The Role of Family Physicians in Mental Health Care: Screening, Diagnosis, and Treatment Options

amily physicians play a pivotal role in the early detection, diagnosis, and management of mental health disorders within the community. This review article delves into the multifaceted responsibilities of family physicians in the realm of mental health care. Emphasizing the importance of primary care settings as the first point of contact for many patients, the article underscores the need for effective screening tools and methodologies tailored for these environments. The diagnostic precision of family physicians, often challenged by the broad spectrum of mental health symptoms, is explored alongside the potential implications of misdiagnoses. Furthermore, the article evaluates various treatment options, from pharmacological interventions to psychotherapy, and their applicability in primary care settings. The integration of technological advancements, such as electronic health records and telemedicine, is also discussed in the context of enhancing patient care. The review concludes by highlighting the importance of educating primary care physicians to not only pay close attention to the mental health of their patients, but also to be able to accurately screen and diagnose mental health issues using various diagnostic tools. Moreover, it is critical to develop more useful tools that can be used in the context of primary care settings

Why Do Parotid Pleomorphic Adenomas Recur? A Systematic Review of Pathological and Surgical Variables

BackgroundThe recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy.MethodsA systematic review was undertaken to clarify the surgical and pathological variables related to PA recurrence. Inclusion criteria were as follows: English literature, and prospective or retrospective studies. Exclusion criteria were as follows: single case reports, reviews, and lack of PA recurrence data.ResultsPathology-related variables associated with recurrence include the histological subtype, the thickness and incompleteness of the tumor capsule, pseudopodia, and satellite nodules. Surgery-related variables associated with recurrence are the presence of intact margins and tumor puncture or spillage. Other factors are the size of the tumor and the age of patient. Myxoid subtypes of PA tend to have incomplete and thinner capsules and to recur more frequently. Surgical variables related to recurrence include positive margins and tumor spillage.ConclusionMyxoid and/or large PA, especially in young patients, should be approached more cautiously to avoid recurrences

Open Maximal Mucosa-Sparing Functional Total Laryngectomy

BackgroundTotal laryngectomy after (chemo)radiotherapy is associated with a high incidence of fistula and therefore flaps are advocated. The description of a transoral robotic total laryngectomy prompted us to develop similar minimally invasive open approaches for functional total laryngectomy.MethodsA retrospective study of consecutive unselected patients with a dysfunctional larynx after (chemo)radiation that underwent open maximal mucosal-sparing functional total laryngectomy (MMSTL) between 2014 and 2016 is presented. The surgical technique is described, and the complications and functional outcome are reviewed.ResultsThe cohorts included 10 patients who underwent open MMSTL. No pedicled flap was used. Only one postoperative fistula was noted (10%). All patients resumed oral diet and experienced a functional tracheo-esophageal voice.ConclusionMMSTL could be used to perform functional total laryngectomy without a robot and with minimal incidence of complications

Effectiveness of antibiotic-loaded bone cement in total joint arthroplasty at a tertiary medical center: A retrospective cohort study

Background: Data regarding the effectiveness of antibiotic-loaded bone cement (ALBC) in preventing prosthetic joint infections (PJI) after total joint arthroplasty (TJA) is inconsistent. The objective of this study was to evaluate if the routine use of ALBC influenced the risk of revision surgery due to PJI. Methods: This is a retrospective cohort study performed between January 2018 and September 2020. Adult patients aged ≥ 18 years who underwent TJA (knee or hip) and received either ALBC or plain cement (PC) were included. The outcome of this study was the rate of revision due to PJI. Multivariate analysis using logistic regression was used to identify factors that may be associated with increased risk of PJI, using STATA 15.1 (StataCorp LP, College Station, Texas, USA). Results: A total of 844 patients were screened and 319 patients were included. There were 247 patients in ALBC group and 72 patients in the PC group. Only vancomycin powder was used in all ALBC cases, with a 2 g dose in 50% of the cases (dose ranged between 1 g and 8 g). The status of the prosthetic joint was assessed and recorded up to 2 years of the TJA. Overall, the difference in the rates of PJI between the two groups after primary arthroplasty was not statistically significant (5.6% vs 1.4%; p = 0.173; OR, 4.2; 95% CI, 0.5–33). Conclusion: ALBC was not associated with a reduction in PJI rates after primary TJA. More research is needed to further evaluate the effectiveness of ALBC in preventing PJI

Persistent symptoms of severe and critical COVID-19: A cross-sectional study after more than 120 days from disease onset

Objective: The objective of this study is to assess the prevalence and predictors of symptom persistence associated with severe and critical coronavirus disease-2019 (COVID-19) after more than 120 days from the onset of the disease. Materials and Methods: This is a single-center, cross-sectional study of 125 adults who were admitted to King Khalid University Hospital (Riyadh, Saudi Arabia) with severe and critical COVID-19 between March 4 and December 1, 2020. Telephone interviews were conducted between April 1 and May 31, 2021, to collect data on COVID-19 symptoms persisting after more than 120 days from the onset of the disease. All of the participants had been discharged from the hospital and had resumed their normal lives. Symptoms of COVID-19 that had not been present before the onset of the disease were considered to be persistent if participants confirmed their continued presence at the time of the interview. The impact of chronic disease on persistent symptoms was considered. Results: About 42.4% (53/125) of patients had at least one or more persistent symptoms; 27.2% (34/125) had breathlessness, 5.6% (7/125) cough, and 4.8% (6/125) chest pain. These three symptoms had been present from the first presentation. Hair loss was reported by 14.4% (18/125), forgetfulness by 8% (10/125), difficulty in concentrating by 6.4% (8/125), and lack of energy by 4% (5/125). Those had manifested after more than 120 days from the symptom's onset. The major factors in suffering from persistent symptoms were intensive care unit (ICU) admission or/and fever (temperature >38°), or/and diarrhea. There was no correlation between persistent symptoms and chronic diseases. Conclusions: After more than 120 days from the confirmation of severe and critical COVID-19, more than one-third of discharged adults were found to have one or more persistent symptoms. These were mainly associated with the need for ICU admission, fever (temperature >38°), and diarrhea. More care needs to be given to COVID-19 patients in the presence of these factors and prolonged medical care would appear to be essential

