Search

Background: Recovery processes during residential treatment for eating disorders, especially in patients with a history of maltreatment, are insufficiently understood. This study aimed to explore the temporal relationships among comorbid factors, including depression, anxiety, and self‐compassion, with the influence of childhood maltreatment. Method: Using Dynamic Time Warp (DTW), weekly scores from the Symptom Checklist‐5, Eating Disorder Examination, and Self‐Compassion Scale were analysed over 12 weeks. The study generated undirected and directed networks to identify influential symptoms in a transdiagnostic sample, comparing patients with and without childhood maltreatment. Results: The study included 124 patients with eating disorders (ED) (97% women), mean age of 30.9 years (SD = 9.7, range 18–61 years). Diagnoses included anorexia nervosa (26%), bulimia nervosa (38%), and other specified feeding and eating disorders (36%). The directed DTW network showed that hopelessness, worrying, and restlessness had the highest out‐strength, predicting changes in self‐compassion and ED behaviour. In maltreatment cases, hopelessness and low acceptance predicted changes, while worry, restlessness, and nervousness were predictive in non‐maltreatment cases. Conclusion: Temporal network analyses suggest that a change in hopelessness, worrying, and restlessness drives symptom improvement in ED behaviour and the development of self‐compassion during residential treatment. These processes vary between patients with and without a history of childhood maltreatment separately, indicating the need for further analyses. Key points: Temporal network analysis can contribute to further advances in personalised medicine.Our study indicates that patients with eating disorders (ED) and a history of childhood maltreatment differ from patients without a history of childhood maltreatment in network dynamics, indicating different therapy processes.We find that a change in hopelessness and acceptance of disliked personality traits preceded and predicted change in ED behaviour and the ability to feel self‐compassionate in patients with ED and a history of childhood maltreatment.These findings point to a need to study patients with a history of maltreatment separately to further advance the field of personalised medicine in ED treatment. [ABSTRACT FROM AUTHOR]

In the context of an aging population, older adults increasingly face the challenge of managing multiple chronic conditions simultaneously. This study utilized analytical methods such as propensity score matching (PSM) and multivariate logistic regression, to explore the relationship between physical activity and the number of chronic diseases as well as the risk of developing co-morbidities among middle-aged and elderly Chinese individuals using data from the 2020 China Health and Retirement Longitudinal Survey. The PSM results showed that physical activity decreased the number of chronic diseases in middle-aged and elderly people by 0.050 (p < 0.05). The multivariate logistic regression results the odds ratio (OR) for the risk of multimorbidity in the moderate and high intensity physical activity groups compared to the group with inadequate physical activity were 0.845 (95% CI 0.729–0.980) and 0.847 (95% CI 0.727–0.988), which means that moderate-intensity physical activity is strongly associated with a reduced risk of multimorbidity. Regular physical activity among middle-aged and older adults is associated with a reduction in the number of chronic diseases they suffer from. [ABSTRACT FROM AUTHOR]

This article provides original insight into women's experiences of adulthood diagnoses of attention deficit hyperactivity disorder (ADHD) and autism. Research exploring experiences of adulthood diagnoses of these conditions is emerging. Yet, there is no research about the gendered experiences of an adulthood combined ADHD and autism (AuDHD) diagnosis. This article addresses this gap through interpretative phenomenological analysis of email interviews with six late-diagnosed AuDHD women revealing the complex interplay between late diagnosis, being a woman, and combined diagnoses of ADHD and autism. It underscores how gender norms and stereotypes contribute to the oversight and dismissal of women's neurodivergence. Interpretative phenomenological analysis reveals the inextricability of femininity and neurotypicality, the gendered burden, discomfort, and adverse consequences of masking, along with the adverse outcomes of insufficient masking. Being an undiagnosed AuDHD woman is a confusing and traumatising experience with profound and enduring repercussions. The impact of female hormones exacerbated participants' struggles with (peri)menopause often being a catalyst for seeking diagnosis after decades of trauma. The epistemic injustice of not knowing they were neurodivergent compounded this trauma. Diagnosis enabled participants to overcome epistemic injustice and moved them into a feminist standpoint from which they challenge gendered inequalities relating to neurodiversity. This article aims to increase understanding and representation of late-diagnosed AuDHD women's lived experiences. The findings advocate for trauma-informed pre- and post-diagnosis support which addresses the gendered dimension of women's experiences of being missed and dismissed as neurodivergent. There needs to be better clinical and public understanding of how AuDHD presents in women to prevent epistemic injustice. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoke exposure (TSE) is a major public health concern, impacting not only smokers but also those around them, particularly children and adolescents. TSE is linked to various neuropsychiatric conditions and significantly impacts quality of life. This study examines the prevalence, socio-demographic factors, and the impact of TSE on the severity of neurological and psychiatric co-morbidities. Methods: Data from the National Survey of Children's Health (NSCH) in the US from 2020 to 2021 were used in this study. We included 91,404 children and adolescents aged between 0 to 17 years for the TSE prevalence and socio-demographic analysis, and 79,182 children and adolescents aged between 3 and 17 years for the neuropsychiatric co-morbidities analysis. The mean age of these individuals was 8.7 (standard deviation: 5.3), and 11,751 (12.9%) had confirmed TSE. Results: Our analysis showed that TSE is more common in males (53%) than females (47%). Additionally, the odds of TSE were higher in families with a lower income level and with American Indian/Native Alaska racial descent. We found that 36.4% of youths with TSE developed at least one co-morbid condition. The most common neuropsychiatric co-morbidities were anxiety problems (15.7%), Attention-Deficit Hyperactivity Disorder (ADHD) (15.5%), behavioral and conduct problems (13.7%), and learning disability (12%). Females had lower odds of co-morbid anxiety (OR: 0.3, p = 0.02) and Autism Spectrum Disorder (ASD) (OR: 0.9, p = 0.04) than males. Asians showed lower odds of co-morbid ADHD (OR: 0.3, p-value: 0.001), anxiety problems (OR: 0.4, p-value: 0.003), speech/other language disorder (OR: 0.4, p-value: 0.001), developmental delay (OR: 0.4, p-value: 0.001), behavioral and conduct problems (OR: 0.4, p-value: 0.003), and learning disability (OR: 0.5, p-value: 0.004). Conversely, American Indian children and adolescents had higher odds of co-morbid headaches (OR: 3, p-value: 0.005). TSE co-occurring with Tourette's Syndrome (TS) (OR: 4.4, p < 0.001), ADHD (OR: 1.3, p < 0.001), developmental delay (OR: 1.3, p < 0.001), behavioral problems (OR: 1.3, p < 0.001), headaches (OR: 1.3, p = 0.005), depression (OR: 1.2, p = 0.02), anxiety (OR: 1.2, p < 0.01), ASD (OR: 1.2, p < 0.001), and learning disability (OR: 1.2, p = 0.03) may contribute to a more severe manifestation. Conclusions: ADHD, behavioral/conduct problems, and learning disabilities were the most prevalent co-occurring conditions with TSE. Our findings show that 36.4% of youths with TSE had at least one neuropsychiatric comorbidity. Screening for these conditions in youths exposed to TSE is crucial for early detection and interventions to increase their mental health and well-being. [ABSTRACT FROM AUTHOR]

