Journal of Clinical & Medical Case Reports, Images (JCMCRI)

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Analysis and Control of the Dopamine Circadian Rhythms Model by Lakshmi N Sridhar* in Journal of Clinical & Medical Case Reports, Images (JCMCRI)

Abstract Background: The high nonlinearity of the dopamine circadian rhythms model is seen in the presence of limit cycles that disrupt the circadian rhythms. Limit Cycles originate from Hopf bifurcation points. Bifurcation analysis and Multiobjective nonlinear model predictive control is performed on the dopamine circadian rhythms model. Methods: The MATLAB software MATCONT was used to perform the bifurcation analysis. The Multi-objective Nonlinear Model Predictive Control was performed using the optimization language PYOMO. Results: The Bifurcation analysis reveals Hopf Bifurcation points that produce limit cycles. To eliminate the rhythm disturbing limit cycles the bifurcation parameter is multiplied by an activation factor involving the tanh function. The nonlinearity of the dopamine circadian rhythms model also causes spikes in the control profiles when multiobjective nonlinear model predictive control calculations are performed. The spikes are also eliminated when the control variable is multiplied by the same activation factor. Conclusion: The dopamine circadian rhythms model is shown to have two Hopf bifurcations, which cause limit cycles that can disrupt the circadian rhythms. An activation factor involving the tanh function eliminates the limit cycle causing Hopf bifurcations. This activation factor also removes the spikes that occur in the control profile.

Keywords: Circadian; Dopamine; Bifurcation; Optimal control

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The Seesaw in Healthcare by Deane Waldman* in Journal of Clinical & Medical Case Reports, Images (JCMCRI) ISSN: 3064-8025

Introduction

Government insurance: The Affordable Care Act (ACA, colloquially Obamacare) was signed into law in 2010 but was not fully implemented until 2014. In 2010, the U.S. uninsured rate was 16 percent. [2] By 2017, nearly 20 million Americans had gained government coverage dropping the uninsured rate to 9 percent. Roughly 90 percent of the increased coverage was due to Medicaid expansion: the rest resulted from ACA subsidies. In 2017, Merritt Hawkins measured wait times to see a doctor and acceptance rates of Medicaid patients by physicians. [3] Patients’ maximum wait time for a primary care physician in a mid-sized city increased from 99 days in 2010 to 122 days in 2017. Since then, wait times have gotten longer. [4] In 2011, the Medicaid acceptance rate was 69 percent nationally [5] and has fallen since then. In nine of 14 major cities studied by Merritt Hawkins in 2017, less than 50 percent of physicians would accept new Medicaid patients into their practices. Doctors cited two reasons: [6] excessive regulatory/administrative burden [7] and low payment schedules, often below cost-of-doing-business. Association does not equal causation. Nonetheless, the fact that access to care has declined is alarming. The seesaw relationship – government coverage up, access down – is worrisome especially given data on death-by-queue. The phrase death-by-queue refers to people dying while waiting in line for technically possible medical care that is not provided in time to save them. This has been reported particularly in government-insured Americans in both Medicaid [9] and Tricare. [10] Death-by-queue is due to excessively long wait times and low Medicaid acceptance rates. If patients wait too long for care or don’t have a doctor at all, their health suffers. Even a four-week delay in a cancer diagnosis increases mortality. [11] Imagine what a four-month delay does to patient survival. [3]

Insurance profits: A 2023 Kaiser financial analysis showed that Medicare Advantage had the highest gross margin in the health insurance market. [12] Gross margin, often used as a proxy for profit, is defined as revenue retained after paying for goods sold and services provided. It does not include administrative costs or tax liabilities. Bottom line for non-economists: selling health insurance is highly profitable. Another metric of insurance profitability is stock price. People will pay higher prices for a stock when they anticipate higher returns (more personal profit) in the future. Between 2007 and 2017, stock prices of the seven largest health insurance companies rose 157 percent to 635 percent. [13] Over the same time, the S&P 50 index rose 82 percent.As noted previously, during the 2007 to 2017 period, wait times increased and Medicaid acceptance rates fell. Thus, access to medical care declined as profits increased. Keeping in mind that association isn’t causation, a Pearson chi square test (χ2=24.5582) of stock profits versus access to care indicates a very strong seesaw correlation, p < 0.0001. [13] Insurance premium rates are set by federal and state agencies. Thus, revenue for insurance companies is determined solely by how many people they sign up. They generate profits when they don’t spend money. Typically, they use a “three D” strategy to increase profits: delay, defer, and deny paying for patient care. [14] The economic incentive structure of insurance third-party payment in healthcare exposes another seesaw relationship: insurance profits increase when sellers reduce delivery of care. Federal regulations There is a common misconception that writing a federal regulation somehow directly causes the effect regulated. By this reasoning, passing a mandate for price transparency will immediately make health care price lists available to the public. Such magical thinking does not recognize the process called BARRCOME between passing a federal law and having an impact on the public. BARRCOME stands for bureaucracy, administration, rules, regulations, compliance, oversight, mandates, and enforcement. [15] After passing a law or issuing an executive order, Bureaucrats are hired to populate a new Agency. Lawyers are tasked with writing Rules to reflect the law’s intent. Then others are hired to create actionable Regulations (second R). Compliance must be assured requiring new Overseers. Mandates must be Enforced by additional new hires, including penalizing the non-compliant. BARRCOME costs money, particularly for the tens of thousands of new bureaucrats, administrators, agents, lawyers, and overseers. One look at the organizational chart of the ACA confirms the massive size of the non-clinical healthcare workforce. [16] Nationally, BARRCOME cost between 31 percent [17] and more than 50 percent [14] of all U.S. spending on its healthcare system, which totaled $4.5 trillion in 2023. Thus, Washington expended $1.4 trillion to $2.25 trillion healthcare dollars to pay people who provide no patient care. Where does all that money come from? It is diverted to pay bureaucrats stealing money intended for care providers. [14] To pay for ACA BARRCOME, former President Obama took $716 billion from the Medicare Trust, money intended to pay for seniors’ hospital care. [18] On the healthcare seesaw, as the BARRCOME money side goes up, the patient care side goes down.

Conclusion

Washington directly controls healthcare spending for 186 million Americans (56 percent of population) as their third-party insurer through Medicaid/CHIP, Medicare, Tricare, and EMTALA (for the uninsured). Federal government indirectly controls health expenditures for 147 million with private coverage as insurance sellers must strictly follow federal insurance regulations. Thus, Washington is the ultimate third-party controller of American healthcare dollars. The common element in seesaw relationships is money, specifically who does or does not control it. Whether it is an insurance company, a health plan, a pharmacy benefits manager, state or federal government, the one person who does not control his or her health care spending is the consumer, the patient. In market terms, this is called “microeconomic disconnection,” [19] where buyer and seller are disconnected by a third-party.

As the payer or controller of money, the third party becomes the decision-maker, both financial and medical.  [20, 21] “Disconnection” suppresses free market forces. Buyers (patients, who are not payers) have no incentive to economize, and sellers do not compete for buyers’ dollars. Without these forces, spending rises inexorably, and service (access to care) declines – the exact problems U.S. patients are experiencing. The solution stems directly from identification of the root cause. Since disconnection of buyer from seller is the central problem in healthcare, the answer is to reconnect them. Remove third parties from decision-making in healthcare. Allow patients and providers to interact (connect) directly. Patients would then control their own hard-earned dollars, medical autonomy would be restored, [22] and the seesaw would vanish.