Acceptability of the COVID-19 Vaccine and Its Determinants among University Students in Saudi Arabia: A Cross-Sectional Study

COVID-19 vaccine hesitancy is a significant threat to the efforts that have been taken to combat the pandemic. This study assessed the acceptability of the COVID-19 vaccine among university students in Saudi Arabia. A cross-sectional online survey using a Google Form was conducted between 2 April and 23 April 2021. A snowball technique was used to recruit participants for this study. The final sample consisted of 407 participants. More than one-third of the participants (36.1%) had received the COVID-19 vaccine, and 13.3% had registered to receive the vaccine. Of the participants who were not yet vaccinated (n = 260), 90.4% indicated that they would like to be vaccinated when given the opportunity. Of the unvaccinated participants, 82.3% trusted the COVID-19 vaccines that had been provided in Saudi Arabia. The most reported reasons for the participants’ acceptance to receive the COVID-19 vaccine included preventive purposes (95.8%), a belief in the safety of the vaccines (84.3%), and the availability of public awareness information regarding the vaccines (77.3%). A small portion of participants (6.1%) were refusing to receive the vaccine due to the potential long-term side effects (92.0%) and expedited vaccine trials (80.0%). Acceptability of the COVID-19 vaccine was strongly associated with participants who regularly received the flu vaccine (p < 0.05). All other demographic variables were not statistically associated with the acceptability of the COVID-19 vaccine. In conclusion, it would be appropriate for universities to launch peer programs to urge reluctant students to receive the vaccine voluntarily. In terms of further research, it is valuable to follow up with unvaccinated participants to investigate if they received the vaccine since the data were collected, and their reasons for doing so. This research would reveal changes toward vaccine acceptability over time and any related determinants. Future research should consider students from non-Arabic speaking backgrounds

A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture

In this systematic review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome. A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect. Of 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies. Endoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated

A systematic review of endoscopic versus open treatment of craniosynostosis. Part 2: the nonsagittal single sutures

Despite increasing adoption of endoscopic techniques for repair of nonsagittal single-suture craniosynostosis, the efficacy and safety of the procedure relative to established open approaches are unknown. In this systematic review the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of metopic, unilateral coronal, and lambdoid craniosynostosis, with an emphasis on quantitative reported outcomes. A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Of 316 screened records, 7 studies were included in a qualitative synthesis of the evidence, of which none were eligible for meta-analysis. These reported on 111 unique patients with metopic, 65 with unilateral coronal, and 12 with lambdoid craniosynostosis. For all suture types, 100 (53%) children underwent endoscope-assisted craniosynostosis surgery and 32 (47%) patients underwent open repair. These studies all suggest that blood loss, transfusion rate, operating time, and length of hospital stay were superior for endoscopically treated children. Although potentially comparable or better cosmetic outcomes are reported, the paucity of evidence and considerable variability in outcomes preclude meaningful conclusions. Limited data comparing open and endoscopic treatments for metopic, unilateral coronal, and lambdoid synostosis suggest a benefit for endoscopic techniques with respect to blood loss, transfusion, length of stay, and operating time. This report highlights shortcomings in evidence and gaps in knowledge regarding endoscopic repair of nonsagittal single-suture craniosynostosis, emphasizing the need for further matched-control studies

Evaluation of 34 Cytokines and Vitamin D Status Reveal A Sexually-Dimorphic Active Immune Response to SARS-CoV-2

Background: Several observational studies have inconsistently demonstrated that vitamin D deficiency is a risk factor for coronavirus disease-19 (COVID-19) infection and severity. Discrepancies in results may partially be explained by the individuals’ immune profiles, which are modulated, in varying degrees, by vitamin D status and sex hormones. Methods: In this study we evaluated the differences and associations of serum levels of 25(OH)D with 34 cytokines in 220 adults (82 controls (41 males; 41 females) and 138 SARS-CoV-2 patients (79 males and 59 females)) with and without COVID-19. Results: Serum 25(OH)D levels were significantly lower in the SARS-CoV-2 group than in the controls. Serum IP-10, MCP-1, CRP, IFNγ, IL-10, IL-13, IL-17α, IL-23, and IL-6 were significantly higher in COVID-19 patients compared to controls. Serum levels of VEGF, IFNγ, IL-13, and IL-5 were significantly higher in male patients than in females. 25(OH)D was significantly correlated with EFG (R = 0.39, p < 0.05) and IL-15 (R = 0.39, p < 0.05) in male patients, while it was inversely correlated with CRP (R = −0.51, p < 0.05) in female patients. Conclusions: Altered levels of cytokines, chemokines, and vitamin D were observed in SARS-CoV-2 adult patients. These expressions were sexually dimorphic and thus highlight the sex-specific nature of the active immune response following SARS-CoV-2 infection