Skills Training in Affective and Interpersonal Regulation for Refugees Integrated With Narrative Exposure Therapy: A Case Study on the Treatment of PTSD and Emotion Dysregulation for Refugees and Asylum-Seekers

The prevalence of post-traumatic stress disorder (PTSD) in individuals affected by war and conflict is high, with approximately 1 in 3 refugees and asylum-seekers meeting diagnostic criteria for PTSD. PTSD in refugees and asylum-seekers is associated with significant emotion dysregulation which may arise from chronic trauma exposure and post-migration stressors and lead to impaired day-to-day functioning. There is evidence that treatments that target emotion regulation skills prior to implementing exposure-based therapies lead to improved treatment response and reduced attrition in survivors of interpersonal traumas such as sexual abuse. The current case study details the use of a novel adaptation of one such treatment – Skills Training in Affective and Interpersonal Regulation for refugees and asylum-seekers (STAIR-R). In this case study, we report on the implementation of STAIR-R in combination with Narrative Exposure Therapy (NET) with Sara, a 60-year-old Iraqi woman who presented with high levels of nightmares, avoidance and emotion dysregulation following exposure to war- and conflict-related trauma and post-migration stressors. In this case study, we explore the intersection of emotion regulation skills training (in STAIR-R) and exposure therapy (in NET), and the potential for this combined intervention to improve emotion regulation skills, enhance coping with post-migration stressors and facilitate engagement with exposure-based treatment for PTSD.

Out-of-hospital cardiac arrest due to refractory pulseless ventricular tachycardia and/or ventricular fibrillation

Background

Survival rates for out-of-hospital cardiac arrest (OOHCA) are extremely low and neurologic recovery is poor. Extracorporeal cardiopulmonary resuscitation (ECPR), which combines extracorporeal membrane oxygenation (ECMO) with cardiopulmonary resuscitation (CPR), has emerged as a viable strategy to improve outcomes in OOHCA. A collaborative ECPR program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire Emergency Medical Services (EMS).

Purpose

Outcomes for patients who present as an ECPR alert from the field, but did not meet predefined criteria for placement of extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL) is described.

Methods

Between September 15, 2017 and October 12, 2019, 50 subjects presented as an ECPR alert for OOHCA secondary to pulseless VT/VF refractory to defibrillation. All subjects were placed on an automated CPR device prior to transfer to the CCL. From these 50 individuals, 28 (56%) did not meet prespecified laboratory criteria (lactate ≤15 mg/dL, partial pressure of oxygen (PaO2) ≥50 mm Hg, end-tidal carbon dioxide (ETCO2) of ≥10) and did not have a shockable rhythm in the CCL, thus ECMO was not placed and usual care for cardiac arrest was administered.

Results

Nine (32%) of the 28 patients achieved return of spontaneous circulation (ROSC), while the remaining 19 (68%) where pronounced deceased in the CCL. All 9 patients who achieved ROSC underwent a coronary angiography with 4 (44%) requiring percutaneous coronary intervention and 4 (44%) requiring an acute mechanical circulatory support device (Impella with 1 change out to ECMO). Of the patients that achieved ROSC, 4 (44%) were discharged from the hospital with good neurologic recovery; the remaining 5 (56%) ultimately expired during the hospitalization. From the initial 28 patient cohort, there were 4 (14%) patients discharged alive. Patients who achieved ROSC as compared to no ROSC were found on presentation in the CCL to have a significantly lower lactate (12.3±4.3 vs 16.2±3.6, respectively; p=0.03) and greater PaO2 (145±125 vs 47±9, respectively; p=0.01); there was no significant differences between groups in ETCO2, age or emergency services dispatch to CCL arrival time.

Conclusion

This study demonstrates that an ECPR program for OOHCA due to refractory VT/VF may provide benefit to patients that do not meet the predefined criteria for ECMO. This may be due to minimizing no flow/low flow time by early recognition and ongoing CPR en route to the CCL by a skilled EMS team, high efficiency citywide expedited transport/triage, the provision of high quality uninterrupted chest compressions using the mechanical CPR device during transport, and the care provided by highly trained multidisciplinary team members in the CCL.

Funding Acknowledgement

Type of funding sources: None.

Coronavirus disease 2019: scientific overview of the global pandemic

Coronavirus disease 2019 (COVID-19) is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Genome sequencing of the virus revealed that it is a new zoonotic virus that might have evolved by jumping from bats to humans with one or more intermediate hosts. The immediate availability of the sequence information in the public domain has accelerated the development of quantitative RT-PCR-based diagnostics. Numerous clinical trials have been prioritized globally for testing new vaccines and treatments against this disease. This review provides a broad insight into different aspects of COVID-19, an introduction to SARS-CoV-2 mitigation strategies and the present status of diagnostics and therapeutics.

