Anterior cervical hybrid constructs reduce superior adjacent segment burden compared to multilevel anterior cervical discectomy and fusion.

Background: Traditional surgical treatment for symptomatic cervical degenerative disc disease is anterior cervical discectomy and fusion (ACDF), yet the increased risk of adjacent segment degeneration (ASD) requiring additional surgery exists and may result in limiting long-term surgical success when it occurs. Disc arthroplasty can preserve or restore physiologic range of motion (ROM), decreasing adjacent level stress and subsequent surgery. For patients with multilevel pathology requiring at least a 1-level fusion, interest is growing in anterior cervical hybrid (ACH) surgery as a partial motion-preserving procedure to decrease the adjacent level burden. This radiographic study compares postoperative superior adjacent segment motion between ACH and ACDF. Secondarily, total global motion, construct motion, inferior adjacent segment motion, and sagittal alignment parameters were compared. Methods: This is a single-center, multi-surgeon, retrospective cohort study of 2- and 3-level ACH and ACDF cases between 2013 and 2021. Degrees of motion were analyzed on flexion/extension views using Cobb angles to measure global (C2-C7) construct and adjacent segment lordosis. Neutral lateral X-rays were analyzed for alignment parameters, including global lordosis, cervical sagittal vertical axis (cSVA), and T1 slope (T1S). Differences were determined by independent t-test and Fisher's exact test. Results: Of 100 patients, 38% were 2-level cases (47% ACH, 53% ACDF) and 62% were 3-level cases: (52% ACH, 48% ACDF). Postoperatively, superior adjacent segment motion increased with ACDF and decreased with ACH (-1.3°±5.3° ACH, 1.6°±4.6° ACDF, P=0.005). Postoperatively, the ACH group had greater ROM across the construct (16.3°±8.7° ACH, 4.7°±3.3° ACDF, P<0.001) and total global ROM (38.0°±12.8° ACH, 28.0°±11.1° ACDF, P<0.001). ACH resulted in a significant reduction of motion loss across the construct (-10.0°±11.7° ACH, -18.1°±10.8° ACDF, P<0.001). Postoperative alignment restoration was similar between both cohorts (-2.61°±8.36° ACH, 0.04°±12.24° ACDF, P=0.21). Conclusions: Compared to ACDF, hybrid constructs partially preserved motion across operative levels and had greater postoperative global ROM without increasing superior adjacent segment mobility or sacrificing alignment restoration. This supports the consideration of ACH in patients with multilevel degenerative cervical pathology requiring at least a 1-level fusion and suggests a propensity for long-term success by reducing the superior adjacent segment burden.

Cervical Disc Arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF) for Two-Level Cervical Disc Degenerative Disease: An Updated Systematic Review and Meta-Analysis.

Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both considered to be efficacious surgical procedures for treating cervical spondylosis in patients with or without compression myelopathy. This updated systematic review and meta-analysis aimed to compare the outcomes of these procedures for the treatment of cervical degenerative disc disease (DDD) at two contiguous levels. Methods: The PubMed, EMBASE, and Cochrane CENTRAL databases were searched up to 1 May 2023. Studies comparing the outcomes between CDA and ACDF in patients with two-level cervical DDD were eligible for inclusion. Primary outcomes were surgical success rates and secondary surgery rates. Secondary outcomes were scores on the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, as well as the Japanese Orthopaedic Association (JOA) score for the severity of cervical compression myelopathy and complication rates. Results: In total, eight studies (two RCTs, four retrospective studies, and two prospective studies) with a total of 1155 patients (CDA: 598; ACDF: 557) were included. Pooled results revealed that CDA was associated with a significantly higher overall success rate (OR, 2.710, 95% CI: 1.949-3.770) and lower secondary surgery rate (OR, 0.254, 95% CI: 0.169-0.382) compared to ACDF. In addition, complication rates were significantly lower in the CDA group than in the ACDF group (OR, 0.548, 95% CI: 0.326 to 0.919). CDA was also associated with significantly greater improvements in neck pain VAS than ACDF. No significant differences were found in improvements in the arm VAS, NDI, and JOA scores between the two procedures. Conclusions: CDA may provide better postoperative outcomes for surgical success, secondary surgery, pain reduction, and postoperative complications than ACDF for treating patients with two-level cervical DDD.

The Trend of Antibiotic Consumption After the COVID-19 Pandemic: Approach to Future Outbreaks.

Background: Earlier reports suggested high rates of antibiotic utilization among COVID-19 patients despite the lack of direct evidence of their activity against viral pathogens. Different trends in antibiotic consumption during 2020 compared to 2019 have been reported. Purpose: The objective of this study is to assess the impact of COVID-19 pandemic on antibiotic consumption in the presence of active Antibiotic Stewardship Program. Methods: This study represented a five years assessment of the consumption of the commonly prescribed antibiotics measured as DDDs/100-Bed Days. We analyzed the data by using nonparametric Friedman and Friedman tests to compare the antibiotic consumption before and during the three subsequent waves of COVID-19. Results: Antibiotic consumption through the DDDs/100-BD has shown reduction in the median of antibiotics consumption of most antibiotics during the period of COVID-19 as compared to the pre-COVID-19 period, which was significant for meropenem and ciprofloxacin, except colomycin that slightly increased. Significant reduction in the consumption of imipenem and meropenem during the second and third waves as compared to the pre-COVID period. Throughout the years, significant reductions were observed between 2018 and 2019 (p=<.001), 2018 and 2020 (p=0.008), and 2018 and 2022 (p=0.002). Conclusion: The reduction in antibiotic consumption is attributed to the strong influence if the ASP and the reluctance of people to visit hospitals during the COVID-19 pandemic. Other related COVID-19 precautions such as physical distance, good hand hygiene, facemasks, that resulted in the prevention of secondary bacterial infections have contributed to the reduction in antibiotic utilization during the pandemic.

