Problem Management Plus (PM plus ) in the management of common mental disorders in a specialized mental healthcare facility in Pakistan; study protocol for a randomized controlled trial

Additional file 1. Appendix A

Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial

Abstract Background In many low resource settings, the provision of government mental health care services is limited to specialized psychiatry units in urban hospital care facilities, where the most common treatment for common mental disorders (CMDs) is pharmacotherapy, occasionally with adjunct nonspecific psychological support. We aimed to evaluate the effectiveness of adding a low intensity, psychological intervention, Problem Management Plus (PM+) for CMDs into routine care in a specialized mental health care facility in Pakistan. Methods A two arm, single-blind individual randomized controlled trial (RCT) was carried out with adults (N = 192), referred for psychological support by psychiatrists. The study participants were randomized (1:1) to PM + plus Treatment as Usual (TAU) (n = 96) or TAU only (n = 96). The primary outcomes were symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and functional impairment as measured by WHO Disability Assessment Schedule (WHODAS 2.0) at 20 weeks after baseline. Results The analysis was done on intention-to-treat principle. The linear mixed model analysis showed that at 20 weeks after baseline, there was a significant reduction in symptoms of anxiety and depression (mean [SD], 16.23 [8.81] vs 19.79 [7.77]; AMD, − 3.10; 95% CI, − 0.26 to − 5.76); p = 0.03 and improvement in functioning (mean [SD], 22.94 [9.37] vs 27.37 [8.36]; AMD, − 4.35; 95% CI, − 1.45 to − 7.24); p = 0.004 in PM + plus TAU versus TAU arm. The follow-up rate was 67% at primary end-point. Conclusions Specialized care facilities in LMICs may consider adding brief, evidence-based psychological treatments for CMDs to their routine care. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12616000381482. Registered March 23, 2016. Retrospectively registered, https://www.anzctr.org.au/Default.aspx/ ACTRN12616000381482 </jats:sec

Pathways to care for people for dementia: an international multi-centre study

Objective: the aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. Methods: we recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centers for dementia care in 15 countries. The WHO “Encounter Form”, a standardized schedule that enables data concerning basic socio-demographic, clinical and pathways data to be gathered, was completed for each participant. Results: the median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy and practical advice) were delivered in less than 3% of situations. The analyses of the ‘pathways diagram’ revealed that the path of PwD to receiving care is complex, diverse across countries, and that there are important barriers to clinical care. Conclusions: the study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally and internationally

Adult-Onset greither's disease: A rare report of two cases

Inherited palmoplantar keratodermas (PPKs) have onset in the late infancy or early childhood and have a positive family history. Sporadic cases and cases with onset in adulthood have been rarely reported. We describe two female cases with transgradiens and progradiens PPK, with onset in adulthood having clinical and histological features of Greither's disease (GD). Only a single report of adult-onset GD has been reported in the literature. All patients presenting with palmoplantar keratoderma should be thoroughly evaluated, as it may be a late-onset inherited disorder, it adds to the spectrum of conditions to presenting with PPKs of late-onset

Lipoid proteinosis coexisting with rare psychiatric manifestations: a case report with a review of literature

Lipoid proteinosis is a rare autosomal recessive genodermatosis characterized by the deposition of hyaline material in the skin and internal organs. Skin involvement is in the form of blisters in infancy healing with pock-like scars, yellow waxy papules, plaques, moniliform blepharosis and diffuse infiltration. Neurological manifestations such as epilepsy, schizophrenia and memory loss have also been reported. We report the case of a 24-year-old female with lipoid proteinosis with neuro-psychiatric symptoms. Her non-contrast computed tomography of the head showed symmetrical calcification involving bilateral medial temporal lobes. We also review the literature on previous publications of lipoid proteinosis cases with neuropsychiatric involvement

Solidification/stabilization of lead-contaminated soil using alkali-activated volcanic ash

The bioaccumulation of lead in soil poses a significant human health risk. The Solidification/Stabilization (S/S) technique, employing binders like Portland cement or lime, is a common method for remediating lead-contaminated soil. However, cement production has adverse environmental impacts, prompting the exploration of eco-friendly alternatives like alkali-activated materials (AAMs). This study assesses AAMs efficacy in the S/S of lead-contaminated soil. The effects of several factors, including varying amounts of Volcanic Ash (VA), lead concentration, curing temperatures, and curing times are investigated. Unconfined compressive strength (UCS), Toxicity characteristic leaching procedure test (TCLP), X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR) and Field Emission Scanning Electron Microscope-Energy Disperse Spectroscopy-mapping analyses (FESEM/EDS/Mapping) analyses are used to study the specimens. The findings indicated a substantial increase in the UCS of lead-contaminated soil treated with 15% VA (under oven curing (OC) conditions) and 10% VA (under ambient curing (AC) conditions) exhibited remarkable increases of up to 600% and 458%, respectively. Moreover, the leaching of Pb2+ ions from samples contaminated with 10,000 mg/kg (under OC conditions) and 2,500 mg/kg (under AC conditions) experienced significant reductions of 87% (from 135.14 to 13.36 ppm) and 91% (from 26.32 to 2.21 ppm), respectively. The S/S process in these samples operated through three primary mechanisms of chemical bonding, physical encapsulation and the formation of insoluble silicate. The formation of N-A-S-H and hydroxy sodalite structures played a vital role in facilitating these mechanisms. Therefore, alkali activated VA demonstrated excellent performance in the remediation of lead-contaminated soil

Evaluation of prevalence of Pseudomonas aeruginosa infection in operated patients with Chronic Sinusitis in Rasoule Akram Hospital by Polymerase Chain Reaction (PCR)

Background: Chronic sinusitis(CS) is one of the most prevalent chronic illnesses that affecting persons of all age groups. It is an inflammatory process that involves the paranasal sinuses. There isn't definitive and consistent data concerning the distribution of bacterial species in patients with Chronic Sinusitis. Pseudomonas aeruginosa has emerged as a potential pathogen in the immunocompromised patients, so this microorganism is one of the most important cause of Chronic sinusitis. The purpose of this study is molecular detection of sinusitis caused by P.aeruginosa. Material and Methods: 50 specimens was provided from the secretion of maxillary and frontal sinuses of patients from Rasoule Akram hospital during operation. Genomic bacterial DNA was extracted by DNP kit and detection of this bacteria was proceeded by employing sequence-specific target namely the outer membrane protein (oprL) gene locus and designing primers. PCR optimized and sensitivity and specificity tests was performed. Amplicon was cloned by T/A Cloning method and was used for sequencing and positive control. Results: The product of optimized PCR with 504 bp length correctly amplified and observed on electrophoreses gel 1.5% and confirmed by sequencing. Evaluation of the selected primers with 8 various DNA demonstrated 100% specificity. Sensitivity of optimized test was Evaluated 10 CFU of bacteria. From the 50 samples, 22% of specimens were positive for P.aeruginosa. Conclusion: This study indicates that molecular detection of P.aeruginosa employing the oprL gene target is a rapid and useful technique for detection of P.aeruginosa