Preparation and Characterization of Celecoxib Entrapped Guar Gum Nanoparticles Targeted for Oral Drug Delivery against Colon Cancer: An In-Vitro Study

The present study is an attempt to synthesize nanosized guar gum carriers encapsulating celecoxib as the chemopreventive agent for experimental colorectal cancer (CRC).  Guar gum nanoparticles without celecoxib (eGGNPs) and celecoxib loaded guar gum nanoparticles (cGGNPs) were prepared by oil-in-water emulsification and in situ polymer crosslinking method. Electron microscopy, zeta potential and fourier transform infrared spectra analysis was used to affirm the size, stability and morphology of the nanoparticles. In-vitro drug release was investigated using dialysis method. Further, the effect of nanoparticles (eGGNPs & cGGNPs) was evaluated on Caco 2 colon cancer cell lines. Spherical guar gum nanoparticles were obtained in the size range of 200±6nm with zeta potential of -32.1mV indicating good stability of the GGNPs with drug loading of 30±3.2%, and drug release following zero order kinetics. The eGGNPs had no effect on Caco2 cell viability whereas the cGGNPs showed time and concentration dependent growth inhibition of Caco 2 cells. These findings suggest the successful preparation of chemopreventive nanoparticles that can be targeted as the prophylactic agent for experimental colorectal cancer. Keywords: nanoparticles, guar gum, celecoxib, colorectal cancer, release kinetics, cytotoxicity

Magnetically retrievable Ce-doped Fe3O4 nanoparticles as scaffolds for the removal of azo dyes

Considering the significant impact of magnetically retrievable nanostructures, herein, Fe₃O₄ and Ce-doped Fe₃O₄ nanoparticles were employed as scaffolds for the removal of the Reactive Black 5 (RB5) azo dye. We synthesized the Ce-doped Fe₃O₄ nanoparticles via hydrothermal treatment at 120 °C for 10 h with varying cerium concentrations (1.5–3.5%) and characterized them using basic techniques such as FTIR and UV-visible spectroscopy, and XRD analysis. The retention of their magnetic behaviors even after cerium amalgamation was demonstrated and confirmed by the VSM results. FESEM and EDX were used for the morphological and purity analysis of the synthesized nanoabsorbents. XPS was carried out to determine the electronic configuration of the synthesized samples. The porosity of the magnetic nanoparticles was investigated by BET analysis, and subsequently, the most porous sample was further used in the adsorption studies for the cleanup of RB5 from wastewater. The dye adsorption studies were probed via UV-visible spectroscopy, which indicated the removal efficiency of 87%. The prepared Ce-doped Fe₃O₄ nanoabsorbent showed the high adsorption capacity of 84.58 mg g⁻¹ towards RB5 in 40 min. This is attributed to the electrostatic interactions between the nanoabsorbent and the dye molecules and high porosity of the prepared sample. The adsorption mechanism was also analyzed. The kinetic data well-fitted the pseudo-first-order model, and the adsorption capability at different equilibrium concentrations of the dye solution indicated monolayer formation and chemisorption phenomena. Furthermore, the magnetic absorbent could be rapidly separated from the wastewater using an external magnetic field after adsorption.

Considering the significant impact of magnetically retrievable nanostructures, herein, Ce-doped Fe₃O₄ nanoparticles were employed as scaffolds for the removal of the Reactive Black 5 (RB5), an azo dye.

Internet-based cognitive behavioral therapy versus psychoeducation control for illness anxiety disorder and somatic symptom disorder: A randomized controlled trial

OBJECTIVE

To examine the efficacy of an Internet-delivered cognitive-behavioral therapy (iCBT) program for health anxiety compared to an active psychoeducation control group.

METHOD

Individuals (N = 86, mean age: 30 years, 87% female) with a Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnosis of illness anxiety disorder or somatic symptom disorder with health anxiety were randomized to either a 6-lesson clinician-guided iCBT program for health anxiety (n = 45) or an active control group who received anxiety psychoeducation, clinical support, and monitoring (control, n = 41) over a 12-week period.

RESULTS

Both groups experienced significant improvements between baseline and posttreatment on self-report measures of health anxiety, depression, general anxiety, and functional impairment. Intention-to-treat analyses indicated that the iCBT group experienced greater improvements in health anxiety on the Short Health Anxiety Inventory (SHAI) compared to controls (between-groups effect size = 1.39, 95% confidence interval [0.87, 1.93]), and a greater proportion of the iCBT group showed clinically reliable change on the SHAI (84% vs. 34% in the control group). Similarly, the iCBT group outperformed the control group on secondary measures of depression, generalized anxiety, functional impairment, maladaptive cognitions, body hypervigilance, safety behaviors and avoidance, and intolerance of uncertainty. Gains were maintained at 3-month follow-up in the iCBT group.