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EVALUATION OF THE WOUND HEALING EFFECT OF THE CARBONIZED SEED POD OF PENTACLETHRA MACROPHYLLA BENTH IN DIABETIC FOOT ULCER by Johnson–Ajinwo in  Journal of Clinical & Medical Case Reports, Images (JCMCRI) ISSN: 3064-8025

Introduction

Diabetes, a global disease estimated to have a global burden of about 693 million individuals by 2045 [1] is a metabolic disorder caused by abnormalities in insulin secretion, action, or both. Diabetic patients are more likely to get wounds, and these wounds frequently require more time to heal because of a variety of issues including immunological dysfunction, vascular disease, and neuropathy [2]. Diabetes-related wounds pose a substantial risk to one's health because they might result in amputation, infections, or even death [3]. The pathophysiology of DFU is multifaceted and is an interlink between the neuropathic, vascular, and immune systems [4]. Because neuropathy results in decreased sensation, a diabetic patient may develop a cut on the foot and would not notice until an ulcer is formed. Also, diabetic nerves are poorly perfused, and the wound-healing process is slower than usual due to the slow migration of inflammatory mediators to the injury site [5]. Diabetic Foot Ulcers (DFUs) are significant comorbidities of diabetes mellitus that demand medical attention and have the potential to be fatal. DFU affects 19–34 % of diabetics at some point in their lives, and 9.1–26.1 million people are estimated to get DFU annually by the International Diabetes Federation [6]. In the UK, population-based cohort research indicated that 5% of the study population developed foot ulcers, with 5% of those developing new ulcers dying within the first 12 months of ulcer development and a death rate of 42.2% for those with foot ulcers [7].

Additionally, patients with DFU experience higher morbidity, a greater burden of healthcare contacts, a lower quality of life related to their health, and a worse psychosocial adjustment [8]. The current management of DFU includes Offloading, surgical debridement, use of topical dressings, and achieving glycemic control [9].

African oil bean tree or Pentaclethra macrophylla, is a plant with a long history of traditional use for wound healing. Alkaloids, flavonoids, and saponins are among the bioactive substances found in Pentaclethra macrophylla seeds [10]. Research has demonstrated that these compounds have antibacterial, anti-inflammatory, and antioxidant properties [11, 12]. Furthermore, the leaves of this plant have been shown to reduce blood glucose levels. Hence, these properties suggest that Pentaclethra macrophylla might be useful as a DFU treatment [13].

MATERIALS AND METHODS

2.1 COLLECTION OF PLANT MATERIAL The seed pod of the Pentaclethra macrophylla plant was collected from a bio-reserve in Ethiope West LGA of Delta State, Nigeria on February 2023. Soon after collection, the seed pods were cleaned and shade-dried. The plant was identified, confirmed, and authenticated by Dr. Suleiman, a Taxonomist in the Department of Pharmacognosy and Phytotherapy, Faculty of Pharmaceutical Sciences University of Port Harcourt Rivers State, Nigeria. (Voucher No: UPHF0598). A voucher specimen of the plant was deposited in the Departmental herbarium for future reference. After drying, they were crushed to a powder and stored in an airtight plastic container for further use.

2.2 EXTRACTION The crushed seed pod powder was weighed and then carbonized at 550 - 600°C in a Muffle furnace. The carbonized sample was properly crushed into fine particles and sieved through a 125um sieve.

2.3 QUALITY CONTROL PARAMETERS Coarse powder of the seed pod of Pentaclethra macrophylla was used to perform quality control test which include the determination of acid-insoluble ash and water-soluble ash.

2.3.1 Acid insoluble ash (AIA): 40ml of concentrated HCl was diluted with distilled water to make the volume 100ml and was stored in an amber glass bottle. About 2gm of the powdered drug was weighed accurately into a tared silica crucible and incinerated at 450°C in a muffle furnace until free from carbon. 25ml of the 40% HCl solution was poured into the crucible with the ash and boiled for 5 minutes. After which, it was filtered with an ash-less filter paper, and the crucible was properly rinsed with additional hot water to ensure that no residue of HCl was left in the filter paper. The crucible and the lid were placed inside the hot air oven at 130°C for about 20 minutes, then cooled in the desiccator and weighed blank. The filter paper was transferred into the prepared crucible and incinerated at 450°C in a muffle furnace until free from carbon. The crucible containing the acid-insoluble ash was cooled and weighed. The percentage of acid-insoluble ash was calculated as follows with reference to the air-dried substance. The procedure for the acid-insoluble and water-soluble ash was carried out according to the procedure of the Association of Official Analytical Chemists [14]. Results were calculated as,

Acid insoluble ash = Wf - Wc/ Ws Where, Wf = Crucible + Ash weight Wc = Crucible weight Ws = Sample weight 2.3.2 Water soluble ash: Same procedure as in acid insoluble ash. Where 25ml of 40% HCl solution was poured into the crucible with the ash and boiled for 5 minutes, 25ml of distilled water was used instead.

 2.4 FORMULATION OF CREAM The formula for cream formation is as follows: Plant Extract:                                      4%, 2.5%, 1% Emulsifying ointment:                        30% Shear butter                                         20% Purified water to                                 100% A 50 g preparation was made.

Preparation of emulsifying ointment: Formula got from Pharmaceutical codex 1979 Rx Emulsifying wax 300 g White soft paraffin 500 g Liquid paraffin 200 g The formula was reduced by 50%

Procedure for Formulation of Emulsifying Ointment The three ingredients were accurately weighed and/or measured and transferred into the glass container. Subsequently, they were melted over a water bath and stirred until cooled to form the emulsifying ointment.

Method of cream formation:

15 g of Emulsifying ointment and 10 g of shear butter were combined in a beaker and gently heated over a water bath until melted. 23 ml of purified water was measured into another beaker and placed over the water bath. The thermometer was used to regulate their temperature to 60 °C. The mixture was transferred into a porcelain mortar and stirred. A 2g of the carbonized extract was incorporated into this to give a 4% cream.

This base was then transferred into a wide-mouthed plastic jar, capped and labeled appropriately. For the 2.5% and 1% cream formulation, 1.25g and 0.5g of the plant powdered extract were added respectively in place of 2g. 23.75ml and 24.5ml of purified water were used respectively in place of 23ml.

The base was prepared following the method without incorporating the carbonized plant extract.

2.5       PHARMACOLOGICAL STUDY 2.5.1    ANIMALS AND MANAGEMENT: Thirty-six (36) Wistar albino rats male and female weighing between 150 g - 200 g were obtained from the Department of Experimental Pharmacology & Toxicology Animal House, University of Port Harcourt. They were sorted, and housed in standard cages with housing conditions consisting of 12 hours of light and dark cycles. They were fed with standard rat pellets and water ad libitum. The rats were maintained at room temperature and allowed to acclimatize to the new environment for two weeks.

2.5.2 DRUG: Commercially available Dermazin cream and Glibenclamide were used as the control drug. The Dermazin was applied topically over the wound area while the glibenclamide was administered orally.

 2.5.3 Induction of Diabetes: Diabetes was induced in the rats by using Alloxan Monohydrate (Sigma-Aldrich), a compound that has preferential toxicity towards pancreatic beta cells. Diabetic conditions were induced by a single intraperitoneal injection of Alloxan at a concentration of 150 mg/kg body weight in overnight fasted rats [15]. After three days of induction, blood samples were collected from the tail and measured using an Accu-Check glucometer. Animals with fasting blood glucose levels from 10 mMol/L and above were considered diabetic.

