Post-COVID Neuropsychiatric Complications in Children and Adolescents: a Study Design for Early Diagnosis and Treatment Using Innovative Technologies.

BACKGROUND: The COVID-19 pandemic has had significant impacts on the child and adolescent population, with long-term consequences for physical health, socio-psychological well-being, and cognitive development, which require further investigation. We herein describe a study design protocol for recognizing neuropsychiatric complications associated with pediatric COVID-19, and for developing effective prevention and treatment strategies grounded on the evidence-based findings. METHODS: The study includes two cohorts, each with 163 participants, aged from 7 to 18 years old, and matched by gender. One cohort consisted of individuals with a history of COVID-19, while the other group presents those without such a history. We undertake comprehensive assessments, including neuropsychiatric evaluations, blood tests, and validated questionnaires completed by parents/guardians and by the children themselves. The data analysis is based on machine learning techniques to develop predictive models for COVID-19-associated neuropsychiatric complications in children and adolescents. RESULTS: The first model is focused on a binary classification to distinguish participants with and without a history of COVID-19. The second model clusters significant indicators of clinical dynamics during the follow-up observation period, including the persistence of COVID-19 related somatic and neuropsychiatric symptoms over time. The third model manages the predictors of discrete trajectories in the dynamics of post-COVID-19 states, tailored for personalized prediction modeling of affective, behavioral, cognitive, disturbances (academic/school performance), and somatic symptoms of the long COVID. CONCLUSIONS: The current protocol outlines a comprehensive study design aiming to bring a better understanding of COVID-19-associated neuropsychiatric complications in a population of children and adolescents, and to create a mobile phone-based applications for the diagnosis and treatment of affective, cognitive, and behavioral conditions. The study will inform about the improved management of preventive and personalized care strategies for pediatric COVID-19 patients. Study results support the development of engaging and age-appropriate mobile technologies addressing the needs of this vulnerable population group.

Dietary Patterns as Modifiable Risk Factors for Depression: a Narrative Review.

BACKGROUND: The role of nutrition in treating clinical depression has been widely discussed. Unhealthy lifestyle patterns, like lack of physical activity, junk food consumption, and irregular sleep patterns are common in depressed patients. Considering the mental and physical side-effects, the daily nutrition of these patients seems to be a plausible option for reducing depressive symptoms and enhancing treatment results. METHODS: A PubMed search was done for meta-analyses published from January 2018 to June 2023 with the query: (diet) AND (psychiatric disorder) AND (depression). We selected meta-analyses that met specific criteria like including the entire diet or specific diet patterns and having depression or depressive symptoms as a primary or secondary outcome. RESULTS: Out of 28 papers found, the 9 meta-analyses, selected for review, revealed different types of correlation between dietary patterns and the symptoms of depression and anxiety. Healthy diets were associated with higher intake of fruits, vegetables, nuts, and lower intake of pro-inflammatory food items like processed meats and trans fats. Adherence to such diets showed a negative association with incident depression in cross-sectional and longitudinal studies. A diet mostly including ultra-processed foods was associated with higher odds of depressive and anxiety symptoms. Women were found to be more susceptible than men both in developing the depressive symptoms with unhealthy diet and in reducing the symptoms of depression and anxiety with improvement of diet quality. Statistically significant improvement in symptoms of depression and anxiety in both sexes was observed in study groups assigned for individual consultations of a dietician and a psychotherapist when compared with group sessions or general recommendations. CONCLUSIONS: Research on the correlation of healthy dietary patterns and symptoms of depression and anxiety has mainly focused on non-clinical populations. The evidence supports an inverse association between healthy eating habits and symptoms of depression. Further research should be encouraged on the eating habits of clinically depressed individuals and the underlying physiological mechanisms of uncontrolled food intake.

Educational Initiative about the COVID-19 Pandemic-Related Neuropsychiatry for Early Career Professionals in EU: The Impact of the Novel Virus on Brain, Mind, and Society.