Exploring Patterns of Medication Usage in Affective Disorder Patients: A Comprehensive Investigation at a Psychiatry Outpatient Clinic of a Tertiary Care Hospital.

INTRODUCTION: Affective disorders impose a significant burden on public health due to their high prevalence and associated suffering. This study addresses gaps in current literature and clinical practice by providing insights into medication usage trends, which can inform treatment strategies and optimize patient care. The study aims to investigate drug utilization patterns, particularly focusing on defined daily dose/1000/day, among individuals attending a psychiatric outpatient department of a tertiary care hospital. METHODS: This cross-sectional, prospective drug utilization study included 600 affective disorder patients aged 18 years and above. The study period spanned 12 months, from March 2021 to February 2022. Data on demographics, diagnosis, treatment, and counseling were collected and analyzed using descriptive statistics. RESULTS:  Among the 600 patients analyzed, bipolar mood disorder was the most prevalent (239 patients, 39.83%), followed by depressive disorder (208 patients, 34.67%). Triple therapy was the most common prescription regimen, accounting for 308 encounters (51.33%). The average number of drugs per encounter was 3.75 ± 1.01. A combination of psychotherapy and medication counseling sessions was provided to 594 patients or their relatives, representing 99% of the total encounters. CONCLUSION: The study highlights the prevalent use of triple therapy in managing affective disorders, especially bipolar mood disorder and mania disorder. Effective utilization of essential drug lists and comprehensive patient counseling underscores the importance of holistic care in psychiatric outpatient settings. RECOMMENDATION:  Given the high prevalence of triple therapy, further research into the efficacy and safety of this treatment approach is warranted. Additionally, continued emphasis on patient education and counseling can enhance treatment adherence and overall outcomes in individuals with affective disorders.

Utilization Trends of Phosphodiesterase Type-5 Inhibitors for Erectile Dysfunction Between 2019 and 2023 in Tanzania.

Introduction Erectile dysfunction (ED) profoundly affects millions of people globally, including interfering with mental health and quality of life. Phosphodiesterase type-5 inhibitors (PDE5Is) such as sildenafil are pivotal in ED treatment. This study aimed to examine the utilization patterns of PDE5Is in Tanzania. Materials and methods In this retrospective longitudinal study, data on sildenafil and other similar PDE5Is imported between 2019 and 2023 were sourced from the Tanzania Medicines and Medical Devices Authority (TMDA). Pre-processing and visualization were performed using Microsoft Power BI Desktop, and further analysis was performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Utilization trends were ascertained through curve fitting, Holt's linear trend model, and autoregressive integrated moving average (ARIMA) models. The defined daily doses (DDDS) per 1000 inhabitants (DID) were calculated using the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) Classification System and the DDD methodology endorsed by the WHO Collaborating Centre for Drug Statistics Methodology. Results Between 2019 and 2023, there was a pronounced increase in the importation of approximately 587 consignments of PDE5Is. Employing the Holt model (R-square = 0.843), a substantial increase from 0.220910 DID in 2019 to 0.534272 DID by 2025 was observed and anticipated. The period witnessed sildenafil dominating 75.5% of the total use, with Erecto being the most consumed brand (37.6% of total DID). Notably, 2022 had the highest surge (27.2% of the total), albeit a slight decline was observed in 2023 (20.5%). This trend was supported by a linear regression model (R-square = 0.889). Conclusion We found increasing annual trends of PDE5Is of utilization. This requires critical oversight and effective policies to ensure appropriate use and risk minimization.

Calculating daily dose in the Observational Medical Outcomes Partnership Common Data Model.

PURPOSE: We aimed to develop a standardized method to calculate daily dose (i.e., the amount of drug a patient was exposed to per day) of any drug on a global scale using only drug information of typical observational data in the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) and a single reference table from Observational Health Data Sciences And Informatics (OHDSI). MATERIALS AND METHODS: The OMOP DRUG_STRENGTH reference table contains information on the strength or concentration of drugs, whereas the OMOP DRUG_EXPOSURE table contains information on patients' drug prescriptions or dispensations/claims. Based on DRUG_EXPOSURE data from the primary care databases Clinical Practice Research Datalink GOLD (United Kingdom) and Integrated Primary Care Information (IPCI, The Netherlands) and healthcare claims from PharMetrics® Plus for Academics (USA), we developed four formulas to calculate daily dose given different DRUG_STRENGTH reference table information. We tested the dose formulas by comparing the calculated median daily dose to the World Health Organization (WHO) Defined Daily Dose (DDD) for six different ingredients in those three databases and additional four international databases representing a variety of healthcare settings: MAITT (Estonia, healthcare claims and discharge summaries), IQVIA Disease Analyzer Germany (outpatient data), IQVIA Longitudinal Patient Database Belgium (outpatient data), and IMASIS Parc Salut (Spain, hospital data). Finally, in each database, we assessed the proportion of drug records for which daily dose calculations were possible using the suggested formulas. RESULTS: Applying the dose formulas, we obtained median daily doses that generally matched the WHO DDD definitions. Our dose formulas were applicable to >85% of drug records in all but one of the assessed databases. CONCLUSION: We have established and implemented a standardized daily dose calculation in OMOP CDM providing reliable and reproducible results.

Psychology as a Science of the Soul: Evangelos Christou's The Logos of the Soul (1963).