Background: Transition readiness, or skills and preparation for navigating adult health care, is an important factor in the successful transition from child and adolescent mental health services (CAMHS) to adult care; however, predictors of transition readiness are not fully understood. One factor which may impact transition readiness among youth accessing CAMHS is the presence of a co‐occurring physical health condition; however, this has not been previously examined. Within a cohort of youth receiving CAMHS, the objective of this study was to understand if there is an association between co‐occurring physical health conditions and transition readiness and if this relationship is impacted by severity of mental health symptoms. Methods: This study was a secondary analysis of baseline data from the Longitudinal Youth in Transition Study, including 237 16‐ to 18‐year‐old youth accessing outpatient CAMHS from four different clinical sites. Participants completed self‐report measures on mental health symptoms, functioning, service use, transition readiness, and physical health conditions. Multiple linear regression models were used to measure the association between the presence of health conditions and transition readiness scores as well as determine if there was an interaction between mental health symptoms and physical health conditions to predict transition readiness. Results: Co‐occurring physical conditions were reported by 41% of youth and were associated with greater overall transition readiness. There was no interaction between mental health symptom severity and co‐occurring physical conditions, though attention problems were independently associated with lower transition readiness scores. Conclusions: Youth accessing CAMHS who have a co‐occurring physical condition have overall greater transition readiness than youth without a co‐occurring condition. Further research should explore the role of frequency and types of healthcare encounters in transition readiness for transition age youth needing ongoing mental health care to better understand how to support self‐management and care navigation skill development. [ABSTRACT FROM AUTHOR]

Limited research exists regarding the impact of the Ukrainian War on mental distress among refugees or the presentation of post-traumatic stress disorder (PTSD) as a co-morbidity. This study analyzes the mental distress experienced by displaced Ukrainian refugees, including exposure to war-related trauma, PTSD, psychological distress based on socio-demographic factors, prevalence of concurrent mental illnesses, and associated risk factors. Ukrainian refugees in Israel were included in the study shortly after their arrival. Participants completed questionnaires on socio-demographic information, exposure to war-related events, presence of PTSD, depression, anxiety, and current life satisfaction. The 128 participants reported an average of 6.4 traumatic events (SD = 2.97). Among them, 69.5% (n = 89) met the criteria for probable PTSD, 36.7% (N = 47) for depression, and 53.1% (N = 68) for anxiety. The "comorbidity" cohort, consisting of refugees with PTSD and depression/anxiety or both, included 65 participants (53.3%), the "only PTSD" group was 24 participants (19.7%), and 33 (27%) had "no probability". Women and those who had left family members behind were 2.9 and 3.2 times more likely to experience comorbidity, respectively. Refugees with comorbidity reported higher distress and functional impairments compared to the "only PTSD" group, and lower life satisfaction than those with "no probability". This study highlights the significant traumatology experienced by Ukrainian refugees, with attention to the unique impact of comorbidity on functional and subjective well-being among refugees. Therefore, a comprehensive approach is necessary to appropriately diagnose and support refugees, considering the interconnected impact of PTSD, anxiety, and depression. [ABSTRACT FROM AUTHOR]

