Ultra-resistant schizophrenia and potentiation strategies

2017 ◽  
Vol 41 (S1) ◽  
pp. s834-s834 ◽  
Author(s):  
S. Khouadja ◽  
R. Ben Soussia ◽  
S. Younes ◽  
A. Bouallagui ◽  
I. Marrag ◽  
...  
Keyword(s):  
Treatment Resistance ◽  
Cost Benefit ◽  
Clinical Excellence ◽  
University Hospital ◽  
Dsm Iv ◽  
Competing Interest ◽  
A Prospective Study ◽  
Psychiatric Department ◽  
The Cost ◽  
The University

IntroductionTreatment resistance to clozapine is estimated at 40–70% of the treated population. Several clozapine potentiation strategies have come into clinical practice although often without evidence-based support.ObjectiveThe aim of our work was to identify the potentiation strategies in ultra-resistant schizophrenia depending on the subtype of schizophrenia.MethodologyThis is a prospective study conducted on patients with the diagnosis of schizophrenia, based on DSM-IV-TR criteria, and hospitalized in the psychiatric department of the university hospital in Mahdia, Tunisia. The study sample consisted of patients meeting the resistant schizophrenia criteria as defined by national institute for clinical excellence (NICE), and the prescription of clozapine for 6 to 8 weeks was shown without significant improvement.Resultswe have collected 10 patients. The mean serum level of clozapine was 462.25 mg/L. The potentiation strategies were different depending on the subtype of schizophrenia. For the undifferentiated schizophrenia, we have chosen ECT sessions. For the disorganized schizophrenia, we opted for amisulpiride and aripiprazole. For the paranoid forms, we have chosen the association of risperidone and ECT. A psychometric improvement was noted in BPRS ranging from 34 to 40%.ConclusionEvery potentiation strategy entails a cost, whether it is an additional monetary cost, adverse effects or greater stress to caregivers. The cost/benefit equation should be thoroughly evaluated and discussed before commencing a strategy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antipsychotic-induced hyperprolactinemia

2017 ◽  
Vol 41 (S1) ◽  
pp. S701-S701
Author(s):  
S. Khouadja ◽  
R. Ben Soussia ◽  
A. Bouallagui ◽  
I. Marrag ◽  
S. Younes ◽  
...  
Keyword(s):  
Prolactin Level ◽  
Atypical Antipsychotics ◽  
Antipsychotic Agents ◽  
University Hospital ◽  
Therapeutic Assessment ◽  
Assessment And Monitoring ◽  
Competing Interest ◽  
A Prospective Study ◽  
Psychiatric Department

IntroductionAs antipsychotic agents are increasingly used, many patients are at risk for antipsychotic-induced hyperprolactinemia.Aims of the studyEstimate the prevalence of hyperprolactinemia in patients treated by a single antipsychotic and identify the risk factors for its occurrence.MethodsThis is a prospective study carried out at the psychiatric department of psychiatry of university hospital of Mahdia during 24 months. We have included all patients with a follow up and treated by single antipsychotic for at least 12 weeks. A pituitary MRI has been requested for patients with a prolactin level higher than 100 ng/ml.ResultsWe have collected 92 patients. Hyperprolactinemia was found in 34.8% of patients among which 7.6% have had prolactin level greater than 150 ng/ml. Pituitary MRI have revealed 2 cases of macro-adenoma. The decrease of the antipsychotic doses has significantly improved prolactin levels. The switch of antipsychotic with another less inducing hyperprolactnimea has significantly decreased prolactin levels. 7 factors were correlated significantly to hyperprolactinemia: sex (female), substance use, presence of side effects, combination of psychotropic drugs, atypical antipsychotics, type of antipsychotic: Haloperidol and amisulpride, antipsychotic dose greater than 1000 mg Chlorpromazine equivalent.ConclusionHyperprolactinemia must be carefully identified, through a pre-therapeutic assessment and monitoring of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evolutionary Aspects of Psychotic Disorders Induced by Cannabis

2017 ◽  
Vol 41 (S1) ◽  
pp. S203-S203
Author(s):  
F. Guermazi ◽  
R. Ennaoui ◽  
N. Halouani ◽  
S. Chouayakh ◽  
J. Aloulou ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Cannabis Use ◽  
University Hospital ◽  
Early Screening ◽  
Effective Strategies ◽  
Competing Interest ◽  
Psychiatric Department ◽  
The University ◽  
Evolutionary Aspects ◽  
Chronic Psychosis

