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The role of severe respiratory coronavirus virus 2 (SARS-CoV-2)–laden aerosols in the transmission of coronavirus disease 2019 (COVID-19) remains uncertain. Discordant findings of SARS-CoV-2 RNA in air samples were noted in early reports.
Sampling of air close to 6 asymptomatic and symptomatic COVID-19 patients with and without surgical masks was performed with sampling devices using sterile gelatin filters. Frequently touched environmental surfaces near 21 patients were swabbed before daily environmental disinfection. The correlation between the viral loads of patients’ clinical samples and environmental samples was analyzed.
All air samples were negative for SARS-CoV-2 RNA in the 6 patients singly isolated inside airborne infection isolation rooms (AIIRs) with 12 air changes per hour. Of 377 environmental samples near 21 patients, 19 (5.0%) were positive by reverse-transcription polymerase chain reaction (RT-PCR) assay, with a median viral load of 9.2 × 102 copies/mL (range, 1.1 × 102 to 9.4 × 104 copies/mL). The contamination rate was highest on patients’ mobile phones (6 of 77, 7.8%), followed by bed rails (4 of 74, 5.4%) and toilet door handles (4 of 76, 5.3%). We detected a significant correlation between viral load ranges in clinical samples and positivity rate of environmental samples (P < .001).
SARS-CoV-2 RNA was not detectable by air samplers, which suggests that the airborne route is not the predominant mode of transmission of SARS-CoV-2. Wearing a surgical mask, appropriate hand hygiene, and thorough environmental disinfection are sufficient infection control measures for COVID-19 patients isolated singly in AIIRs. However, this conclusion may not apply during aerosol-generating procedures or in cohort wards with large numbers of COVID-19 patients.
The etiology of depression remains poorly understood. Changes in blood lipid levels were reported to be associated with depression and suicide, however study findings were mixed.
We performed a two-sample Mendelian randomisation (MR) analysis to investigate the causal relationship between blood lipids and depression phenotypes, based on large-scale GWAS summary statistics (N = 188 577/480 359 for lipid/depression traits respectively). Five depression-related phenotypes were included, namely major depression (MD; from PGC), depressive symptoms (DS; from SSGAC), longest duration and number of episodes of low mood, and history of deliberate self-harm (DSH)/suicide (from UK Biobank). MR was conducted with inverse-variance weighted (MR-IVW), Egger and Generalised Summary-data-based MR (GSMR) methods.
There was consistent evidence that triglyceride (TG) is causally associated with DS (MR-IVW β for one-s.d. increase in TG = 0.0346, 95% CI 0.0114–0.0578), supported by MR-IVW and GSMR and multiple r2 clumping thresholds. We also observed relatively consistent associations of TG with DSH/suicide (MR-Egger OR = 2.514, CI 1.579–4.003). There was moderate evidence for positive associations of TG with MD and the number of episodes of low mood. For HDL-c, we observed moderate evidence for causal associations with DS and MD. LDL-c and TC did not show robust causal relationships with depression phenotypes, except for weak evidence that LDL-c is inversely related to DSH/suicide. We did not detect significant associations when depression phenotypes were treated as exposures.
This study provides evidence to a causal relationship between TG, and to a lesser extent, altered cholesterol levels with depression phenotypes. Further studies on its mechanistic basis and the effects of lipid-lowering therapies are warranted.
This chapter describes how civil society has played a role in catalyzing response to the challenge of antimicrobial resistance, and in so doing, brought early on an intersectoral lens to such efforts as well as lifted up voices from low- and middle-income countries into the global policy dialogue. The Declaration on Antibiotic Resistance penned by the founding members of the Antibiotic Resistance Coalition (ARC) provided a shared set of key principles across innovation, access, stewardship as well as sustainability and systems thinking. Within the chapter are notable examples of how ARC members have harnessed these principles and put them into practice. These efforts include successfully introducing the concept of delinkage into the policy vernacular including the UN Political Declaration on AMR and rallying consumer pressure on major restaurant chains to source food animal products raised without routine use of antibiotics. Monitoring for accountability, putting forward alternative proposals for innovation, and addressing procurement in the food system are some of the policy levers that civil society has successfully advanced. The remarkable richness of the contributions that civil society has made to the discussions and debates over AMR serves as a reminder of the need to encourage and include such voices in future policy-making.
