Gender bias in antidepressant direct-to-consumer pharmaceutical advertising.

BACKGROUND: Direct to consumer pharmaceutical advertising (DTCPA) may have significant impacts on public perception of diseases and treatments. Our objective was to examine whether DTCPA for antidepressants disproportionately portray and hence target women in the United States. METHODS: DTCPA for branded medications for depression, psoriasis and diabetes were analyzed to determine the gender of the main "patient" portrayed, as well as the content of the disease depiction. RESULTS: DTCPA for antidepressants included only women in 82% of ads, only men in 10.1% of ads, and both genders in 7.8% of ads. There were significantly higher representations of women versus men in DTCPA for antidepressants (82%) compared to either psoriasis (50.4%) or diabetes (37.6%) medications. These differences remained statistically significant even after adjusting for gender disparities in disease prevalence. CONCLUSIONS: Antidepressant DTCPA in the United States disproportionately target women. There are potential adverse consequences for both women and men resulting from unequal representations in DTCPA for antidepressant medications.

Primary Outcomes for Adults Receiving the Unified Protocol after Hurricane Harvey in an Integrated Healthcare Setting.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy for treating anxiety and depression. However, there are limited effectiveness data when conducted in real-world settings with diverse populations, including those with trauma. We evaluated treatment outcomes in a naturalistic, community setting among 279 adults who received UP following Hurricane Harvey. We examined change in overall clinical severity, depression and anxiety symptoms, functional impairment, and baseline outcome predictors (i.e., demographic characteristics, impact from Hurricane Harvey, co-occurrence of depression and anxiety symptoms). Global clinical severity, depression and anxiety symptoms, and functional impairment decreased by end-of-treatment. Participants experienced global symptom improvement to a lesser degree than demonstrated in efficacy trials. Participants who experienced greater storm impact reported larger reductions in anxiety symptoms than those less impacted by Harvey. Further studies evaluating the effectiveness of the UP post-disaster and with diverse samples are needed.

Phenotypic detection of extended-spectrum beta-lactamase in multidrug-resistant acinetobacter baumannii isolated in Fauji Foundation Hospital Rawalpindi.

OBJECTIVE: To evaluate the phenotypic detection of extended-spectrum betalactamase in multidrug-resistant acinetobacter baumannii. METHODS: The cross-sectional study was conducted at the Department of Microbiology, Fauji Foundation Hospital, Rawalpindi, Pakistan, from August 2018 to April 2019, after the ethical approval from the Institutional Review Committee. Consecutive Non- probability sampling technique was used, and comprised clinical specimens, including pus, blood, sputum, urine, tracheal tubes and canula double lumen, which were processed using standard protocols. Colonies of acinetobacter baumannii were identified by gram staining and Analytical Profile Index-20E kit. Combination disc method was used for the identification of extended-spectrum beta-lactamse. Clinical and Laboratory Standards Institute guidelines were used for antimicrobial susceptibility. Data was analysed using SPSS 22 and Sample size was calculated by using earlier study with 5 % margin of error and 95 % confidence level. RESULTS: Of the 78 isolates, 58(74.4%) related to females and 20(25.6%) to males. There was no extended-spectrum beta-lactamse producer. Imipenem, meropenem, cefotaxime, ampicillin and ceftazidime showed 100% resistance, while colistin and polymyxin B were sensitive to all strains. The incidence rate was high in samples isolated from tracheal tubes 47(60.3%), followed by pus 21(26.9%). Age was not found to be a significant factor (p>0.05). CONCLUSIONS: Acinetobacter baumannii showed a high resistance to multiple drugs and was not confined to any specific age group. Colistin and polymyxin B were found to be better choices.

In vitro efficacy of Daptomycin against clinical isolates of Methicillin-resistant Staphylococcus aureus (MRSA).

This descriptive cross-sectional study was performed in the Department of Microbiology, Fauji Foundation Hospital, Rawalpindi, from March 2019 to September 2019 to determine the in vitro efficacy of Daptomycin against clinical isolates of Methicillin-Resistant Staphylococcus aureus (MRSA). Consecutive non-probability sampling technique was used and a total number of 270 patients' Pan Cultures having MRSA growth on Cefoxatin Disc with size less than 22 mm zone size were included in the study. Cultures were inoculated on MacConkey, Chocolate and Blood agar and then incubated for 24 hours at 37 degree Celsius. After incubation, Coagulase test, Catalase test and Gram staining technique were used for further identification. Minimum Inhibitory Concentration (MIC) of the isolates for Daptomycin was obtained by using E strips (Oxoid UK) according to Clinical & Laboratory Standards Institute (CLSI) guidelines. The mean age of the patients was 46.73±12.22 years, and the study included 147 (54.44%) males and 123 (45.56%) females. Regarding the type of specimen, there were 154 (57.04%) pus specimens, 54 (20.00%) blood specimens, 27 (10.00%) fluid specimens, 18 (6.67%) urine specimens, 10 (3.70%) high vaginal swabs (HVS) specimens and 7 (2.59%) sputum specimens. Daptomycin was effective in 264 (97.78%) patients with MIC range from .015 to 1 µg/ml on E strip.