After Evangelos Christou (1923-1956) studied philosophy at King's College, Cambridge, with Wittgenstein and others, he earned a doctorate at the Jung Institute in Zürich. He then returned home to Alexandria, near which he died in a car crash. The Logos of the Soul, published posthumously, argued for a psychology that would be neither a natural scientific psychology, devoted to causal analyses, nor a philosophical discipline that analysed mental events. Psychology would be an autonomous science of the soul, an unknown distinct from body and mind. Science deals with bodies and behaviours; philosophy with the mental concepts and acts. Psychology deals with "psychological experience". Dreams and fantasies can be sources of psychological experience, but so can perceptual acts and mental acts. Meaning occurs when something encounters an ego or self in a psychological experience. Observation in psychology is participant observation, akin to witnessing of a drama. Psychological methods, such as psychotherapy, are both means of discovery and means of becoming. Christou's work brought together Jung's analytical psychology and mid-century British philosophy in order to stake out the ground for psychology that would be an empirical analysis of psychological experience and a logical analysis of the concepts used in that psychology.

Après qu'Evangelos Christou (1923­1956) ait étudié la philosophie au King's College à Cambridge, avec Wittgenstein et d'autres, il fit un doctorat à l'Institut Jung de Zurich. Il retourna ensuite à Alexandrie, où il mourut peu de temps après dans un accident de voiture. The Logos of the Soul, publié à titre posthume, plaide pour une psychologie qui ne serait ni une psychologie scientifique naturelle, dédiée aux analyses causales, ni une discipline philosophique qui analyse les événements du mental. La psychologie serait une science autonome de l'âme, une inconnue distincte du corps et du mental. La science traite des corps et des comportements; la philosophie s'occupe des concepts et des actes. La psychologie s'intéresse à « l'expérience psychologique ¼. Les rêves et les fantasmes peuvent être des sources d'expérience psychologique, mais il en est de même pour les actes de perception et les actes du mental. Le sens apparait quand quelque chose rencontre un moi ou un soi dans une expérience psychologique. L'observation en psychologie est une observation participative, qui s'apparente à être témoin d'une pièce dramatique. Les méthodes psychologiques, telles la psychothérapie, sont à la fois des moyens d'exploration et des moyens pour devenir. L'œuvre de Christou a relié la psychologie analytique de Jung et la philosophie britannique du milieu du siècle afin de revendiquer le terrain pour une psychologie qui serait une analyse empirique de l'expérience psychologique et une analyse logique des concepts utilisés dans cette psychologie.

Luego de estudiar filosofía en el King's College de Cambridge, con Wittgenstein y otros, Evangelos Christou (1923­1956) obtuvo un doctorado en el Instituto Jung de Zúrich. Posteriormente regresó a su casa en Alejandría, cerca de la cual murió en un accidente de auto. El Logos del alma, publicado póstumamente, abogaba por una psicología que no fuera ni una psicología científica natural, dedicada a los análisis causales, ni una disciplina filosófica que analizara los acontecimientos mentales. La psicología sería una ciencia autónoma del alma, lo desconocido distinto del cuerpo y de la mente. La ciencia se ocupa de los cuerpos y las conductas; la filosofía, de los conceptos y los actos mentales. La psicología se ocupa de la "experiencia psicológica". Los sueños y las fantasías pueden ser fuentes de experiencia psicológica, pero también los actos perceptivos y mentales. El sentido se produce cuando algo se encuentra con un ego o un self en una experiencia psicológica. La observación en psicología es una observación participante, similar a ser testigo de un drama. Los métodos psicológicos, como la psicoterapia, son a la vez medios de descubrimiento y medios de devenir. La obra de Christou reunió la psicología analítica de Jung y la filosofía británica de mediados de siglo para sentar las bases de una psicología que fuera un análisis empírico de la experiencia psicológica y un análisis lógico de los conceptos utilizados en esa psicología.

IGF2BP2 modulates autophagy and serves as a prognostic marker in glioma.

Glioma, a malignant brain tumor originating from neural glial cells, presents significant treatment challenges. However, the underlying mechanisms of glioma development are not fully understood, and effective targets are lacking. This study provides insights into the role of insulin-like growth factor 2 messenger RNA-binding protein 2 (IGF2BP2) in glioma progression and its therapeutic potential. Our analysis illustrated that elevated IGF2BP2 expression associated with significantly shorter survival among patients with low-grade glioma (LGG) in The Cancer Genome Atlas (TCGA) database. IGF2BP2 depletion led to compromised cell viability, G0/G1 phase arrest, and reduced colony-formation ability. Furthermore, ultrastructural analysis and mCherry-GFP-LC3 reporter assay revealed an increased abundance of autophagosomes upon IGF2BP2 knockdown. Western blot analysis corroborated these findings by showing reduced p62 levels coupled with increased LC3-ІІ/LC3-I ratio upon IGF2BP2 knockdown. A multicolor immunohistochemistry assay demonstrated the positive correlation between IGF2BP2 and p62 expression in glioma patient samples. Additionally, our analysis suggested a link between IGF2BP2 expression and drug-resistant markers in TCGA-LGG samples, and Cell Counting Kit-8 cell viability assay revealed that knockdown of IGF2BP2 sensitized cells to temozolomide treatment. This comprehensive exploration unveils the role of IGF2BP2 in glioma progression, shedding light on autophagy modulation and chemosensitization strategies for glioma therapy.

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data.

Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.

The Love Problem of a Student-Revisited: A Psycho-Ethical Map for Cases of Anima Projection.