CONCLUSION

iCBT for health anxiety is more effective than psychoeducation, clinical support, and monitoring, and presents an efficacious and accessible treatment option for people with health anxiety. (PsycINFO Database Record

Encompassment of Benzyl Isothiocyanate in cyclodextrin using ultrasonication methodology to enhance its stability for biological applications

The use of methodical and innovative sonication method has been explored for the fabrication of inclusion complex of Benzyl Isothiocyanate, a potential anticancer and -antimicrobial agent. The advancement involved investigation of inclusion behaviour, characterisation and an in-depth study of thermal and UV stability of Benzyl Isothiocyanate with cyclodextrins; β-CD and hp-β-CD. The sonication driven encompassment in cyclodextrins helped to overcome the hindrance of low solubility and high volatility. Investigations of physical and thermodynamic parameters using UV-visible spectroscopy, FTIR, XRD, TGA etc confirmed stability of inclusion complexes. Both β-CD and hp-β-CD based inclusion complexes retained the antimicrobial property of the free Benzyl Isothiocyanate, indicating their potential utility as antimicrobial agents. Haematological safety and cellular uptake data gives direction to in-depth analysis for its exploitation of anti-tumour activity.

Ultrasound processed nanoemulsion: A comparative approach between resveratrol and resveratrol cyclodextrin inclusion complex to study its binding interactions, antioxidant activity and UV light stability

Resveratrol is a naturally occurring therapeutic molecule used for treatment of diseases caused by oxidative stress. This investigation elucidates the advantages of fabrication of size controlled resveratrol inclusion complex. This has been done by encapsulating resveratrol-cyclodextrin inclusion complex in a phospholipid stabilized nanoemulsion formulated by ultrasonication emulsification method. The prepared nanoemulsion has been compared with resveratrol encapsulated nanoemulsion system. The morphology of the resveratrol nanoemulsion and inclusion complex nanoemulsion have been observed using transmission electron microscopy with average size 20.41±3.41 and 24.48±5.70nm respectively. The nanoemulsion showed good loading and release efficiency. The radical diminishing potential of resveratrol and its inclusion complex has been compared in nanoemulsion. The effect of UV irradiation (365nm) on resveratrol in different solvent systems (ethanol, water and nanoemulsion) indicated that nanoemulsion prevents degradation of resveratrol. Efforts have also been made to explore the interactions between bovine serum albumin and resveratrol in nanoemulsion.

Physiochemical and cytotoxicity study of TPGS stabilized nanoemulsion designed by ultrasonication method

The main aim of the present work was to prepare TPGS stabilized D-α-Tocopherol, lemon oil, tween-80, and water nanoemulsion by low cost and highly effective sonication method. The prepared nanoemulsion showed good stability for 60days at variable temperature conditions i.e. 4, 25 and 37°C. The tolerance of the prepared nanoemulsion to salt (50mM-500mM) and pH (pH 2-pH 7.4) was also studied. The morphology and droplet size of pure and quinine loaded nanoemulsion was characterized with transmission electron microscopy. The prepared formulation was transparent and the obtained average particle size ranged between 25nm and 35nm. The nanoemulsion was found to be non toxic. The cell viability study of pure nanoemulsion carried out on Hep G2 cells revealed that the cell viability was 100%. The formulation further exhibited high quinine loading and release capacity with cumulative release up to 76±2% and 65±2% at pH 7.4 and pH 5.5 respectively. The interaction between quinine and vitamins (riboflavin, thiamine and biotin) was also carried out (aqueous medium). The study revealed that riboflavin had strong interaction with quinine and vitamins vis-à-vis thiamine and biotin.

Pilot trial of a therapist-supported internet-delivered cognitive behavioural therapy program for health anxiety

Cognitive behavioural therapy (CBT) is an effective treatment for health anxiety, but more research is needed to evaluate accessible, low cost ways of delivering CBT. Internet CBT may be effective, but there are no iCBT programs available outside of Sweden. We developed the first English-language clinician-guided iCBT program for health anxiety and conducted an open pilot trial (n = 16) to examine its acceptability, and impact on health anxiety and comorbidity, disability, and the cognitive and behavioural factors thought to maintain the disorder (e.g., catastrophising, hypervigilance). 13/16 participants completed the program (81% adherence). We found large and significant reductions in health anxiety, depression, distress, anxiety and disability (g's > 1.0), dysfunctional cognitions, behaviours and body vigilance between pre- and post-treatment, which were maintained at 3-month follow-up. The results provide preliminary support for the use of iCBT for health anxiety. Randomised controlled efficacy trials are now needed to evaluate this program.

Energy efficient, facile and cost effective methodology for formation of an inclusion complex of resveratrol with hp-β-CD

A stable inclusion complex was obtained by using a greener, energy proficient approach via an ultrasonic method.

Ocular manifestations of cavernous sinus thrombosis

A 17-year-old male presented with a 10-day history of symptoms of upper respiratory tract infection, headaches, photophobia and progressive swelling around both eyes. Clinical examination revealed a temperature of 39 °C and bilateral periorbital swelling which was worse on the left side. Initial ophthalmological examination revealed a dilated non-reactive pupil on the left side and a sluggish pupillary reflex on the right side. The patient also had a lateral rectus palsy of the left eye. Fundoscopy showed bilateral papilloedema, and visual acuity on admission was 6/12 in the right and 6/18 in the left eye. Ear, nose and throat examination revealed a rhinitic nasal mucosa with thick mucopus in the left middle meatus. The patient required surgical intervention to drain his sinuses followed by long-term intravenous antibiotic therapy and anticoagulation. After 6 weeks of therapy and close observation, he recovered with minimal sequelae.