IntroductionCannabis is increasingly used by young people. Its several noxious effects on mental health have become a matter of preoccupation. Although cannabis use may be involved in the etiology of acute psychosis, there has been considerable debate about the association observed with chronic psychosis.Aims(1) To describe the profile of patients with cannabis use disorders (CUD); (2) to determine the evolutionary aspects.MethodsWe proceed with a retrospective and descriptive study conducted among 16 male patients with CUD and hospitalised for the first time in the psychiatric department at the University Hospital Hedi Chaker during the period from 1 January 2012 to 31 December 2014.ResultsAn overwhelming majority of the subjects were single and unemployed. One-third of the users had a stay abroad, the half was incarcerated at least once and one patient was implicated in illegal drugs trade. CUD were associated with specific personality disorders: borderline (18.8%) and antisocial (6.3%) personality. Into at least the 2 years of follow-up, different evolutionary aspects were distinguished. Many of the patients were lost to follow (18.8%). A total restitution of symptoms or a recurrence of the same disorders were observed in 25% of cases. About 56.3% of subjects had a change in diagnosis to either schizophrenia (43.3%) or affective disorder (12.5%).ConclusionThis study showed that cannabis use can be a cause of the emergence of chronic psychosis. This emphasizes the importance of early screening of the vulnerability to psychotic disorder and identify more effective strategies to improve intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

2021 ◽  
Vol 13 (5) ◽  
pp. 95-97
Author(s):  
Augustin Delange Hendrick ◽  
Almenord Pharol ◽  
Khawly Clifford PG ◽  
Augustin Delange ◽  
Pierre Marie Woolley
Keyword(s):  
Hospital Stay ◽  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Patient Morbidity ◽  
Duration Of Hospitalization ◽  
The Cost ◽  
The University

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

Schizoaffective disorder and life events

2017 ◽  
Vol 41 (S1) ◽  
pp. s845-s845
Author(s):  
B. walid ◽  
I. Marrag ◽  
F. Ellouze ◽  
A. Dekhil ◽  
M. Nasr
Keyword(s):  
Life Events ◽  
Schizoaffective Disorder ◽  
Age At Onset ◽  
Dsm Iv ◽  
The Mean ◽  
Competing Interest ◽  
New Perspective ◽  
Emotional Events ◽  
Psychiatric Department

IntroductionThe schizoaffective disorder is multifactorial. Several factors almost unquestioned, even indisputable, participate in the episodes’ decompensation and affect various fields: biological, pharmacological or neurobiochemical.ObjectivesDraw up the sociodemographic and clinical profile of patients treated for schizoaffective disorder and determine the role of life events in the onset of the disorder.MethodsThis is a retrospective study of 52 patients hospitalized in the psychiatric department of Mahdia diagnosed with schizoaffective disorder according to DSM-IV-TR during the period from January 2014 until June 2014. The information was collected using a preset sheet with 35 items.ResultsA total of 52 records was gathered. The average age was 38 years. The sample was predominantly male, of rural origin in 61.5% of cases. The level of education was low in 59.6% of cases. More than half were without profession and single in 46.2% of cases. The mean age at onset of the disorder was 25.2 years. The presence of life events preceding the onset of the disorder was noted in 22 patients, that to say, 42.3% of the sample. Family and emotional events were most frequently encountered with respective rates of 48.2 and 24.7%, followed by the professional events (20%) and social ones (6%).ConclusionLife events are due to chance but also to the environment. The complexity of the “event” concept was again underlined in a new perspective, breaking social rhythms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Sepsis in a university hospital: a prospective study for the cost analysis of patients' hospitalization

2016 ◽  
Vol 50 (2) ◽  
pp. 302-308 ◽  
Author(s):  
Maynara Fernanda Carvalho Barreto ◽  
Mara Solange Gomes Dellaroza ◽  
Gilselena Kerbauy ◽  
Cintia Magalhães Carvalho Grion
Keyword(s):  
Severe Sepsis ◽  
Public Hospital ◽  
Epidemiological Data ◽  
University Hospital ◽  
Preventive Actions ◽  
Focus Of Infection ◽  
One Year ◽  
A Prospective Study ◽  
The Cost ◽  
Pulmonary Focus

Abstract OBJECTIVE To estimate the cost of hospitalization of patients with severe sepsis or septic shock admitted or diagnosed in the Urgent and Emergency sector at a university hospital and followed until the clinical outcome. METHOD An epidemiological, prospective, observational study conducted in a public hospital in southern Brazil for the period of one year (August 2013 to August 2014). Sepsis notification forms, medical records and data of the cost sector were used for the collection of clinical and epidemiological data. RESULTS The sample comprised 95 patients, resulting in a total high cost of hospitalization (R$ 3,692,421.00), and an average of R$ 38,867.60 per patient. Over half of the total value of the treatment of sepsis (R$ 2,215,773.50) was assigned to patients who progressed to death (59.0%). The higher costs were related to discharge, diagnosis of severe sepsis, the pulmonary focus of infection and the age group of up to 59 years. CONCLUSION The high cost of the treatment of sepsis justifies investments in training actions and institution of protocols that can direct preventive actions, and optimize diagnosis and treatment in infected and septic patients.

