.38; 95% CI (3.50–19.9)]; high-stress level [AOR = 47.8; 95% CI (8.65–263.7)] and self-reported history of emotional problems [AOR = 3.25; 95% CI (1.43–7.38)]. There was a significant direct association between PPD and poor maternal-infant bonding [AOR = 3.91; 95% CI (1.04–4.60)]. PPD reduces the odds of early breastfeeding initiation [AOR = 0.43; 95% CI (0.28–0.68)], but no association was found between PPD and exclusive breastfeeding [AOR = 1.07; 95% CI (0.07–1.67)].ConclusionThe prevalence of PPD was high in our study population and associated with poor maternal-infant bonding and late breastfeeding initiation but not with exclusive breastfeeding. Promoting maternal mental health to foster stronger mother-infant relationships and better breastfeeding practices has become crucial.

Effectiveness of a digital single-session cognitive behavioral psychoeducational intervention in reducing public stigma associated with psychosis: A randomized controlled trial

Psychosis is a severe mental health condition that is highly stigmatized, significantly increasing the costs of mental healthcare and reducing the productivity of those affected. Due to public stigma, individuals with psychosis often delay seeking professional help, exacerbating the socioeconomic burden of their ill-health. Psychoeducation, delivered in a structured and systematic manner, has been a key part of evidence-based psychological treatments and has been gradually adopted in stigma reduction efforts. This study evaluated the effectiveness of a digital single-session cognitive behavioral psychoeducation intervention in reducing public stigma toward people with psychosis in a collectivist society through a randomized controlled trial. Stigma was assessed using standardized self-report tools at pre-intervention, post-intervention, and 1-month follow-up. A significant reduction was observed in stereotyping, prejudice, and discrimination on seven out of 10 public stigma components post-intervention. However, the desired effects were maintained for only two components at the 1-month follow-up. No significant changes were found in negative emotions, tolerance, and support from pre-intervention to post-intervention. Attribution of responsibility significantly increased after the intervention, contrary to predictions. The findings of this study provide empirical support for the short-term effectiveness of a brief cognitive behavioral psychoeducation intervention in reducing public stigma toward individuals with psychosis while highlighting the potential benefits of delivering this intervention digitally. At the same time, the limitations of individual-level interventions in sustaining long-term effects are discussed from a sociocultural perspective. This study also examined the relevance of these findings in the context of health economics.

Microbiota–gut–brain axis: Natural antidepressants molecular mechanism

BackgroundMajor depressive disorder (MDD) is a severe mental health condition characterized by persistent depression, impaired cognition, and reduced activity. Increasing evidence suggests that gut microbiota (GM) imbalance is closely linked to the emergence and advancement of MDD, highlighting the potential significance of regulating the "Microbiota-Gut-Brain" (MGB) axis to impact the development of MDD. Natural products (NPs), characterized by broad biological activities, low toxicity, and multi-target characteristics, offer unique advantages in antidepressant treatment by regulating MGB axis. PurposeThis review was aimed to explore the intricate relationship between the GM and the brain, as well as host responses, and investigated the mechanisms underlying the MGB axis in MDD development. It also explored the pharmacological mechanisms by which NPs modulate MGB axis to exert antidepressant effects and addressed current research limitations. Additionally, it proposed new strategies for future preclinical and clinical applications in the MDD domain. MethodsTo study the effects and mechanism by which NPs exert antidepressant effects through mediating the MGB axis, data were collected from Web of Science, PubMed, ScienceDirect from initial establishment to March 2024. NPs were classified and summarized by their mechanisms of action. ResultsNPs, such as flavonoids,alkaloids,polysaccharides,saponins, terpenoids, can treat MDD by regulating the MGB axis. Its mechanism includes balancing GM, regulating metabolites and neurotransmitters such as SCAFs, 5-HT, BDNF, inhibiting neuroinflammation, improving neural plasticity, and increasing neurogenesis. ConclusionsNPs display good antidepressant effects, and have potential value for clinical application in the prevention and treatment of MDD by regulating the MGB axis. However, in-depth study of the mechanisms by which antidepressant medications affect MGB axis will also require considerable effort in clinical and preclinical research, which is essential for the development of effective antidepressant treatments.

