Pathogenesis of hallucinations in sleep paralysis

Sleep paralysis is a state of involuntary immobility that occurs during REM sleep, which is accompanied by “ghostly” hallucinations and strong reactions of fear and anxiety. This article presents the neuropharmacological mechanisms of these hallucinatory experiences. Attention is drawn to the role of the serotonin 5HT 2A R receptor in their implementation Studies have shown that activation of 5‑HT2AR can cause visual hallucinations, mystical, subjective states and out‑of‑body experiences. Hallucinatory experiences caused by serotonin tend to be “dreamlike” when the experiencer has an understanding that he is hallucinating. Presumably, there is a mechanism by which serotonin can be functionally involved in the creation of hallucinations of sleep paralysis and fear reactions through the activation of 5‑HT2AR. In addition, this article discusses the influence of the orbitofrontal cortex, rich in 5‑HT2A receptors, on the visual pathways during sleep paralysis, in fact, on the formation of hallucinations. Also information is provided on how this process can become a vicious circle, through the formation of feedback “fear — serotonergic system”.Сонный паралич — это состояние непроизвольной неподвижности, возникающее во время быстрого сна, который сопровождается «призрачными» галлюцинациями и сильными реакциями страха и тревоги. В данной статье описываются нейрофармакологические механизмы этих галлюцинаторных переживаний. Обращается внимание на роль рецептора серотонина 5‑HT2AR в их реализации. Исследования показали, что активация 5‑HT2AR может вызывать зрительные галлюцинации, мистические, субъективные состояния и внетелесные переживания. Галлюцинаторные переживания, вызванные серотонином, имеют тенденцию быть «сноподобными», когда у переживающего появляется понимание, что он галлюцинирует. Предположительно существует механизм, посредством которого серотонин может быть функционально вовлечен в создание галлюцинаций сонного паралича и реакций страха посредством активации 5‑HT2AR. Кроме того, в данной статье приводятся рассуждения о влиянии орбитофронтальной коры, богатой рецепторами 5‑HT2A, на зрительные пути во время сонного паралича, по сути, на формирование галлюцинаций. Также приводится информация о том, как данный процесс может стать порочным кругом, посредством формирования обратных связей «страх — серотонинергическая система»

Quality of colonoscopy in an emerging country: A prospective, multicentre study in Russia

Background: The quality of colonoscopy has been related to a higher risk of interval cancer, and this issue has been addressed extensively in developed countries. The aim of our study was to explore the main quality indicators of colonoscopy in a large emerging country. Methods: Consecutive patients referred for colonoscopy in 14 centres were prospectively included between July and October 2014. Before colonoscopy, several clinical and demographic variables were collected. Main quality indicators (i.e. caecal intubation rate, (advanced) adenoma detection rate, rate of adequate cleansing and sedation) were collected. Data were analysed at per patient and per centre level (only for those with at least 100 cases). Factors associated with caecal intubation rate and adenoma detection rate were explored at multivariate analysis. Results: A total of 8829 (males: 35%; mean age: 57 + 14 years) patients were included, with 11 centres enrolling at least 100 patients. Screening (including non-alarm symptoms) accounted for 59% (5188/8829) of the indications. Sedation and split preparation were used in 26% (2294/8829) and 25% (2187/8829) of the patients. Caecal intubation was achieved in 7616 patients (86%), and it was ≥85% in 8/11 (73%) centres. Adenoma detection rate was 18% (1550/8829), and it was higher than 20% in five (45%) centres, whilst it was lower than 10% in four (33%) centres. At multivariate analysis, age (OR: 1.020, 95% CI: 1.015–1.024), male sex (OR: 1.2, 95% CI: 1.1–1.3), alarm symptoms (OR: 1.8, 95% CI: 1.7–2), split preparation (OR: 1.4, 95% CI: 1.2–1.6), caecal intubation rate (OR: 1.6, 95% CI: 1.3–1.9) and withdrawal time measurement (OR: 1.2, 95% CI: 1.6–2.1) were predictors of a higher adenoma detection rate, while adequate preparation (OR: 3.4: 95% CI: 2.9–3.9) and sedation (OR: 1.3; 95% CI: 1.1–1.6) were the strongest predictors of caecal intubation rate. Conclusions: According to our study, there is a substantial intercentre variability in the main quality indicators. Overall, the caecal intubation rate appears to be acceptable in most centres, whilst the overall level of adenoma detection appears low, with less than half of the centres being higher than 20%. Educational and quality assurance programs, including higher rates of sedation and split regimen of preparation, may be necessary to increase the key quality indicators