Copyright of Modern Preventive Medicine is the property of Modern Preventive Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A drug design strategy called a codrug or mutual prodrug binds two or more pharmacophore with similar or different pharmacological activities elicit synergistic action or help to target the parent drug to specific site/organ/cells respectively and to improve physicochemical, biopharmaceutical and drug delivery properties of therapeutic agents. This review presents various codrug design approach, objectives, properties and therapeutic approach in a methodical manner. Codrugs offer a promising approach in pharmaceutical research, combining multiple active compounds into one molecule to improve drug efficacy and minimize side effects. They can be tailored for specific tissues or organs, making them effective in treating CNS, cardiovascular, cancerous, inflammatory, infectious and comorbid disorders. By enhancing drug delivery through increased lipophilicity, codrugs provide targeted therapy and better outcomes across various medical conditions. Since the 2000s, mutual prodrugs and codrugs have been recognized as potential treatments for a range of illnesses. This approach is commonly used to improve physicochemical, biopharmaceutical and drug delivery properties of therapeutic agents. Additional clinical trial profiles will help expand the scope of codrug therapy. Care must be taken to maximise the positive effects of codrugs while minimising their negative side effects and toxicity. [ABSTRACT FROM AUTHOR]

As the COVID‐19 pandemic persists, SARS‐CoV‐2 infection is increasingly associated with long‐term neurological side effects including cognitive impairment, fatigue, depression, and anxiety, colloquially known as "long‐COVID." While the full extent of long‐COVID neuropathology across years or even decades is not yet known, we can perhaps take direction from long‐standing research into other respiratory diseases, such as influenza, that can present with similar long‐term neurological consequences. In this review, we highlight commonalities in the neurological impacts of influenza and COVID‐19. We first focus on the common potential mechanisms underlying neurological sequelae of long‐COVID and influenza, namely (1) viral neurotropism and (2) dysregulated peripheral inflammation. The latter, namely heightened peripheral inflammation leading to central nervous system dysfunction, is emerging as a shared mechanism in various peripheral inflammatory or inflammation‐associated diseases and conditions. We then discuss historical and modern examples of influenza‐ and COVID‐19‐associated cognitive impairment, depression, anxiety, and fatigue, revealing key similarities in their neurological sequelae. Although we are learning that the effects of influenza and COVID differ somewhat in terms of their influence on the brain, as the impacts of long‐COVID grow, such comparisons will likely prove valuable in guiding ongoing research into long‐COVID, and perhaps foreshadow what could be in store for individuals with COVID‐19 and their brain health. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to study Risk factors, Demographic profile of patients of Influenza A, H1N1 attending the tertiary care centre of Kashmir, North India. Materials and Methods: The present study was carried out at Government Medical College and associated Hospitals Srinagar, Department of Microbiology. Patients with symptoms of Influenza like illness (ILI) attending outpatient department of SMHS and chest diseases hospital as well as hospitalized cases in the month of February 2019, were recruited. 128 Patients of all age groups were included in the study. Clinical specimens of nasopharyngeal and throat swabs (nasal swab/TS) were collected. Results: Out of total 46 influenza positive cases, majority 39% patients belonged to 41-60 years age group followed by 21-40 years (26%), 61-80years (19.5%), 0-20years (10%) and least fraction of patients 4.3% belonged to 81-100 years. 58.6% patients were males while 31.3% patients were females. Hypertension was the chief predisposing factor 10.1% for influenza followed by diabetes mellitus 7.8%. From the 46 influenza patients, 23.9% patients were vaccinated and 76% were non vaccinated. 78.2% patients were reported in IPD and 21.7% cases were reported in OPD. 17 cases of CAP were reported in IPD and 3 cases reported in OPD. 56.5% patients had severe acute respiratory infections and 43.4% patients had influenza like illness. Conclusion: Despite the fact that the H1N1 pandemic has concluded, epidemics serve as a perpetual reminder of the underlying threat. The sole method of minimizing the disease progression and associated mortality appears to be vaccination, early recognition of the disease, and prompt initiation of treatment. [ABSTRACT FROM AUTHOR]

Background and aims: Hyperglycemia, also known as diabetes, is a metabolic disorder characterized by elevated levels of glucose in the bloodstream. It can lead to the prolonged dysfunction, injury, and deterioration of several organs. In addition, dengue is a viral illness transmitted by mosquitoes that has reached epidemic proportions worldwide. In this article, we focused on the severity of comorbidities, difficulties in managing them, and preventive measures meant to lessen the risks associated with comorbidities in diabetic patients with dengue infection. Methods: We explored a number of databases, including PubMed, Scopus, Embase, Web of Science, Google Scholar, and the Cochrane Library, for this review article using various related keywords. Results: The findings of this review article indicate that elderly dengue patients with diabetes should be admitted to the hospital for close observation and early management using fluid therapy. An observed association exists between dengue hemorrhagic fever (DHF) and diabetes, indicating a possible consequence in this specific group. Additionally, patients with diabetes who contract dengue show elevated levels of inflammatory markers. Diabetes mellitus deteriorates the immune system, which exacerbates the progression of dengue fever. Cutting‐edge technology and scientific research may assist in addressing the challenges that diabetes and dengue viruses pose in low‐ and middle‐income countries. Implementing innovative diabetic care management is essential to ensuring consistency of care, improving a healthy lifestyle, and lowering patient risk factors and comorbidities. Conclusion: Dengue fever has spread to epidemic levels throughout the world. Inflammatory markers increase and the prevalence of DHF is greater in diabetes individuals with dengue infection. Given the continued growth of dengue in Asian nations, it is imperative that we concentrate our efforts and resources on providing more precise and effective treatment for this emerging issue. [ABSTRACT FROM AUTHOR]

