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Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review
Qingqing Huang,
Xuemei Dai,
Shuai Xu,
Libang Yuan,
Gu Gong
Issue:
Volume 10, Issue 3, September 2022
Pages:
86-88
Received:
16 June 2022
Accepted:
29 June 2022
Published:
20 July 2022
DOI:
10.11648/j.ajpn.20221003.11
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Abstract: Background: Currently, postoperative delirium is a common postoperative complication in elderly patients. However, it lacks effective treatment measures, and this case report strives to find a more effective treatment method based on the existing treatment measures. Objectives: The aim of this study was to investigate the efficacy of intranasal insulin combined with low-dose propofol in the treatment of refractory delirium. Methods: Five days after a 66-year-old woman underwent surgery under general anesthesia, she underwent surgery again under general anesthesia. After the second operation, the patient was sent to the ICU to continue observation. On the second day after entering the ICU, the patient was confused, restless, increased speech, unable to respond correctly, and had aggressive behavior. After the neurologist's treatment was invalid, the anesthesiologist was invited again for consultation. The anesthesiologist evaluated the patient through the RASS scale, CAM-ICU scale and CAM-R scale and found that the patient was currently in a state of delirium. Therefore, it was decided to take TCI target-controlled infusion of propofol, intranasal insulin administration, and dynamic monitoring of the patient's breathing with a microfluidic end-tidal carbon dioxide (PETCO2) monitor through a nasal cannula to control the patient's delirium state. Results: After 36 hours of treatment, the patient was conscious and quiet, communicated to the point, and had a clear understanding of the surrounding environment. Conclusion: Intranasal insulin combined with low-dose propofol can provide reference for the treatment of intractable delirium.
Abstract: Background: Currently, postoperative delirium is a common postoperative complication in elderly patients. However, it lacks effective treatment measures, and this case report strives to find a more effective treatment method based on the existing treatment measures. Objectives: The aim of this study was to investigate the efficacy of intranasal ins...
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Mrs. Dalloway: A Path Towards Virginia Woolf’s Unconscious
Issue:
Volume 10, Issue 3, September 2022
Pages:
89-94
Received:
8 June 2022
Accepted:
11 July 2022
Published:
29 July 2022
DOI:
10.11648/j.ajpn.20221003.12
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Abstract: The author is interested by the latent content of the novel, the fantasies and unconscious desires conveyed by the work. Mrs Dalloway is a good example. Virginia Woolf stages characters to whom she gives life, body and soul. She has an extraordinary ability to put herself in the place of each of her characters and gives us their most secret and intimate thoughts and moods. Mrs Dalloway’s novel tells us about the day of a middle class woman who is going to give a party in the evening at her home. We understand that she is married but it is an unsatisfactory marriage. She remembers a lover from her youth, Peter Walsh, and he shows up at her home. Her unconscious desire is to renew with this ancient love she refused. The Lucrezia-Septimus couple is also an unsatisfactory marriage. He develops delirious symptoms. Virginia Woolf is projecting her own mental illness on Septimus with a remarkable description. Her first crisis appeared at the death of her mother, then at the death of her father and her marriage with Leonardo was followed by three crises. Her manic-depressive illness is linked to a lack of her mother, a beautiful woman who took more time to take care of poor and sick people and to the incest “half-brother and sister”. The work seems to be built like a dream with defense mechanisms to hide the unconscious desires of the novelist: the nostalgia of a youth love and unconscious death wishes for her husband.
Abstract: The author is interested by the latent content of the novel, the fantasies and unconscious desires conveyed by the work. Mrs Dalloway is a good example. Virginia Woolf stages characters to whom she gives life, body and soul. She has an extraordinary ability to put herself in the place of each of her characters and gives us their most secret and int...
