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Background:The prevalence of pediatric mental illnesses has been increasing in recent years,with a great potential to impact on individual's functionality and adaptation in adulthood.Objective:This study aims to assess emotional and behavioral problems among schoolchildren in Herat City of Afghanistan.Methods:This cross-sectional study was conducted on schoolchildren(grade 5-10),between September and November 2021.Sociodemographic data was collected using a paper-based 14-item structured questionnaire.Data on emotional and behavioral problems was collected using the Strengths and Difficulties Questionnaire(SDQ)based on teachers'and children's report.Statistical analyses were performed in IBM SPSS Statistics(version 27).Results:A total of 418 students,including 190(45.5％)males and 228(54.5％)females with a mean age of 14.1±1.7(11-＜18)years were included in the study.The prevalence of students'self-reported total difficulties and prosocial problem were 5.7％and 1.2％,respectively.An insignificant difference was observed between mean total difficulties scores between students'self-reported and teachers'reported SDQ.Gender,grade,concern about shortage of food,and concern about losing house were significantly predicting students'self-reported total difficulties scores.Conclusion:This is the first study to report the prevalence of emotional and behavioral problems among schoolchildren in Herat City,Afghanistan.This,together with relevant global literature,highlight the need to address pediatric mental health,and provide services aimed at preventing,and treating children with these prob-lems around the world.
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Objective:Afghanistan has witnessed a long-lasting 4-decade armed conflict,which together with high levels of poverty and interpersonal violence,resulted in high incidence and prevalence of mental disorders in general population,including children and adolescents.Until mid-2018,there was neither mental health care facility nor a child psychiatrist in Afghanistan.Here,we report the establishment of the first children and adolescents'mental health center(CAMHC)in Herat province of Afghanistan. Methods:In July 2018,CAMHC was initiated at Mental Health Training Center-Herat.CAMHC was initially planned by the International Assistance Mission(IAM)and Herat Public Health Directorate;and financially sup-ported by the Tearfund UK,the United Methodist Committee on Relief and Tearfund Australia.The target pop-ulation of CAMHC was children and adolescents in Herat and neighboring provinces,healthcare professionals,staff of government and non-governmental organizations,school teachers and community leaders. Results:A group of eight mental health professionals were trained and made the interdisciplinary board for di-agnosis and management of mental disorders in children and adolescents.During the initial three-year period,2 448 patients,including 1 264(51.6％)boys and 1 184(48.4％)girls,presented with mental disorders to CAMHC.Diagnosis and management of mental disorders were performed according to standard international protocols.Eighteen awareness-raising seminars were held;2 000 leaflets,10 000 posters,and 30 000 brochures were pre-pared and distributed;and two short video clips were produced and broadcast via IAM website,social media and local TV channels.A database was developed to house for project data,assessment of outcomes and reporting to stakeholders. Conclusion:Establishment of CAMHC resulted in significant achievements in diagnosis and management of men-tal disorders among children and adolescents,healthcare staff capacity building,and awareness-raising about mental disorders.Data obtained in CAMHC offers government,mental health professionals and the community the opportunity of improving mental health in the region.
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Objectives:Coronavirus disease 2019(COVID-19)pandemic has been associated with a great level of psychological distresses in people around the world.This study aims to assess the prevalence of depression,anxiety and stress among COVID-19 patients and identify the associated factors,in Herat Province of Afghanistan.Methods:This cross-sectional study was conducted on 459 hospitalized patients between May and September 2021.Data was collected with a structured questionnaire on depression,anxiety and stress scale,which was the validated Dari-version.Chi-square test was adopted to analyze the associations of the prevalence of the mental disorders and the factors.Results:The mean age of participants was 38.05;51.9％(238/459)were male and 84.1％(386/459)were married.Median scores for depression,anxiety and stress were 5.0,8.0,and 10.0,respectively.Gender,general health condition,nutritional status,COVID-19 clinical manifestation and concurrent comorbidities(except diabetes and hypertension)were significantly associated with mental disorders;while association between marital status and these psychological disorders was not significant.Moreover,a significant difference was observed in the level of anxiety between healthcare workers and other respondents.Conclusion:This is the first study to report the high prevalence of depression,anxiety and stress among CO VID-19 patients in Herat,which indicates the negative effect of mental health for COVID-19 patients globally and highlights the need for urgent and appropriate interventions to improve mental health of people during the pandemic.
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G protein-coupled receptors (GPCRs) convert extracellular stimuli in the form of hormones, odorants and light into profound changes in cell homeostasis. Their timely desensitization is critical for cells to rapidly respond to changes in their environment and to avoid damage from sustained signaling. Seven GPCR kinases (GRKs) phosphorylate and regulate the activity of most of the ~800 GPCRs in the human genome. Although GRKs normally play an adaptive role, in conditions such as chronic heart failure they are overexpressed and linked to disease progression. GRK2 and GRK5 have thus become important targets for the treatment of heart failure and pathological cardiac hypertrophy, respectively. Our lab has determined atomic structures representing all three vertebrate GRK subfamilies, and is now in the midst of a campaign to develop selective inhibitors of these enzymes using structure-based rational design. We have identified the FDA approved drug paroxetine as a selective GRK2 inhibitor, determined the crystal structure of the GRK2·paroxetine complex and, in collaboration with the Koch lab, showed that the drug improves contractility in myocytes and, most impressively, recovery in post-myocardial infarcted mice. Since then, we have identified additional chemical scaffolds that exhibit even higher potency and/or selectivity for GRK5. Using a ″hybrid″ inhibitor design approach we have generated GRK selective chemical probes that exhibit improved potency and stability and are able to increase inotropy and dampen the hypertrophic response in cardiomyocytes and small animal models. Structural analysis has revealed the molecular basis for selectivity and potency in many of these compounds, allowing for the design of future generations of GRK chemical probes.
