Visual and auditory hallucinations revealing cerebellar extraventricular neurocytoma: uncommon presentation for uncommon tumor in uncommon location

Objective

Visual and auditory hallucinations in relation to a cerebellar tumor are rarely reported in children. Primary origin of extraventricular neurocytoma (EVN) in the cerebellum is very rare.

Clinical Presentation

We report on a case of a cerebellar EVN in a 13-year-old girl with the initial symptoms of psychiatric manifestations for more than 2 months. Magnetic resonance imaging of the brain revealed a patchy enhanced tumor in the paramedian left cerebellar region. No obstructive hydrocephalus was noted.

Intervention

Total surgical removal of the tumor was performed. The tumor was initially diagnosed as an oligodendroglioma. After special immunohistochemical studies, the final definitive diagnosis was an EVN without isocitrate dehydrogenase mutation.

Conclusion

EVNs located in the cerebellum are extremely rare. We discuss the clinical symptoms and histological–immunohistochemical features of this rare tumor in that rare location.     

Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: A randomized clinical trial

Mental health is an important medical issue in perinatal care, and there is increasing evidence that insomnia during pregnancy is associated with postpartum depression (PPD). Therefore, the present study evaluated the effect of insomnia treatment during the third trimester of pregnancy on PPD symptoms. Fifty-four pregnant women with insomnia were randomly assigned to trazodone, diphenhydramine, or placebo treatment. Sleep quality was measured by actigraphy at baseline, and after 2 and 6 weeks of treatment. In addition, depression was assessed 2 and 6 weeks after delivery. Trazodone and diphenhydramine improved sleep profile compared to placebo after 6 weeks of treatment. Further, depressive symptoms were reduced 2 and 6 weeks after delivery in trazodone and diphenhydramine groups compared to placebo. No differences in depressive symptoms were observed between the trazodone and diphenhydramine groups. These findings indicate that insomnia treatment with trazodone or diphenhydramine during the third trimester of pregnancy may prevent PPD.     

急性应激干预的原则和方法

应激干预对维护和促进人类身心健康的有重要意义,重大事件和战争等应激干预研究已成为国家和军队重要课题。急性应激干预根据措施性质和干预对象的差异性分为一般干预方法和特殊干预模式,一般干预方法包括认知干预、社会支持和药物干预,特殊干预模式包括关键事件应激报告(criticalincidentstressdebriefing,CISD)模式、消融干预(defusingintervention)模式和灾难后心理卫生工作策略(disastermentalhealthworkstrategies)模式,其中灾难后心理卫生工作策略是由美国国立创伤后应激障碍(posttraumaticstressdisorder,PTSD)研究中心提出的,在9.11事件发生后具有较高的参考和借鉴价值。     

医学评估对孤独症谱系障碍儿童训练效果影响的研究

目的 探索医学评估对孤独症谱系障碍(ASD)儿童康复训练的影响。方法 采用Gesell发育量表、社会生活能力量表(SM)、社会沟通能力问卷(SCQ)分别对特教学校67名ASD儿童的发育水平、社会生活能力,社会交流能力进行评估。然后对其中48名干预组儿童,根据其发育年龄、实际生活能力制定干预目标,由特教老师根据目标,制定符合其发育水平的个体化训练方案实施训练。对19名对照组儿童按特教学校原有日常康复训练课程进行训练。训练1年后,采用同样方法再次进行评估。结果 干预组儿童训练后,在适应性、语言、沟通能力方面的进步情况好于对照组,差异有统计学意义。结论 在医学评估的基础上对ASD儿童制定康复训练方案,有利于促进ASD儿童发育水平、社会生活能力,沟通能力的提高。     

重性精神障碍患者社区管理存在问题的调查与分析

目的了解重性精神疾病患者社区管理开展的项目、管理对象及存在问题,为社区重性精神病患者管理提供信息和依据。方法采用问卷调查法,对54名社区卫生服务中心及站的医护人员的一般情况、在社区重性精神障碍患者管理工作中发现的问题及在工作中存在的不安全因素进行调查分析。结果存在的主要问题有:精神卫生体系不健全,实施社区管理的法律法规以及风险防范对策不完善,家属及社会对重性精神障碍患者社区管理的认知不足。结论为确保社区管理安全和减轻医务工作者的风险,满足重性精神障碍患者社区管理的需求,促进患者社会功能的改善,应建立完整的社区管理制度。     