Disordered eating (DE) is associated with elevated cardiometabolic risk (CMR) factors, yet little is known about this association in non-Western countries. We examined the association between DE characteristics and CMR and tested the potential mediating role of BMI. This cross-sectional study included 2005 Chinese women (aged 18–50 years) from the 2015 China Health and Nutrition Survey. Loss of control, restraint, shape concern and weight concern were assessed using selected questions from the SCOFF questionnaire and the Eating Disorder Examination-Questionnaire. Eight CMR were measured by trained staff. Generalised linear models examined associations between DE characteristics with CMR accounting for dependencies between individuals in the same household. We tested whether BMI potentially mediated significant associations using structural equation modelling. Shape concern was associated with systolic blood pressure (β (95 % CI) 0·06 (0·01, 0·10)), diastolic blood pressure (DBP) (0·07 (95 % CI 0·03, 0·11)) and high-density lipoprotein (HDL)-cholesterol (–0·08 (95 % CI –0·12, −0·04)). Weight concern was associated with DBP (0·06 (95 % CI 0·02, 0·10)), triglyceride (0·06 (95 % CI 0·02, 0·10)) and HDL-cholesterol (–0·10 (95 % CI –0·14, −0·07)). Higher scores on DE characteristics were associated with higher BMI, and higher BMI was further associated with lower HDL-cholesterol and higher other CMR. In summary, we observed significant associations between shape and weight concerns with some CMR in Chinese women, and these associations were potentially partially mediated by BMI. Our findings suggest that prevention and intervention strategies focusing on addressing DE could potentially help reduce the burden of CMR in China, possibly through controlling BMI. [ABSTRACT FROM AUTHOR]

Purpose: This study explores the association of the American Society of Anesthesiologists (ASA) score with 90-day mortality in complicated mild traumatic brain injury (mTBI) patients, and in trauma patients without a TBI. Methods: This retrospective study was conducted using a cohort of trauma patients treated at a level III trauma center in Stockholm, Sweden from January to December 2019. The primary endpoint was 90-day mortality. The population was identified using the Swedish Trauma registry. The Trauma and Injury Severity Score (TRISS) was used to estimate the likelihood of survival. Trauma patients without TBI (NTBI) were used for comparison. Data analysis was conducted using R software, and statistical analysis included univariate and multivariate logistic regression. Results: A total of 244 TBI patients and 579 NTBI patients were included, with a 90-day mortality of 8.2% (n = 20) and 5.4% (n = 21), respectively. Deceased patients in both cohorts were generally older, with greater comorbidities and higher injury severity. Complicated mTBI constituted 97.5% of the TBI group. Age and an ASA score of 3 or higher were independently associated with increased mortality risk in the TBI group, with odds ratios of 1.04 (95% 1.00–1.09) and 3.44 (95% CI 1.10–13.41), respectively. Among NTBI patients, only age remained a significant mortality predictor. TRISS demonstrated limited predictive utility across both cohorts, yet a significant discrepancy was observed between the outcome groups within the NTBI cohort. Conclusion: This retrospective cohort study highlights a significant association between ASA score and 90-day mortality in elderly patients with complicated mTBI, something that could not be observed in comparative NTBI cohort. These findings suggest the benefit of incorporating ASA score into prognostic models to enhance the accuracy of outcome prediction models in these populations, though further research is warranted. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) are often accompanied by gastrointestinal (GI) distress. Anxiety sensitivity is the tendency to interpret sensations of anxiety as threatening or dangerous, and includes both broad physical symptoms (e.g., elevated heartrate) and GI‐specific symptoms. Physical and GI‐specific anxiety sensitivity may be important risk and maintaining factors in EDs. This study tested the hypothesis that greater reductions in both types of anxiety sensitivity during the first month of treatment would predict lower ED symptoms and trait anxiety at discharge and 6‐month follow‐up. Patients (n = 424) in ED treatment reported physical and GI‐specific anxiety sensitivity, ED symptoms, and trait anxiety at treatment admission, 1‐month into treatment, discharge, and 6‐month follow‐up. Analyses were conducted with hierarchical linear regression with imputation, controlling for relevant covariates. Results indicated that early reduction in GI‐specific but not general physical anxiety sensitivity predicted both lower ED symptoms and lower trait anxiety at discharge and 6‐month follow‐up. These findings demonstrate the importance of GI‐specific anxiety sensitivity as a potential maintaining factor in EDs. Developing and refining treatments to target GI‐specific anxiety sensitivity may have promise in improving the treatment not only of EDs, but also of commonly co‐morbid anxiety disorders. Highlights: Anxiety sensitivity, the fear of symptoms of anxiety, is common in eating disorders (EDs), and may predict treatment outcomes.In this study, greater reduction in anxiety sensitivity for gastrointestinal symptoms within the first month of ED treatment predicted lower ED symptoms and anxiety at discharge from treatment but not 6‐month follow‐up. By contrast, reduction in more general physical anxiety sensitivity did not predict ED symptoms or anxiety at discharge or follow‐up.Findings highlight the importance of targeting anxiety about body sensations in treatment for EDs. [ABSTRACT FROM AUTHOR]