In its typical form, an "anima projection" is a psychic experience in which a heterosexual man is caught up by an intense, almost magical attraction for a woman. What sets these numinous experiences apart from a common "crush" is a pattern of specific phenomenological characteristics. Anima projections are particularly common in late adolescence and early adulthood, when they can cause a deep sense of disorientation. Little education exists for young men on how to deal with these experiences and to actualize the developmental opportunity that underlies them. In this paper, I frame anima projections as an ethical problem and outline a psycho-ethical "map" that is intended for use by disoriented young men, or by any practitioner who may be tasked with helping them navigate this challenge along the path of individuation. The map considers four solutions to the love problem: the "concretistic-literal", the "fearful-avoidant", the "rational-depressive", and the "transitional-developmental" solution, and indicates the latter as the one that is conducive to optimal psychic development. Although developed with a focus on young men, the map may apply to other relations based on projection, regardless of age, sex, gender, or sexual orientation.

Dans sa forme typique, une "projection de l'anima" est une expérience psychique dans laquelle un homme hétérosexuel est pris dans une attirance intense, presque magique, pour une femme. Ce qui distingue les expériences numineuses de simples béguins, c'est un ensemble de caractéristiques phénoménologiques spécifiques. Les projections de l'anima sont particulièrement fréquentes à la fin de l'adolescence et au début de l'âge adulte, où elles produisent un profond sentiment de désorientation. Il n'existe que peu de formation pour les jeunes hommes en ce qui concerne comment faire face à de telles expériences et comment utiliser de manière profitable l'opportunité de développement qui les sous­tend. Dans cet article, je considère les projections de l'anima comme étant un problème éthique et j'esquisse une "carte" psycho­éthique visant à aider les jeunes hommes désorientés ­ ou tout praticien dont la tâche est d'aider ces jeunes hommes ­ à relever ce défi sur le chemin de l'individuation. Cette carte envisage quatre solutions au problème de l'amour: la solution "concrète­littérale", celle de "l'évitement angoissé", la "dépressive­rationnelle" et la "transitionnelle­développementale". La carte indique que cette dernière solution est celle qui permet un développement psychique optimal. Bien que conçue pour les jeunes hommes, cette carte peut également être utilisée pour d'autres relations fondées sur la projection, quel que soit l'âge, le sexe, le genre ou l'orientation sexuelle.

En su forma típica, una "proyección del ánima" es una experiencia psíquica en la que un hombre heterosexual se ve atrapado por una atracción intensa, casi mágica, hacia una mujer. Lo que diferencia a estas experiencias numinosas de un "flechazo" común es un patrón de características fenomenológicas específicas. Las proyecciones del ánima son especialmente frecuentes al final de la adolescencia y al principio de la edad adulta, cuando pueden causar una profunda sensación de desorientación. Existe poca educación para los hombres jóvenes sobre cómo tratar estas experiencias y dar lugar a la oportunidad de crecimiento y desarrollo que subyace a las mismas. En este artículo, planteo las proyecciones del ánima como un problema ético y esbozo un "mapa" psico­ético destinado a ser utilizado por jóvenes desorientados o por cualquier profesional que tenga la tarea de ayudarles a navegar este desafío en el camino de la individuación. El mapa considera cuatro soluciones al problema del amor: la "concreta­literal", la "temerosa­evitativa", la "racional­depresiva" y la "transicional­del desarrollo", e indica esta última como la que conduce a un desarrollo psíquico óptimo. Aunque se ha elaborado centrándose en los hombres jóvenes, el mapa puede aplicarse a otras relaciones basadas en la proyección, independientemente de la edad, el sexo, el género o la orientación sexual.

Diverse origins of near-identical antifreeze proteins in unrelated fish lineages provide insights into evolutionary mechanisms of new gene birth and protein sequence convergence.

Determining the origins of novel genes and the genetic mechanisms underlying the emergence of new functions is challenging yet crucial for understanding evolutionary innovations. The novel fish antifreeze proteins, exemplifying convergent evolution, represent excellent opportunities to investigate the evolutionary origins and pathways of new genes. Particularly notable is the near-identical type I antifreeze proteins (AFPI) in four phylogenetically divergent fish taxa. This study tested the hypothesis of protein sequence convergence beyond functional convergence in three unrelated AFPI-bearing fish lineages, revealing different paths by which a similar protein arose from diverse genomic resources. Comprehensive comparative analyses of de novo sequenced genome of the winter flounder and grubby sculpin, available high-quality genome of the cunner, and those of 14 other relevant species found that the near-identical AFPI originated from a distinct genetic precursor in each lineage, and independently evolved coding regions for the novel ice-binding protein while retaining sequence identity in the regulatory regions with their respective ancestor. The deduced evolutionary processes and molecular mechanisms is consistent with the Innovation-Amplification-Divergence (IAD) model applicable to AFPI formation in all three lineages, a new Duplication-Degeneration-Divergence (DDD) model we propose for the sculpin lineage, and a DDD model with gene fission for the cunner lineage. This investigation illustrates the multiple ways by which a novel functional gene with sequence convergence at the protein level could evolve across divergent species, advancing our understanding of the mechanistic intricacies in new gene formation.

Prescriptions of homeopathic remedies at the expense of the German statutory health insurance from 1985 to 2021: scientific, legal and pharmacoeconomic analysis.