The Mediterranean diet and periodontitis: A systematic review and meta-analysis

Periodontitis is a severe oral health condition that affects the soft tissue and bone supporting the teeth. The Mediterranean diet has been proposed as a potential contributor to reducing the risk of periodontitis. This systematic review and meta-analysis aims to explore the association between adherence to the Mediterranean diet and periodontitis. A comprehensive literature search from 1992 to January 2024 was conducted across multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar. The included studies were clinical trials, randomized controlled trials, and observational studies that evaluated the impact of the Mediterranean diet on periodontitis. Data extraction and quality assessment of the included studies were performed using standardized protocols. A meta-analysis was conducted to combine effect sizes from multiple studies. This review included seven studies, comprising one cohort study, five cross-sectional studies, and one randomized controlled trial. While some studies reported a potential link between Mediterranean diet adherence and periodontitis, the overall analysis did not demonstrate a significant association. The meta-analysis revealed an Odds Ratio (95 % Confidence Interval) of 0.77 (0.58, 1.03) for the association between adherence to the Mediterranean diet and periodontitis (p = 0.08). This systematic review and meta-analysis found no statistically significant association between periodontitis and Mediterranean diet adherence. Future research should prioritize the implementation of rigorous clinical studies with longer follow-up periods to better understand the causal association between the Mediterranean diet and periodontitis. Observational studies with larger sample sizes are needed to establish more conclusive evidence regarding the impact of dietary patterns on periodontal health.

The Therapeutic Role of Lamotrigine in Borderline Personality Disorder: A Comprehensive Review of Outcomes, Mechanisms, and Treatment Strategies.

Borderline personality disorder (BPD) is a severe mental health condition characterized by pervasive instability in mood, self-image, and interpersonal relationships, significantly impacting individuals' personal, social, and occupational functioning. Current treatment strategies primarily include psychotherapy and pharmacotherapy, but there remains a need for more effective and targeted pharmacological options. This review examines the therapeutic role of lamotrigine in BPD, focusing on its efficacy, safety, mechanisms of action,and practical treatment strategies. A comprehensive review of the existing literature was conducted, including clinical trials, observational studies, and relevant pharmacological data. Key focus areas included lamotrigine's impact on BPD symptoms, pharmacological profile, and comparative effectiveness with other treatments. Lamotrigine has shown promise in managing BPD symptoms, particularly in stabilizing mood and reducing emotional dysregulation and impulsivity. Clinical trials suggest that lamotrigine can effectively address core symptoms of BPD, with a safety profile generally comparable to other treatments. The medication's mechanism of action, which involves modulation of glutamate release and mood stabilization, aligns with the therapeutic goals for BPD. Lamotrigine represents a potential adjunctive treatment for BPD, offering benefits in mood stabilization and symptom management. Integrating psychotherapy and other pharmacological options should be considered within a multimodal treatment approach. Further research is needed to better understand its long-term efficacy and safety and its role in combination therapy.

'I am more than my diagnosis': Amplifying the voice of consumers in the design and delivery of mental health services.

In line with the Australian Government's Vision 2030, this research foregrounds consumer experiences of recovery to inform the (co)design and delivery of mental health services for people living with complex needs and/or a severe and persistent mental health condition. The research takes a specialist focus on the regional setting, with data collected from client experiences within Western NSW, Australia, in the context of the National Disability Insurance Scheme (NDIS) implementation and inclusion of psycho-social disability within the NDIS service environment. Thirty-seven people aged 19-70 years living with complex needs and/or a diagnosis of a severe and persistent mental health condition were recruited from services where they had a care plan or where they were members of a consumer reference group for recovery-oriented services. A tripartite framework integrating recovery oriented, trauma-informed and collective impact approaches for a qualitative, arts-based (photovoice) study. In areas of the mental health service system that had not yet applied a personalised understanding of recovery or embraced trauma-informed practice there were a range of issues and gaps in service delivery relating to authentic relationships, belonging and connection, service cultures, trauma-informed care, and workforce investment. Clinical and non-clinical services need to ensure consistent person-centred and trauma-informed practice is implemented throughout the mental health service system to meet the needs of the consumer. An eight-point checklist serves as the basis for services to reflect on how they are working with consumers and to support the review of systems and clinical governance frameworks.