BACKGROUND: The COVID-19 pandemic brought challenges to governments, healthcare systems (including, mental healthcare services), clinicians and researchers in the EU and worldwide. A range of neurological (e.g., brain fog, encephalitis, myalgia) and psychiatric (e.g., affective disorders, delirium, cognitive disturbances) complications of a novel nature have been observed in patients during the acute phase of illness, which often persist as a Long-COVID state for months after the primary recovery. The pandemic has progressed to a psychodemic and syndemic, affecting communities with social distress, panic, fears, increased home violence, and protest movements that derive from conspiracy theories and hostile attitudes towards vaccination and lockdown measures. In response to this complex scenario of major social changes, universities must face the need to equip the new generation of doctors with novel special skills. SUBJECTS AND METHODS: The study course (50 hours duration; 20 lectures, three webinars, three e-discussion forums, five local seminars, two social events, three intermediate assessments and a final test for certification; bilingual Russian/English hybrid format, information materials, video-content, interactive web-page and social media) was developed by the team of the International Centre for Education and Research in Neuropsychiatry (ICERN), and is unique for the EU. The course integrates the most relevant data on SARS-Cov-2-related neuropsychiatry, and COVID-19' pandemic impact on mental health and society, including assignment of the vulnerable groups of students and healthcare professionals. The major topics covered during the course are (i) Novel virus, (ii) Brain, (iii) Society. The project takes place originally in Samara State Medical University. The ICERN Faculty includes academic staff from France, Hungary, Italy, Russia, Switzerland, invited speakers from the WHO Regional Office for Europe and World Psychiatric Association (EU Zones) members, some of them employed at ICERN by remote work contracts. The format of the educational process for students is hybrid suggesting both remote and face-to-face events. Distant learning participants and EU lecturers are to attend on-line via zoom platform, whereas local participants and staff work face-to-face in the ICERN video-conference room. The course is addressed to a broad audience of doctors, undergraduate and postgraduate students, and researchers from EU wishing to upgrade their knowledge in the pandemic-associated neuropsychiatry. RESULTS: The evaluation process supposes three intermediate assessments and a final test for certification. On-line assessment is to be performed at the project web-page - 10 randomly selected questions with scoring from 1 to 10 each. The Pass Score is 70-100. At the end of the course all the participants receive certificates of Samara State Medical University according to the ERASMUS policy book, as planned in 2021. CONCLUSIONS: We formatted this course as essential for the target audience to improve their resources of professional adaptability in the field of neuropsychiatry and mental healthcare management during challenging times. The ICERN course in pandemic-related neuropsychiatry is essential for early career health professionals and targets the principles of "academia without borders" in the context of international medical knowledge exchange. In the conditions of the changing social situation this educational content is necessary for the young doctors to acquire the add-on skills on flexibility to switch toward new professional approaches in the times of need. The long-term outcomes in pandemic-related neuropsychiatry are still to be seen, though the first feedback on the course content is already promising for the academic community.

Virtual Reality-Based Interventions for Treating Depression in the Context of COVID-19 Pandemic: Inducing the Proficit in Positive Emotions as a Key Concept of Recovery and a Path Back to Normality.

