A sticky situation: When trypanosomatids attach to insect tissues.

Transmission of trypanosomatids to their mammalian hosts requires a complex series of developmental transitions in their insect vectors, including stable attachment to an insect tissue. While there are many ultrastructural descriptions of attached cells, we know little about the signaling events and molecular mechanisms involved in this process. Each trypanosomatid species attaches to a specific tissue in the insect at a particular stage of its life cycle. Attachment is mediated by the flagellum, which is modified to accommodate a filament-rich plaque within an expanded region of the flagellar membrane. Attachment immediately precedes differentiation to the mammal-infectious stage and in some cases a direct mechanistic link has been demonstrated. In this review, we summarize the current state of knowledge of trypanosomatid attachment in insects, including structure, function, signaling, candidate molecules, and changes in gene expression. We also highlight remaining questions about this process and how the field is poised to address them through modern approaches.

Evaluation of the effectiveness and acceptability of intramuscular clozapine injection: illustrative case series.

AIMS AND METHOD: A series of eleven patients prescribed intramuscular clozapine at five UK sites is presented. Using routinely collected clinical data, we describe the use, efficacy and safety of this treatment modality. RESULTS: We administered 188 doses of intramuscular clozapine to eight patients. The remaining three patients accepted oral medication. With the exception of minor injection site pain and nodules, side-effects were as expected with oral clozapine, and there were no serious untoward events. Nine patients were successfully established on oral clozapine with significant improvement in their clinical presentations. CLINICAL IMPLICATIONS: Although a novel formulation in the UK, we have shown that intramuscular clozapine can be used safely and effectively when the oral route is initially refused.

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness.

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user's lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.