Introduction: Childhood obesity is associated with chronic low-grade systemic inflammation, which results in obesity-related comorbidities. This study compared the inflammatory markers between obese and normal children and assessed obesity-related comorbidities. Methods: In this cross-sectional analytical study, 40 obese children between 5-18 years of age were recruited as cases, and an equal number of age and gender-matched normal children as the control. The inflammatory markers-high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and adiponectin were compared between the groups. Hypothyroidism, dyslipidemia, insulin resistance, hypertension, and nonalcoholic fatty liver disease (NAFLD) were screened among obese children. Results: We observed a male-female ratio of 1.5:1 in each group. The median hs-CRP between obese and normal children were 2.53 mg/L (0.94,6.85) and 0.77 mg/L (0.19,7.19), and the median IL-6 levels were 3.56 pg/ml (2.17,5.48) and 3.76 pg/ml (1.08,7.91) respectively. The median IL-10 levels between obese and control groups were 2.06 pg/ml (0.35,6.3) and 1.82 pg/ml (0.41,6.5), and the median adiponectin levels between the groups were 8.6 mcg/ml (6.65,16.04) and 9.79 mcg/ml (8.45,11.91) respectively. We didn't observe significant differences in the markers between the groups. Dyslipidemia, insulin resistance, and metabolic syndrome were seen in 80%, 52.5%, and 45% of obese children, respectively. Other comorbidities-NAFLD, hypertension, and hypothyroidism, were observed in 27.5%, 25%, and 7.5% of obese children, respectively. IL-6 had a significant positive correlation with total cholesterol (r = 0.40), LDL levels (r = 0.50), and HDL (r = 0.32). Conclusion: There was no difference in inflammatory markers between obese and normal children. Dyslipidemia and insulin resistance were the most common comorbidities. [ABSTRACT FROM AUTHOR]

Purpose: Chronic obstructive pulmonary disease and obstructive sleep apnea are two common respiratory diseases. Chronic obstructive pulmonary disease patients co-morbid with obstructive sleep apnea are associated with increased cardiovascular adverse events, frequent acute exacerbations, and higher mortality. Only a few studies on obstructive sleep apnea among patients with chronic obstructive pulmonary disease are available in Vietnam. The study aims to determine the prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam. Methods: This is a cross-sectional study in patients with chronic obstructive pulmonary disease at multi-sites in Vietnam: the People's Hospital of Gia Dinh, Bach Mai Hospital, Phoi Viet Clinics, and Lam Dong Medical College using type 3 sleep monitoring device at sleep labs to diagnose obstructive sleep apnea in all study participants. Results: Two hundred seventy-eight patients with chronic obstructive pulmonary disease were enrolled. Among the patients, 93.2% were male, with an average age of 66.9 ± 9.3 and a BMI of 21.9 ± 3.8 kg/m2; 82.0% were symptomatic including 44.6% in group B and 37.4% in group D with average post-FEV1 of 49.8 ± 18.3% predicted values. One hundred seventeen patients (42.1%) with chronic obstructive pulmonary disease presented obstructive sleep apnea defined by AHI ≥ 15 events/h. Conclusions: The prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam was 42.1% for an AHI of ≥ 15 events/h. [ABSTRACT FROM AUTHOR]

Introduction: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in China, the epidemic has rapidly spread all over the world in just a few months. Different steroids have been proven effective in treating COVID-19 pneumonia. However, comparative efficacy data between different steroids have been evaluated in a few studies from various parts of the world. To date, no study with a large number of patients has been conducted in the eastern part of India. Aim: To compare the efficacy of dexamethasone and methylprednisolone in terms of outcomes and disease progression in COVID-19 pneumonia patients. Materials and Methods: This retrospective cohort study included 377 patients with moderate and severe COVID-19 pneumonia admitted to Medical College and Hospital from May 2020 to December 2020, Kolkata, West Bengal, India. Patient records were divided into two groups based on the type of steroids administered (dexamethasone and methylprednisolone). Clinical, laboratory, treatment, and outcome data were tabulated for analysis. Demographic patterns in the two groups were compared, and efficacy was analysed in terms of hospital course (hospital stay length, type of respiratory support received) and final outcome (cured or death) in both groups. The data collected were analysed using Statistical Package for Social Sciences (SPSS) software version 29.0. Qualitative variables were expressed as counts and percentages, while quantitative variables were presented as mean±Standard Deviation (SD). Results: There were no significant differences between the two treatment groups based on demographic features (age, sex), co-morbidities (diabetes, hypertension, etc.), disease severity (hypoxia, hypotension) on admission day, and smoking status. The study showed that methylprednisolone significantly reduced the requirement for high-flow oxygen (p-value=0.002), Non Invasive Ventilation (NIV) (p-value=0.001), and invasive ventilation (p-value=0.001) compared to dexamethasone. However, there was no significant difference (p-value=0.800) in the duration of hospital stay between the methylprednisolone and dexamethasone treatment groups. Kaplan-Meier survival analysis also showed a significant survival benefit among patients who received methylprednisolone compared to dexamethasone (log-rank p-value=0.039). Conclusion: The present study concludes that in COVID-19 pneumonia, the administration of methylprednisolone leads to a significant reduction in mortality and the need for high-flow oxygen, NIV, and invasive ventilation compared to dexamethasone. [ABSTRACT FROM AUTHOR]