Using Neurocognitive Phenotypes to Inform Interventions for Adult Survivors of Childhood Cancer.

Neurocognitive impairments are sequelae of childhood cancer treatment, however little guidance is given to clinicians on common phenotypes of impairment, or modifiable risk factors that could lead to personalized interventions in survivorship. Standardized clinical testing of neurocognitive function was conducted in 2,958 (74.1%) eligible survivors, who were ≥5 years post-diagnosis and >18 years old, and 477 community controls. Impairment was examined across 20 measures and phenotypes were determined by latent class analysis. Multinomial logistic regression was used to estimate risk for phenotype, predicted by cancer diagnosis and treatment exposures, chronic health conditions, and lifestyle, adjusted for sex and age. Associations between phenotypes and social attainment were examined. Five neurocognitive phenotypes were identified in survivors (global impairment 3.7%, impaired attention 5.0%, memory impairment 7.2%, processing speed/executive function impairment 9.3%, no impairment 74.8%). Risk of global impairment was associated with severe chronic health condition burden (odds ratio [OR]=20.17, 95% confidence interval [95%CI] 11.41-35.63) including cerebrovascular disease (OR = 14.5, 95%CI = 5.47-38.44) and cerebrovascular accident (OR = 14.7, 95%CI = 7.50-26.40). Modifiable risk factors, like quitting smoking reduced risk for global impairment (OR = 0.21, 95%CI 0.06-0.66). Low physical activity increased risk for global impairment (OR = 4.54, 95%CI 2.86-7.21), attention impairment (OR 2.01, 95%CI 1.41-2.87), processing speed/executive function impairment (OR 1.90, 95%CI 1.46-2.48), and memory impairment (OR 2.09, 95%CI 1.54-2.82). Results support the clinical utility of neurocognitive phenotyping to develop risk profiles and personalized clinical interventions, such as preventing cerebrovascular disease in anthracycline treated survivors by preventing hypercholesterolemia, smoking, and sedentary lifestyle, to reduce the risk for global impairment.

Selected nursing diagnoses and interventions in patients with COVID-19 hospitalized during pandemic

Introduction. In March 2020, the WHO announced global pandemic due to the outbreak of coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus. COVID-19 is considered as a highly infectious disease, with a considerable mortality rate, especially among older people with concomitant diseases (heart failure, pulmonary diseases, arterial hypertension, diabetes). The pathogen affects mainly the respiratory system, and may also lead to acute respiratory distress syndrome, sepsis. In a severe state of health of a patient nurses make many nursing diagnoses, based on which they plan and implement nursing interventions to limit the risk of complications/death. Objective. The aim of the study was presentation of selected nursing diagnoses and interventions in patients hospitalized due to COVID-19 during the period of pandemic. Materials and Method. Nursing diagnoses and nursing interventions associated with these diagnoses were analyzed among patients hospitalized due to COVID-19 during pandemic, based on practical experiences in Poland. Results. The COVID-19 pandemic was a new challenge for nurses in inpatient health care to provide patients with attentive care in a severe health condition. The efforts of nurses had to be focused on solving many care problems in the bio-psycho-social sphere in order to limit the risk of complications/death. The implementation of nursing interventions had to proceed smoothly, with consideration of the provision of secure environment of patient care and personal protection. Conclusions. The symptoms of COVID-19 are frequently multisystemic and are related with the risk of complications/death. The presented nursing diagnoses and interventions in patients ill with COVID-19 disease are an example of the provision of high quality care of patients infected with SARS-CoV-2 virus. Nursing care of a patient with COVID-19 should be characterized by the subjective approach to the patient in accordance with the holistic concept of solving health problems in the bio-psycho-social sphere.

COVID-19 experience of people with severe mental health conditions and families in South Africa.