2.5.4 Evaluation of Wound Healing Effect of Pentaclethra Macrophylla on Excision Wound: On the fourth day after the induction of the Alloxan, the diabetic rats were randomly classified into 9 groups. Group 1 (Diabetic wounded and treated with cream base)

Group 2 (Diabetic wounded and treated with Dermazin cream + Glibenclamide) Group 3 (Diabetic wounded and treated with Dermazin cream) Group 4 (Diabetic wounded and untreated) Group 5 (Non-diabetic wounded and untreated) Group 6 (Diabetic wounded and treated with 4% cream of carbonized plant sample) Group 7 (Diabetic wounded and treated with 2.5% cream of carbonized plant sample) Group 8 (Diabetic wounded and treated with 1% cream of carbonized plant sample) Group 9 (Diabetic wounded and treated with 2.5% cream of carbonized plant sample + Glibenclamide)

Induction of Wound On the wounding day, the rats were anaesthetized with diethyl ether. prior to the creation of the wounds. The dorsal fur of the animals was shaved with an electric clipper and the area for excision was marked. Following proper aseptic techniques, a 1.5cm wound was created on the marked area. The wound was left for some days until it turned into an ulcer. The cream was applied gently to cover the ulcerated area once daily for 21 days. The wound area and rate of wound contraction were monitored [16].

 2.6       Estimation of Parameters Measurement of Wound Contraction: The wound healing progression was evaluated by the periodic measurement of the contraction of the excision site [17].

Wound contraction was monitored by tracing the outline of the wound on a tracing sheet and then using a graph sheet to calculate the area of the wound size. All animals in each group were monitored until complete healing of wounds occurred and the mean daily wound healing for all groups was calculated.

Wound healing was calculated by : 2.7 Histological Analysis of Tissues Following the conclusion of the experiment, the animals were sacrificed according to ethical guidelines and had histological tissue examination according to the procedure by Slaoui, et al [18].

 2.8       Statistical Analysis Tests were carried out in quadruplets and their values were expressed as mean ± standard error of mean (SEM). The One-way analysis of variance (ANOVA) was used to determine the significant differences amongst all groups against control and the P value < 0.05 was considered as significant. All statistical analysis was performed using Graph Pad Prism version 8.0 software.

RESULTS

3.1 Result of Quality Control Analysis Physicochemical analysis was carried out on the pulverized seed pod of Pentaclethra macrophylla Benth. The acid-insoluble ash (AIA), and water-soluble ash were determined as represented in Table 1. The result contained in Table 1 shows that the extract is free of inorganic residue as only 1% of AIA is present in the carbonized sample; which is negligible.

3.2 Pharmacological Studies Results Following wound induction, images were taken across the various test groups to show the rate of wound healing. These images are presented below:

3.3: Fasting Blood Glucose Results Alloxan was used to induce diabetes in the test animals. Their blood glucose levels were measured before and after induction. These values are represented in Table 2.

3.4 RESULTS OF HISTOLOGY The results of the histological investigations on the wound healing activities of the various test samples and the control groups are presented in Figure 4 – 12 below.

Table 1: Showing physicochemical parameters of the seed pod of Pentaclethra macrophylla Benth.

Figure 1: Wound contraction of different test groups on Days 1, 7 and 14.

Table 2: Table showing the blood sugar readings of the various groups, before induction, after induction, and on Days 7 and 14.

Table 3: Showing the mean and standard error of mean, of the wound contraction in centimeters (cm) on Days 7, 14 and 21.

Figure 2: Chart showing wound contraction in centimeters (cm) for control (Based treated, dermazin treated, diabetic and treated with dermazin plus drug, diabetic and untreated, non-diabetic and untreated, and test group (1% carbonized plant sample, 2.5% carbonized plant sample, 4% carbonized plant sample, 2.5% carbonized plant sample plus drug).

Figure 3: Chart of wound contraction in percentage (%) for control group (Based treated, dermazin treated, diabetic and treated with dermazin plus drug, diabetic and untreated, non-diabetic and untreated and test group (1% carbonized plant sample, 2.5% carbonized plant sample, 4% carbonized plant sample, 2.5% carbonized plant sample plus drug).

Figures 4 & 5

Figures 6 & 7

Figures 8 & 9

Figures 10 & 11

Figures 12: (2.5% CARBONIZED + DRUG) Photomicrograph of rat skin tissue showing distorted epidermal granules, scaring tissue, distinct collagen fibres with distinct nuclei. H & E, X400.

DISCUSSION

Pentaclethra macrophjylla Benth (Fabaceae) is a plant with a long history of traditional use in wound healing [10]. The result of the quality control analysis of the seed pod of Pentaclethra macrophylla is shown in Table 1. The acid-insoluble ash and water-soluble ash values are 1.0% and 2.5% respectively. High acid-insoluble ash values may indicate contamination or poor quality of the sample, affecting its suitability for various applications, while excessive water-soluble ash may suggest the presence of unwanted salts or substances, which can affect the product's quality, taste, or medicinal properties [19]. The low acid insoluble and water soluble ash values suggest that the sample has fewer non-volatile and inorganic contaminants.

DFU is a major complication of diabetes that results in increased hospitalization time, increased health costs, and even death [20].

The wound healing process is a myriad of events. These include homeostasis; the recruitment of platelets and other clotting factors in response to a leaking vessel, inflammation; which involves the invasion of macrophages and neutrophils to clear up any pathogens at the injury site, proliferation; which involves the keratinocytes and matrix deposition to enhance wound closure and remodeling; where collagen is remodeled to finish up the wound healing process [21]. The aim of this study was to compare the different strengths of the carbonized plant extract by evaluating their effectiveness in diabetic wound healing.

From the results obtained, the 2.5% + drug group gave the highest percentage of wound contraction. This was followed by the dermazin + drug group, which is not surprising as the drug; glibenclamide is a sulfonylurea that increases insulin sensitivity of cells. When comparing the Dermazin + drug and the 2.5% + drug groups, they both gave similar percentage wound contraction rates. However, comparing the 1%, 2.5%, and 4% carbonized drug groups, the 2.5% gave a comparable percentage of wound healing as the 4% group. While a comparison of the percentage contraction of the dermazin group to that of the 2.5 and 4% groups, revealed that these two groups demonstrated superior wound healing activities; pointing towards the powerful wound healing effects of the plant. When comparing the results of the 2.5% and 4% groups, it was bserved that the 4% group had a slightly higher wound healing rate from day 0 to 14, which was not statistically significant. But on day 21, the 2.5% treated group showed slightly better results; which were not statistically significant than that of the 4%; suggesting that the 2.5% extract would be the optimal dose for wound healing.

A comparison of the wound healing activities of the extracts and the positive standard, showed that the plant extracts gave a better wound healing profile. Despite the decline in the pursuit of natural products as potential drug leads, encouraging results, like this obtained by the plant extracts of P. macrophylla, provide hope for the use of natural products in disease treatment.

Conclusion

This study demonstrated the wound healing effect of the carbonized seed pod extracts of Pentaclethra macrophylla, with the 2.5% plant extract showing the optimal wound healing activity. This provides a foundation for further research on the plant and its potential as a therapeutic agent for diabetic foot ulcers.

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Cutaneous sarcoidosis case report  by Mohammed Abdul Qader AlMalmi in Journal of Clinical & Medical Case Reports, Images

Abstract 

Cutaneous and systemic sarcoidosis case report Sarcoidosis is an inflammatory disease that affects multiple organs in the body, but mostly the lungsand lymph glands. In people with sarcoidosis, abnormal masses or nodules (called granulomas) consisting of inflamed tissues form in certain organs of the body. These granulomas may alter the normal structure and possibly the function of the affected organ(s).