Background: The transitional state between normal aging and dementia is known as Cognitive impairment (CI) where a person has memory complaints and objective evidence of CI but no evidence of dementia. With the globe undergoing a "demographic transition," the magnitude of neurodegenerative disorders is rising. In India, 27.3% of older persons with comorbidities had CI. Early identification of CI will likely help initiate proper remedial intervention, leading to better overall outcomes. In order to determine the prevalence of CI in older persons and whether it is associated with co-morbid conditions, this study was designed. Methods: A descriptive cross-sectional study was conducted among 350 older adults aged ≥60 residing in rural areas of Lucknow, selected using multistage cluster sampling. The Hindi Mental State Examination (HMSE) scale was used to assess cognitive function. A pretested semi-structured questionnaire was used to collect information on sociodemographic characteristics and comorbidity status. Results: Among 350 participants, with mean ± SD age 70.66 ± 9.53 years, the prevalence of CI as per HMSE (<23) was 24.9%. Overall, the mean HMSE score was less in individuals with (25.2) than without (27.19) comorbidities. Those with comorbidities had significantly lower mean scores in all individual domains of HMSE. Conclusion: CI affects one-fourth of the older adult population. Risk increases with the presence of comorbidities. Hence, screening, and early treatment are recommended. [ABSTRACT FROM AUTHOR]

Background: Mental illness (MI) remains stigmatized globally, including in India, where suicide and suicidality have been rising. Internalization of society's negative stereotypes by people with MI is known as internalized MI stigma. Aims: The present paper examined the prevalence of internalized MI stigma in a large sample of rural Indian participants with comorbid chronic medical conditions and previously undiagnosed, mostly mild-to-moderate depression/anxiety. It further examined correlates of internalized MI stigma and its association with suicidality. Subjects and Methods: Face-to-face interviews were conducted at four-time points with adults with depression/anxiety and chronic physical illness in primary health centers in Ramanagaram, Karnataka. Topics included demographics, social support, depression (9-item Patient Health Questionnaire scale), anxiety (7-item General Anxiety Disorder scale), suicidality (Mini-International Neuropsychiatric Interview), and internalized MI stigma (Internalized Stigma of Mental Illness [ISMI] scale). Data analysis included linear and hierarchical logistic regression. Results: At baseline, 29.1% of participants showed a high level of internalized stigma, and 10.4% exhibited at least moderate suicidality. Hierarchical logistic regression showed that every 1-point increase on the ISMI scale more than tripled the odds of moderate to high suicidality (adjusted odds ratio [AOR] 3.24). Those being at least moderately depressed/anxious were 2.4 times more likely to be at least moderately suicidal than participants with no-mild depression/anxiety. Social support lowered the odds of suicidality (AOR 0.44). Conclusions: Internalized MI stigma and suicidality were substantial among these rural adults with mostly mild-to-moderate anxiety/depression. Higher stigma was associated with increased suicidality, independently of depression/anxiety. Therefore, efforts to reduce internalized MI stigma should be included in mental health treatment. [ABSTRACT FROM AUTHOR]

Turner syndrome (TS) affects 50 per 100 000 females. TS affects multiple organs through all stages of life, necessitating multidisciplinary care. This guideline extends previous ones and includes important new advances, within diagnostics and genetics, estrogen treatment, fertility, co-morbidities, and neurocognition and neuropsychology. Exploratory meetings were held in 2021 in Europe and United States culminating with a consensus meeting in Aarhus, Denmark in June 2023. Prior to this, eight groups addressed important areas in TS care: (1) diagnosis and genetics, (2) growth, (3) puberty and estrogen treatment, (4) cardiovascular health, (5) transition, (6) fertility assessment, monitoring, and counselling, (7) health surveillance for comorbidities throughout the lifespan, and (8) neurocognition and its implications for mental health and well-being. Each group produced proposals for the present guidelines, which were meticulously discussed by the entire group. Four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with systematic review of the literature. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with members from the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology, the European Reference Network on Rare Endocrine Conditions, the Society for Endocrinology, and the European Society of Cardiology, Japanese Society for Pediatric Endocrinology, Australia and New Zealand Society for Pediatric Endocrinology and Diabetes, Latin American Society for Pediatric Endocrinology, Arab Society for Pediatric Endocrinology and Diabetes, and the Asia Pacific Pediatric Endocrine Society. Advocacy groups appointed representatives for pre-meeting discussions and the consensus meeting. [ABSTRACT FROM AUTHOR]