People with severe mental health conditions, such as schizophrenia, and their family caregivers are underserved in low- and middle-income countries where structured psychosocial support in the community is often lacking. This can present challenges to recovery and for coping with additional strains, such as a pandemic. This study explored the experiences and coping strategies of people with lived experience of a severe mental health condition, and family caregivers, in South Africa during the initial stages of the coronavirus disease 2019 (COVID-19) pandemic. This qualitative study was conducted in the Nelson Mandela Bay District, Eastern Cape, South Africa, in the most restrictive period of the COVID-19 lockdown. Telephonic qualitative interviews were conducted with people with lived experience (n = 14) and caregivers (n = 15). Audio recordings were transcribed and translated to English from isiXhosa. Thematic analysis was conducted with NVivo 12. Participants described negative impacts including increased material hardship, intensified social isolation and heightened anxiety, particularly among caregivers who had multiple caregiving responsibilities. Coping strategies included finding ways to not only get support from others but also give support, engaging in productive activities and taking care of physical health. The main limitation was inclusion only of people with access to a telephone. Support needs for people with severe mental health conditions and their families should include opportunities for social interaction and sharing coping strategies as well as bolstering financial security. These findings indicate that current support for this vulnerable group is inadequate, and resource allocation for implementation of additional community-based, recovery-focused services for families must be prioritised.

The feasibility of a combined approach including neuromodulation by tDCS and cognitive remediation for people with borderline personality disorder (BPD)

IntroductionBPD is a common and severe mental health condition. Longitudinal studies related to BPD show a reduction of symptoms related to the disorder but very little improvement in functionality. The betterment of executive functions of people with BPD after psychotherapy is very limited. The efficacy of those treatments on functionality appears to be mild with a small effect size. Based on previous studies, transcranial direct current stimulation (tDCS) can be used to improve impulsivity and emotional instability in patients with BPD. Moreover, cognitive remediation focuses on reducing neuropsychological alterations by re-educating patients and apply specific strategies to aid them long term on certain daily functions like developing healthy habits, executive functions, problem solving, attention, working memory and cognition.ObjectivesOur objective is to assess the feasibility and efficacy of the tDCS and cognitive remediation on BPD symptoms and functioning.MethodsThe open study includes 10 daily sessions of tDCS for 2 weeks and 8 weekly group meetings for the cognitive remediation. Based on studies conducted on people with BPD, the settings for the tDCS are as follows; 20 minutes of continuous current at the intensity of 2mA and the electrodes are placed on specific stimulation sites related to impulsivity. To verify the effectiveness of the combination on the symptoms and evaluate the cognition and functionality of the patients, questionnaires at neuropsychological texts are conducted at the beginning of the study, after the tDCS, after the cognitive remediation and 3 months after the end of the study. The expected results of this study are that the combination of the two treatments will reduce the symptoms of BPD and improve executive functions compared to the treatment as usual or tDCS alone. This study would allow the implementation of an efficient and low-cost first-line treatment and a better functional progression of BPD patients.ResultsThe expected results of this study are that the combination of the two treatments will reduce the symptoms of BPD and improve executive functions compared to the treatment as usual or tDCS alone. This study would allow the implementation of an efficient and low-cost first-line treatment and a better functional progression of BPD patients.ConclusionsThis study would allow the implementation of an efficient and low-cost first-line treatment and a better functional progression of BPD patients.Disclosure of InterestNone Declared

Evaluation of the therapeutic effect of very small stem cells from peripheral blood on the treatment of Premature Ovarian Failure: A pilot study.

Premature ovary failure (POF) is a severe health condition with multiple negative outcomes, which deteriorate a patient's life. The current study aimed to evaluate the therapeutic effect of mesenchymal stem cells (MSCs) derived from peripheral blood in the treatment of women with the POF background. The current study was a pilot study carried-out on women younger than 40 with premature ovarian failure. Study participants underwent 4-months cell therapy using Mesenchymal stem cells extracted from peripheral bloods. Serum level of Follicle-stimulating hormone (FSH), Estradiol (E2), Anti-mullerian hormone (AMH), and Antral follicle count (AFC) were the main investigated outcomes that were assessed at baseline, month two and month four of the very small stem cell intervention. Average serum level of FSH was 45.0 (12.1) mIU/mL at baseline and continually decreased during the study and reached 33.2 (12.4) mIU/mL in the fourth month. The average AMH level was 0.10 ng/mL prior to the intervention and increased to 0.13 ng/mL in the 2nd month and 0.15 ng/mL in the fourth month. The level E2 was 85.7 (23.6) pg/ml on average at baseline, while the average E2 reduced to 77.2 (25.6) pg/ml in the fourth month. Average number of AFC was 2.0 (0.8) at baseline. We observed a gradual increase in the second month (Mean AFC=2.2) and after four months it increased to 3.1 (1.8) as the highest menstrual restoration and pregnancy was observed in 10% of our study participants. MSCs could significantly improve hormone secretion in women with POF. Implantation of MSCs in women with POF background was associated with an increase in AMH and AFC, while it downed the serum level of E2 and FSH. MSCs could also lead to menstrual restoration and pregnancy in women with POF.

Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience.

Borderline personality disorder (BPD) is a severe mental health condition marked by impairments in self and interpersonal functioning. Stigma from health staff may often result in a reluctance to diagnose, impacting recovery trajectories. Qualitative interviews were conducted with participants (N = 15; M Age = 36.4 years, SD = 7.5; 93.3% female) with lived experience of BPD exploring topics of illness onset, insight, experience of diagnosis and treatment. Qualitative responses were analysed within a co-design framework with a member of the research team who identifies as having a lived experience of BPD. On average, participant symptoms emerged at 12.1years of age (SD = 6.6years, range 1.5-27), but diagnoses of BPD were delayed until 30.2years (SD = 7.8years, range 18-44) resulting in a 'diagnosis gap' of 18.1years (SD = 9.6years, range 3-30). Participant explanations for BPD emergence varied from biological, psychological and social factors. Benefits of diagnosis (e.g., fostering insight, aiding treatment planning and reducing isolation) were contrasted with challenges (e.g., stigma and treatment unavailability). Delay in diagnosis was common, and no participants reported receiving a diagnosis of BPD during their adolescence yet 85% felt they would have benefited from a diagnosis in adolescence. Only a quarter (27%) felt highly supported in the diagnostic process. An ideal four-step diagnosis procedure was outlined based on recommendations from participants with a lived experience; this involved the following: (1) explain the process, (2) assess thoroughly, (3) explore how the features are active in everyday life and (4) link diagnosis to evidence-based treatment planning.

Quality of Life and Comorbidities of Adult Survivors of Allogeneic Hematopoietic Cell Transplant Versus Their Siblings