BACKGROUND: During the COVID-19 pandemic as much as 40% of the global population reported deterioration in depressive mood, whereas 26% experienced increased need for emotional support. At the same time, the availability of on-site psychiatric care declined drastically because of the COVID-19 preventive social restriction measures. To address this shortfall, telepsychiatry assumes a greater role in mental health care services. Among various on-line treatment modalities, immersive virtual reality (VR) environments provide an important resource for adjusting the emotional state in people living with depression. Therefore, we reviewed the literature on VR-based interventions for depression treatment during the COVID-19 pandemic. SUBJECTS AND METHODS: We searched the PubMed and Scopus databases, as well as the Internet, for full-length articles published during the period of 2020-2022 citing a set of following key words: "virtual reality", "depression", "COVID-19", as well as their terminological synonyms and word combinations. The inclusion criteria were: 1) the primary or secondary study objectives included the treatment of depressive states or symptoms; 2) the immersive VR intervention used a head-mounted display (HMD); 3) the article presented clinical study results and/or case reports 4) the study was urged by or took place during the COVID-19-associated lockdown period. RESULTS: Overall, 904 records were retrieved using the search strategy. Remarkably, only three studies and one case report satisfied all the inclusion criteria elaborated for the review. These studies included 155 participants: representatives of healthy population (n=40), a case report of a patient with major depressive disorder (n=1), patients with cognitive impairments (n=25), and COVID-19 patients who had survived from ICU treatment (n=89). The described interventions used immersive VR scenarios, in combination with other treatment techniques, and targeted depression. The most robust effect, which the VR-based approach had demonstrated, was an immediate post-intervention improvement in mood and the reduction of depressive symptoms in healthy population. However, studies showed no significant findings in relation to both short-term effectiveness in treatment of depression and primary prevention of depressive symptoms. Also, safety issues were identified, such as: three participants developed mild adverse events (e.g., headache, "giddiness", and VR misuse behavior), and three cases of discomfort related to wearing a VR device were registered. CONCLUSIONS: There has been a lack of appropriately designed clinical trials of the VR-based interventions for depression since the onset of the COVID-19 pandemic. Moreover, all these studies had substantial limitations due to the imprecise study design, small sample size, and minor safety issues, that did not allow us making meaningful judgments and conclude regarding the efficacy of VR in the treatment of depression, taking into account those investigations we have retrieved upon the inclusion criteria of our particularistic review design. This may call for randomized, prospective studies of the short-term and long-lasting effect of VR modalities in managing negative affectivity (sadness, anxiety, anhedonia, self-guilt, ignorance) and inducing positive affectivity (feeling of happiness, joy, motivation, self-confidence, viability) in patients suffering from clinical depression.

Comparison of two levonorgestrel-releasing intrauterine systems for the treatment of heavy menstrual bleeding: a randomised, controlled, phase 3 trial.

PURPOSE: To evaluate the levonorgestrel-releasing intrauterine system Donasert® (also known as Levosert®) compared with the reference product Mirena® for the alleviation of heavy menstrual bleeding (HMB). MATERIALS AND METHODS: A phase 3 multicentre, non-inferiority, active-controlled study in non-menopausal women with HMB (menstrual blood loss [MBL] ≥ 80 mL) as the primary symptom randomised to either Donasert® or Mirena® and followed for 6 months. MBL was evaluated using a validated, modified version of the Wyatt pictogram. RESULTS: Overall, 312 were randomised (158 to Donasert® and 154 to Mirena®). The mean (standard deviation) absolute change in MBL from baseline to 6 months in the per-protocol population (N = 300) was -130 (71.8) mL and -127 (67.3) mL in the Donasert® and Mirena® groups, respectively; non-inferiority of Donasert® was confirmed (p-value <0.0001). Successful treatment of HMB (MBL <80 mL) and a decrease to ≤50% of baseline MBL was achieved in 139/154 (90.3%) and 126/146 (86.3%) participants in the Donasert® and Mirena® groups, respectively and the between-treatment difference was non-significant. Most adverse events were mild in severity. Only two device expulsions occurred in the study and there were no uterine perforations. CONCLUSIONS: Donasert® has equivalent efficacy and safety during the first 6 months foralleviation of HMB compared to the reference device, Mirena®. TRIAL REGISTRATION NUMBER: 348 (Clinical Trials Registry of the Ministry of Health of the Russian Federation, http://grls.rosminzdrav.ru/default.aspx).

STUDY OF RELATIONSHIP OF PSYCHOSOCIAL FACTORS WITH SMOKING IN NORTHERN POPULATION.