Antimicrobial susceptibility pattern of Methicillin-resistant Staphylococcus Aureus isolates in Fauji Foundation Hospital Rawalpindi.

The current study was conducted in the Department of Microbiology, Fauji Foundation Hospital, Rawalpindi, from July 2018 to January 2019. The main purpose of the study was to evaluate Methicillin-resistant Staphylococcus aureus antimicrobial susceptibility pattern. Clinical samples were collected and cultured according to Clinical and Laboratory Standards Institute (CLSI) guidelines. A total of 90(30%) samples were found to be methicillin-resistant out of 300 samples of Staphylococcus aureus. Major isolates were 42 (46.67%) from pus and 22 (24.44%) from tracheal tubes. The incidence ratio of Methicillin-resistant Staphylococcus aureus was high in the samples isolated from 69 (76.67%) females compared to those of 21 (23.33%) males. Patients were more in the age group of 41 to 60 years. Vancomycin 90 (100%) was sensitive to all strains followed by Chloramphenicol 66 (73.33%) and Doxycycline 52 (57.78%). Imipenem, Meropenem andAugmentin showed resistance to all strains.

Psychiatric Diagnoses and Medications for Hurricane Harvey Sheltered Evacuees.

To report on the diagnosis of and pharmacological services provided to 229 evacuees of Hurricane Harvey housed within a large convention center. Retrospective chart review of services rendered. Evacuees were primarily adults who presented with varied diagnoses, most commonly mood, anxiety and/or psychotic disorders. There was significant need for medications and psychosocial support to address preexisting conditions, as well as emerging problems (e.g., insomnia). Individuals presenting for pharmacological services following natural disasters may require medications to continue ongoing care, and/or treatment for insomnia. Therapists can provide direct intervention as well as identify those in need of further evaluation/intervention. Providers should be prepared with a fully stocked pharmacy, accessible but confidential location, and a pre-established method of record keeping.

Susceptibility pattern of tracheal tube isolates from Intensive Care Unit of Fauji Foundation Hospital Rawalpindi.

OBJECTIVE: To determine the prevalence of resistant pathogens and their antimicrobial susceptibility pattern in an intensive care unit. METHODS: The cross-sectional observational study was conducted at Foundation Hospital, Rawalpindi, Pakistan, from May to September 2016, and comprised tracheal tubes which were collected in sputum culture bottles from patients with clinical findings of ventilator associated pneumonia. The tubes were cultured to locate the resistant pathogens. RESULTS: A total of 113 different strains of bacteria were isolated from 80 patients. The main isolated bacteria was acinetobacter baumannii 45(39.8%) followed by klebsiella pneumonia 14(12.3%) and methicillin-resistant staphylococcus aureus 13(11.5%). Polymyxin B was the most appropriate drug for treating patients infected with acinetobacter baumannii with a sensitivity of 64% while vancomycin and linez oli dhad 100% sensitivity for methicill in - resistant staphylococcusaureus. CONCLUSIONS: Acinetobacter baumannii was the most prevalent strain in tracheal tubes and polymyxin B was the most effective medicine.

Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) from Pakistan: molecular characterisation by microarray technology.

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Pakistan is known to be high, but very few studies have described the molecular epidemiology of the different MRSA clones circulating in the country. Forty-four MRSA isolates were collected from two tertiary care hospitals of the Rawalpindi district of Pakistan. All strains were identified by a conventional phenotypic method and then subjected to genotyping by microarray hybridisation. Six clonal complexes (CCs) and 19 strains were identified. The most commonly identified strains were: (i) Panton-Valentine leucocidin (PVL)-positive CC772-MRSA-V, "Bengal Bay Clone" (ten isolates; 22.3%), (ii) ST239-MRSA [III + ccrC] (five isolates) and (iii) a CC8-MRSA-IV strain, as well as CC6-MRSA-IV (both with four isolates; 9.1% each). Several of the strains detected indicated epidemiological links to the Middle Eastern/Arabian Gulf region. Further studies are needed to type MRSA from countries with less known epidemiology and to monitor the distribution and spread of strains, as well as possible links to global travel, migration and commerce.