SHANK3 mutation in consanguineous schizophrenia family in northwest Algeria

2017 ◽  
Vol 41 (S1) ◽  
pp. S595-S596
Author(s):  
A. Dahdouh ◽  
J. Prados ◽  
M. Guipponi ◽  
F. Bena ◽  
W. Adouan ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Rare Variants ◽  
University Hospital ◽  
High Rate ◽  
Common Disease ◽  
Multiplex Family ◽  
Illumina Hiseq ◽  
Genetic Technologies ◽  
Competing Interest ◽  
The University

IntroductionSeveral studies have asserted the existence of a strong and complex genetic component in the determination of psychotic disorders. GWAS studies conducted over the past decade lead to the identification of only a few low effect associations, calling questioning the hypothesis of “common disease – common variants” for a model involving a large number of rare variants.AimsHere, we studied a multigenerational multiplex family with schizophrenia a high rate of consanguinity, located in the northwest of Algeria. This study aims to identify inherited rare variants of schizophrenia using new genetic technologies.MethodsThis family has received complete clinical (DIGS, DSM-IV criteria), genealogical investigations, CNV analysis using CGH Microarray Kit 244 K (Santa Clara, CA) and WES (by GAIIx Illumina/HiSeq 2000) focused in CNV regions, that were performed in the department of genetics in the university hospital of Geneva.ResultsWe identify 11 affected members by psychotic disorders. The main CNVs analysis results found in a schizophrenic member a Del 22q13.33 affecting SHANK3 gene. WES regarding these regions identified a mutation at position 511178000 in SHANK3 gene in all the selected affected relatives.DiscussionSeveral studies have asserted the association of SHANK3 mutations with schizophrenia and autism disorders. This is the first observation of rs511,178,000 in schizophrenia phenotype.ConclusionIn total, this highly informative family have identified new rare genetic variant of schizophrenia. The search for this mutation in wider control population in would be useful to validate these data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Cost of Hypertermia: Nine Years Experience at the Radiation Therapy Department of the Turin University

1994 ◽  
Vol 80 (5) ◽  
pp. 327-331 ◽  
Author(s):  
Pietro Gabriele ◽  
Roberto Orecchia ◽  
Eugenia Madon ◽  
Maria Grazia Ruo Redda ◽  
Gian Luca Sannazzari
Keyword(s):  
Radiation Therapy ◽  
Life Expectancy ◽  
Palliative Treatment ◽  
National Health System ◽  
Cost Benefit ◽  
Elective Treatment ◽  
The Mean ◽  
The Cost ◽  
The University ◽  
Therapy Department

Background In this paper the authors try to quantify the expenditure for the equipment, staff, treatment per patient and research, sustained at the Radiation Therapy Department of the University of Turin for the treatment of cancer with hyperthermia Methods Two hyperthermic computerized devices are available: the SAPIC SV03 multifrequencies system (915, 434 and 2-30 MHz) for external hyperthermia, and the SACEM system. working only with the frequency of 915 MHz, for interstitial and intracavitary heating. From September 1983 to December 1991, 408 patients have been treated with hyperthermia, for a total number of treated sites of 483; 2960 heating sessions were performed, with a average of six sessions per patient. Results The overall cost of our “hyperthermia project” was about 2,000,000,000 Italian liras; the equipment cost was estimated at 1,258,650,000 Liras (839,100 US$), and the cost per treatment and per heat session at about 3,985,200 (2676 US$) and 664,200 liras (443 US$), respectively. The cost of the research program can be estimated in 175,000,000 liras (116,666 US$). The National Health System provides for a partial reimbursement of 2,000,000 liras (1,333 US$) for each course of hyperthermia. Taking into account the mean expected life expectancy and increasing purchases for replacement of equipment, these costs increase 10% each year. As regards the cost-benefit problem, using the Rees formula it varies from 1112 US$ when hyperthermia is used as elective treatment to 3380 US$ when hyperthermia is used as palliative treatment. Conclusions Hyperthermia is, in our experience, an expensive therapy.

scholarly journals Student Perceptions of a Trial of Electronic Text Matching Software: A Preliminary Investigation

2005 ◽  
Vol 2 (3) ◽  
pp. 31-43
Author(s):  
D. Green ◽  
◽  
I. Lindemann ◽  
K. Marshall ◽  
G. Wilkinson ◽  
...  
Keyword(s):  
Student Perceptions ◽  
Preliminary Investigation ◽  
Cost Benefit ◽  
Perceived Usefulness ◽  
Detection Methods ◽  
Potential Benefits ◽  
English Speaking ◽  
The Cost ◽  
The University ◽  
The Impact