The prescription of homeopathic remedies at the expense of the statutory health insurance (SHI) system in Germany has been criticized for years due to a lack of evidence. Now, on the planned abolition of the reimbursement of homeopathic medicines in Germany, the debate on this topic has been reignited. The aim of this paper is to show the costs and their development over time incurred by homeopathic remedies in the healthcare system from 1985 to 2021. For this purpose, 15 selected homeopathic medicines were chosen from the drug prescription report (Arzneiverordnungsreport) and analyzed with regard to their development of DDD (Defined Daily Dose) using data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Funds) and compared with their respective rational pharmacological alternatives. The price comparison was based on the DDD costs and the pharmacy retail price of the smallest packaging in each case. The clinical study situation for the preparations was also analyzed. For this purpose, the clinical studies provided by the manufacturer and those on PubMed were divided into evidence levels and analyzed. In addition, the presentation of homeopathic remedies on company websites, in online pharmacies, in specialist information and package leaflets was analyzed with regard to side effects, interactions, indication, and information on the alleged effect/proof of efficacy. In many media, information on homeopathic medicines remained incomplete, and non-compliance with the Therapeutic Product Advertising Act (Heilmittelwerbegesetz) was noted. Naming of the products if often very suggestive, too. Manufacturers' claims of efficacy go far beyond what can be considered proven in terms of evidence-based medicine and the quality of most clinical studies is poor. Homeopathic remedies are on average significantly more expensive than their rational pharmacological alternatives. Furthermore, DDD costs have continued to rise over the years analyzed. In aggregate, from a pharmacoeconomic, legal, and scientific perspective, abolition of reimbursement of homeopathic medicines in Germany at the expense of the SHI system is well justified.

On Theoretical Edges and Exclusionary Borders: Towards a Genealogy of "Analyzability" in Jungian Psychoanalysis1.

An oft-repeated and largely unexamined assumption in Jungian psychoanalysis is the notion of "analyzability", that is, of an individual's ability or present capacity to think symbolically. It is often taught that if someone is unable to think symbolically, a depth analysis is not possible. Such an individual may be more aptly suited for supportive psychotherapy, the argument goes, an experience that may very well lead to the development of the ego's capacity for symbolic thought but is not, in and of itself, a Jungian analysis. While this sort of categorical thinking has, at times, crossed over into ontological claims about individuals and groups, the notion of analyzability encountered in psychoanalytic theory and praxis is often cloaked in facially neutral language. The impact, however, has been anything but neutral in effect. In this paper, I propose a softening of our theoretical edges through a genealogy of the category of analyzability within the broader history of psychoanalysis. Through this excavation, I explore the contingent nature of the category of analyzability, how it has constricted knowledge, perpetuated inequality, and, more broadly, obscured ways of knowing. In so doing, I recover the radically democratic potential that lies at the heart of Jungian psychoanalysis.

Notre tente jungienne est peut­être grande et ses contours théoriques indispensables, mais que se passe­t­il lorsque nos contours théoriques se durcissent, devenant des frontières inhospitalières, des frontières servant à exclure et des zones d'occlusion? Une hypothèse souvent mise en avant et peu remise en question dans la psychanalyse jungienne est la notion d'« analysabilité ¼, c'est­à­dire de l'aptitude d'une personne, ou de sa capacité actuelle, à penser symboliquement. On enseigne souvent que si quelqu'un est incapable de penser symboliquement, une analyse en profondeur n'est pas possible. A une telle personne on proposerait plutôt une psychothérapie de soutien, une expérience qui peut très bien conduire au développement de la capacité de pensée symbolique de l'ego, mais qui n'est pas, en soi, une analyse jungienne. Alors que ce type de pensée catégorique a, en certaines occasions, rejoint des revendications ontologiques sur les individus et les groupes, la notion d'analysabilité rencontrée dans la théorie et la pratique psychanalytiques est souvent enveloppée dans un langage apparemment neutre. L'impact, cependant, a été tout sauf neutre dans ses effets. Dans cet article, je propose un assouplissement de nos frontières théoriques à travers une généalogie du concept d'analysabilité au sein de l'histoire plus large de la psychanalyse. À travers cette plongée, j'ai pour but d'explorer la nature contingente de la notion d'analysabilité, de voir comment elle a limité la connaissance, perpétué des inégalités et, plus largement, obscurci les modes de connaissance. Par cette démarche, je crois que nous pourrions nous rendre compte du potentiel radicalement démocratique qui se trouve au cœur de la psychanalyse jungienne.

Nuestra tienda junguiana puede ser amplia y sus bordes teóricos vitales, pero ¿qué ocurre cuando nuestros bordes teóricos se endurecen, agudizándose en fronteras inhóspitas, límites de exclusión y zonas de oclusión? Un supuesto a menudo repetido y en gran medida no examinado en el psicoanálisis Junguiano es la noción de "analizabilidad", es decir, de la habilidad o capacidad actual de un individuo para pensar simbólicamente. A menudo se enseña que si alguien es incapaz de pensar simbólicamente, no es posible un análisis en profundidad. Tal individuo, se argumenta, puede ser más adecuado para una psicoterapia de apoyo, una experiencia que puede muy bien conducir al desarrollo de la capacidad del ego para el pensamiento simbólico, pero no es, en sí misma, un análisis Junguiano. Aunque este tipo de pensamiento categórico se ha extendido, en ocasiones, a afirmaciones ontológicas sobre individuos y grupos, la noción de analizabilidad encontrada en la teoría y práctica psicoanalíticas suele estar envuelta en un lenguaje aparentemente neutro. Sin embargo, su impacto no ha sido neutro en absoluto. En este artículo, propongo suavizar nuestros bordes teóricos a través de una genealogía de la categoría de analizabilidad dentro de la historia más amplia del psicoanálisis. A través de esta excavación, propongo explorar la naturaleza contingente de la categoría de analizabilidad, cómo ha restringido el conocimiento, perpetuado la desigualdad y, más ampliamente, oscurecido las formas de conocer. Al hacerlo, creo que podríamos darnos cuenta del potencial radicalmente democrático que yace en el corazón del psicoanálisis Junguiano.

Complete genome sequence of Chlamydia psittaci АМК-16, isolated from a small ruminant in the Middle Volga Region, Russia.