Pathophysiological Role of HERV-W in Schizophrenia.

Schizophrenia is a neuropsychiatric disorder of complex etiology. Human endogenous retroviruses (HERVs) have been presented as possible candidates explaining the connections between the genetic, infectious, neurodevelopmental, and neuroinflammatory aspects of schizophrenia, with the human endogenous retrovirus type W family (HERV-W) showing the greatest evidence of association. Studies have identified retroviral nucleotide sequences, envelope and capsid proteins, and elevated transcription of HERV-W elements in CSF, blood, and brain samples from individuals with schizophrenia. The HERV-W elements can trigger the immune system in a variety of ways. HERV genetic elements may be activated by various prenatal maternal infections, leading to neuroinflammation and genetic abnormalities, altering the development of the brain, and eventually culminating in the development of schizophrenia. This review presents a concise synthesis of available evidence and theoretical speculation regarding the role of HERV-W in schizophrenia. The need for further investigation is highlighted before any conclusions can be stated with confidence.

A survey of Australian public opinion on using comorbidity to triage intensive care patients in a pandemic.

ObjectivesThis study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers.MethodsA postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers.ResultsThe proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%).ConclusionRespondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy.

Recent Advances in Psychopharmacology: From Bench to Bedside Novel Trends in Schizophrenia.

Research in the field of psychopharmacology is ongoing to develop novel compounds which can revolutionize the treatment of psychiatric disorders. The concept of bench-to-bedside is a tedious process, transforming the initial research performed in the laboratories into novel treatment options. Schizophrenia (SCZ) is a chronic psychiatric illness with significant morbidity and mortality. SCZ not only presents with psychotic symptoms including hallucinations and delusions but also with negative and cognitive symptoms. The negative symptoms include the diminished ability to express emotions, loss of pleasure, and motivation with minimal social interactions. Conventional antipsychotics primarily target positive symptoms with minimal therapeutic benefits for negative and cognitive symptoms along with metabolic side effects. Researchers have explored novel targets to develop new compounds to overcome the above limitations. The glutamatergic system has provided new hope in treating schizophrenia by targeting negative and cognitive symptoms. Other receptor modulators, including serotonergic, phosphodiesterase, trans-amine-associated receptors, etc., are novel targets for developing new compounds. Future research is required in this field to explore novel compounds and establish their efficacy and safety for the treatment of schizophrenia. Last but not least, pharmacogenomics has effectively utilized genetic information to develop novel compounds by minimizing the risk of failure of the clinical trials and enhancing efficacy and safety.

Insights into the microbiological and virulence characteristics of bacteria in orthopaedic implant infections: A study from Pakistan.

The exponential increase in the prevalence of multidrug resistant bacteria has resulted in limiting surgical treatment options globally, potentially causing biofilm-related complications, implant failure, and severe consequences. This study aims to isolate and characterize bacteria from post-surgical orthopaedic implant infections and screening for multiple antibiotic resistance. A cross-sectional study was conducted, involving isolation of forty-four dominant pathogenic bacterial isolates from 16 infected implant samples from across Islamabad and Rawalpindi. Out of forty-four, 38% cocci and 61% bacilli were obtained. Approximately 90% of isolates showed multiple antibiotic resistance (MAR) index of more than 0.2. Eleven strains were identified via 16S rRNA gene sequencing as Pseudomonas aeruginosa, Bacillus spp., Planococcus chinensis, Staphylococcus, Escherichia coli and Enterobacter cloacae. The bacterial strain E. coli MB641 showed sensitivity to Polymyxin only, and was resistant to all other antibiotics used. Maximum biofilm forming ability 0.532 ± 0.06, 0.55 ± 0.01 and 0.557 ± 0.07 was observed in Pseudomonas aeruginosa MB663, Pseudomonas aeruginosa MB664 and Bacillus spp. MB647 respectively after 24 hours of incubation. EPS production of bacterial strains was assessed, the polysaccharides and protein content of EPS were found to be in the range of 11-32 µg/ml and 2-10 µg/ml, respectively. Fourier transform infrared spectroscopic analysis of EPS showed the presence of carbohydrates, proteins, alkyl halides, and nucleic acids. X-ray diffraction analysis revealed crystalline structure of EPS extracted from biofilm forming bacteria. These findings suggest a high prevalence of antibiotic-resistant bacteria in orthopaedic implant-associated surgeries, highlighting the urgent need for ongoing monitoring and microorganism testing in infected implants.

Lessons learned: a "homeless shelter intervention" by a medical student.