Assessment of family physicians' knowledge about fibromyalgia in Egypt

Aim of the workTo assess knowledge of Egyptian family physicians about the diagnostic criteria and treatment modalities of fibromyalgia.Subjects and methodsA questionnaire and an informed consent were sent by email to family physicians working in primary health care centers in Egypt. The questionnaire assessed 3 areas: sociodemographic and professional data; knowledge about diagnosis; and knowledge about treatment modalities. Scoring system was used to categorize levels of knowledge into very low, low, moderate, high and very high.ResultsA total of 108 family physicians responded, with a response rate of 60%.The respondents were 27 consultants, 54 specialists and 27 residents, with a median age of 33 years and a median experience of 12 years. Very low, low and moderate levels of familiarity with fibromyalgia were perceived by 28.7%, 30.6% and 28% respectively. Close to half of participants (46.2%) gained their knowledge about fibromyalgia through self-study. According to the scoring system, 39.8% had low level of knowledge about clinical presentation and 37% had the same level of knowledge about treatment modalities. About three quarters (76%) of participants agreed that patients with fibromyalgia should be referred to rheumatologists. The most common selected clinical presentations were widespread pain (94.4%) and excessive fatigue (91.7%), while the most selected treatment modalities were non-steroidal anti-inflammatory drugs (89.8%) and selective serotonin reuptake inhibitors (47.2%).ConclusionKnowledge about clinical presentation and treatment modalities of fibromyalgia among Egyptian family physicians is low. Continuing medical education about fibromyalgia is needed to improve quality of health care.     

行为障碍儿童的母亲心理健康调查与分析

目的调查行为障碍儿童的母亲心理健康状况,并采取有效干预措施。方法采用Zung焦虑自评量表（SAS）对心理门诊儿童的母亲进行测量。结果78名母亲SAS得分为44．08±11．17分,高于我国常模29.78±0．46分,具有显著性差异（P〈0．01）。分组比较,离异母亲焦虑水平高于其他组（P〈0．01）,年龄分组41-45岁组焦虑水平显著高于其他年龄组,有显著性差异（P〈0．01）。结论行为障碍儿童的母亲焦虑水平偏高者较多,在治疗行为障碍儿童的同时,应注重对其母亲进行心理干预,改善母亲心理健康状态。     

颞下颌关节紊乱病患者疼痛的临床描述分析

目的通过研究颞下颌关节紊乱病（TMD）患者对疼痛的主观描述情况,分析TMD患者疼痛的特点。方法选择以口颌面部疼痛为主诉的TMD患者90例为研究对象,检测患者疼痛的强度和相关功能丧失的程度,记录患者自述的疼痛规律和描述疼痛的词汇。结果90例患者主要为轻到中等强度的疼痛,男女之间以及急、慢性期之间疼痛强度的差异无统计学意义（P>0.05）。TMD疼痛对咀嚼功能的影响最大,其次是对心情状况有比较大的影响。急、慢性期患者下颌静止时疼痛出现率无统计学差异（P>0.05）。急性期患者常用酸痛、隐痛、刺痛和抽着痛来描述疼痛,慢性期患者常用的词汇是钝痛、木痛和胀痛。结论急、慢性期TMD导致的疼痛强度均较低,主要影响患者的咀嚼功能和心理状态。急、慢性TMD疼痛的描述词汇有所不同。     

遗传病患者诊治经济学分析

目的对罕见遗传病患者的诊疗状况进行初步调查,就患者的疾病负担及成本构成进行分析。方法对北京大学第一医院儿科2019年4～12月门诊就诊的372例罕见遗传病患儿及其家庭进行调查,统计资料并分析。结果 372例中包括93种罕见遗传病,其中遗传代谢病226例,来自32个省市自治区,发病年龄从日龄2d到27岁,调查时年龄1月龄至30岁。确诊前,61.0%的患者辗转就医1～26年,经历3～6家医院。患者发病形式多样,58%的患者为急性发病,多以惊厥为首发症状。一些患者为慢性起病,如智力运动落后或倒退。57%的患者发病后及时就医。仅4.3%的患者在初诊时得到正确诊断,从发病到确诊花费<1万元。患者在确诊前因盲目诊治花费了不同的费用,其中花费医疗费用<1万元的占4.3%,40.9%的患者花费的医疗费用为1～9万,23.9%的患者花费的医疗费用为10～19万,22.0%的患者花费的医疗费用为20～49万,8.9%的患者确诊前花费的医疗费用在50万元以上。70.0%的患者在得到确诊前被诊断为脑瘫、智力运动落后、癫痫、肾功能衰竭、新生儿溶血、缺血缺氧性脑病、贫血、孤独症、精神病等多种疾病,并接...