We report the complete genome sequence of the Chlamydia psittaci АМК-16, recovered from the aborted caprine fetus during a case of chlamydia infection. This 1,152,497-bp genome with 7,552-bp cryptic plasmid provides novel insights into the genetic diversity of chlamydia agent strains particularly those causing the infection in small ruminants.

Unhinged: A Prospective Perspective on Being Unsafe1.

Given the unprecedented events unfolding around the globe over the past four years, psychoanalytic communities near and far have sought to ask and ventured to answer the question: What does psychoanalysis have to offer individuals, and the collective, as a way of seeing and being with the reality of what is? Taking up these questions in such a time as this, feels, perhaps inevitably, unsafe. Sometimes it can feel as if there is a silent and unspoken mandate to ensure safety at all costs when we seek to find a spirit of the depth's response to the spirit of the times. I propose that the work of psychoanalysis is grounded in nothing but the journey through that which is unsafe. This article will take up Ann Ulanov's notion that one's own evil is the hinge door into collective and archetypal evil. To become unhinged means to risk well-formulated understandings, theories, and modalities about being and becoming for the other and instead to allow the other to penetrate that which is unknown in ourselves, upending our well-formed theories and pressing us to take up our own lives in new and unpredictable ways.

Compte tenu des événements sans précédent qui se sont déroulés dans le monde entier au cours des quatre dernières années, les communautés psychanalytiques proches et lointaines ont cherché à poser la question suivante et à y proposer des réponses: qu'est­ce que la psychanalyse peut offrir aux individus, et au collectif, comme moyen de voir et d'être avec la réalité de ce qui est ? Aborder ces questions dans un moment comme celui­ci nous fait nous sentir en danger, et c'est peut­être inévitable. Parfois, on peut avoir le sentiment qu'il y a un décret silencieux et tacite d'assurer la sécurité à tout prix lorsque nous cherchons à trouver une réponse de l'esprit des profondeurs à l'esprit du temps. Je propose que le travail de la psychanalyse n'est fondé sur rien d'autre que le voyage à travers ce qui est dangereux, risqué. C'est, en effet, ce qu'implique la recherche d'une conversation active et vivante avec l'esprit des profondeurs et c'est ce qui distingue le travail de thérapie du travail de psychanalyse. Si nous nous enfermons dans des notions de sécurité, nous resterons liés à des notions similaires d'anonymat analytique et d'innocence, restant inconscients de notre propre implication dans les horreurs qui continuent d'aliéner, d'étouffer et d'isoler ceux qui sont en marge. Cette présentation reprendra la conception d'Ann Ulanov selon laquelle le mal d'une personne est la porte charnière du mal collectif et archétypal. Notre travail, individuellement et collectivement, est de descendre dans ce territoire dangereux à l'intérieur de nous­mêmes pour voir ce qui s'y est passé et ce qui reste à vivre dans les zones d'ombre. Devenir déséquilibré signifie mettre en doute des compréhensions, des théories et des modalités bien formulées sur l'être et le devenir pour l'autre et, à la place, permettre à l'autre de pénétrer ce qui est inconnu en nous­mêmes, bouleversant nos théories bien formées et nous poussant à prendre notre propre vie en main d'une manière nouvelle et imprévisible. En ce sens, la psychanalyse est intrinsèquement une forme d'activisme intérieur et extérieur. Ce qui est proposé ici est un regard sur la façon dont la psychanalyse, déséquilibrée, se déplace au­delà des murs sécurisants et au­delà des murs de la salle de consultation vers le monde au sens large.

Dados los acontecimientos sin precedentes que han tenido lugar en todo el mundo en los últimos cuatro años, las comunidades psicoanalíticas cercanas y lejanas han tratado de preguntarse y han intentado responder a la pregunta: ¿qué tiene el psicoanálisis que ofrecer a los individuos, y al colectivo, en términos de ver y estar con la realidad de lo que acontece? Abordar estas cuestiones en un momento como el actual puede resultar inevitablemente inseguro. A veces puede dar la sensación de que existe un mandato silencioso y tácito de garantizar la seguridad a toda costa cuando tratamos de encontrar una respuesta del espíritu de las profundidades al espíritu de los tiempos. Propongo que el trabajo del psicoanálisis no se basa en otra cosa que en el viaje a través de lo que es inseguro. Esto, de hecho, es lo que implica buscar una conversación activa y viva con el espíritu de las profundidades y es lo que distingue el trabajo de la terapia del trabajo del psicoanálisis. Si nos encerráramos en las nociones de seguridad, seguiríamos limitados por nociones similares de neutralidad analítica e inocencia, permaneciendo inconscientes de nuestra propia implicancia en los horrores que continúan ajenos, encerrando y aislando a aquellos que se encuentran en los márgenes. Esta presentación retomará la noción de Ann Ulanov de que el mal propio es la puerta de entrada al mal colectivo y arquetipal. Nuestro trabajo individual y colectivo es descender a este territorio inseguro dentro de nosotros mismos para ver lo que ocurrió allí y lo que permanece viviendo en las sombras. Perturbarse significa arriesgar comprensiones, teorías y modalidades bien formuladas sobre el ser y el devenir para el otro y, en su lugar, permitir que el otro penetre en lo que es desconocido en nosotros mismos, trastornando nuestras teorías bien formadas y presionándonos para que asumamos nuestras propias vidas de maneras nuevas e impredecibles. De este modo, el psicoanálisis es inherentemente una forma de activismo interior y exterior. Lo que se ofrece es una mirada sobre cómo el psicoanálisis, perturbado, traspasa los muros de la seguridad y va más allá de las paredes del consultorio analítico para adentrarse en el mundo en general.