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Spatial Memory Deficits in Patients with Meniere’s Disease
Manuel Arturo Gallardo-Flores
Issue:
Volume 10, Issue 3, September 2022
Pages:
95-101
Received:
30 June 2022
Accepted:
20 July 2022
Published:
4 August 2022
DOI:
10.11648/j.ajpn.20221003.13
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Abstract: Background: Spatial memory is a cognitive process that allows us to locate ourselves in space based on visual references. Vestibular signals reaching the hippocampus from the vestibular nuclei have an important role in building this process. Vestibular conditions could affect this cognitive process. Meniere's disease is a chronic internal ear disease that causes impairment of hearing and vestibular function Objective: To determine the relationship between Meniere's disease and spatial memory in patients who attend the Anglo American clinic between 2016 and 2018. Specific objectives are: 1) identify patients with Meniere's disease and 2) assess spatial memory in these patients. Design: It is a cross-sectional correlated analytical study, where two groups were evaluated: a) with Meniere's disease and b) without Meniere's disease, comparable in age and sex. As a student T test statistic for mean difference in independent samples, considering equal variances. Methodology: Hearing and vestibular functions were evaluated, and Morris' virtual test was used to measure spatial memory. Four indicators were measured in the latter: time, percentage, distance and angle. Results: Group with Meniere's disease: N = 76, 38 males and 38 females, average age of 44.21-10 years; Meniere's disease-free group: N = 76, 38 males and 38 females, average age of 43.85-10. Comparing spatial memory between the two groups found a statistically significant difference (p < 0.000) in favor of Meniere's disease-free group in the four indicators. Within the group with Meniere's disease, spatial memory was evaluated according to the stage, without any significant difference between the different stages for the time indicators (p = 0.334), percentage (p = 0.659), distance (p = 0.955) and angle (p = 0.916). As for vestibular function, in which there was unilateral vestibular deficit, when compared to the Meniere's disease-free group, there was significant difference (p < 0.000) in the four indicators. The worst results were in those who had bilateral vestibular deficits. Conclusions: The group with Meniere's disease had poor spatial memory when compared to Meniere's disease-free group. The greatest commitment to space memory was in subjects with bilateral vestibular deficits.
Abstract: Background: Spatial memory is a cognitive process that allows us to locate ourselves in space based on visual references. Vestibular signals reaching the hippocampus from the vestibular nuclei have an important role in building this process. Vestibular conditions could affect this cognitive process. Meniere's disease is a chronic internal ear disea...
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A Cross-Sectional Study on Knowledge and Attitude Towards Epilepsy Among High School Students in Asmara, Eritrea
Teame Kiflom Gaim,
Aster Andom Beraki,
Semere Teklebrhan Tewelde,
Bietiel Woldemichel Goniche,
Elsa Afewerki Kesete,
Aklilu Gebrit Mebrahtu,
Salem Sium Mesfin,
Frewengel Melake Weldeslassie,
Firuz Tesfazieghi Fesiha
Issue:
Volume 10, Issue 3, September 2022
Pages:
102-110
Received:
16 July 2022
Accepted:
9 August 2022
Published:
17 August 2022
DOI:
10.11648/j.ajpn.20221003.14
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Abstract: Epilepsy is a kind of neurological disorder which is usually handled in a wrong way with social stigma and discrimination. This stigma arises from having lack of awareness and misinformation about the disease. Students who suffer from epilepsy are usually discriminated in school by their peers and schoolmates. Student’s awareness and approach to epilepsy varies with the accuracy of their knowledge, which is often inadequate, limited, or even erroneous. Objective: The aim of this study was to assess the knowledge and attitude of high school students toward epilepsy. Methodology: The study conducted a quantitative descriptive cross-sectional study in selected High Schools of Asmara. One high school was taken for pilot study and not included in the actual study. The study population was all high school students of Asmara Secondary Schools. Sample was selected using the probability random sampling method. Hence our sample size was included 383 high school students. We adopted a questionnaire and distributed it to the eligible students. Once we have finished data collection procedure, data entry was done using CS Pro version 7.0 and analyzed by SPSS version 23. Descriptive statistics included frequency, mean, percentage and standard deviation. In addition, inferential statistics was also used. Result: The study revealed that 14.9% of the students had good level, nearly three-fourth (73.9%) of the students had moderate level, and 11.2% had poor level of knowledge. Majority (65%) of the students had moderate level of attitude and the remaining 30.3% and 4.7% of the research participants had, good and low level of attitude respectively. Conclusion: In this study the overall knowledge and attitude level of the participants was found to be moderate. Recommendation: Broad and continuous health education programs should be provided in schools to enhance the knowledge and attitude of the students related to epilepsy. Further extensive and nationwide studies should be done.