There is growing concern about the influence of the pharmaceutical industry on psychiatric teaching and psychiatric professionalism as a whole. As a consequence, several national and international medical and psychiatric associations have issued guidelines to regulate the interactions between physicians and industry.
The EFPT-PRIRS study aims to provide the lacking data on the extent and nature of these interactions among psychiatric trainees across Europe.
Study objectives were determined by the EFPT research group (EFPT-RG), after discussion with national and international experts. A survey was then devised compiling previously published questionnaires extending them by questions with specific relevance to psychiatric trainees. The resulting questionnaire was piloted amongst members of the EFPT-RG, modified accordingly and subsequently distributed to the national study coordinators. All 24 EFPT member countries were invited to participate in the study and data collection is currently ongoing.
Preliminary analysis reveals the vast differences in industry - trainee relationships across European countries as well as major differences in personal attitudes towards these interactions.
EFPT-PRIRS will potentially have an impact on the regulation of the interactions between the pharmaceutical industry and psychiatric trainees.
Previous studies of patients with unipolar depression have shown that early decreases of prefrontal quantitative EEG (QEEG) cordance in theta band can predict clinical response to various antidepressants. We now examined whether reduction of prefrontal cordance value after 1 week of venlafaxine treatment predicts clinical response to venlafaxine in non-responders to previous antidepressant treatments.
We analyzed 25 inpatients, who finished 4-week treatment with venlafaxine. EEG data were monitored at baseline and after 1 week of treatment. QEEG cordance was computed at 3 frontal electrodes in theta frequency band. Depressive symptoms were assessed using Montgomery-Åsberg Depression Rating Scale (MADRS).
Eleven of 12 responders (reduction of MADRS ≥50%) and only 5 of 13 non-responders decreased prefrontal QEEG cordance value after the first week of treatment. The decrease of prefrontal cordance after week 1 in responders was significant (p=0.03) and there was no change in nonresponders. Positive and negative predictive value of cordance reduction for response was 0.7 and 0.9, respectively.
The reduction of prefrontal theta QEEG cordance value after first week of treatment is a useful tool in the response prediction to venlafaxine.
This study was supported by a grant from Internal Grant Agency of Ministry of Health of Czech Republic No. NR/9330-3 and a grant of Ministry of Education of Czech Republic MSMT 1M0517.
Transcranial magnetic stimulation (TMS) is a non-invasive method that induces functional changes in a relatively small area of the cerebral cortex. It is supposed that the effect of the method in therapy of neuropatic pain is based on the induction of spinothalamic tract inhibiton, which leads to the symptom withdrawal.
To prove the clinical and electrophysiological effect of rTMS in the therapy of chronic neuropatic pain.
29 patients with medication-resistant neuropatic pain were examined by Visual analog scale (VAS), McGill Pain Questionnaire (MPQ) and QST(Quantitative sensory Testing, consisted of von Frey and thermic treshold examination),then treated by high frequency rTMS in the study using double-blind randomized sham-controlled parallel design. rTMS parameters: 5 rTMS sessions (2 weeks treatment), where each session consisted of three 10 Hz rTMS series using:
1) 85%MT (motor treshold),
2) 90%MT and
Each rTMS série consisted of 20 pulses in 12 trains. Location of the active coil was administered over the contralateral motor cortex, directed specifically to facial area of homunculus (according to funcional location). Sham coil was angled 90° degrees away from the skull.
Confirmation of a significant decrease of VAS item in active group, trend to improvement in tactile sensation of severed patient faces. The changes of thermic treshold were not found. Sham rTMS did not show any trend for improvement.
Although no general recommendations can be drawn based on our result, our study is another one that suggest rTMS should be considered as an effective and safe treatment option for chronic neuropatic pain.
