Despite growing awareness of the importance of sexual health, SA-based scientific research on sexual dysfunction is limited. Further work is needed to inform recommendations for ICD-11 revisions drawn from the SA context.

Objectives: (1) Appreciate the use of laryngeal manipulation as treatment for perceived dysphagia resulting from excessive paralaryngeal muscle tension. (2) Describe the patients likely to have symptomatic improvement. Methods: A retrospective review identified patients from 2007‐2011 with laryngeal manipulation for muscle tension‐caused dysphagia in an academic otolaryngology practice. Subjects with dysphagia not attributable to anatomic cause who attended therapy twice or more had symptoms, demographic information, treatment, and response to therapy abstracted. Results: Thirty‐five subjects were included, consisting of 28 women and 7 men. Race was recorded as black (11), Hispanic (8), white (9), and other (7). Improvement in dysphagia was seen in 25 (71.4%, 95% confidence interval 53.7% to 86.4%). No significant differences were seen in improvement based on sex ( P =. 381) or race ( P =. 439) in chi‐square testing. The combination of age and number of sessions were predictive of improvement ( P =. 041) but were not individually significant (age P =. 096, sessions P =. 084) using logistic regression. Conclusions: We found improvement with laryngeal manipulation among individuals with muscle‐tension‐caused dysphagia. No significant differences in efficacy were seen among racial and sex subgroups. A model with age and number of sessions was significant. A prospective trial of this therapy appears warranted.

A proper understanding of COVID-19 mortality is central to effective responses. We examine the trends in mortality rates and totals in China, South Korea, Italy, Spain, and New York State to provide some estimate of possible best and worst-case scenarios of COVID-19 deaths in high-income countries. We review also the challenges in tracking mortality in low-income countries, where many deaths occur at home without medical certification, and for which alternative systems to document COVID-19 mortality will be needed. We also explain the role and appropriate timing of antibody-based surveillance to understand the extent of the first wave of COVID-19 and resulting case fatality rates.

Hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder have long been recognized by clinicians as diagnostic entities. Trichotillomania was included in DSM-III-R (American Psychiatric Association 1987), and hoarding disorder and excoriation disorder are new entities in DSM-5 (DSM-5 criteria for these disorders are shown in Boxes 23- , 23- , and 23- ) (American Psychiatric Association 2013). In this chapter, we review the pharmacotherapy and psychotherapy of these disorders. DSM-5 Diagnostic Criteria for Hoarding Disorder 300.3 F42 Persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities). The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome). The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder , decreased energy in major depressive disorder , delusions in schizophrenia or another psychotic disorder , cognitive deficits in major neurocognitive disorder , restricted interests in autism spectrum disorder ). Specify if: With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space. Specify if: With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic. With poor insight : The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary. With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary. DSM-5 Diagnostic Criteria for Trichotillomania (Hair-Pulling Disorder) 312.39 F63.3 Recurrent pulling out of one’s hair, resulting in hair loss. Repeated attempts to decrease or stop hair pulling. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition). The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder). DSM-5 Diagnostic Criteria for Excoriation (Skin-Picking) Disorder 698.4 L98.1 Recurrent skin picking resulting in skin lesions. Repeated attempts to decrease or stop skin picking. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies). The skin picking is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies in stereotypic movement disorder, or intention to harm oneself in nonsuicidal self-injury).

Results from this international cross-sectional study indicate that current OCD treatment is in line with evidence-based treatment guidelines. Although augmentation strategies are widely used, no significant differences in OCD symptom severity were found between monotherapy and augmentation or between different therapeutic agents.

Introduction: Chronic hepatitis C infection is one of the most common causes of chronic liver disease, with evidence of infection in nearly 4.1 million individuals in the United States. Acute hepatitis C affects about 17,000 people per year. Here, we present a patient who acquired acute hepatitis C from an unusual mode of transmission. Case: Our patient is a 45-year-old man who was admitted with nausea/vomiting, jaundice, abdominal pain, acholic stools, and scleral icterus for the past three months. These symptoms developed approximately two weeks after he debrided a pustule on his hand with a used insulin needle from a friend with known hepatitis C. Anti-HCV antibodies were positive, and a viral load of 11,413 (4.1 log) copies was noted on RNA quantitative PCR testing. HCV genotyping showed genotype-3 disease. Additional work-up for etiologies of chronic liver disease, included testing for autoimmune hepatitis, Wilson's disease, hemochromatosis, and alpha-1-antitrypsin deficiency, all of which were negative. The patient's hospital course was otherwise unremarkable, and his symptoms and labs improved with symptomatic cares only. The patient's symptoms and pattern of LFT abnormality was most likely due to acute hepatitis C infection rather than chronic disease, given the patient's prior history and identifiable, though unique, exposure prior to onset of symptoms. The patient had spontaneous lab-confirmed clearance of the virus, normalization of his LFTs, and no further symptoms. Discussion: Our patient is unique for several reasons. His postulated mode of transmission was highly unusual, given the type of needle and how it was used. The patient did require surgical debridement of his hand for wound management after using his friend's needle, and thus appears to have used what is ordinarily a subcutaneous needle for deeper penetration. The patient's male sex and genotype-3 disease put him at higher risk of progression from his HCV disease, but the patient was able to spontaneously clear the disease without treatment.