War: Mentalization and Totalitarian State of Mind.

For most residents of Europe, war is a new experience in which they find themselves both as witnesses and participants. In this paper the war in Ukraine serves as an illustration and case example. Like any unfamiliar experience, war elicits profound emotional responses which can be so overwhelming that an individual may be unable to fully process them and to create mental representations of the reality of war. When the psyche becomes entrapped in an unprocessed state, without the capacity to derive meaning from it, this results in the "fossilization" of the psyche akin to what McGinley and Segal describes as a totalitarian state of mind. Subjectivity and individual differences come under collective or personal attack, or both. This state of being prioritizes the needs of the collective psyche over the individual psyche. The image of Gorgon Medusa, who transformed living people into "fossilized" ones, is presented as a metaphor of total identification with the collective dimension. In contrast, the psyche can reveal a creative approach to resolving war-induced trauma. This is depicted in the concept of the Alchemical Stone and its creation, which symbolizes a harmonious connection between the external and internal realms, the subjective and objective experiences, and the real and the imaginal dimension.

Pour la plupart des habitants de l'Europe, la guerre est une nouvelle expérience dans laquelle ils se retrouvent à la fois témoins et participants. Dans cet article, la guerre en Ukraine sert d'illustration et de cas exemplaire. Comme toute expérience qui sort de l'ordinaire, la guerre suscite des réactions émotionnelles profondes qui peuvent être si accablantes qu'un individu peut se trouver incapable de les traiter pleinement et de créer des représentations mentales de la réalité de la guerre. Lorsque la psyché se retrouve piégée dans un état qu'elle ne peut pas traiter, sans la capacité d'en tirer un sens, il en résulte une « fossilisation ¼ de la psyché, semblable à ce que McGinley et Segal a décrit comme un état d'esprit totalitaire. La subjectivité et les différences individuelles font l'objet d'attaques collectives ou personnelles, ou des deux. Cet état d'être donne la priorité aux besoins de la psyché collective plutôt qu'à la psyché individuelle. L'image de la Gorgone Méduse, qui a transformé des êtres vivants en êtres «fossilisés¼, est présentée comme une métaphore de l'identification totale à la dimension collective. En revanche, la psyché peut révéler une approche créative pour résoudre les traumatismes induits par la guerre. Ceci est représenté par le concept de la Pierre Alchimique et de sa création, qui symbolise un lien harmonieux entre les royaumes extérieur et intérieur, les expériences subjectives et objectives, et les dimensions réelles et imaginales.

Para la mayoría de los habitantes de Europa, la guerra es una experiencia nueva en la que se encuentran tanto como testigos y como participantes. En este artículo, la guerra en Ucrania sirve como ilustración y ejemplo de caso. Como cualquier experiencia desconocida, la guerra provoca profundas respuestas emocionales que pueden ser tan abrumadoras que un individuo puede ser incapaz de procesarlas completamente y de crear representaciones mentales de la realidad de la guerra. Cuando la psique queda atrapada en un estado, sin posibilidad de elaborar y sin la capacidad para hallarle un sentido, se produce una "fosilización" de la psique similar a lo que McGinley Segal describe como un estado mental Totalitario. La subjetividad y las diferencias individuales son objeto de ataques colectivos o personales, o ambos. Este estado de ánimo prioriza las necesidades de la psique colectiva sobre la individual. La imagen de la Gorgona Medusa, que transformó a las personas vivas en "fosilizadas", se presenta como una metáfora de la identificación total con la dimensión colectiva. Por el contrario, la psique puede revelar un enfoque creativo para resolver el trauma inducido por la guerra. Esto se representa en el concepto de la Piedra Alquímica y su creación, que simboliza una conexión armoniosa entre los reinos externo e interno, las experiencias subjetivas y objetivas, y las dimensiones real e imaginal.

Treatment Cost Along With Pattern of Disease and Therapy in the Intensive Care Unit of a Tertiary Care Teaching Hospital in India.

Background The intensive care unit (ICU) represents an important platform for conducting drug utilization analysis using defined daily dose (DDD)/100 bed-days and the financial burden of treatment as patients are seriously ill and are often suffering from chronic critical illnesses. Therefore, in this study, we evaluated the drug utilization patterns and cost of treatment in the ICU. Methods A retrospective observational analysis of the medical records obtained for the medical ICU of an apex tertiary care teaching hospital in central India was conducted for a period of three years from 2017 to 2019. All the patients admitted to the medical ICU during the study tenure were included in the study. Patients hospitalized in neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), and surgical ICU were excluded from the study. The socio-demographic and clinical data, utilization of different classes of drugs, WHO-Anatomic Therapeutic Chemical (WHO-ATC) classification, DDD/100 bed days, hospital stay, etc. were analyzed. A partial pharmaco-economic analysis of the average cost of admission to patients was done. Results Data from 280 patients was assessed. The mean age was 47 ± 19.18 years and 58% were males. Antibiotics and injections were prescribed to 96% and 97.5% of the patients, respectively, during their ICU stay (median: seven days). Antimicrobial drugs were most frequently prescribed (n=1096, 68%); the most common were beta-lactams and carbapenems, followed by drugs acting on the central nervous system (5%) and cardiovascular system (4.3%). Cefoperazone/sulbactum, ceftriaxone, and piperacillin/tazobactam were the most utilized antibiotics with 8, 16, and 6 DDD/100 bed-days, respectively, while proton pump inhibitors, analgesics, and anti-epileptics were the most frequently prescribed non-antimicrobial drug class. The median cost of treatment per ICU admission was Indian Rupees (INR) 23,347 (IQR 12,552- 65,524). Conclusion Drug utilization assessment provides crucial information for understanding the usage of drugs in the settings of the ICU, and should be conducted regularly to help in the proper planning and implementation of rational drug use. Treatment costs reflect the high economic burden seen in ICU admissions.

