In order to evaluate the effect of training primary health care (PHC) physicians to recognize mental disorders, an intervention randomized controlled trial was conducted. Three categories of PHC physicians were selected: the index group (n = 12 doctors), control group 1 (n = 12) and control group 2 (n = 4). For 1 week randomly selected patients from all trial centres were asked to complete the General Health Questionnaire (GHQ-28), and the three groups of doctors were asked to identify the presence of and rate the severity of any mental disorder in these patients. The same process was repeated for all three groups after a 6-month training course which was provided for the index group only. The doctors' ability to detect mental disorders was measured by calculating Spearman's correlation coefficient between their severity rating and the GHQ scores of their patients. Training produced a noticeable improvement in the diagnostic accuracy of the index group, whereas there was minimal improvement in control group 1 and deterioration in control group 2. Recommendations to improve the ability of PHC physicians to detect mental disorders are discussed.
BackgroundKaposi’s sarcoma (KS), an endothelial neoplasm, is associated with human herpes virus (HHV) -8 infection. KS has four clinical sub-types: Mediterranean/classic, African/endemic, human immunodeficiency virus (HIV) -associated/epidemic, and transplantation-related/iatrogenic. Immunosuppression is an important cofactor in KS process. Classic KS (CKS) is exceedingly rare in children and when occurs, it is much more disseminated than adults. The epidemic, HIV-associated and the iatrogenic forms of childhood KS are a result of a profound and acquired T-cell deficiency. To our knowledge, this is the first paediatric KS case report from Iraq. Our patient was showing an unusual aggressive course of the disease while receiving Valproic acid (VPA) of the potential immune-suppressive effect.Case presentationA six-year-old Iraqi boy, who had cerebral palsy (CP) and epilepsy since the age of 9-months, had received VPA to control his seizures. He developed skin discoloration followed by nodules that disseminated proximally from the lower extremities to the groin, face, ears and oral cavity, and then he died from severe respiratory distress after 110 days from the disease evolution. KS diagnosis was proved by a skin biopsy. As the patient was of Arab-Asian ethnicity and was HIV-seronegative status, accordingly, his condition best fitted the classic form of KS. However, recent studies showed the link of VPA with the reactivation of HHV-8. Moreover, accumulated experimental and clinical data elucidated that VPA induces T-cell suppression. Given that there was a lack of facilities to perform the laboratory immunological diagnostic tests in Iraq, the VPA-induced effect on immunity in our case (iatrogenic KS) could not be evaluated.ConclusionsOur report demonstrates a rare, rapidly progressing paediatric KS case and highlights the possible role of the 5-years’ administration of VPA and its challenging effect on cellular immunity based on recent studies. Thus, VPA could have promoted the development of the KS in our patient. This report also recalls the need of paediatricians to consider KS especially when the skin lesion appears at the child’s foot even in countries outside the geographical map of the disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0653-3) contains supplementary material, which is available to authorized users.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.