Previous studies of patients with unipolar depression have shown that early decrease of prefrontal EEG cordance in theta band can predict clinical response to various antidepressants. We have now examined whether decrease of prefrontal quantitative EEG (QEEG) cordance value after 1 week of venlafaxine treatment predicts clinical response to venlafaxine in resistant patients.
We analyzed 25 inpatients who finished 4-week venlafaxine treatment. EEG data were monitored at baseline and after 1 week of treatment. QEEG cordance was computed at three frontal electrodes in theta frequency band. Depressive symptoms and clinical status were assessed using Montgomery–Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory-Short Form (BDI-S) and Clinical Global Impression (CGI).
Eleven of 12 responders (reduction of MADRS ≥50%) and only 5 of 13 non-responders had decreased prefrontal QEEG cordance value after the first week of treatment (p = 0.01). The decrease of prefrontal cordance after week 1 in responders was significant (p = 0.03) and there was no significant change in non-responders. Positive and negative predictive values of cordance reduction for response were 0.7 and 0.9, respectively.
The reduction of prefrontal theta QEEG cordance value after first week of treatment might be helpful in the prediction of response to venlafaxine.
The previous studies have detected changes of brain electrical activity after the cerebellar hemisphere rTMS and the vermis rTMS. We supposed that right cerebellar 1Hz rTMS evokes changes in the left frontal cortex. The aim of our study was to determine if 1Hz cerebellar hemisphere and 1 Hz vermis rTMS induces different effect in frontal electrical activity.
We used 10 minutes of 1 Hz rTMS (with 600 impulses) in two sessions (first session- application over the right cerebellar hemisphere, second over the vermis). 31-channel EEG was recorded in 5 right-handed healthy volunteers before and after rTMS. The 3D distribution of the current density was revealed by a method of qEEG- Low Resolution Brain Electromagentic Tomography (LORETA, Pascual-Marqui et al. 1994; 1999).
After 1 Hz right cerebellar hemisphere rTMS the current density decreased in the alfa2, beta1, beta2 and beta3 band over the frontal cortex including medial frontal cortex and the anterior cingulate (p<0.01). After 1 Hz vermis rTMS we found no significant changes.
Our results suggest the possibility to influence the frontal cortical activity by means of the cerebellar hemisphere rTMS. No significant changes after 1Hz vermis rTMS may suggest either large distance between the rTMS coil and the vermis or our sample is too small to make definitive conclusions.
Previous studies demonstrated predictive effect of reduction of prefrontal cordance for non-resistant outpatients or resistant inpatients treated by various antidepressants or venlafaxine. The aim of the present study was to examine whether the reduction of theta prefrontal QEEG cordance value after 1 week of bupropion administration is associated with response to 4 weeks treatment in patients with resistant depressive disorder. We extended our previous pilot data.
We analyzed 18 inpatients, who finished 4-week treatment with venlafaxine. EEG data were monitored at baseline and after 1 week of treatment. QEEG cordance was computed at 3 frontal electrodes in theta frequency band. Depressive symptoms were assessed using Montgomery-Åsberg Depression Rating Scale (MADRS).
Nine of 11 responders (reduction of MADRS ≥50%) and no one of 7 non-responders decreased prefrontal QEEG cordance value after the first week of treatment. Positive and negative predictive value (PPV, NPV) of cordance reduction for response to treatment was 1.0 (95% CI, 0.8-1.0) and 0.78 (95% CI, 0.57-0.78), respectively.
Based on our results, the prefrontal QEEG cordance might be helpful in the prediction of the response to bupropion treatment in resistant patients.
This study was supported by a grant from Internal Grant Agency of Ministry of Health of Czech Republic No. NR/9330-3 and a grant from Ministry of Health of Czech Republic MZ0PCP2005.
The previous studies have detected changes of brain electrical activity (current density) after cerebellar rTMS. We suppose that right cerebellar rTMS evokes changes in the left frontal cortex. The aim of our study was to determine if 1Hz and 10Hz cerebellar rTMS induces antagonistic effect in frontal electrical activity.
