Doctors of the World

Mucopolysaccharidosis type I is a rare metabolic disorder characterized by the accumulation of glycosaminoglycans, leading to musculoskeletal disorders such as carpal tunnel syndrome. This retrospective cohort study was performed to determine the prevalence and timing of the development of carpal tunnel syndrome, assess the efficacy of surgery on recurrence and the effect of haematopoietic stem cell transplantation in resolving accumulated degradation products. Thirty-three mucopolysaccharidosis type I patients, born between 2001 and 2023, were included in this study. They received annual screening and treatment at our specialist hospital. Patient demographics, clinical symptoms of carpal tunnel syndrome pre- and post-carpal tunnel release and histopathological sections of the flexor retinaculum were collected. Regression analyses were conducted to assess cumulative risks and determine hazard ratios and survival curves were plotted. Twenty-seven of 33 mucopolysaccharidosis type I patients, with a median age at the latest follow-up of 13 years (IQR 7.7 to 18.3), were diagnosed with carpal tunnel syndrome on electrophysiological tests or ultrasound at a median age of 3.6 years (IQR 2.8 to 5.2). Only a few patients exhibited clinical symptoms. Twenty-one patients underwent carpal tunnel release and 13 patients experienced recurrence. The highest risk of developing carpal tunnel syndrome was within the first 6 years of life. Eight of the 11 patients accumulated degradation products within lysosomes despite successful haematopoietic stem cell transplantation. In this study, 27 mucopolysaccharidosis type I patients were diagnosed with carpal tunnel syndrome, showing a high-risk window from 0 to 6 years of age. Recurrence of carpal tunnel syndrome after carpal tunnel release surgery was common, occurring in 61.9% of patients. III.

Since the 2022 full-scale invasion of Ukraine, civilians have experienced substantial war-related trauma, yet little is known about the prevalence and risk factors of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) among internally displaced persons (IDPs) actively seeking medical or psychological care. To examine the prevalence of PTSD and CPTSD in a clinical sample of Ukrainian IDPs, compare diagnostic rates between psychological and medical treatment-seekers, and identify sociodemographic and war-related predictors of diagnostic outcomes. A total of 224 adult IDPs attending an outpatient clinic in Chernivtsi oblast completed the International Trauma Questionnaire. Descriptive statistics, bivariate analyses, and multinomial logistic regression models were used to assess prevalence and identify predictors of PTSD and CPTSD. In the full sample, 24.5% met criteria for ICD-11 PTSD and 7.6% for CPTSD. Among psychological treatment-seekers, prevalence was higher (PTSD: 28.3%; CPTSD: 9.0%) compared to those seeking exclusively medical care (PTSD: 13.8%; CPTSD: 3.4%). Losing someone close due to the war significantly predicted both PTSD and CPTSD in the final multivariable model, while male gender independently predicted CPTSD. PTSD rates in this sample were broadly comparable to global estimates for conflict-affected populations, whereas CPTSD prevalence appeared lower than that reported in other Ukrainian samples. Relocation to safer areas within one's own country-without the additional stressors associated with forced international migration-together with the relatively older age of the sample, may have contributed to a reduced CPTSD risk. Sociocultural expectations surrounding masculine roles during wartime might also play a role in male vulnerability to CPTSD, though further evidence is needed. Individuals bereaved by the war may represent a subgroup at heightened risk, highlighting the potential value of targeted psychosocial support. Longitudinal, multi-site studies with diverse samples are needed to clarify symptom trajectories and contextual risk factors in displaced civilians.

ABSTRACT In “Images of the Past” we introduce the times, life and philosophical formation of the early twentieth century German Jewish philosopher and pioneering cultural critic Walter Benjamin. We discuss his theories of experience and nonsensuous similarities and refer to his masterpiece “Berlin Childhood around 1900” to examine these and other key concepts in his work. Representing a peak in his exceptionally fecund and still immediately relevant contribution, the book is a profound meditation on childhood, memory, language and long experience (Erfahrung), and a vivid illustration of his concept of the “social unconscious.”