OBJECTIVE: The aim: Of our study was to identify the relationship between the main risk factors for heart disease and social factors among northern population. PATIENTS AND METHODS: Materials and methods: We polled 3092 native and non-native habitants of the Sakha Republic (Yakutia). The poll consists of several sections. It includes questions related to social, demographic and life record data, heredity, physical activity and unhealthy habits. RESULTS: Results: Among the people diagnosed with hypertension (HT), there are more smokers than among the people without this medical condition. On the contrary, in the group of people diagnosed with HT at the examination for taking blood pressure, there were fewer smokers than in the group, in which HT was not registered. Patients with CHD, Myocardial infarction (MI) in past medical history, cerebrovascular accident (CVA) and type 2 diabetes (T2D), are smokers to the same degree as the other group. This indicates that this category of the examined are exposed to the risk of cardiovascular aggravations. We determined a high spread of psychosocial risk factors for the examined respondents - the relationship between smoking, overweight, obesity, abdominal obesity and HT, and the level of education, marital status and labor specificity. The increase in the level of education is associated with fewer amounts of smokers among both non-native and native habitants. Overweight is more frequently observed for the people who are not single, have low level of education and are engaged in manual labor. In particular, it is applicable to native habitants. CONCLUSION: Conclusions: Abdominal obesity did not have any relationship with psychosocial factors for native habitants. However, in relation to non-native habitants, overweight, obesity, abdominal obesity and HT are associated with marital status (married) and with manual labor.

The hypo- and hyperelementosis to women of the Republic of Sakha (Yakutia).

OBJECTIVE: Introduction: Stability of the chemical composition of the body is one of the most important and mandatory conditions for its normal functioning. Accordingly, deviations in the content of chemical elements caused by environmental, climatic-geographical factors or diseases will lead to a wide range of disorders in the state of health. Therefore, the identification and evaluation of deviations in the exchange of macro- and microelements, as well as their correction, are a promising direction of modern medicine. The aim of the work is to reveal the regularity of distribution of diselementoses and the elemental profile of pathology in women from various regions of the Republic of Sakha (Yakutia). PATIENTS AND METHODS: Materials and methods: Using the multielement analysis system using AES-ISP and MS-ISP methods, the content of chemical elements in the hair of 555 women from various regions of the Republic of Sakha (Yakutia) was investigated. The study of hair was conducted on the content of 24 chemical elements (Al, As, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, P, Pb, Se, Si, Sn, Ti, V, Zn , µg / g). RESULTS: Results and conclusions: The results obtained show that the risk of hyperelementosis in the female population of the Republic of Sakha (Yakutia) is significantly increasing in the direction of south-south; in the direction of north-south the risk of development of hypo-elemental diseases increases significantly. At the same time, the central regions of the republic are an exception to the general scheme: the prevalence of excessive accumulation in the hair as toxic and essential chemical elements is also great here, as in the arctic regions of the republic.

Successful endovascular treatment of a 13-month-old child with gastrointestinal bleeding due to Dieulafoy syndrome of duodenum.

Dieulafoy disease can manifest itself with spontaneous massive recurrent gastrointestinal bleeding in children. We report a case of successful management of a 13-month-old child with Dieulafoy disease of duodenum when traditional methods of examination and treatment failed.

The effects of time and money prices on treatment attendance for methadone maintenance clients.

Many methadone maintenance clients are required to visit a clinic daily, so treatment attendance is essential for clients' compliance and treatment effectiveness. Using data derived from a unique survey, this study provides evidence of economic barriers to regular treatment attendance. Hypotheses tested are (1) higher personal costs reduce treatment attendance, and (2) willingness to pay (WTP) provides better time price estimates than wage rates. The findings suggest that both time and money function as rationing devices for methadone maintenance clients. The study finds WTP preferable to wage rate in measuring time price as evaluated by the effects of time price on treatment attendance.

Measuring the value of time for methadone maintenance clients: willingness to pay, willingness to accept, and the wage rate.

Three measures of the value of time - willingness to pay (WTP) for a reduction in travel time, willingness to accept (WTA) a monetary compensation to forgo it, and the wage rate - are evaluated and compared. WTP and WTA were estimated from the two-part regressions of time price, using contingent valuation methods with primary survey data. Systematic differences are found in comparisons of WTP and WTA with the wage rate.