Background: Survivors of allogeneic hematopoietic cell transplant (allo-HCT) are at risk of developing chronic health conditions. Prior studies have shown that survivors of allo-HCT in childhood/young adulthood who mainly received high dose total body irradiation (TBI)-based conditioning experience excess health conditions and more distress vs. their siblings. In recent years, allo-HCT is offered to adults of increasing age and there has been increasing use of chemotherapy +/- low dose TBI conditioning rather than high dose TBI. We set out to describe and compare the QoL and comorbidities of adults who underwent allo-HCT with chemotherapy +/- low dose TBI conditioning vs. their siblings. Methods: Allo-HCT recipients attending 1 of 2 survivorship clinics at ≥2 years post-HCT without active cGVHD or relapse, were enrolled. Beginning in 2023, participants were asked to forward an electronic version of the study survey to their biological sibling(s). The survey includes the PROMIS-Global Health instrument: raw scores are converted to a mental (MH) and physical health (PH) subscale T-score (population mean 50/SD 10). Comorbidities were scored with a published post allo-HCT morbidity index. Associations between MH and PH-related QoL, comorbidities, and patient/transplant-related variables were investigated with linear regression. Patient and sibling comparisons were made with paired sample and chi-square tests. A significance level of <0.05 was statistically significant & a difference in QoL T-score of 5 was clinically significant. Results: Of 330 patients approached during their clinic visit, 320 consented to participate (97%). To date, 105 siblings of 57 recipients have been sent surveys and 47 siblings (45%) of 32 recipients (56%) have completed the survey. Among all recipients, median age at HCT is 47 (IQR 35-57) with 21% ≥60 years old, 48% are female, 78% are Caucasian, 69% are college educated or more & 51% are working full/part-time. Median time post-HCT is 9 years (IQR 6-14). The mean PH T-score is 48.5 (SD 8.6). In the multivariable model, total number of comorbidities (p<0.01) and a work status of disability (p<0.01) are associated with inferior PH QoL. The mean MH T-score was 49.1 (SD 8.4). In the multivariable model, total number of comorbidities (p<0.01) and a work status of disability (p<0.01) are associated with inferior MH QoL. HCT characteristics, including history of moderate-severe cGVHD, and demographic characteristics are not associated with either QoL subscale. Among all recipients, the median number of comorbidities is 3 (IQR 1.5-4). The most common comorbidities include hyperlipidemia (39%), hypertension (25%) & hypothyroidism (24%). At least one severe comorbidity (vascular disease, chronic heart/lung/liver/kidney disease or subsequent malignancy) is present in 23% of patients. In multivariable analysis, a greater number of years post-HCT is associated with a greater number of comorbidities (p=0.03) and full/part-time work status is associated with fewer comorbidities (p=0.01). In the sibling-recipient comparison, median age of siblings and recipients is 55 (IQR 37-66) & 54 (IQR 40-64), respectively. The MH QoL of recipients is statistically, but not clinically, better than their siblings: T-score 52.9 (SD 7.1) versus 49.9 (SD 6.9), respectively, p=0.04. The PH QoL of recipients was not significantly different than their siblings: T-score 52.6 (SD 5.6) versus 50.7 (SD 8.2), respectively, p=0.23. Recipients are suffering from significantly more comorbidities vs. their siblings: median 2.5 (IQR 1.8-4) versus 1 (IQR 0-3), respectively, p=0.03. The prevalence of ≥1 severe comorbidity is greater in recipients vs. siblings, but not statistically significant (13% vs. 2%, p=0.06). Conclusion: Adult recipients of allo-HCT, living without cGVHD or relapse and conditioned without high dose TBI, in aggregate experience similar QoL but suffer excess chronic health conditions as compared to their siblings. One in 4 recipients are suffering from ≥1 severe chronic health condition(s). Time post-HCT is associated with comorbidities, suggesting that recipients continue to accumulate health conditions in the years post-HCT. Number of comorbidities, rather than transplant and demographic factors (including prior cGVHD), is associated with impaired MH and PH QoL. Preventative care after allo-HCT is critical, even in those receiving HCT in adulthood without high dose TBI.

Construction of Phlorotannin-Based Nanoparticles for Alleviating Acute Liver Injury.

Acute liver injury (ALI) is a severe health condition with limited treatment options. Phlorotannin (PT), a natural compound extracted from seaweeds, has shown potential in improving liver function. However, its poor stability and bioavailability have limited its applications in vivo. In this study, we developed PT-based nanoparticles (NPs) through a Mannich reaction with glycine, which exhibited good biocompatibility and prolonged circulation time in vivo. Our results revealed that the PT NPs possess strong free radical scavenging ability, effectively reducing reactive oxygen species (ROS) and alleviating oxidative stress and proinflammatory responses in the H2O2-induced oxidative damage model of HepG2 cells. Furthermore, the PT NPs effectively attenuated oxidative stress and inflammation in the liver tissue of carbon tetrachloride (CCl4)-induced liver injury mice by regulating the Nrf2/HO-1 signaling pathway. In summary, our results suggested that the PT NPs could serve as a promising nano-therapeutic strategy for alleviating ALI.

A Deep Learning-based System for Detecting Anemia from Eye Conjunctiva Images taken from a Smartphone

Anemia is a severe health condition commonly prevalent among women of reproductive age and children below five years. Screening patients before the condition becomes critical and can save many lives. World Health Organization (WHO) has set the “Global nutrition target 2025-anemia,” aiming to reduce 50% of anemia cases among women of reproductive age. This target can be achieved through a time-efficient, cost-effective, and easy-to-use tool. Traditional testing methods require specific chemicals, machines, and equipment that are not available everywhere. It also requires the presence of nurses, laboratory workers, and doctors. These methods are costly, time-consuming, and produce biohazard waste, thus polluting the environment. We developed an Artificial Intelligence (AI)-based bot that can be used for screening people for anemia. The bot service is based on two models: a segmentation model to segment the Region of Interest (ROI) and a classification model to classify anemic cases from normal ones. To train the model, we have collected data from 160 anemic and 140 non-anemic persons. In this paper, we have explained the architecture of the models, all the training parameters, and their deployment on cloud services using the REAN chatbot service. We manage to reach an Intersection Over Union (IOU) score of 0.922 for the segmentation model; validation recall of 0.95 and validation accuracy of 0.9699 for the classification model. This system is easy to use and does not depend on the availability of comprehensive laboratory infrastructure or trained personnel and thus can enable screening of anemia in low-resource settings.

