Stigma towards mental illness and substance use issues in primary health care: Challenges and opportunities for Latin America

Stigma towards mental illness and addictive disorders is a global problem and one of the main obstacles in tackling this issue remains the effective integration of mental health services into primary health care (PHC). In Latin America, information has significantly increased on the existence of stigma; however, little is known about effective interventions to prevent stigma and promote recovery-oriented practices in PHC. The aim of this study is to understand the existing evidence regarding mental health stigma in PHC with a special focus on the Latin American region. A scoping review of the literature related to mental health stigma in PHC was conducted. Two hundred and seventeen articles were evaluated; 74 met inclusion criteria and 14 additional articles were selected from references of search results. Results were subdivided into five different perspectives: users, family members and significant others, health professionals, contextual factors, and potential effective interventions. Only nine studies were based in Latin America, and only one described an intervention to reduce stigma in mental health services, not specifically in PHC. We found an urgent need to develop interventions to understand and reduce stigma in PHC settings, especially in Latin America.     

Imaging of pediatric adrenal tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

Adrenal tumors other than neuroblastoma are uncommon in children. The most frequently encountered are adrenocortical carcinoma and pheochromocytoma. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary adrenal malignancy other than neuroblastoma at diagnosis and during follow-up.     

Radiofrequency Neurolysis for Facet Arthropathy: A Retrospective Case Series and Review of the Literature

Abstract Context: Facet arthropathy is a common cause of spine‐related pain. Typically resulting from spondylosis, trauma, including surgical trauma or post surgical stress is also a significant cause. Radiofrequency thermocoagulation or neurolysis may be an effective modality providing long‐term improvement. Objectives: To evaluate the success rates for radiofrequency neurolysis for facet arthropathy in a large retrospective case series in a single pain practice setting. Design: A retrospective case series involving chart reviews and patient follow‐up visits or telephone contacts of radiofrequency neurolytic procedures performed for facet arthropathy over a 4‐year period. Setting: Private practice pain clinic with academic affiliation in Tulsa, OK. Participants: One hundred forty eight patients with confirmed facet arthropathy refractory to conservative measures underwent 230 radiofrequency neurolysis procedures and were followed for a minimum of 1 year post procedure. For cervical facet procedures: 63 patients (106 procedures); age range F: 27‐84 years old; M: 33‐65 years old. For lumbar facet procedures: 85 patients (124 facet procedures); age range F: 19‐81 years old; M: 20‐77 years old. Main Outcome Measures: After the radiofrequency procedure, patients were followed with periodic visits or telephone contacts. Outcome measures were McGill short form pain questionnaire, VAS pain scores, muscle spasm scores, tenderness, range of motion and patient subjective global responses. Results: Subjective patient responses were graded as follows: excellent:greater than 70% improvement, good: 50% to 70% improvement, fair: 30% to 49%, and poor: less than 30%. One hundred six radiofrequency procedures were performed in the 63 cervical cases and 124 in the 85 lumbar cases with those patients who had good to excellent responses undergoing repeat procedures. Of the patients with cervical facet radiofrequency procedures, 38 (37%), 51 (48%), 4 (3%) and 13 (12%) had excellent, good, fair or poor responses, respectively. Of the lumbar facet radiofrequency cases, 37 (30%), 52 (41%), 13 (10%) and 22 (19%) had excellent, good, fair or poor responses, respectively. Excellent responders noted an average duration of 10.8 months (range 3‐34 months before dropping below 70% improvement level) for cervical cases and 7.9 months (range 3‐20) for lumbar. Good responders noted an average duration of 6.5 months (range 3‐22 months before dropping below 50% improvement level) for cervical and 6.8 months (range 3‐48) for lumbar radiofrequency procedures. No significant side effects were experienced (short‐term neuritis was seen in 2 patients who had cervical and 1 who had lumbar RFTC, but resolved in each case after a few weeks). Conclusions: In summary, 85% of cervical and 71% of lumbar RFTC cases had at least a 50% improvement in symptoms for extended periods. RFTC of median branches for facet arthropathy is a safe and efficacious modality with the potential for long‐term benefit.     

General Beliefs and Stigma Regarding Illicit Drug Use: Perspectives of Family Members and Significant Others of Drug Users in an Inner City in Brazil

People who use drugs are continuously subjected to harsh stigmatization through a process of relational and social degradation, which limits their possibility for recovery. This quantitative study explores the perspectives of family members or significant others of illicit drug users, regarding general beliefs about illicit drug use and their stigma. Respondents agree that most people do not trust people who use drugs, disregard individuals who have been hospitalized due to drug problems and do not think people who use drugs are as intelligent as the general population. These findings reveal a high level of public stigma regarding illicit drug use.     

Colonoscopy polypectomy management in Glanzmann’s thrombasthenia

Glanzmann's thrombasthenia (GT) is a rare autosomal recessive bleeding syndrome characterized by abnormal Glycoprotein IIb/IIIa complex (GIIb/IIIa) on platelets with resultant abnormality in platelet aggregation. There is very little information regarding polypectomy management in GT. We report a single patient with this rare disease, who underwent sequential endoscopic management of large colon polyps. Polypectomy in our GT patient was complicated by immediate and delayed bleeding. Multiple clips used after standard cautery polypectomy for a polyp 10 mm or larger in our GT patient, was most effective in preventing immediate and delayed post-polypectomy bleeding than other known therapeutic approaches. We favor preemptive use of multiple clips in large polypectomy defects for GT patients and we may argue the added cost may be offset by the reduction in the need for blood products, and by averting or shortening potential hospitalizations.     

Etoposide Loaded PLGA and PCL Nanoparticles II: Biodistribution and Pharmacokinetics after Radiolabeling with Tc-99m

Etoposide and nanoparticle formulations were labeled with Tc-99m and their biodistribution and pharmacokinetics were studied after intravenous administration in healthy mice and rabbits respectively. Etoposide was rapidly cleared from the body, while the disposition of nanoparticles was slower. A higher proportion of nanoparticles compared with etoposide was observed in different organs of mice. Scintigraphic images of rabbits concluded that the radioactivity shown by formulations is significantly higher after 4 and 24 h, as compared with etoposide administered in rabbits. AUC_{0 ? ∞}, clearance and MRT are better than those obtained with etoposide administration. The overall high residence of nanoparticles, compared with etoposide, signifies the advantage of PLGA and PCL nanoparticles as drug carriers for etoposide in enhancing the bioavailability and reducing the etoposide-associated toxicity.