Abstract: Epilepsy is a kind of neurological disorder which is usually handled in a wrong way with social stigma and discrimination. This stigma arises from having lack of awareness and misinformation about the disease. Students who suffer from epilepsy are usually discriminated in school by their peers and schoolmates. Student’s awareness and approach to ep...
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Suicide: A New Hypothesis on the Pathogenesis of Disease, Method of Screening, and Means of Prevention
Issue:
Volume 10, Issue 3, September 2022
Pages:
111-124
Received:
2 August 2022
Accepted:
17 August 2022
Published:
29 August 2022
DOI:
10.11648/j.ajpn.20221003.15
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Abstract: Suicide has become a global epidemic. Every 40 seconds, another person completes the act, and for every person who successfully commits suicide, there are many more who attempt to take their lives. Although many factors are known to increase the risk of suicide, there continues to be a lack of clarity about why some persons decide to end their lives and, equally disturbing, a lack of predictability about when they decide to end their lives. However, an emerging hypothesis contends that a subtle but highly prevalent neurophysiological abnormality is at the root of nearly all psychopathology, including suicidal thinking and behavior. According to the multi-circuit neuronal hyperexcitability hypothesis of psychiatric disorders, an inherent hyperexcitability of the neurological system causes normal thoughts and emotions to become abnormally amplified and persistent. Thus, persistent firing in anxiety circuits causes persistent feelings of anxiety; persistent firing in depressive circuits causes persistent feelings of depression; persistent firing in cognitive circuits causes ruminative and obsessive thoughts; etc... In addition to offering a biologically-based explanation for the development of psychiatric symptomatology, the severe emotional distress, loss of behavioral control, and waxing and waning of symptoms that this neurophysiological abnormality can create from an early age offers a highly plausible explanation for why an affected person might eventually attempt suicide and why the timing of that decision is so difficult to predict. This article will trace the epidemic of suicide to its molecular roots and propose a simple, objective way to assess one’s vulnerability to suicide and an equally simple way to reduce that vulnerability before it is too late.
Abstract: Suicide has become a global epidemic. Every 40 seconds, another person completes the act, and for every person who successfully commits suicide, there are many more who attempt to take their lives. Although many factors are known to increase the risk of suicide, there continues to be a lack of clarity about why some persons decide to end their live...
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The Envelopmental Unconscious: An Alternative Perspective to the Psychoanalytic Psychodynamic Formulation of the Unconscious
Issue:
Volume 10, Issue 3, September 2022
Pages:
125-133
Received:
28 July 2022
Accepted:
17 August 2022
Published:
29 August 2022
DOI:
10.11648/j.ajpn.20221003.16
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Abstract: The theory of the psychoanalytic psychodynamic based unconscious is discussed as an extension of the ways we understand consciousness; as an expression and interplay of largely objectifiable manifestations of cognitive and perceptual events and processes rooted in and oriented to reality in life. Offered here will be an alternative perspective on the unconscious, an envelopmental unconscious that is outside of the dimensions of psychic time and space. It is conceived of as an instantaneous dimension of psychic wholeness or oneness bounded only by contextually situational and imaginative, even visionary scope, extending outwards and inwards towards infinity. Whereas consciousness exists within a deterministic cause-and effect sensibility that we understand to be what reality is, the envelopment stands for all that is. The quantum and quantum physics in general is used to explore the above two perspectives. The quantum in particular has properties that correspond to both: its particle aspect can be realistically studied and worked with, and its wave, whose unconscious counterpart is seen as being able to extend to the limits of the psychic and physiical universe. Quantum mechanical concepts, such as entanglement and collapsing the wave function are utilized in exploring how conscious functioning can become part of the envelopmental unconscious, thus broadening the scope of Freud’s original psychoanalytic enterprise of making the unconscious conscious.