Objective :- to identify systemic and cutaneous disease in human body with bone marrow proliferation. Patients and Methods :- 54 years old man patient complained of fever and night sweats. He was missed diagnosed in Cairo by oncologist as diffuse large B cell lymphoma patient since 2007 due to involvement liver and lymgh nodes and he received treatment with Gemzar drug and he complete remission from liver damage . At 2015 complained of night sweats;, fever and loss of weight and high couph and reumatic pain miss diagnosed as tuberculosis T B in Jordan and he received treatment for one year without improvement. I received the patient in 2018 started appeared erythematous papulo nodular skin eruptions in his body I revised all his previous investigations . CBC , Bone marrow biopsy and aspiration, liver biopsy, hilar lymph node biopsy skin biopsy , immunohistochemical cytology zeil Nelson stain-ve ,PCR-VE, tuberclin test -ve ACE angiotenosin converting enzyme and liver function test were diagnostic plain chest xr-ay, ultrasound for liver . Results :- The clinical data and invistigations showed the pateint had non Caseating necrosis inflammatory granuloma in his thoracic lymph nodes and liver and skin most probably systemic and cutaneous sarcoidosis. Conclusion :- sarcoidosis is unknown etiology disease and treated with methotrexate and prednisolone orally with monitoring follow up. 

Keywords: Yemeni , male , patient , sarcoidosis , cutaneous

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Jesus Christ is the healer-Child Health Nursing Care Perspective by Mary Anbarasi Johnson in Journal of Clinical & Medical Case Reports, Images (JCMCRI) ISSN: 3064-8025

Introduction

In the realm of pediatric nursing, providing holistic care that encompasses physical, emotional, and spiritual dimensions is crucial for the comprehensive well-being of children and their families. From a Christian perspective, Jesus Christ is often viewed as the ultimate healer, whose compassionate and transformative approach to healing offers valuable insights for nursing practice. This perspective not only addresses the physical ailments of patients but also provides profound emotional and spiritual support, fostering a more resilient and hopeful outlook during challenging times.

Incorporating the belief in Jesus Christ as the healer into pediatric nursing care involves integrating spiritual support, therapeutic touch, and faith-based counseling into the care plans. This approach recognizes the importance of addressing the spiritual needs of children and their families, providing comfort and hope through prayer, scripture, and religious rituals. By creating an environment that supports Christian beliefs and collaborating with spiritual leaders, nurses can offer a comprehensive and compassionate care experience that aligns with the teachings of Jesus.

 Background: 

Pediatric nursing care aims to address the multifaceted needs of children, encompassing physical, emotional, and spiritual dimensions to promote comprehensive well-being. Traditionally, nursing has focused on the physical aspects of care, but there is a growing recognition of the importance of holistic approaches that integrate emotional and spiritual support. This holistic perspective is particularly relevant in the context of pediatric care, where young patients and their families often face significant stress and uncertainty.  The Christian faith, with its deep-rooted belief in Jesus Christ as the ultimate healer, offers a unique framework for providing holistic care. In the Gospels, Jesus is depicted as a compassionate healer who not only addressed physical ailments but also offered emotional comfort and spiritual restoration. His healing touch and words of reassurance brought profound transformation to those he encountered. This model of care emphasizes the interconnectedness of body, mind, and spirit, highlighting the importance of addressing all aspects of a person's well-being.

Integrating faith into nursing practice is not a new concept. Florence Nightingale, the founder of modern nursing, emphasized the role of spirituality in healing and advocated for the inclusion of spiritual care in nursing practice. Modern nursing theories, such as Jean Watson's Theory of Human Caring, also emphasize the importance of spiritual care in promoting holistic health. In pediatric nursing, the integration of spiritual care can be particularly impactful. Children, due to their developmental stages, often have a unique understanding of and relationship with spirituality. Providing spiritual support can help alleviate fear, anxiety, and emotional distress, offering a sense of peace and hope. For families, faith can be a vital source of strength and resilience during challenging times.

Research has shown that spiritual care can enhance patient outcomes, improve coping mechanisms, and foster a more positive healthcare experience. However, integrating spiritual care into pediatric nursing requires sensitivity, cultural competence, and a deep understanding of the family's beliefs and values. Nurses need to be equipped with the knowledge and skills to provide spiritual support that is respectful and meaningful to each individual child and family.

This background sets the stage for exploring how the Christian belief in Jesus Christ as the healer can be effectively integrated into pediatric nursing care. By drawing on biblical principles and contemporary nursing theories, this paper aims to provide practical strategies and insights for enhancing the holistic care of pediatric patients. From a Christian perspective, Jesus Christ is often regarded as the ultimate healer, providing not only physical healing but also emotional and spiritual restoration. Integrating this belief into pediatric nursing care can offer a holistic approach that supports the child's overall well-being. Here are some ways this perspective can be applied in nursing child care:

Holistic Care Approach

Spiritual Support: Providing spiritual care by praying with or for the child and their family, reading scriptures, or offering comforting religious rituals.

Emotional Support: Offering a compassionate presence, listening actively, and providing reassurance that aligns with Christian teachings of love, hope, and faith.

Integrating Faith into Care Plans

Incorporating Prayer: Including prayer as a part of the daily routine, either led by the nurse or inviting the family to participate.

Faith-Based Counseling: Utilizing Christian counseling techniques to address fears, anxieties, and emotional distress, helping children and families find peace through faith.

Therapeutic Touch and Healing

Jesus as the Model Healer: Emulating the compassionate and caring touch of Jesus, understanding that therapeutic touch can be a powerful tool in the healing process.

Faith in Healing: Encouraging children and families to have faith in the healing process, which can enhance their emotional resilience and positive outlook.

Education and Empowerment

Teaching about Jesus' Healing: Educating children and families about the stories of Jesus’ healing in the Bible, which can inspire hope and belief in recovery.

Empowering Families: Encouraging families to engage in their faith communities for support, providing them with resources such as pastoral care, church groups, and Christian literature.

Creating a Healing Environment

Faith-Friendly Spaces: Creating an environment that supports Christian beliefs, such as having Bibles, Christian music, or religious symbols available in the child’s room.

Community Support: Facilitating connections with faith-based support groups and resources, helping families feel supported by their faith community during difficult times.

Collaboration with Spiritual Leaders

Interdisciplinary Team: Collaborating with chaplains, pastors, and other spiritual leaders to provide comprehensive care that addresses the spiritual needs of the child and family.

Spiritual Assessments: Including spiritual assessments as part of the holistic nursing assessment to understand and respect the child’s and family’s faith practices and needs.

Conclusion

Integrating the belief in Jesus Christ as the healer into pediatric nursing care can enhance the holistic care provided to children and their families. By addressing physical, emotional, and spiritual needs, nurses can support the healing process in a comprehensive and compassionate manner, embodying the love and care that Jesus exemplified.