We used 10 minutes of 10 Hz and 10 minutes of 1 Hz rTMS (both with 600 impulses, application over the right cerebellar hemisphere) in two sessions. 31-channel EEG was recorded in 10 right-handed healthy volunteers before and after rTMS. The 3D distribution of the current density was revealed by a method of qEEG- Low Resolution Brain Electromagentic Tomography (LORETA, Pascual-Marqui et al. 1994; 1999).
After right cerebellar 1 Hz rTMS the current density decreased in the alfa2, beta1, beta2 and beta3 band over the frontal cortex including medial frontal cortex and anterior cingulate. After 10 Hz rTMS we found a decrease over the frontal cortex in the delta, theta and alfa1 band bilaterally, more on the left side (p<0.01).
Our results suggest the possibility to influence the frontal cortical activity by means of the cerebellar 1Hz and 10 Hz rTMS (antagonistic effect in the frontal cortex- decrease in slow frequencies after 1 Hz and in fast frequencies after 10 Hz rTMS).
A series of clinical studies demonstrated that QEEG prefrontal theta cordance value decreases after one week of treatment in responders to antidepressants and precedes clinical improvement. Ketamine, a non-competitive antagonist of NMDA receptors, has a unique rapid antidepressant effect but its influence on theta cordance is still unknown.
In a double-blind, cross-over, placebo-controlled experiment we studied the influence of ketamine (0.54 mg/kg) on theta cordance in a group of 20 right-handed healthy volunteers. Participants were evaluated with the Brief Psychiatric Rating Scale before infusion and after 10 and 30 min. Three EEG segments obtained at baseline and prior to BPRS examinations at 10 and 30 min after dosing were entered into spectral analyses and QEEG cordance values in theta frequency band were calculated for four regions (prefrontal, central, left and right temporal).
Ketamine infusion induced a decrease in prefrontal theta cordance at 10 (p=0.04) and 30 min (p=0.02) and a significant increase of theta cordance in central region at both time points (p=0.01). We observed no significant effect on cordance values in the left and right temporal regions.
Our data indicate that ketamine infusion immediately induces similar changes as monoaminergic-based antidepressants do gradually after a series of downstream signaling steps. The reduction in theta prefrontal cordance could serve as a marker of fast antidepressant effect of ketamine, a hypothesis that should be tested in antidepressants-refractory patients.
This study was supported by a grant of IGA MHCR NR/9330-3 and by a project of MEYS CR VZ0021620816.
Hundreds of QEEG-related papers brought new information about the temporal dynamics of complex neuronal interactions that underlie impaired processing in many psychiatric diagnoses. Besides this fact, many researchers, clinical psychiatrists and neuroscientists prefer new imaging techniques (Positron Emission Tomography, PET; and functional Magnetic Resonance, fMRI) even if they are based on an indirect index of brain computing as metabolic or hemodynamic measurements which are blind to millisecond phenomena. We present the results of our studies provided with QEEG techniques (Low Resolution Electromagnetic Tomography, LORETA; EEG coherence, EEG cordance) in: 1) more than 60 patients with schizophrenia examined by means of QEEG and PET. We found significantly lower EEG coherence values, mainly from the left frontotemporal derivations in patients group and there was also significant correlation between the decrease of frontotemporal EEG coherence and elevated glucose metabolic uptake in the limbic structures (posterior cingulate and hippocampus). LORETA analysis showed almost the same results as analysis of PET images, not only in basal disease process, but also after successful application of rTMS in the subgroup of patients with treatment-resistant auditory hallucination. 2) in more than 30 patients with resistant depressive disorder we computed the new EEG indicator value (EEG cordance), and we showed, that the decrease in prefrontal EEG cordance in theta frequency band may indicate early changes of prefrontal activity and can become a useful tool in the prediction of response to antidepressants.