In Memory of Anthony Stevens: A Career Retrospective with Emphasis on His Formative Role in the Archetype Debate.

This paper celebrates the life and legacy of psychiatrist and Jungian author Anthony Stevens, who passed away at age 90 on July 13, 2023. It outlines Stevens's origins as a research fellow in Greece, where his work on infant attachment led to a lifelong dedication to establishing the biological and evolutionary foundation of psychiatry. It details his instrumental role in the debate about the theory of archetypes and describes the current state of the literature including the responses and reactions to Stevens's biological innatist position. The paper concludes with a career retrospective in which Stevens's major works are introduced and briefly described.

Cet article célèbre la vie et l'héritage du psychiatre et auteur jungien Anthony Stevens, décédé à l'âge de 90 ans le 13 juillet 2023. L'article décrit les origines de Stevens en tant que chercheur en Grèce, où ses travaux sur l'attachement du nourrisson l'ont conduit à se consacrer toute sa vie à établir le fondement biologique de la psychiatrie, dans une perspective évolutionniste. L'article détaille son rôle important dans le débat sur la théorie des archétypes et décrit l'état actuel de la littérature, y compris les réponses et réactions à la position biologique innéiste de Stevens. L'article se termine par une rétrospective de sa carrière, dans laquelle les œuvres majeures de Stevens sont présentées et brièvement décrites.

Este artículo celebra la vida y el legado del psiquiatra y autor Junguiano Anthony Stevens, quien falleció a los 90 años el 13 de julio de 2023. Describe los orígenes de Stevens como investigador en Grecia, donde su trabajo sobre el apego infantil lo llevó a una dedicación de por vida para establecer los fundamentos biológicos y evolutivos de la psiquiatría. Detalla su papel instrumental en el debate sobre la teoría de los arquetipos y describe el estado actual del arte, incluyendo las respuestas y reacciones a la posición biológica innatista de Stevens. El artículo concluye con una retrospectiva de su carrera en la que se presentan y describen brevemente las principales obras de Stevens.

Research on the volatility, phase transitions and thermodynamic stability of five organochlorine compounds.

The present investigation describes the experimental evaluation of relevant physicochemical properties of five organochlorine compounds (OCs), including some that are related to their environmental mobility. The vapor pressures of (2,4'-Dichlorodiphenyl)dichloroethane (2,4'-DDD, CASN:53-19-0), 1,1-Dichloro-2,2-bis(4-chlorophenyl)ethane (4,4'-DDD, CASN:72-54-8) and 2,2-Bis(4-chlorophenyl)acetic acid (4,4'-DDA, CASN:83-05-6), as well as of the bactericide Nitrapyrin (CASN:1929-82-4) and of the rodenticide Crimidine (CASN:535-89-7) were determined at different temperatures. The Knudsen mass-loss effusion technique was employed to determine the sublimation vapor pressures of the referred compounds, apart from Crimidine. For the latter compound, a static method using a capacitance diaphragm manometer enabled the measurement of vapor pressures of both condensed (crystalline and liquid) phases. This technique was also used to measure the vapor pressures of the crystalline phase of Nitrapyrin over a larger temperature range, as well as its vaporization vapor pressures. The results of the standard molar enthalpies, entropies, and Gibbs energies of sublimation for all five compounds and of vaporization for Crimidine and Nitrapyrin, at reference temperatures, were derived. For these two compounds the phase diagram representations of the (p,T) results, in the vicinity of the triple point, were obtained. DSC analysis enabled the determination of the crystalline heat capacities of the five OCs studied and also of their temperatures and enthalpies of fusion. Gas-phase thermodynamic properties were estimated using quantum chemical calculations. The thermodynamic stability of the compounds studied was evaluated and compared in the crystalline and gaseous phases, at 298.15 K, in consideration with estimated results of the standard Gibbs energies of formation. Combined with other physical and chemical properties, the results derived from this study can be used to predict the mobility, and environmental fate of these pollutants.

Pacing mode survival in patients with single chamber atrial pacemaker for sinus node dysfunction.

BACKGROUND: Single chamber atrial pacemaker should be sufficient for patients with sinus node dysfunction (SND) with normal atrioventricular (AV) conduction. However, most patients undergo dual chamber pacemaker implantation because of concern of new onset AV block. The annual incidence of new AV block has been reported from 0.6 to 4.4 % in various studies. OBJECTIVES: Our aim is to assess mode survival in sinus node dysfunction with normal AV conduction patients implanted with AAIR. METHODS: Patients who underwent single chamber atrial pacemaker implantation for SND with normal AV conduction between January 2014 and December 2021 were followed up for pacemaker device change, new onset AV block, bundle branch block, atrial fibrillation (AF), lead complications, reoperation and mortality rate. RESULTS: A total of 113 patients underwent single chamber atrial pacemaker implantation for SND during the study period. Mean age was 55.6 ± 12.7 years. During a mean follow up of 48.7 ± 24.9 months, none of the patients required pacemaker device change to VVIR/DDDR. Nine patients underwent reoperation, 5 for lead dislodgment, 1 for high threshold, 1 for pocket site erosion and 3 for pulse generator change. None developed AV block or AF with slow ventricular rate. Only 4 patients developed AF (3 paroxysmal,1 permanent). There were 3 deaths during follow up and none were sudden deaths. CONCLUSION: Single chamber atrial pacing is an acceptable mode of pacing in patients with SND in developing countries. Development of AV conduction abnormalities is rare in this relatively younger population.