Copyright of Cyprus Turkish Journal of Psychiatry & Psychology (CTJPP) / Kıbrıs Türk Psikiyatri ve Psikoloji Dergisi is the property of Cyprus Turkish Journal of Psychiatry & Psychology (CTJPP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

While motor and psychiatric phenotypes in idiopathic dystonia are increasingly well understood, a few studies have examined the rate, type, and temporal pattern of other clinical co-morbidities in dystonia. Here, we determine the rates of clinical diagnoses across 13 broad systems-based diagnostic groups, comparing an overall idiopathic dystonia cohort, and sub-cohorts of cervical dystonia, blepharospasm, and dystonic tremor, to a matched-control cohort. Using the SAIL databank, we undertook a longitudinal population-based cohort study (January 1st 1994–December 31st 2017) using anonymised electronic healthcare records for individuals living in Wales (UK), identifying those diagnosed with dystonia through use of a previously validated algorithm. Clinical co-morbid diagnoses were identified from primary health care records, with a 10% prevalence threshold required for onward analysis. Using this approach, 54,166 dystonia cases were identified together with 216,574 matched controls. Within this cohort, ten of the main ICD-10 diagnostic codes exceeded the 10% prevalence threshold over the 20-year period (infection, neurological, respiratory, gastrointestinal, genitourinary, dermatological, musculoskeletal, circulatory, neoplastic, and endocrinological). In the overall dystonia cohort, musculoskeletal (aOR: 1.89, aHR: 1.74), respiratory (aOR: 1.84; aHR: 1.65), and gastrointestinal (aOR: 1.72; aHR: 1.6) disorders had the strongest associations both pre- and post-dystonia diagnosis. However, variation in the rate of association of individual clinical co-morbidities was observed across the cervical, blepharospasm, and tremor dystonia groups. This study suggests an increased rate of specific co-morbid clinical disorders both pre- and post-dystonia diagnosis which should be considered during clinical assessment of those with dystonia to enable optimum symptomatic management. [ABSTRACT FROM AUTHOR]

Introduction: Depression is a significant co-morbid condition for diabetics. Co-morbid depression results in worsened diabetes complications, deleterious effects on self-care activities, non adherence, and poor treatment outcomes. Aim: To assess the prevalence of depression among type 2 diabetic patients attending a tertiary hospital and to find its association with socio-demographic and lifestyle factors. Materials and Methods: A hospital-based cross-sectional study was done in the diabetic clinic of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India between June 2016 and August 2016, involving 500 patients with Type II Diabetes Mellitus (T2DM) of less than five years' duration. The prevalence of depression was calculated using Beck's Depression Inventory Scale for a period of three months. The results were expressed in proportions, and the association of factors was tested using the Chi-square test and multivariable logistic regression analysis. A p-value <0.05 was considered statistically significant. Results: The study included 500 participants, of whom the majority (276, 55%) were female, with a mean age of 46.2 years. The prevalence of depression was 55 (11%). It was found that being female, illiterate, and unemployed were significantly associated with depression. Among disease-related factors, diabetes duration of 3-5 years, insulin injection usage, and the presence of diabetic complications were significantly associated with depression. Regarding lifestyle factors, the prevalence of depression was significantly higher among those who were non adherent to dietary modification practices and those with family worries and work-related tension. Multivariable logistic regression analysis revealed that the independent predictors of depression among diabetics were the presence of diabetic complications {Odds Ratio (OR)-2.48 (1.27-4.84)}, family worries {OR-2.54 (1.34-4.80)}, non adherence to follow-up {OR-2.61 (1.37-4.99)}, and non compliance with dietary modifications {OR-2.93 (1.43-5.99)}. Conclusion: The present study revealed that about one in 10 (11%) diabetics with less than five years' duration have associated depression, with significant independent predictors being non compliant behaviours, the presence of complications, and family issues. Hence, diabetics should be screened simultaneously for depression, giving due attention to those with complications, family issues, and non compliant behaviours. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Uludag University Medical Faculty / Uludağ Üniversitesi Tıp Fakültesi Dergisi is the property of Journal of Uludag University Medical Faculty and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article discusses the co-morbidity of COVID-19 and fungal infections. It highlights the significant role that fungal infections play in the prognosis of COVID-19 patients, with candidemia and mucormycosis being particularly prevalent. The article emphasizes the need for improved antifungal therapies, early detection strategies, and preventive measures to reduce fungal transmission. It also calls for multidisciplinary collaboration and research to better understand the pathogenesis of fungal co-infections in COVID-19 patients. [Extracted from the article]