It is accepted that using electronic detection methods has benefits within an overall strategy to promote academic integrity in an institution. Little attention has been paid to obtaining student perceptions to evaluate the cost/benefit of using such methods. This study reports on the evaluation of a trial of Turnitin software. 728 students responded to a survey about their thoughts on plagiarism and being involved in the trial. This study found that students were generally unsure about the benefits and whether the university should use the software. In particular, two groups of students showed significant differences to the rest of the students sampled. While Non English Speaking Background (NESB) students reported higher levels of perceived usefulness of the software, they also reported higher levels of anxiety about the impact on them. Law students reported lower levels of perceived usefulness of the software and higher levels of concern and mistrust. The impact of such perceptions on the learning environment needs to be investigated. Special attention may be needed in introducing such software to different groups of students in order to limit possible deleterious effects and enhance potential benefits.

scholarly journals Costs of bariatric surgery in a teaching hospital and the financing provided by the Public Unified Health System

2010 ◽  
Vol 25 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Wilson Salgado Júnior ◽  
Karoline Calfa Pitanga ◽  
José Sebastião dos Santos ◽  
Ajith Kumar Sankarankutty ◽  
Orlando de Castro e Silva Jr ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health System ◽  
Perioperative Period ◽  
University Hospital ◽  
Retrospective Evaluation ◽  
The Public ◽  
Unified Health System ◽  
The Government ◽  
The Cost ◽  
The University

PURPOSE: Analyze the effect of some measures on the costs of bariatric surgery, adopting as reference the remuneration of the procedure provided by the Unified Health System (SUS). METHODS: A retrospective evaluation conducted in the Costs Section of the University Hospital of Ribeirão Preto, of the costs involved in the perioperative period for patients submitted to bariatric surgery from 2004 to 2007. Changes in the routines and protocols of the service aiming at the reduction of these costs during the study period were also analyzed. RESULTS: Nine patients in 2004 and seven in 2007 submitted to conventional vertical banded "Roux-en-Y" gastric bypass were studied. All patients presented good postoperative evolution. The average cost with these patients was R$ 6,845.17 in 2004. Even though an effort was made to contain expenditures, the cost in 2007 was of R$ 7,525.64 because of the increase in the price of materials and medicines. The Government remuneration of the procedure in the two years was R$ 3,259.72. CONCLUSION: Despite the adoption of diverse measures to reduce the expenditures of bariatric surgery, in fact there was an increase in the costs, a fact supporting the necessity of permanent evaluation of the financing of public health.

scholarly journals Impact of a Novel Oblique-Tip Papillotome for Biliary Cannulation during ERCP: A Nonrandomized Coarsened Exact Matching Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Hiroo Imazu ◽  
Shiaw-Hooi Ho ◽  
Shoryoku Hino ◽  
Khean-Lee Goh ◽  
Mitsuhiko Moriyama ◽  
...  
Keyword(s):  
University Hospital ◽  
Exact Matching ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Coarsened Exact Matching ◽  
Patient Allocation ◽  
Cannulation Technique ◽  
The Mean ◽  
A Prospective Study ◽  
The University

Background. We developed a novel oblique-tip papillotome (OT-papillotome) to facilitate biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate the utility of the OT-papillotome for contrast-guided cannulation (CGC) and wire-guided cannulation (WGC) during ERCP, compared with standard cannulation by WGC using a standard-tip papillotome (ST-papillotome). Methods. A prospective study was performed at two centers. CGC with the OT-papillotome (OT-CGC group) was performed at Jikei University Hospital, while WGC was done with the OT-papillotome and ST-papillotome (OT-WGC and ST-WGC groups, respectively) at the University of Malaya Medical Centre. The results of the OT-CGC and OT-WGC groups were compared with those of the ST-WGC group after performing coarsened exact matching (CEM) to reduce bias due to nonrandomized and center-based patient allocation. Results. Eighty patients were enrolled in each of the OT-CGC, OT-WGC, and ST-WGC groups. After CEM, the successful biliary cannulation rate was significantly higher in the OT-CGC and OT-WGC groups than in the ST-WGC group, while rescue cannulation was reduced. The mean number of unintended pancreatic access events in the OT-WGC and OT-CGC groups was similar to the ST-WGC group. However, it was significantly lower in the OT-WGC group than in the OT-CGC group. Multivariate analysis revealed that the OT-papillotome was independently associated with less frequent rescue cannulation and a higher successful biliary cannulation rate. Conclusions. Although use of the OT-papillotome in biliary cannulation did not reduce unintended pancreatic access events or PEP compared to the ST-papillotome, the OT-papillotome increased the successful biliary cannulation rate, while reducing the frequency of rescue cannulation procedures. Combining the OT-papillotome with WGC might be the best cannulation technique for minimizing unintended pancreatic access.

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