Indicadores de severidad clínica en la comorbilidad de trastorno bipolar y trastorno límite de personalidad: una revisión sistemática

IntroductionBipolar disorder (BD) is a severe chronic mental health condition with significant morbidity and mortality. It is characterized by affective episodes of mania and depression, as well as mixed states. Borderline personality disorder (BPD) is characterized by emotional instability and a pattern of impulsive behavior associated with suicidality. Both diagnoses can be comorbid and present high dysfunction and severity. MethodsThe aim of this study was to describe the differential characteristics in terms of clinical severity, present in samples of patients with BD–BPD comorbidity versus samples of patients with only one of these diagnoses. A systematic review of the literature of cross-sectional, case–control and cohort studies was carried out in which samples of BD or BPD patients were compared with samples of BD–BPD comorbidity, published in English and Spanish, and that considered a population between 18 and 65 years old. Those studies that considered samples of patients with other comorbidities were excluded. ResultsA total of 12 studies were included, which included a total of 4246 patients of both sexes. The comorbidity of BD and BPD presented higher suicidality, depressive episodes and mania/hypomania, aggressiveness, anger and hostility, hospitalizations, worse functioning and greater severity of symptoms compared to those with a single diagnosis, especially BD. ConclusionsThe comorbidity of BD and BPD presents evidence of a greater impact on the clinical course compared to those who do not present this condition.

Readmission and associated clinical factors among individuals admitted with bipolar affective disorder at a psychiatry facility in Uganda

BackgroundBipolar affective disorder (BAD) is a common severe mental health condition with a relapsing course that may include periods of hospital re-admissions. With recurrent relapses and admissions, the course, prognosis, and patient’s overall quality of life can be affected negatively. This study aims to explore the rates and clinical factors associated with re-admission among individuals with BAD.MethodThis study used data from a retrospective chart review of all records of patients with BAD admitted in 2018 and followed up their hospital records for four years till 2021 at a large psychiatric unit in Uganda. Cox regression analysis was used to determine the clinical characteristics associated with readmission among patients diagnosed with BAD.ResultsA total of 206 patients living with BAD were admitted in 2018 and followed up for four years. The average number of months to readmission was 9.4 (standard deviation = 8.6). The incidence of readmission was 23.8% (n = 49/206). Of those readmitted during the study period, 46.9% (n = 23/49) and 28.6% (n = 14/49) individuals were readmitted twice and three times or more, respectively. The readmission rate in the first 12 months following discharge was 69.4% (n = 34/49) at first readmission, 78.3% (n = 18/23) at second readmission, and 87.5% (n = 12/14) at third or more times. For the next 12 months, the readmission rate was 22.5% (n = 11/49) for the first, 21.7% (n = 5/23) for the second, and 7.1% (n = 1/14) for more than two readmissions. Between 25 and 36 months, the readmission rate was 4.1% (n = 2/49) for the first readmission and 7.1% (n = 1/14) for the third or more times. Between 37 and 48 months, the readmission rate was 4.1% (n = 2/49) for those readmitted the first time. Patients who presented with poor appetite and undressed in public before admission were at increased risk of being readmitted with time. However, the following symptoms/clinical presentations, were protective against having a readmission with time, increased number of days with symptoms before admission, mood lability, and high energy levels.ConclusionThe incidence of readmission among individuals living with BAD is high, and readmission was associated with patients’ symptoms presentation on previous admission. Future studies looking at BAD using a prospective design, standardized scales, and robust explanatory model are warranted to understand causal factors for hospital re-admission and inform management strategies.