АЛГОРИТМ ДИАГНОСТИКИ И ЛЕЧЕНИЯ БОЛЬНЫХ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА С ОСТРЫМ ХОЛЕЦИСТИТОМ, ХОЛЕДОХОЛИТИАЗОМ И МЕХАНИЧЕСКОЙ ЖЕЛТУХОЙ

We performed a retrospective analysis of treatment in 4,197 patients with acute cholecystitis. Destructive complicated cholecystitis was diagnosed in 658 (25.3%) patients . There were 431 (65.5%) patients of elderly and senile age. All patients had comorbidities. Cardiovascular insufficiency — 73.9%, respiratory diseases — 29.2%, diabetes — 26%. For urgent indications, 12 (2.8%) patients were operated, 2 (16.6%) of them died. In 419 (97.2%) patients, mini-invasive treatment was performed. Endoscopically, jaundice wasn’t managed in 86 (20.5%) cases. In 62 (14.8%) cases, percutaneous transhepatic microcholangiography was performed under ultrasound guidance. Laparoscopic cholecystectomy was performed in 183 (43.6 %) cases, traditional cholecystectomy was performed in 149 (35.6%) cases, and in 38 of them (23.9%) it was combined with Kerr’s drainage of choledoch. Mini-invasive cholecystectomy was performed in 87 (20.7%) cases. Postoperative complications were revealed in 21 (5.0%) patients, in 7 (2.9%) of elderly age and 14 (7.9%) of senile age. Postoperative mortality rate was 2.0%. The use of minimally invasive interventions in the complex treatment of this group of patients was the main goal and it was reasoned by the severity of the initial condition of elderly and senile patients.Проведен ретроспективный анализ лечения 4197 больных, страдавших острым холециститом. Деструктивный осложненный холецистит был обнаружен у 658 больных (25,3%). Пациентов пожилого и старческого возраста было 431 (65,5%). В последней группе коморбидные изменения наблюдались у 100% больных. Сердечно-сосудистая недостаточность имела место у 73,9% больных, заболевания органов дыхания — у 29,2%, сахарный диабет — у 26%. По экстренным и срочным показаниям оперированы 12 пациентов (2,8%), умерли 2 (16,6%). Мини-инвазивное лечение проведено 419 больным (97,2%). Эндоскопически желтуха не разрешена у 86 пациентов (20,5%), 62 больным (14,8%) произведена чрескожная чреспеченочная микрохолецистостомия под УЗ-наведением. Лапароскопическая холецистэктомия выполнена 183 больным (43,6%), традиционная холецистэктомия — 149 пациентам (35,6%) , из них с дренированием холедоха по Керу — 38 (23,9%). Холецистэктомия из мини-доступа произведена 87 пациентам (20,7%). Послеоперационные осложнения выявлены у 21 больного (5,0%): у 7 лиц (2,9%) пожилого и у 14 (7,9%) — старческого возраста. Послеоперационная летальность составила 2,0%. Использование мини-инвазивных вмешательств в комплексном лечении группы коморбидных больных при осложнениях желчнокаменной болезни позволило значительно улучшить результаты хирургического лечения

ALGORITHM OF DIAGNOSTICS AND TREATMENT OF ELDERLY AND SENILE PATIENTS WITH ACUTE CHOLECYSTITIS, CHOLEDOCHOLITHIASIS AND OBSTRUCTIVE JAUNDICE

We performed a retrospective analysis of treatment in 4,197 patients with acute cholecystitis. Destructive complicated cholecystitis was diagnosed in 658 (25.3%) patients . There were 431 (65.5%) patients of elderly and senile age. All patients had comorbidities. Cardiovascular insufficiency — 73.9%, respiratory diseases — 29.2%, diabetes — 26%. For urgent indications, 12 (2.8%) patients were operated, 2 (16.6%) of them died. In 419 (97.2%) patients, mini-invasive treatment was performed. Endoscopically, jaundice wasn’t managed in 86 (20.5%) cases. In 62 (14.8%) cases, percutaneous transhepatic microcholangiography was performed under ultrasound guidance. Laparoscopic cholecystectomy was performed in 183 (43.6 %) cases, traditional cholecystectomy was performed in 149 (35.6%) cases, and in 38 of them (23.9%) it was combined with Kerr’s drainage of choledoch. Mini-invasive cholecystectomy was performed in 87 (20.7%) cases. Postoperative complications were revealed in 21 (5.0%) patients, in 7 (2.9%) of elderly age and 14 (7.9%) of senile age. Postoperative mortality rate was 2.0%. The use of minimally invasive interventions in the complex treatment of this group of patients was the main goal and it was reasoned by the severity of the initial condition of elderly and senile patients