The aim of our study was detection of brain electrical activity changes in panic disorder (PD) patients by means of the electromagnetic tomography. Several observations suggest the panic disorder should be characterized by right frontal hyperactivation (Wiedemann et al., 1999).
Electroencephalograms of 33 panic disorder patients (9 men and 24 women) were compared with the same number of age and gender matched control subjects. EEG was recorded in the resting state with a 19-channel amplifier. 3-dimensional distribution of the current density was revealed by a method of quantitative electroencephalography - Low Resolution Brain Electromagentic Tomography (LORETA, Pascual-Marqui et al. 1994)
There was increase in the beta1 and beta2 frequency band over the frontal cortex including the insula and orbitofrontal cortex (p<0.01) with right side maximum in panic disorder patients. Also bilateral decrease in the alpha band over the occipital cortex including precuneus and posterior cingulate (p<0.02) was found.
The findings of our study confirmed hypothesis of frontal brain asymmetry with higher level of right hemisphere activation in panic disorder patients. These data are the first evidence of applying LORETA method to panic disorder studying.
This study was supported by the project MZ0PCP2005
QEEG almost consistently reports an abnormal excess of delta/theta activity, reduced alpha activity and posterior excess of beta activities in schizophrenics. LORETA allows more precise localization of these findings (excess of delta in bilateral anterior cingulate, increase of beta in parietal gyrus).All antipsychotic drugs induce significant changes in QEEG reflecting differential effects on inhibitory and excitatory activities. Two QEEG profiles of first-generation antipsychotics may be differentiated: a)chlorpromazine-type profile, characterized by an increase in delta/theta and a decrease in alpha and beta power spectra, and b)haloperidol-type profile, which exhibits no significant change in delta/theta frequency band but increase of alpha and alfa adjacent beta activity. The second generation antipsychotics have different QEEG and LORETA profiles probably reflecting their different mechanism of action. Clozapine produces an increase of delta, theta and alpha1 and decrease of alpha2 and fast beta activities. Comparing to antipsychotic-naïve schizophrenics, clozapine-treated patients showed an excess of delta and theta activities in anterior cingulate and medial frontal cortex. QEEG profile of olanzapine is similar to clozapine, whereas tomography show slightly different pattern (decrease of alpha1-beta activities in the occipital cortex and posterior limbic structures and decrease of beta3 sources in the fronto-temporal cortex and anterior cingulum). Risperidone increased current density in frontal regions for delta, theta and alpha1 in healthy subjects, whereas we found no changes in LORETA between risperidone-treated and antipsychotic-naïve patients. According to‘key–lock principle'the pharmaco-EEG topography and tomography could be helpful in the optimization of antipsychotic therapy.
Supported by the projects IGA MZCR NR9330-3/2007 and MSMTCR1M0517.
The aim of our study was to examine whether the change of current density detected by standardized low resolution brain electromagnetic tomography (sLORETA) is different between responders and non-responders to prefrontal repetitive transcranial magnetic stimulation (rTMS).
A total of 25 inpatients with depressive disorder (DSM-IV criteria), who previously did not respond to at least one antidepressant treatment underwent 4 weeks of rTMS treatment (1 Hz, 100% of motor threshold, 600 pulses/session, 20 session) applied over the right dorsolateral prefrontal cortex. 19-channel EEG was recorded before treatment and 3 days after rTMS treatment. The effect of rTMS on brain electrical activity (revealed by the use of sLORETA, Pascual-Marqui RD, 2002) was measured separately in responders (reduction of MADRS≥50%) and non-responders.
The significant current density increase in alpha 1 band was detected in prefrontal and limbic cortex (Brodman areas 6, 8, 9, 32) bilaterally (p < 0.05, corrected) in a group of nine responders. No significant changes were detected in non-responders.
Our findings implicate that the antidepressant effect of 1 Hz rTMS is connected with a current density increase in alfa 1 band in the prefrontal cortex. Supported by 1M0517 and MZ0PCP2005.