Conflict of Interests: None

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Complex psychological evaluation and correction methods of disorders in the emotional and personal sphere in children with post-COVID syndrome, considering structural and functional features of the brain by Inga A. Plotnikova in Journal of Clinical & Medical Case Reports, Images (JCMCRI) ISSN: 3064-8025

Abstract

Introduction: A number of systematic reviews on the PubMed and Scopus databases confirmed that post-COVID syndrome in children is a topical issue and is considered mainly in terms of the influence of social factors. The COVID-19 pandemic by itself and lockdown have created fear and anxiety around the world, leading to short- and long-term consequences for the psychosocial and mental health of children and adolescents. The reviews analyzed studies to understand the major effects of COVID-19 in children with the goal of developing effective treatment strategies. However, such strategies must be designed with consideration of the pathogenetic mechanisms that explain the deleterious effects of COVID-19 on the central nervous system. In the meantime, the evidence for long-term effects on neurodevelopment after COVID-19 should be further investigated. The timing of the resolving of neurological damage or the appearance of nervous dysfunction is still largely unclear, due to the fact that this disease has only recently become known to the world. The present study in this area aims to help in the rehabilitation of children after COVID-19. Purpose of the study. Development of rehabilitation programs for children with postCOVID syndrome, which is based on a comprehensive psychological assessment of the cognitive and emotional sphere, taking into account the structural and functional characteristics of the brain. Materials and methods. 25 children (9 girls and 16 boys) aged from 12 to 17 years were admitted to the hospital, among them 9 children were in a state of moderate severity of acute respiratory infections and indication of family contact with COVID-19 patients. 16 children had mild form of COVID-19 during the 12 months preceding the examination, including 8 children (50%) in the previous 4 months and 8 (50%) in the previous 6-12 months. The control group consisted of 25 students in Moscow (14 girls and 11 boys) aged from 12 to 16 years, who were examined before the pandemic. Examination methods consisted of 2 blocks. In the first block we investigated: kinesthetic, spatial, dynamic, graphic praxis; auditory-motor coordination; visual, object-constructive gnosis; auditory-verbal, visual memory; voluntary attention; and thinking. The second block of methods were “Eysenck Questionnaire” for studying three individual qualities: introversion - extroversion, neuroticism and deceit, “Lüscher Color Test. Diagnosis of a neuropsychic state,” adapted by V.I. Timofeeva, Yu.I. Filimonenko, which is an assessment of psycho-functional state (determination of the level of unproductive neuropsychic tension or total deviation from the autogenic norm; autonomic coefficient).

Results: Significant differences were found with the neuropsychological tests in the control group, suggesting impairment of memory, attention, visual gnosis, visuospatial function, kinesthetic and dynamic praxis, verbal and non-verbal components of thinking. In 85% of children with post-Covid syndrome, two primary colors are in the last three places of the color gamut in the Luscher test. In 65% of cases, the presence of gray is at the beginning of the color scheme. Compensatory mechanisms were observed in 55% of cases. Conclusions. Complex psychological examination in children with post-COVID syndrome has showed that the revealed changes in the emotional and personal sphere have a common pathogenesis with cognitive impairments (auditory-speech memory disorders, insufficiency of optical-spatial gnosis and praxis, verbal and non-verbal intelligence). Disorders of higher mental functions, changes in the emotional and personal sphere and the nature of neurological complaints indicate the involvement of the mediobasal parts of the brain, reticular formation, brain stem, basal ganglia, which provide energetic activation of brain activity and modally nonspecific brain functions. When developing neuropsychological rehabilitation programs for children with post-Covid syndrome, it is necessary to observe the principle of unity of diagnosis and correction, which makes it possible to determine the topic of brain damage in the relationship of the cognitive and emotional-personal spheres, to conduct restorative training using the method of “replacement dysontogenesis”, relying on intact functions.

Key words: pediatric neuropsychology, long-term consequences of COVID-19, neurocognitive tests, cognitive functions, disorders in the emotional and personal sphere.

Introduction

A sudden outbreak of infectious disease caused by SARS-CoV-2 has been officially named a novel coronavirus disease (COVID-19) by the World Health Organization [1]. As of September 2020, there were over 6 million reported cases in the United States [2], including 8.4% in children [3]. According to November 28, 2021, about 261 million people infected with COVID were registered worldwide [4].

In addition to detailed studies of respiratory symptoms associated with COVID-19, the occurrence of neurological and neuropsychoneurological complications of novel coronavirus infection, such as acute demyelinating encephalopathy, meningitis, strokes, etc., has been widely reported in the academic research. [5,6]. It was determined that novel coronavirus infection can worsen previous neurological disorders or cause new neuropsychiatric disorders. Neurological disorders were noted in 36.4% of patients with COVID-19 [6].

Relevance of research

A brief review of neurological conditions, potential mechanisms of their development, and possible outcomes of COVID-19 in the pediatric population was conducted at New York Presbyterian Morgan Stanley Children's Hospital, based on literatures and primary data.

In particular, among children with COVID-19 in the United States, 28% of them experienced headaches [7]. 31–47% of children, who diagnosed with multisystem inflammatory syndrome in New York City, had neurological symptoms, including headache, mental status changes, and encephalopathy [8–10].

A multicenter study of children with multisystem inflammatory syndrome in the USA found that 5% of them suffered from severe neurological complications such as seizures, coma, encephalitis, demyelinating disorders, as well as aseptic meningitis [10].

In a study of 27 children from 8 to 15 years old with multisystem inflammatory syndrome in the United Kingdom, 4 of them experienced neurological symptoms including encephalopathy, dysarthria, dysphagia, cerebellar ataxia and peripheral neuropathy that resulted in proximal limb muscle weakness and decreased reflexes. As the same time according to MRI or CT data, all of them showed changes, which localized in the posterior part of the corpus callosum [11].

In summary, a number of systematic reviews conducted on the basis of PubMed and Scopus data confirm that post-COVID syndrome in children is a topical issues, which is considered mainly in relation to social factors. The COVID-19 pandemic itself and lockdown have created fear and anxiety around the world, leading to short- and long-term consequences for the psychosocial and mental health of children and adolescents. The quality and severity of the impact on juveniles is determined by many susceptibility factors, such as developmental age, educational status, pre-existing mental health conditions, economic disadvantage, or being quarantined due to infection or fear of infection.

A recent narrative review analyzed the main consequences of COVID-19 in children to develop effective treatment strategies [12]. However, such strategies must be designed with consideration of the pathogenetic mechanisms that explain the deleterious effects of COVID-19 on the central nervous system. For example, transcriptomic analysis has shown low but consistent expression of angiotensin converting enzyme 2 (ACE2) [13] and transmembrane serine protease 2 (TMPRSS2) [14] in various regions of the human brain, which are required for SARS-CoV-2 invasion. The effect of the SARS-CoV-2 virus on the blood-brain barrier is an interesting area of research. In particular, the development of microglia over the lifespan may provide insight into the mechanism of neuroplasticity and injury in childhood, keeping in mind that microglia acquire a phenotype consistent with a proinflammatory response [15].

COVID-19 is also associated with cerebrovascular changes due to the interaction of the virus with ACE2 receptors, which were expressed on vascular endothelial cells at different parts of the central nervous system. These changes could initiate vasculitis and disruption of vascular integrity through activation of the coagulation cascade [16]. Vascular problems have also been reported in previously healthy children and young adults [17,18].

In children with multisystem inflammatory syndrome, neurological symptoms have been found in 12–58% of cases [19]. Neuroinflammation can trigger depression and post-traumatic stress disorder by increasing tryptophan degradation, which leads to a subsequent decrease in 5-hydroxytryptamine and serotonin levels, as well as dysregulation of NMDA receptor activity [20]. Guillain-Barré syndrome, a demyelinating disease of the peripheral nervous system mediated by post-infectious autoimmune reactions, has been associated with SARS-CoV-2 and has responded to typical intravenous immunoglobulin treatment [21,22].

The long-term impact on neurodevelopment following COVID-19 requires further study. Time to achieve remission of neurological damage or onset of dysfunction is still largely unclear since this disease has only recently become known to the world.

This research aims to help children recover from COVID-19.

Multidisciplinary approach

Inclusion of a psychological examination in the diagnosis of children with post-COVID syndrome is dictated by practical necessity. Neuropsychological symptoms reflect “subtle” functional changes in brain tissue. Currently, in psychiatry and neurology, studies of the cognitive and emotional sphere, which based on the neuropsychological method, have become firmly established in the scientific and research practice of medical specialists and psychologists. New research in these areas is relevant for clinical psychology (primarily neuropsychology), pediatrics, psychiatry and neurology [23-26].