Schizophrenia and Sexual Behaviour

Schizophrenia is a chronic and severe mental health condition characterized by a range of symptoms, including hallucinations, delusions, disorganized thinking, and speech difficulties. Sexual behaviour in individuals with schizophrenia can be affected by a combination of factors, including the symptoms of the condition, medication side effects, social factors, and personal beliefs and values. Research suggests that individuals with schizophrenia are more likely to have issues with intimacy, experience difficulties with sexual functioning, and engage in risky sexual behaviour. Treatment strategies for these issues may include addressing the underlying causes of sexual dysfunction, developing appropriate communication skills, and providing support to promote healthy sexual relationships. Overall, understanding the complex relationship between schizophrenia and sexual behaviour is important for promoting the overall wellbeing of individuals living with this condition.

Experiences of and Interventions for Adult Survivors of Childhood Sexual abuse in South Asia: A systematic review

IntroductionAdult survivors of childhood sexual abuse (CSA) may experience psychological difficulties in adulthood. Such adverse experiences in the developmental years, sometimes for prolonged periods, could have an impact on their emotional, social and psychological resources. This impact is heightened in CSA adult survivors as the interpersonal nature of harm could reverberate throughout their adult relationships, with complex emotional responses to traumatic stressors. Despite the demonstrated effectiveness of trauma focused treatments in the West, culturally specific understanding of the needs and treatments for such survivors in South Asia is still in its infancy. This is important to address their meaning of presenting complaints in South Asia and offering them treatments suitable for them.ObjectivesIn this systematic review, we aimed to synthesize the findings of existing research on the impact of CSA on adult survivors in South Asia and the current approaches used to treat them.MethodsWe searched nine databases and ‘hand searched’ important peer-reviewed journals published in South Asian countries from inception until 3rd April 2022. Searches focused on adult survivors of CSA of South Asian origin residing in South Asia, different treatments offered and the efficacy and acceptability of these treatments.ResultsWe identified and screened 2608 records and included 56 articles in our full text screening. Out of those, we included 22 articles in the final review. Studies were from four out of the eight countries in South Asia; India, Sri Lanka, Nepal and Pakistan. Of note, only six of those studies focused exclusively on CSA whereas others included all forms of abuse and neglect. All except one article explored experiences of survivors. Only one article focused on their recovery process, within and/or outside of professional treatment with no published research on treatments for them in South Asia. Physical abuse and emotional abuse or neglect were more often reported in our included studies as compared to sexual abuse.ConclusionsOur review suggests that even though the needs of adult CSA survivors in South Asia have been partly identified, there is very little research into the treatment of CSA adult survivors in this region. Perpetrators often come from their immediate or extended families, leading to their distrust of the familial and legal systems. Even when not diagnosed with a severe mental health condition, there are potentially serious implications for victims’ adult relationships and social functioning. There is a current lack of research and therefore, lack of evidence-based treatment for adult survivors of CSA in South Asia.Disclosure of InterestNone Declared

A Narrative Review on REM Sleep Deprivation: A Promising Non-Pharmaceutical Alternative for Treating Endogenous Depression.

Endogenous depression represents a severe mental health condition projected to become one of the worldwide leading causes of years lived with disability. The currently available clinical and non-clinical interventions designed to alleviate endogenous depression-associated symptoms encounter a series of inconveniences, from the lack of intervention effectiveness and medication adherence to unpleasant side effects. In addition, depressive individuals tend to be more frequent users of primary care units, which markedly affects the overall treatment costs. In parallel with the growing incidence of endogenous depression, researchers in sleep science have discovered multiple links between rapid eye movement (REM) sleep patterns and endogenous depression. Recent findings suggest that prolonged periods of REM sleep are associated with different psychiatric disorders, including endogenous depression. In addition, a growing body of experimental work confidently describes REM sleep deprivation (REM-D) as the underlying mechanism of most pharmaceutical antidepressants, proving its utility as either an independent or adjuvant approach to alleviating the symptoms of endogenous depression. In this regard, REM-D is currently being explored for its potential value as a sleep intervention-based method for improving the clinical management of endogenous depression. Therefore, this narrative review represents a comprehensive inventory of the currently available evidence supporting the potential use of REM-D as a reliable, non-pharmaceutical approach for treating endogenous depression, or as an adjuvant practice that could improve the effectiveness of currently used medication.