WHO’s mandate to provide evidence on health effects must be restored

IntroductionSleep disturbances are prevalent among primary care patients, and psychological dysfunction, including stress, anxiety, and depression, are robust contributors to poor sleep health. Yet, the presence of potential protective characteristics, such as health self-efficacy and engaging in adaptive health behaviors, may mitigate such outcomes. Gratitude (i.e., recognition and appreciation of experiences, relationships, and surroundings), a positive psychological cognitive-emotional characteristic, may serve as a catalyst of these beneficial downstream effects, given its association with improved health functioning and sleep.MethodsIn a sample of primary care patients (N = 869, M age = 53; 60.7% female) from 50 urban and 30 rural practices in Germany, health self-efficacy (i.e., belief in ability to perform necessary actions to manage health) and constructive health behaviors (i.e., actions taken to modify health positively), separately and together as parallel first-order mediators, and stress, anxiety, and depression, as parallel second-order mediators, were investigated as potential serial mediators of the association between gratitude and sleep disturbances. Participants completed self-report measures in person and online.ResultsSignificant serial mediation was observed across models, although effects varied. In the first model, gratitude was associated with greater health self-efficacy and, in turn, to less stress (a1d21b4 = −0.019, 95% CI [−0.039, −0.002], SE = 0.010), anxiety (a1d31b5 = −0.026, 95% CI [−0.045, −0.008], SE = 0.009), and depression (a1d41b6 = −0.020, 95% CI [−0.040, −0.003], SE = 0.009), and fewer consequent sleep disturbances. In the second model, health behaviors, and anxiety (a1d31b5 = −0.009, 95% CI [−0.019, −0.002], SE = 0.004) and depression (a1d41b6 = −0.007, 95% CI [−0.016, −0.001], SE = 0.004), were serial mediators, but health behaviors and stress were not. In a final combined model, serial mediation occurred on two pathways, health self-efficacy and anxiety (a1d41b6 = −0.026, 95% CI [−0.046, −0.009], SE = 0.009), and health self-efficacy and depression (a1d51b7 = −0.019, 95% CI [−0.037, −0.003], SE = 0.009), and a specific indirect effect was found for health behaviors (a2b4= −0.086, 95% CI [−0.140, −0.030], SE = 0.026), but not self-efficacy.DiscussionOverall, gratitude was associated with reduced sleep disturbances through positive health behavior engagement, and via the serial mediation effects of greater health self-efficacy and lower psychological distress. Clinical interventions that enhance gratitude (e.g., gratitude listing or diaries), self-efficacy (e.g., disease self-management programs), or health behavior engagement (e.g., weight management programs) may promote favorable downstream effects on psychological distress and sleep disturbances among primary care patients.

Rheumatoid arthritis (RA) is a complex autoimmune disease causing chronic joint inflammation and, in more serious cases, organ involvement. RA typically affects people between the ages of 35 and 60; however, it can also afflict children younger than the age of 16 years and can also demonstrate a pattern of remission later in the disease course. Non-steroidal anti-inflammatory drugs, glucocorticoids, exercise, and patient education are all used in the management of RA, which is divided into symptomatic management and disease-modifying management (disease-modifying antirheumatic drugs) to reduce pain and inflammation, thereby preserving joint function. Janus kinase inhibitors (JAKis) have led to a substantial improvement in the management of RA. By specifically targeting the JAK-signal transducer and activator of transcription pathway, which is essential for immunological modulation, these inhibitors also demonstrate promise in treating various autoimmune illnesses, including inflammatory bowel diseases, giant cell arteritis, ankylosing spondylitis, and psoriatic arthritis. Tofacitinib, baricitinib, upadacitinib, peficitinib, delgocitinib, and filgotinib are examples of FDA-approved JAKis that have distinct properties and indications for treating a range of autoimmune illnesses. JAKis demonstrate a promising treatment approach for managing RA and other autoimmune diseases while enhancing patient outcomes and quality of life. However, due to major safety concerns and the need for long-term success, meticulous patient monitoring is essential.