ABSTRACT Objectives The analysis of transmission dynamics is crucial to determine whether mitigation or suppression measures reduce the spread of Coronavirus disease 2019 (COVID-19). This study sought to estimate the basic ( R 0 ) and time-varying ( R t ) reproduction number of COVID-19 and contrast the public health measures for ten South American countries. Methods Data was obtained from the European Centre for Disease Prevention and Control. Country-specific R 0 estimates during the first two weeks of the outbreak and R t estimates after 90 days were estimated. Results Countries used a combination of isolation, physical distancing, quarantine, and community-wide containment measures to staunch the spread of COVID-19 at different points in time. R 0 ranged from 1.52 (95% confidence interval: 1.13-1.99) in Venezuela to 3.83 (3.04-4.75) in Chile, whereas R t after 90 days ranged from 0.71 (95% credible interval: 0.39-1.05) in Uruguay to 1.20 (1.19-1.20) in Brazil. Different R 0 and R t values may be related to the testing capacity of each country. Conclusion R 0 in the early phase of the outbreak varied across the South American countries. The public health measures adopted in the initial period of the pandemic appear to have reduced R t over time in each country, albeit to different levels.

With over 1 million incidence cases and more than 780,000 deaths in 2018, gastric cancer (GC) was ranked as the 5th most common cancer and the 3rd leading cause of cancer deaths worldwide. Though several biomarkers, including carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), and cancer antigen 72-4 (CA72-4), have been identified, their diagnostic accuracies were modest. Circulating tumor cells (CTCs), cells derived from tumors and present in body fluids, have recently emerged as promising biomarkers, diagnostically and prognostically, of cancers, including GC. In this review, we present the landscape of CTCs from migration, to the presence in circulation, biologic properties, and morphologic heterogeneities. We evaluated clinical implications of CTCs in GC patients, including diagnosis, prognosis, and therapeutic management, as well as their application in immunotherapy. On the one hand, major challenges in using CTCs in GC were analyzed, from the differences of cut-off values of CTC positivity, to techniques used for sampling, storage conditions, and CTC molecular markers, as well as the unavailability of relevant enrichment and detection techniques. On the other hand, we discussed future perspectives of using CTCs in GC management and research, including the use of circulating tumor microembolies; of CTC checkpoint blockade in immunotherapy; and of organoid models. Despite the fact that there are remaining challenges in techniques, CTCs have potential as novel biomarkers and/or a non-invasive method for diagnostics, prognostics, and treatment monitoring of GC, particularly in the era of precision medicine.

Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

The occurrence of trauma and PTSD in South Africa is not distributed according to the socio-demographic factors or trauma types observed in other countries. The dominant role of witnessing in contributing to PTSD may reflect the public settings of trauma exposure in South Africa and highlight the importance of political and social context in shaping the epidemiology of PTSD.

Chronic methamphetamine (MA) abuse results in an acute psychosis indistinguishable from paranoid schizophrenia. However, less is known of the interaction between MA use and environmental insults, and how this contributes to late-onset psychopathology. Using social isolation rearing (SIR), a neurodevelopmental animal model of schizophrenia, we investigated the association between changes in corticostriatal mono-amines and putative behaviours related to MA-induced psychosis in isolation and group-housed rats following chronic MA or saline exposure. Weaned male offspring of MA-naive female Wistar rats, either group- or isolation-housed from postnatal day (PND) +21, received saline (2 ml/kg s.c. b.i.d.) or an escalating dose of MA (0.2-6 mg/kg s.c. b.i.d.) for 16 days from PND +35 to +50. On PND +78, offspring were tested for deficits in social interactive behaviour (SIB) and prepulse inhibition (PPI) of startle, with frontal cortex and striatum harvested for the assessment of mono-amine concentrations. SIR significantly reduced rearing time, staying together, approaching and anogenital sniffing (outward-directed SIB), but increased self-grooming and locomotor activity (self-directed SIB), and also induced profound deficits in PPI. Pubertal MA exposure in group-housed animals also induced similar alterations in outward- and self-directed SIB and reduced PPI. Combined MA+SIR exposure evoked a similarly intense behavioural response as SIR or MA separately, with no exacerbation evident. Neither treatment separately nor together affected corticostriatal serotonin or noradrenaline levels, although frontal cortical dopamine (DA) levels were significantly increased in SIR and MA+group-housed animals. A trend towards further elevated frontal cortical DA was noted in the MA+SIR treatment group. Striatal DA was unaltered by all treatments. This study provides the first evidence that chronic pubertal MA exposure evokes postpubertal psychosis-like behaviours in rats of similar intensity to that induced by a neurodevelopmental animal model of schizophrenia (SIR). Moreover, the study is unique in that these behavioural changes occur together with associated changes in frontal cortical but not striatal DA, without affecting other mono-amines, and strongly implicates frontal cortical DA changes in the psychotogenic effects of early-life MA exposure or environmental insult. Although MA exposure in animals with a history of environmental insult (i.e. MA+SIR) has similar effects, combined exposure was not additive with regard to behavioural or neurochemical changes. We conclude that a ceiling effect or compensatory mechanisms prevent more pronounced neurobehavioural deficits occurring following MA+SIR treatment, at least under the current study conditions.

Clinical Trials (ClinicalTrials.gov): NCT01977326, registered on 24/10/2013; Pan African Clinical Trials Registry (http://www.pactr.org): PACTR201403000676264, registered on 11/10/2013.