Abstract: The theory of the psychoanalytic psychodynamic based unconscious is discussed as an extension of the ways we understand consciousness; as an expression and interplay of largely objectifiable manifestations of cognitive and perceptual events and processes rooted in and oriented to reality in life. Offered here will be an alternative perspective on t...
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Emergent Success of GABA Modulators Links Neuronal Hyperexcitability to the Pathophysiology of Depression
Issue:
Volume 10, Issue 3, September 2022
Pages:
134-144
Received:
5 August 2022
Accepted:
23 August 2022
Published:
31 August 2022
DOI:
10.11648/j.ajpn.20221003.17
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Abstract: In 2019, after it had demonstrated rapid antidepressant effects in two placebo-controlled trials, the investigational drug brexanolone received FDA approval for the treatment of postpartum depression. Less than a year later, zuranolone, an oral formulation of the same drug, achieved similar results in patients with treatment-resistant depression. Brexanolone and zuranolone are the first in a new line of investigational drugs that act by enhancing GABA neuroinhibitory currents. The significance of this pharmacodynamic effect is that it is associated with a reduction in depressive symptoms in just 2-3 days as opposed to 2-3 weeks with antidepressants. This has naturally raised many questions about the mechanism by which these drugs exert their therapeutic effects. At the same time, an emerging hypothesis contends that psychiatric symptoms are the consequence of an inability of neurons to shut off. According to the multi-circuit neuronal hyperexcitability (MCNH) hypothesis of psychiatric disorders, psychiatric symptoms develop when symptom-related circuits in the brain fire too easily and for too long. Brexanolone and zuranolone put a brake on that firing. This article will discuss the groundbreaking success of GABAergic modulation from the perspective of the MCNH hypothesis and contrast it with the pharmacodynamic effects of standard antidepressant drugs in an effort to highlight the importance of neuronal excitability in the pathophysiology of depression and showcase the utility of the MCNH hypothesis as a guide to the assessment, treatment, and prevention of a wide range of psychiatric symptoms.
Abstract: In 2019, after it had demonstrated rapid antidepressant effects in two placebo-controlled trials, the investigational drug brexanolone received FDA approval for the treatment of postpartum depression. Less than a year later, zuranolone, an oral formulation of the same drug, achieved similar results in patients with treatment-resistant depression. B...
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Anxiety-Depressive Disorders and Neurotrophic Control in Post-Traumatic Gunshot Neuropathies and Plexopathies Accompanied by Chronic Neuropathic Pain Syndrome
Olena Borodai,
Tetyana Litovchenko
Issue:
Volume 10, Issue 3, September 2022
Pages:
145-153
Received:
17 August 2022
Accepted:
2 September 2022
Published:
16 September 2022
DOI:
10.11648/j.ajpn.20221003.18
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Abstract: Introduction: Injuries of peripheral nerves and plexuses usually cause serious impairment of the function of the affected limb. Peripheral nerve injuries not only affect the physical capabilities of the injured person due to the loss of motor or sensory function, but also have a significant impact on psychosocial aspects of life. Materials and Methods: The study included 93 men aged 21 to 59 years with neuropathies and plexopathies of traumatic and non-traumatic origin, which were divided into 3 groups. Neurological, electroneuromyographic, and ultrasound examinations were performed on the patients. The visual analog scale (VAS), the questionnaire DN4 (Douleur Neuropathique 4 Questions), and the questionnaire Pain Detect were used to determine the pain syndrome. The Hospital Anxiety and Depression Scale (HADS), the Center for Epidemiologic Studies Depression (CES-D) Scale, Spielberger State-Trait Anxiety Inventory (STAI) was used to assess and identify psycho-emotional disorders. Immunological examination was performed from 12 to 24 months from the onset of the disease. Results: The content of nerve growth factor (Beta-NGF) in patients of the III group at a statistically significant level depends on the presence of anxiety and depressive disorders in patients (Mann–Whitney U test, p=0.0231). Thus, in patients with post-traumatic gunshot neuropathies and plexopathies in the presence of an anxiety and depressive disorder, the level of Beta-NGF is 404.9 [352.1; 1007] pg/ml, which is significantly higher than in patients without an anxiety and depressive disorder 58.3 [26; 322, 1] pg/ml. A correlation between the content of Beta-NGF and the visual analog scale (VAS) (R=0.88, p=0.00001) was revealed in patients with post-traumatic gunshot neuropathies and plexopathies accompanied by chronic neuropathic pain syndrome. Conclusion: Аccording to the obtained research data, signs of a subclinical and clinically expressed anxiety and depression can negatively affect the severity of the pain syndrome and its subjective assessment by the patient, thus reducing the effectiveness of drug correction of chronic neuropathic pain. It was found that in patients with post-traumatic gunshot neuropathies and plexopathies in the presence of an anxiety and depressive disorder, the level of Beta-NGF is significantly higher (p=0.0231) than in patients without an anxiety and depressive disorder, which indicates the initiation of the homeostatic function of Beta-NGF in order to compensate for the existing pathophysiological changes.