The neuropsychological approach is the most promising way to evaluate disorders in the formation of higher mental functions, opening the following possibilities: the study of changes in the structure of mental functions; the relationship between maturing brain structures and developing mental functions; the correlation of the revealed deficit of mental activity with specific brain dysfunctions or immaturity of brain activity.

The theoretical and methodological basis of this study is as follows

Modern ideas of Russian psychology about higher mental functions as complex self-organizing processes, social in their origin, mediated in their structure, conscious, arbitrary in the way of their implementation, presented in the works of \

The theory of systemic dynamic localization of higher mental functions and the concept of three structural and functional blocks of the brain A.R. Luria and his followers E.D. Chomsky, E.G. Simernitskaya, T.V. Akhutina and others [24].

Psychological and neuropsychological concept of ontogenesis as a sequence of qualitative transitions to new stages of development based on the internal reorganization of individual functions, interfunctional connections and the formation of new systems.

Studies by A.M. Prikhozhan, C.D. Spielberger, O.S. Nikolskaya, E.V. Ustinova, E.V. Fadeeva, aimed at studying the emotional and personal sphere of children with developmental disorders and their families [25,26].

Purpose of the study: Development of rehabilitation programs for children with post-COVID syndrome, which is based on a comprehensive psychological assessment of the cognitive and emotional sphere, taking into account the structural and functional characteristics of the brain.

Research objectives

Evaluation of cognitive functions: mnestic, speech, optical-spatial and thinking structure in children with post-COVID syndrome in comparison with healthy children.Determination of structural and topological factors that influence the changes in higher mental functions of children who have suffered from COVID-19.Analyzing the role of individual links in the structure of the emotional and personal sphere which is in the implementation of the holistic process of perception, communication, learning and social adaptation in children after disease.Development of a corrective-developmental program aimed at activating the cognitive functions and emotional-personal relations of children with post-COVID syndrome.

Organization of the study

Adaptation of existing neuro-psychological tests of the A. R. Luria school to be performed in an online format, without face-to-face presence of children.

Development of a methodology for psycho-emotional and neuro-psychological testing of children in a remote format using digital technologies.

Neuro-psychological testing of children who were receiving round-the-clock treatment in the eighth Children's Hospital in Yekaterinburg [27].

Full-time testing of the emotional and personal state of children who have had COVID 19 in a day hospital setting.

Materials and methods

25 children (9 girls and 16 boys) aged from 12 to 17 years were admitted to the hospital, among them 9 children were in a state of moderate severity of acute respiratory infections and indication of family contact with COVID-19 patients. 16 children had mild form of COVID-19 during the 12 months preceding the examination, including 8 children (50%) in the previous 4 months and 8 (50%) in the previous 6-12 months. The control group consisted of 25 students in Moscow (14 girls and 11 boys) aged from 12 to 16 years, who were examined before the pandemic [27].

First block of techniques: The neuropsychological examination included: assessing visual-spatial gnosis and praxis (Henry Head's test, recognizing the time by a clock without arrows, test for understanding of logical-grammatical constructions); dynamic praxis (fist-edge-palm test); on mnestic functions of memory (auditory-verbal and visual memorization); object gnosis (recognition of realistic images, crossed out, superimposed and unfinished images); assessment of thinking (tests for understanding the meaning of story pictures, "Fourth extra" method, problem solving).

Second block of techniques: The Eysenck Questionnaire is aimed at the study of three individual qualities of a child: introversion - extroversion, neuroticism and deceit.

Based on the analysis of the emotional and personality sphere, the approaches to understanding the psycho-physiological nature of fears and anxiety in children; clinical approaches to the assessment of interpersonal relationships and behavior were taken [23-28]. They consist of “Lüscher Color Test. Diagnosis of a neuropsychic state,” adapted by V.I. Timofeeva, Yu.I. Filimonenko, which is an assessment of psycho-functional state (determination of the level of unproductive neuropsychic tension or total deviation from the autogenic norm; autonomic coefficient).

Results and discussion

In the main group, 12% of children had pneumonia, 8% with acute bronchitis, and 80% of them suffered acute respiratory infections with pulmonary syndrome. Eighty-four percent of children had a fever for 4 to 7 days (t 38.2-39.6 °C), while the remaining 16% were at normal body temperature. Familial contact with patients with new coronavirus infection was noted in all patients, and positive nasopharyngeal swab analysis for SARS-CoV-2 RNA by PCR in 58% of children. Peripheral oxygen saturation (SpO2) of 92-94% was in 25% of them. Severe concomitant pathology in a state of compensation before the acute illness was in 1 child of 13 years (bronchial asthma, condition after liver transplantation for congenital biliary atresia, chronic hepatitis B) [27].

44% of patients had no neurologic complaints. 54% of children self-reported that they had nervous system complaints after a coronavirus infection. One patient reported short-term amnesia. Five children were diagnosed by a neurologist for the first time after the infection, including 2 children with cerebroasthenic syndrome, 1 child with vegetative dystonia syndrome, 1 child with attention deficit syndrome, and 1 child with radiculopathy [27].

Results of neuropsychological diagnostics: When evaluating and analyzing the obtained results, age standards for performing tests were taken into account. The severity of the disorders was determined using a point system from 0 (no disorders) to 3 points (presence of a pronounced defect). The difficulty level of the techniques included in the neuropsychological examination was determined by the possibility of independent and correct performance by the majority (>75%) of adolescents in the control group at the corresponding age group [27].

Analysis of the neurodynamic component of mental activity: Voluntary attention. Low pace of task completion, rapid exhaustion, distractibility, impaired concentration of attention in patients of the main group compared to children in the control group (p <0.001), according to the number of errors when performing tests in the Schulte Table method (Fig. 1). This indicates insufficient activation of the energetic component of activity. Lesions were assumed in the brainstem, limbic structures, reticular formation, or medio basal frontotemporal regions of the brain.

Figure 1: Neurodynamic component of mental activity.

- Mnestic functions in children of the main group.

Significant statistical differences were revealed in the control group in the auditory-verbal direct memory test (1) (p=0.002) (Fig. 2). The nature of errors in memorizing 10 words included an increase in the latency period, verbal paraphasias ("'friend' instead of 'brother', 'pie' in place of 'cake'); verbal perseverations; lack of regulation and control.

When performing the test “Memorization of two phrases” (semantic memorization), the influence of heterogeneous interference, volume reduction and order disruption of representation, changes in the grammatical structure of speech (by gender, number, case) were observed.

The lesion was in mediobasal frontotemporal parts of the brain with the formation of the leading temporal neuropsychological syndrome (T2).

Figure 2: Mnestic functions of different modalities - auditory verbal and visual memorization: direct memorization (1), memorization of two phrases (2) and visual memorization (3) of the main and control groups.

Optical-spatial gnosis

The success of performance in performing opto-spatial gnosis tests was significantly different in the main and control groups. In Figure 3: 1 - recognition of crossed-out images (p=0.265), H=2.659<Hcr; 2 - recognition of superimposed images (p=0.434); 3 - recognition of underdrawn images (p<0.001), H=18.377 >Hcr.

The test for identifying unfinished images, which requires the realization of a complete image, allows us to assess the formation of a holistic strategy of information processing. In result, simultaneous agnosia was revealed. Affected areas were the temporo-parietal-occipital regions of the brain.

Figure 3: The study of optical-spatial gnosis

Graphic praxis.