OBJECTIVE: The authors explored the process of implementing a medical student-initiated program designed to provide computerized mental health screening, referral, and education in a homeless shelter. METHOD: An educational program was designed to teach homeless shelter staff about psychiatric disorders and culturally-informed treatment strategies. Pre- and post-questionnaires were obtained in conjunction with the educational program involving seven volunteer shelter staff. A computerized mental health screening tool, Quick Psycho-Diagnostics Panel (QPD), was utilized to screen for the presence of nine psychiatric disorders in 19 volunteer homeless shelter residents. RESULTS: Shelter staffs' overall fund of knowledge improved by an average of 23% on the basis of pre-/post-questionnaires (p=0.005). Of the individuals who participated in the mental health screening, 68% screened positive for at least one psychiatric disorder and were referred for further mental health care. At the 3-month follow-up of these individuals, 46% of those referred had accessed their referral services as recommended. CONCLUSIONS: Medical student-initiated psychiatric outreach programs to the homeless community have the potential to reduce mental health disparities by both increasing access to mental health services and by providing education. The authors discuss educational challenges and benefits for the medical students involved in this project.

A Qualitative Inquiry of Parents' Observations of Their Children's Mental Health Needs During the COVID-19 Pandemic.

Given that children and adolescents are at critical periods of development, they may be particularly vulnerable to the effects of the COVID-19 pandemic. Using a descriptive phenomenological approach, 71 parents' observations of their child's mental health difficulties were explored. Parents sought out treatment because their children were experiencing significant distress. Data used were transcribed from baseline questionnaires and therapy summaries. Data analysis revealed three themes: emotion regulation difficulties, hypervigilance, and despair. The search for strategies and tailored interventions to help mitigate the potential harmful and long-term mental health impacts of the pandemic should be at the forefront of research and clinical practice.

Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy for youth with emotional problems related to the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has led to increased stress, anxiety, and depression in children. A six-session, parent-led, transdiagnostic, cognitive-behavioral teletherapy program was adapted from an established protocol to help youth aged between 5 and 13 years manage emotional problems during the pandemic. METHODS: One-hundred twenty-nine parents of youth struggling with emotional problems during the COVID-19 pandemic participated in the program. Parents reported on their children's psychosocial functioning before and after treatment using validated assessments. They also reported on treatment satisfaction. Clinician-rated global improvement was assessed at each session to determine clinically significant treatment response. RESULTS: Significant improvements in parent proxy-reported anxiety (d = 0.56), depression (d = 0.69), stress (d = 0.61), anger (d = 0.69), family relationships (d = 0.32), and COVID-19-related distress (d = 1.08) were found, with 62% of participants who completed the program being classified as treatment responders. Parents reported high levels of satisfaction with the program. LIMITATIONS: This study was limited by use of primarily parent-report assessments and a lack of a control group. CONCLUSIONS: Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy appeared to be an effective way to help youth cope with the pandemic and may be a scalable framework in response to large-scale mental health crises.

Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary?

BACKGROUND: Some one-fifth of patients may have accessory spleens (AcS) and require their removal at the time of splenectomy to achieve and maintain hematological response. The purpose of this study was to evaluate the benefit of computed tomography (CT) in patients undergoing laparoscopic splenectomy (LS). METHODS: All patients who required splenectomy were offered LS and underwent preoperative contrast-enhanced CT scan to detect and locate AcS. The surgeon was not blinded to the result of the CT scan. Patients were followed up to determine if there was recurrent disease. RESULTS: Between 2000 and 2007, 58 consecutive patients (31 men) were referred for splenectomy and all underwent LS. Preoperative CT scan detected 11 AcS in 11 patients (19%), of which 9 were confirmed during LS; the remaining 2 patients suffered with ITP preoperatively and had a good hematologic response to LS. At LS, 14 AcS were found in 13 patients (22%), of which 4 patients had negative preoperative CT scan; those additional AcS were readily found and were located close to the lower pole or hilum of the spleen. All removed AcS were confirmed histologically. In one patient who had LS and removal of AcS for ITP a further AcS within the tail of the pancreas was detected 1 year postoperatively on CT after thrombocytopenia relapsed. The sensitivity and specificity of CT scan for the detection of AcS were 60% and 95.6%, and the corresponding values for laparoscopy were 93.3% and 100%, respectively. Pairwise comparison of the ROC curves identified laparoscopy to be associated with a significantly higher area under the curve compared with CT scan (0.967 vs. 0.673; P = 0.004). CONCLUSIONS: Accessory spleens can be readily detected at laparoscopy in the vicinity of the spleen; preoperative CT scan for their detection and localization may not be necessary.