Abstract: Introduction: Injuries of peripheral nerves and plexuses usually cause serious impairment of the function of the affected limb. Peripheral nerve injuries not only affect the physical capabilities of the injured person due to the loss of motor or sensory function, but also have a significant impact on psychosocial aspects of life. Materials and Meth...
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Assessing the Direct Hospital Costs of Stroke in Libreville (Gabon)
Nyangui Mapaga Jennifer,
Gnigone Pupchen Marylise,
Mambila Matsalou Grass Aurelle,
Nsounda Annick Andrea,
Camara Aissata Ibrahima,
Diouf Mbourou Nelly,
Neau Jean Philippe,
Kouna Ndouongo Philomene
Issue:
Volume 10, Issue 3, September 2022
Pages:
154-158
Received:
21 August 2022
Accepted:
3 September 2022
Published:
16 September 2022
DOI:
10.11648/j.ajpn.20221003.19
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Abstract: Introduction: Gabon faces a double epidemiological burden, with persistent infectious diseases and an exponential increase in noncommunicable diseases such as stroke. The growing burden related to stroke is an additional challenge for our health care system. Massive amounts of money are spent annually in industrialized countries to improve stroke management. In contrast, the costs borne by the families and the society are both poorly evaluated in Africa. The objective of this study was to assess the direct hospital cost of stroke in Libreville, Gabon. Methods: By means of an economy-based prospective multicenter study, with descriptive and analytical focus, carried out from 1ͤ ͬ March to 31st July 2020, data from all stroke inpatients on the different consumption functions was collected using the so-called Bottom-up method. The cost to society and the patient was considered; the CFA franc was the cost unit (1 EUR = 655 CFA francs). Multiple linear regression analysis was applied to identify the factors associated with cost. Results: The study included 50 patients, sex ratio was 2.1 in favor of men. Mean age was 54.8 (± 11.1) years. The NIHSS neurological score at admission ranged from 4 to 27 with a mean of 10.5 (± 5.1). Ischemic stroke was predominant in 70% of cases. The average length of hospital stay was 14.2 (± 8.6) days, and the mode of discharge was a return home for 45 patients (90%). During hospitalization, the total direct cost expenditure varied from 266.97€ to 3,376.74€ with a mean of 933.44€ ± 611.13€ or (1,046.48±767.75USD). Factors associated with the average direct cost were the length of hospital stay (longer) and Rankin score (mRS) at discharge. Conclusion: This study highlights the heavy cost of stroke management in Libreville, but the National Health Insurance and Social Guarantee Fund (CNAMGS) is an asset since it reduces the cost of stroke by facilitating better financial management for the Gabonese population.
Abstract: Introduction: Gabon faces a double epidemiological burden, with persistent infectious diseases and an exponential increase in noncommunicable diseases such as stroke. The growing burden related to stroke is an additional challenge for our health care system. Massive amounts of money are spent annually in industrialized countries to improve stroke m...
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