Correlation between blepharospasm and psychological diseases:the anxiety,depression and sleep disorder study

AIM:To investigate the relationship between benign essential blepharospasm(BEB)symptoms and depression/anxiety/sleep disorder in a prospective manner and to determine whether treatment the BEB with botulinum toxin type A(BoNT/A)can impact psychological symptoms.METHODS:This prospective interventional case series recruited 61 adults with evidence of BEB.Patients were administered the Jankovic Rating Scale(JRS),the Blepharospasm Disability Index(BSDI),Personal Health Questionnaire Depression Scale(PHQ-8),Generalized Anxiety Disorder 7-item scale(GAD-7)and the Athens insomnia scale(AIS)to evaluate the severity of BEB symptoms,depression,anxiety and sleep disorder before and 1wk,1,3mo after the BoNTA treatment.Statistical analysis was performed to assess the relationships between changes in the survey scores.RESULTS:The mean score for JRS,BSDI,PHQ-8,and GAD-7 improved significantly(P<0.0001),respectively,compared to the initial visit at follow-up.At baseline,worse BSDI scores were correlated with worse GAD-7 and PHQ-8,but not with worse AIS.At 1mo follow-up visit,there was no correlation between change in BSDI and PHQ-8/AIS,the change in GAD-7 showed a mild association with change in BSDI.The change in BSDI was correlated with the change in both PHQ-8 and GAD-7 in the subgroup of patients without a prior diagnosis of depression or anxiety.Patient satisfaction with BoNT/A treatment reached the highest at 1mo of follow-up(83.6%,51/61).CONCLUSION:BEB may lead to psychological diseases.BoNT/A can significantly improve motor and non-motor symptoms of BEB,which emphasize the effectiveness of BoNT/A and therefore pave the way for its use in the field of psychiatry.However,further research is needed to confirm these findings and understand the underlying mechanisms.

Pharmacological- and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults

Inflammatory bowel diseases (IBDs) are a group of chronic inflammatory conditions mainly of the colon and small intestine. Crohn’s disease (CD) and ulcerative colitis (UC) are the most frequent types of IBD. IBD is a complex disease which arises as a result of the interaction of environmental, genetic and immunological factors. It is increasingly thought that alterations of immunological reactions of the patients to their own enterable bacteria (microfilm) may contribute to inflammation. It is characterized by mucosal and sub mucosal inflammation, perpetuated by infiltration of activated leukocytes. CD may affect the whole gastrointestinal tract while UC only attacks the large intestine. The therapeutic goal is to achieve a steroid-free long lasting remission in both entities. UC has the possibility to be cured by a total colectomy, while CD never can be cured by any operation. A lifelong intake of drugs is mostly necessary and essential. Medical treatment of IBD has to be individualized to each patient and usually starts with anti-inflammatory drugs. The choice what kind of drugs and what route administered (oral, rectal, intravenous) depends on factors including the type, the localization, and severity of the patient’s disease. IBD may require immune-suppression to control symptoms such as prednisolone, thiopurines, calcineurin or sometimes folic acid inhibitors or biologics like TNF-α inhibitors or anti-integrin antibodies. For both types of disease (CD, UC) the same drugs are available but they differ in their preference in efficacy between CD and UC as 5-aminosalicylic acid for UC or budesonide for ileocecal CD. As therapeutic alternative the main mediators of the disease, namely the activated pro-inflammatory cytokine producing leukocytes can be selectively removed via two apheresis systems (Adacolumn and Cellsorba) in steroid-refractory or dependent cases. Extracorporeal photopheresis results in an increase of regulatory B cells, regulatory CD8+ T cells and T-regs Type 1. Both types of apheresis were able to induce clinical remission and mucosal healing accompanied by tapering of steroids.

Bali Rituals and Therapeutic Communication in the Traditional Rural Society in Sri Lanka

Bali is a form of classical ritual that makes a sound performance of a variety of psychological and physical treatments for many psychiatric and cultural diseases. Bali is defined as a form of oblation for gods and deities. Bali is determined by the ephemeral cycle of one＇s life, so that the procedures and practices of specific Bali performances are planned to communicate with the planetary system, which is based on his/her astrology. Hence, Bali is made to perform with the use of traditional dance, music and local cultural substances. There are nearly eighty four thousand forms of Bali performances derived out from the constellation. History of Bali goes back to the early kingdom of Kotte which started in early fifteen century. However, it is considered that the origin of Bali resembles with the Indian Hindu religious cults, so that the Sri Lankan Bali tradition has been transformed by the local cultural and Buddhist religious milieu. This study explores the content and effects of Bali ritual. As the qualitative research, it assumes that Bali constitutes a broad spectrum of human needs and wants despite its communication to the supernatural elements of planetary system. Sederaman （1965） has explored Bali to the extent of its entire performance with respective lyrics and dancing procedures, as the pioneering study. However, present study looks at the diversity of the objectives and effects of a performance of Bali in the set-up of real Kandyan rural village in Sri Lanka. Finally, based on the research, it yields following conclusions. Bali in the rural Kandyan village, is designed to be conducted continuously up to fourteen days. It is traditionally performed by the classical exorcist gurus of Bali, who have been trained by the practice of word of mouth by their generation by generation. They are used to reciting, singing and dancing all the forms of communication from their memory and recalling at the very time of performance without any script or written text. Many Bali doctors are used to conducting entire performance with number of classical lyrics and poems with mellifluous musical melodies, attractive rhythms of dance and theatrical performances, which are not yet scientifically classified. Further, Bali is determined by the use of significant characteristics of one＇s astrology, so that the disease or pathetic situation is the fact that decides the specific Bali form. There are nearly eighty-four thousand Bali which are for numerous physical and psychological illnesses including variety of mental disorders and sexually transmitted diseases. Moreover, as this study found a very rare Ola leaf manuscript, that describes the entire eighty four thousand Bali, which is called Balipatuna in Sinhala （Contents of Bali） from a traditional Bali custodian in Laheba Bali Tradition at Kotabe in Mathale District in Sri Lanka. On the other, knowledge and practices of the traditional local medical sciences of parturition （Child birth） health in the pregnancy and the science of child birth （delivery） is also treated by the faculties of Bali schools. And Also, Bali figures are designed, based on the narration of the Bali lyrics, which explains a group of stars forming a recognizable pattern that is traditionally named after its apparent form and it is identified with a mythological figure. However, this has been the source for very colorful temple arts and craftsmanship at the Buddhist temples built up during the era of Kandyan kingdom （1469-1815 ）.