A battery of neuropsychological methods was used to study visual-spatial gnosis and praxis, including copying (houses, figures with re-coding), a test for understanding logical-grammatical relations, recognizing time using a “blind” clock. Children in the main group made the following types of errors: topological (changes in the general scheme of the figure), metric (errors in estimating distances, angles and proportions), coordinate errors in the arrangement of an object (top-bottom and right-left). In Figure 4: 1 – recognition of time using a “blind” clock, (p <0.001); 2 – understanding of logical-grammatical constructions (p=0.5); 3 - copying a figure with 180º rotation; (p=0.265); 4 – copying a perspective drawing (house) (p=0.002).

The impairment of visual-spatial perception indicates weakness of the temporo-parietal-occipital regions of the brain, which may lead to difficulties in learning geometry and stereometry in children.

Figure 4: The studying result of visuospatial function

Study of motor functions (kinesthetic and dynamic praxis).

For the study of kinesthetic praxis, we used two-handed tests with visual control, and dynamic praxis, which was the “fist-edge-palm” technique. The analysis of the children's performance of these tests was carried out according to the following parameters: serial organization of movements, retention and assimilation of the motor program, the presence of perseverations and errors in the serial organization of movements. The severity of dynamic praxis disorders in children of the main group significantly exceeded that in the control group (p <0.001). In Figure 5: 1 - p=0.365; 2 - p=0.002.

The lesions were localized in convexital frontal parts of the brain under dynamic and regulatory apraxia. Kinesthetic apraxia results as a symptom of inferior parietal syndrome.

Figure 5: Study of motor functions

Study of thinking structure (verbal and non-verbal components).

When assessing verbal thinking, the following methods were used: composing a story based on story pictures (p <0.001), “Fourth extra” (p = 0.5). When assessing nonverbal thinking, tests for performing mathematical actions and operations; solving arithmetic problems (p=0.435) were used (Fig. 6).

The topical lesion in verbal thinking deficiency is prefrontal regions. For insufficiency of nonverbal thinking the damage location is in the temporo-parietal-occipital regions of the brain.

Figure 6: Study results of thinking

Study results of the emotional and personal sphere

Analysis of the study of the emotional and personal sphere in children with post-COVID syndrome using the Eysenck technique

Some children from the main group fall into the category with passive action, which correlates with a high level of neuroticism combined with introversion and deceit. Their lack of self-confidence can lead to withdrawal from communication, isolation, and complexes. Such children are afraid of making a mistake, to cause anger or displeasure of adults. Therefore, they may not answer the question even when they know the correct answer, and their deceit is associated with the desire to please the experimenter. In addition, these children may show aggressive behavior, which is a defense against their anxiety and self-doubt. In unfavorable circumstances, these children may develop depression and phobias, i.e. unmotivated fears (of darkness, heights, enclosed spaces, etc.).

Analysis of the study results of the emotional and personal sphere in children with post-COVID syndrome using the M. Lüscher color test

The core of M. Lüscher's concept comes from the assertion that all people (and more widely living organisms) live and act in approximately the same color environment. Therefore, a number of typical life situations occur when certain color tones dominate. For instance, we see the blue color of the sky in the vast majority of cases, being passive and inactive; red color (fire, blood, mature food, etc.), is generally combined with high activity of the subject, etc.

According to the principles of higher nervous activity, constant combination of certain colors with typical life situations leads to the association of color as an element of life situation, psychophysiological state, energy mobilization, and behavior stimulated by a given situation.

Figure 7: Basic colors of the Lüscher test.

The record of the subject's choices is made in conventional numbers: gray - 0, dark blue - 1, green - 2, orange-red - 3, yellow - 4, purple - 5, brown - 6, black - 7 (Fig. 7).

If at least one of the primary colors is in the last three places of the color scheme, then it and the subsequent colors indicate a state of anxiety. The method of alarm compensation is determined by the characteristics of the color in the first position.

If, in the presence of anxiety, one of the primary colors is in first place, then compensation is considered more successful than in the case of an additional one, which indicates the inadequacy and failure of compensatory behavior.

The presence of gray, brown or black at the beginning of the color range indicates a negative view of life. If one of these colors stands on second or third place, it itself and all the colors to the left of it are considered as compensation.

Among children with post-COVID syndrome the two main colors stand in the last three places in 85% of cases. In 65% of cases, the presence of gray is at the beginning of the color scheme. Compensatory mechanisms are traced in 55% of cases.

Changes in the structure of the emotional sphere are a consequence of insufficiency of the limbic structures and the medio-basal frontal and temporal regions of the cerebral cortex. Lesions of medio-basal cortical sections are a part of the first (energetic) block. Damage to this cortical zone leads to the disruption of modally nonspecific factors, manifested in other disorders of mental functions.

Medio-basal sections of the temporal cortex are part of the limbic, which is characterized by very complex functions. These include regulation of the level of wakefulness, emotional states, memory processes, consciousness, etc. The lesion of temporal parts of the brain causes distinct emotional disorders, which are classified in the psychiatric literature as affective paroxysms (in the form of attacks of fear, sadness, horror), accompanied by violent autonomic reactions. These paroxysms usually precede (as an aura) general convulsive epileptic seizures. Long-term shifts in affective tone are also common. The nature of emotional disorders to a certain extent depends on the side of the lesion [23,26].

Complaints noted in children with post-COVID syndrome during classical neurological examination (taste and smell disorders were 32%; headaches - 12%; myalgia -8%; numbness or tremor of the hands - 8%; hand sweating -8%; dizziness or “darkening in the eyes” when tilting the head - 12%; weakness, fatigue, decreased tolerance to physical activity - 20%; memory impairment, decreased academic performance - 28%; mood swings, irritability - 8%, weather dependence - 8%, dyssomnias, weakness in legs, attention deficit, hyperkinesis - 4% each, persistent tremor of one hand in one case) also indicate the insufficiency of medio-basal parts, reticular formation, brain stem, basal ganglia, which provide energetic activation of brain activity and modally nonspecific brain functions.

Approaches to psychological correction of cognitive impairments in children with post-COVID syndrome

Neuropsychological rehabilitation is a complex medical-psychological-pedagogical impact on the defect, taking into account its mechanism, providing appeal to the patient’s personality, to the patient's small social groups (therapeutic group, family, work team), aimed at the restoration of higher mental functions as the main task, the solution of which allows to achieve the ultimate goal, the psychological rehabilitation of the patient, i.e. restoration of his personal and social status [29].

The main principles of correctional and developmental work are the following [30]:

The principle of unity of diagnosis and correction

The principle of normativity of development

“Bottom-up” correction principle

Principle of systematic development of mental activity

Activity principle of correction

The development of rehabilitation programs for children with post-COVID syndrome, which is based on a comprehensive psychological assessment of the state of the cognitive and emotional spheres, taking into account the structural and functional features of the brain, requires multidisciplinary coverage and in-depth study of theoretical foundations and principles. We have outlined the main contours of this approach, which is the development of a correctional and developmental program. This program is aimed at activating the cognitive functions and emotional and personal relationships of children with post-COVID syndrome.

In developing effective treatment strategies for cognitive and emotional disorders as consequences of COVID-19 in children, we relied on both foreign scientific studies in recent years and Russian heritage. In the first case, we are talking about cognitive rehabilitation of children with an emphasis on cognitive remediation [31]. In the second case, we are talking about the Russian heritage – psychological and pedagogical [32, 33]. Thus, in the context of developing correctional-developmental programs that activate cognitive functions and correct emotional-personal relations of children with post-COVID syndrome, we rely on the theory of P.Ya. Galperin [33] about the “third type of learning”, about “cognitive motivation”, about the orientation basis of the child’s actions that determines learning. P.Y. Halperin's provisions are easily "read out" from the texts of authors who offer cognitive remediation programs for children before the "era" of COVID-19 and for children with post-COVID syndrome. It is about the principles of learning, about the so-called "strategic monitoring", directing the child's activity in the right direction, about reproducing the skill and transferring it into real, everyday life - in other spheres, and on other material [34, 35].