A continuum perspective to understand persecutory delusions suggests that non-clinical persecutory ideations are at the mild end on the same spectrum of persecutory delusions. Based on clinical studies, reasoning biases such as 'jumping to conclusions' (JTC) style, attributional biases (AB), and Theory of Mind (ToM) deficit have been suggested as cognitive risk factors of persecutory delusions, with most robust evidence for JTC. Consistent with the continuum perspective, it is of interest whether these reasoning biases are risk factors of persecutory ideations in the non-clinical population as well.
To examine the association between JTC, AB, ToM deficit, and persecutory ideations in non-clinical populations.
To test the following hypotheses:
1. JTC, AB, and ToM deficit will be found in individuals with non-clinical persecutory ideations.
2. Among the three biases, JTC will be more strongly associated with the severity of persecutory ideations in the non-clinical population.
Twenty studies from 2001 to 2013 analyzing the relationship between reasoning biases and severity of persecutory ideations in non-clinical populations were systematically reviewed.
JTC, AB and ToM deficit were found in individuals with non-clinical persecutory thinking but at reduced levels of severity as compared to the clinical populations. A consistent association between JTC and non-clinical persecutory thinking was found across studies. However, studies of AB and ToM deficit yielded conflicting findings.
Current findings confirm the role of JTC in the pathogenesis of persecutory delusions, and support the development of early interventions targeting data-gathering for individuals at risk of developing persecutory delusions.
Cordance is a QEEG method that incorporates both absolute and relative power and has been shown to have a strong association with cerebral perfusion or metabolism. Cordance accurately characterizes brain function on the cortical convexities and has demonstrated usefulness for characterizing antidepressant response. The aim of this study was to evaluate the efficacy of QEEG cordance in the prediction of response to various antidepressants in patients with resistant depression.
A total of 81 inpatients with depressive disorder (MADRS≥20) who previously did not respond to at least one antidepressant treatment were treated with various antidepressants for 4 weeks. QEEG cordance was computed at 3 frontal electrodes in theta frequency band (4–8 Hz). Depressive symptoms were assessed using Montgomery-Åsberg Depression Rating Scale.
29 from 33 responders and 14 from 48 non-responders decreased prefrontal QEEG cordance value after the first week of treatment (p = 0,0001). There was a difference between responders and nonresponders in the change of cordance value after first week of treatment (p = 0.002). Positive and negative predictive value of cordance reduction for response to treatment was 0.67 (0.58–0.73) and 0.90 (0.79–0.96), respectively. The overall accuracy of the test was 0.78 and the effect size (w = 0.59) was in large range.
Early change in prefrontal theta band cordance probably reflects a common underlying mechanism of antidepressant effect, regardless of the type of treatment. Prefrontal cordance may provide a useful biomarker for the early detection of response to antidepressant therapy.
Jumping to conclusions (JTC) is a reasoning bias where individuals make hasty decisions based on insufficient data. It is commonly observed among patients with delusions and is a risk factor for developing delusions. Several task paradigms have been developed to test JTC, but their convergence in measuring JTC remains unexplored.
This is a pilot test to examine the consistencies between three JTC tasks with a student sample. The relationships between JTC and cognitive abilities were also explored.
Forty-six university students completed the Beads Task, Fish Task and Box Task, as well as assessment of memory, intellectual functioning, executive function, impulsivity and need for closure.
There was a moderate correlation between the beads task and fish task on various measures of JTC (draws to decision [DTD], r=.50, p<.01; confidence, r=.47, p<.01; dichotomous JTC bias, ×2=16.14, p<.001). There was a mild correlation between DTD on the fish task and box task (r=.30, p<.05). General intelligence was associated with DTD and JTC bias (but not confidence) on the beads and fish tasks. Confidence in decision was associated with a higher level of impulsivity and a lower level of set-shifting ability.
Despite differences in materials and design of the three probability-based tasks, results of JTC measured by the beads task and box task were individually consistent with the fish task, and were not correlated between the two. The data-gathering process and the confidence in decision are associated with different cognitive abilities. Further study including a clinical sample is needed.