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Objective To observe before and after surgery plasma vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-β1) content changes in the children with congenital heart disease(CHD) combined severe pulmonary arterial hypertension(PAH),and to explore the relationship with the pulmonary artery pressure.Methods Sixty cases patients with CHD in the First Hospital of Hebei Medical University from June 2014 to January 2015 were selected,including 30 cases left to right shunt CHD with severe PHD,30 cases no PHD.The content of serum VEGF,TGF-β1,parallel echocardiographic estimates pulmonary artery mean pressure(PAMP) of all children were detected with preoperative and postoperative 24 h,7 d and 30d.Results PAMP of children with severe PAH before surgery was (60.29±8.48) mmHg and (48.36±5.25)mmHg of postoperative 24 h,(28.21±3.29) mmHg of 7 d after surgery,(25.21±2.09) mmHg of 30 d after surgery,the difference was statistically significant (F within the grouP=39.86,P＜0.001),and compared with no PHD group,the difference was significant ((14.26±1.78) mmHg,(14.30±1.92) mmHg,(13.31±1.02)mmHg;F between groups=46.01,P＜0.001).The levels of VEGF and TGF-β1 in severe PHD group were (808.90±41.37) ng/L and (1156.96±83.68) ng/L of before operation,(620.21±30.30) ng/L and (906.20±65.11) ng/L of postoperative 24 h,(454.49±21.48) ng/L and (826.23±35.11) ng/L of postoperative 7 d,(454.49±21.48) ng/L and (806.49±29.48) ng/L of postoperative 30 d,the differences were significant (Fwithin the grouP=43.73,P＜0.001;F within the grouP=65.41,P＜0.001),compared with no PHD group,the differences were significant (VEGF:(379.25±20.21) ng/L,(380.05±19.98) ng/L,(380.05±19.98) ng/L,F between groups =54.09,P＜0.001;TGF-β1:(728.56±29.93) ng/L,(728.11±25.26) ng/L,(727.05±24.99) ng/L,F between groups=83.05,P＜0.001).Conclusion Plasma VEGF and TGF-β1 level has correlation with pulmonary artery pressure,the severity evaluation of pulmonary hypertension and surgical curative effect has a certain significance.After surgery,severe PAH is still exist in a certain period in children with pulmonary hypertension,sufficient attention should be paid to strengthening treatment and follow-up.
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Rheumatic valvulitis produces at least three distinct pathologic changes, the degree varying widely among the patients: fusion of the valve leaflets at the commissures; fusion and shortening of chordae tendinae: and fibrosis of the leaflets with subsequent stiffening, contraction and calcification. The most extensive changes usually are seen in patients with recurrent attacks of rheumatic fever. We studied on outcome of the surgical treatments of rheumatic valvular diseases that have been experienced for 12 years since 1982 at Pusan National University Hospital. The diagnoses were made by rheumatic fever history, echocardiographic findings, gross operative findings and microscopic findings. Total 502 patients were performed surgery for valvular heart diseases and 440 patients of rheumatic origin have bene analysed. There were more female than male patients as 1.3:1, and the mean age was 37.8 years old. 96.3% of them affected to the mitral valve, 19.8% to aortic valve, 16.3% affected to the tricuspid valve. Most of them underwent valve replacement, and valve repair was done in 3.9% of patients. There were 36 hospital deaths (8.2%) mainly from low cardiac output syndrome, and 15 late deaths equally due to embolism and hemorrhage. Follow up was 90.1% completed (2890 patient-year). Linealized rates of late complication events are follows : thromboembolism 1.3% per patient year; anticoagulant related hemorrhage 0.8% per patient year. Overall actuarial survival including hospital mortality was 92.7+/-2.9% in 1 year, 88.0+/-4.5% in 5 year, 82.3+/-7.7% in 10 year. We conclude that the rheumatic disease is still the most frequent and the most important cause of heart valve disease. So more intensive study is needed in spite of the abrupt decreasing rate of rheumatic fever in U.S.A. and other industrial country.
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Female , Humans , Male , Aortic Valve , Cardiac Output, Low , Diagnosis , Echocardiography , Embolism , Fibrosis , Follow-Up Studies , Heart Valve Diseases , Heart Valves , Hemorrhage , Hospital Mortality , Mitral Valve , Rheumatic Diseases , Rheumatic Fever , Thromboembolism , Tricuspid ValveABSTRACT
Anesthesiologists may have close relationship with muscle relaxants in clinical practice. Fourtunately, a few of the new muscle relaxants were discovered and used in clinic recently. Newly introduced non-depolarizing muscle relaxant: vecuronium has been clinically in use recently. The most suitable method for reversing the neurom uscular blockade caused by vecuronium continues to provoke discussion and differences of opinion. Simultaneous administration of neostigmine and atropine has been considered safe by some authors and dangerous by others. Both slow and rapid administration have been recommended. The general acceptance of the slow administration of neostigmine and atropine has been confirmed. In view of the various data on vecuronium reversal, neostigmine was compared with pyridostigmine and heart rate changes were studied. The results were as follows: 1) Recovery index after i.v. neostigmine 40 ug/kg and atropine 20 ug/kg when first twitch of the "train of four" was appeared during vecuronium 0.1mg/kg relaxation, was 129.9 sec. Heart rate change was decreased to 46.9/min(15%) after i.v. neostigmine during 16 to 20 minutes period(p<0.05). 2) Recovery index after i.v. pyridostigmine 160 ug/kg and atropine 20ug/kg when first twitch of the "train of four" was appeared during vecuronium 0.1mg/kg relaxation, was 134.0sec. Heart rate change was not statistically significant compared with neostigmine.