The correctional and developmental program, the contours of which we are developing, is basically developmental training that links together affective, cognitive and behavioral components, and includes various kinds of motivational reinforcements.

For example, speech function in ontogenesis is realized in three modalities: auditory-verbal, visual, and kinesthetic. Children with post-COVID syndrome were found to have impaired auditory-speech perception, which led to dysgraphia and dyslexia. To eliminate these defects, it is necessary to build a rehabilitation training program based on preserved functions through visual perception and kinesthetic praxis. In other words, to eliminate agrammatisms in writing, it is necessary to remove the use of dictations (auditory analyzer), and switch the training to visual perception (using tables and rewriting texts).

Conclusions

Comprehensive psychological diagnostics of children with post-COVID syndrome showed that the revealed changes in the structure of emotional and personal sphere have a common pathogenesis with cognitive impairments (disorders of auditory-speech memorization, insufficiency of optical-spatial gnosis and praxis, verbal and non-verbal intelligence).

Disorders of higher mental functions, changes in the emotional and personal sphere and the nature of neurological complaints indicate insufficiency of medio basal parts, reticular formation, brain stem, basal ganglia, which provide energetic activation of brain activity and modally nonspecific brain functions.

When developing neuropsychological rehabilitation programs for children with post-COVID syndrome, it is necessary to observe the principle of unity of diagnosis and correction, which makes it possible to determine the topic of brain damage in the relationship between the cognitive and emotional-personal spheres, to conduct rehabilitation training using the method of “replacing dysontogenesis”, with reliance on preserved functions.

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Title Page:

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Case Report: Description of important materials and equipment, including manufacturer's name and location. Brief description of main clinical features and investigations

Discussion: Interpretation of results, logical presentation of the problem, and scope for further exploration

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For more information regarding author guidelines: https://jcmcrimages.org/author-guidelines/

[jcmcri]

Complex psychological evaluation and correction methods of disorders in the emotional and personal sphere in children with post-COVID syndrome, considering structural and functional features of the brain by Inga A Plotnikova* in Journal of Clinical & Medical Case Reports, Images (JCMCRI)

Abstract Introduction: A number of systematic reviews on the PubMed and Scopus databases confirmed that post-COVID syndrome in children is a topical issue and is considered mainly in terms of the influence of social factors. The COVID-19 pandemic by itself and lockdown have created fear and anxiety around the world, leading to short- and long-term consequences for the psychosocial and mental health of children and adolescents. The reviews analyzed studies to understand the major effects of COVID-19 in children with the goal of developing effective treatment strategies. However, such strategies must be designed with consideration of the pathogenetic echanisms that explain the deleterious effects of COVID-19 on the central nervous system. In the meantime, the evidence for long-term effects on neurodevelopment after COVID-19 should be further investigated. The timing of the resolving of neurological damage or the ppearance of nervous dysfunction is still largely unclear, due to the fact that this disease has only recently become known to the world. The present study in this area aims to help in the rehabilitation of children after COVID-19. Purpose of the study. Development of rehabilitation programs for children with postCOVID syndrome, which is based on a comprehensive psychological assessment of the cognitive and emotional sphere, taking into account the structural and functional characteristics of the brain.

Materials and methods. 25 children (9 girls and 16 boys) aged from 12 to 17 years were admitted to the hospital, among them 9 children were in a state of moderate severity of acute respiratory infections and indication of family contact with COVID-19 patients. 16 children had mild form of COVID-19 during the 12 months preceding the examination, including 8 children (50%) in the previous 4 months and 8 (50%) in the previous 6-12 months. The control group consisted of 25 students in Moscow (14 girls and 11 boys) aged from 12 to 16 years, who were examined before the pandemic. Examination methods consisted of 2 blocks. In the first block we investigated: kinesthetic, spatial, dynamic, graphic praxis; auditory-motor coordination; visual, object-constructive gnosis; auditory-verbal, visual memory; voluntary attention; and thinking. The second block of methods were “Eysenck Questionnaire” for studying three individual qualities: introversion - extroversion, neuroticism and deceit, “Lüscher Color Test. Diagnosis of a neuropsychic state,” adapted by V.I. Timofeeva, Yu.I. Filimonenko, which is an assessment of psycho-functional state (determination of the level of unproductive neuropsychic tension or total deviation from the autogenic norm; autonomic coefficient).

Results: Significant differences were found with the neuropsychological tests in the control group, suggesting impairment of memory, attention, visual gnosis, visuospatial function, kinesthetic and dynamic praxis, verbal and non-verbal components of thinking. In 85% of children with post-Covid syndrome, two primary colors are in the last three places of the color gamut in the Luscher test. In 65% of cases, the presence of gray is at the beginning of the color scheme. Compensatory mechanisms were observed in 55% of cases. Conclusions. Complex psychological examination in children with post-COVID syndrome has showed that the revealed changes in the emotional and personal sphere have a common pathogenesis with cognitive impairments (auditory-speech memory disorders, insufficiency of optical-spatial gnosis and praxis, verbal and non-verbal intelligence). Disorders of higher mental functions, changes in the emotional and personal sphere and the nature of neurological complaints indicate the involvement of the mediobasal parts of the brain, reticular formation, brain stem, basal ganglia, which provide energetic activation of brain activity and modally nonspecific brain functions. When developing neuropsychological rehabilitation programs for children with post-Covid syndrome, it is necessary to observe the principle of unity of diagnosis and correction, which makes it possible to determine the topic of brain damage in the relationship of the cognitive and emotional-personal spheres, to conduct restorative training using the method of “replacement dysontogenesis”, relying on intact functions.

Key words: pediatric neuropsychology, long-term consequences of COVID-19, neurocognitive tests, cognitive functions, disorders in the emotional and personal sphere.

[jcmcri]

Journal of Clinical & Medical Case Reports, Images (JCMCRI)

Welcome to the Journal of Clinical & Medical Case Reports, Images (JCMCRI) where innovation meets exploration in the realm of peer-reviewed open access publishing. Our journal serves as a dynamic platform for showcasing ground-breaking research across various formats including Case Reports, Clinical Images, Case Studies, Short Communications, Commentaries, Technical Notes, Review Opinions, and Brief Notes. Spanning a broad spectrum of Scientific, Clinical, and Medical Sciences, we pride ourselves on fostering a diverse array of scholarly contributions.

At the heart of our mission are Case Reports, the cornerstone of medical literature. These meticulously documented single clinical observations embody a venerable tradition in scientific discourse. They serve as invaluable reservoirs of uncommon insights, often catalysing new avenues of research and innovation in clinical and medical practice. Additionally, Case Studies offer illuminating glimpses into the decision-making process, empowering fellow physicians with the tools of lateral thinking to navigate their own clinical challenges. Particularly in the context of rare diseases, these studies assume paramount significance, enriching our collective understanding of complex medical phenomena.

Our commitment extends to nurturing a collaborative environment that transcends geographical boundaries. We actively encourage clinical and medical professionals, scientists, doctors, professors, and academicians to contribute their latest findings and emerging insights. By providing a dedicated platform for the dissemination of unique, unusual, and rare cases, we aspire to elevate the discourse surrounding disease processes, diagnostics, and management on a global scale.

Join us in our quest to illuminate the frontiers of medical knowledge and make a lasting impact on the landscape of clinical and medical sciences worldwide.

Submit your research here: https://jcmcrimages.org/submit-manuscript/

For more information, regarding our Journal please visit: https://jcmcrimages.org/journal-aims-and-scope/