Introduction: The outbreak of Coronavirus Disease 2019 (COVID-19) affected a large number of people worldwide within a short period of time. The mortality rate was high, and there was no specific medicine available to cure it. Therefore, the situation demanded the rapid development of a vaccine. When the vaccines were introduced, there was limited knowledge about their efficacy, side-effects, and duration of protection. Hence, a detailed study was conducted in these areas. Aim: To study the immunological responses following Covishield vaccination and determine the duration of protection offered by the vaccine. Materials and Methods: The present study is a prospective observational study conducted at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India from March 2021 to May 2023, involving the staff members of the hospital and college who were above 18-year-old. Individuals with immunodeficiency, those on immunosuppressive medication, or anyone with proof of COVID-19 were excluded. The total sample size was 56. Blood samples were collected before administering the vaccine, at 0, 3, and 12 months, and tested for Complete Blood Count (CBC), COVID-19-specific Immunoglobulin G (IgG), Cluster of Differentiation (CD) 45, CD3, CD4, CD8, etc. The findings were statistically analysed using Statistical Packages of Social Sciences (SPSS) software version 22.0 and STATA software version 10. Results: A total of 154 volunteers initially provided the first blood samples. However, only 129 of them provided blood samples 2nd time and received two doses of the vaccine. Out of these, only 56 participants completed the fourth time blood test. The results consistently demonstrated a rise in IgG levels over time, with consistently higher levels observed in females. Participants above 45 years exhibited higher IgG levels. Individuals with co-morbidities also showed an increase in IgG levels. The research revealed that individuals who were initially IgG negative experienced a greater fold increase in IgG levels after the first dose of vaccination. The incidence and duration of side-effects post-vaccination reduced with each successive vaccine dose. Conclusion: All the volunteers developed adequate IgG antibodies. Two doses of Covishield effectively resulted in lasting immunity in 94.64% of cases, and three doses achieved 100% immunity. Females and participants above 45 years consistently exhibited higher antibody levels. Individuals with co-morbidities also developed antibodies, albeit at slightly lower levels. The side-effects were mild and short-lived. No long-term after effects were detected even after two years and two months following vaccination. [ABSTRACT FROM AUTHOR]

Introduction: Clinical decision support (CDS) systems (CDSSs) that integrate clinical guidelines need to reflect real-world co-morbidity. In patient-specific clinical contexts, transparent recommendations that allow for contraindications and other conflicts arising from co-morbidity are a requirement. In this work, we develop and evaluate a non-proprietary, standards-based approach to the deployment of computable guidelines with explainable argumentation, integrated with a commercial electronic health record (EHR) system in Serbia, a middle-income country in West Balkans. Methods: We used an ontological framework, the Transition-based Medical Recommendation (TMR) model, to represent, and reason about, guideline concepts, and chose the 2017 International global initiative for chronic obstructive lung disease (GOLD) guideline and a Serbian hospital as the deployment and evaluation site, respectively. To mitigate potential guideline conflicts, we used a TMR-based implementation of the Assumptions-Based Argumentation framework extended with preferences and Goals (ABA+G). Remote EHR integration of computable guidelines was via a microservice architecture based on HL7 FHIR and CDS Hooks. A prototype integration was developed to manage chronic obstructive pulmonary disease (COPD) with comorbid cardiovascular or chronic kidney diseases, and a mixed-methods evaluation was conducted with 20 simulated cases and five pulmonologists. Results: Pulmonologists agreed 97% of the time with the GOLD-based COPD symptom severity assessment assigned to each patient by the CDSS, and 98% of the time with one of the proposed COPD care plans. Comments were favourable on the principles of explainable argumentation; inclusion of additional co-morbidities was suggested in the future along with customisation of the level of explanation with expertise. Conclusion: An ontological model provided a flexible means of providing argumentation and explainable artificial intelligence for a long-term condition. Extension to other guidelines and multiple co-morbidities is needed to test the approach further. [ABSTRACT FROM AUTHOR]

Purpose: Lophomoniasis is a chronic protozoan respiratory disease in humans with main clinical symptoms such as chronic cough, productive sputum, breath shortness, and occasionally hemoptysis. Differentiation diagnosis of lophomoniasis from tuberculosis (TB) and asthma is crucial. Methods: In this study, 210 participants with suspected TB referred to tuberculosis laboratories in Mazandaran province, northeastern Iran, were enrolled during 2021. All patients showed low grade fever, chronic cough or sputum on referral. Sputum specimens were collected from the participants, and Lophomonas DNA was detected through a conventional genus-specific polymerase chain reaction (PCR). Results: Out of 210 participants, 67 (31.9%) had Lophomonas spp., infection, 38 (18.1%) had TB (Smear and culture-positive), and 20 (9.5%) had both TB and Lophomonas co-infection. Conclusion: Based on our results, a relatively high occurrence of Lophomonas infection was found among patients suspected of having TB. Accordingly, due to the high similarity of clinical symptoms between both pulmonary diseases, it is highly recommended to accurately and early diagnose the parasite in the sputum specimen. [ABSTRACT FROM AUTHOR]

Background: Mortality due to chronic obstructive pulmonary disease (COPD) is increasing. However, dead space fractions at rest (VD/VTrest) and peak exercise (VD/VTpeak) and variables affecting survival have not been evaluated. This study aimed to investigate these issues. Methods: This retrospective observational cohort study was conducted from 2010-2020. Patients with COPD who smoked, met the Global Initiatives for Chronic Lung Diseases (GOLD) criteria, had available demographic, complete lung function test (CLFT), medication, acute exacerbation of COPD (AECOPD), Charlson Comorbidity Index, and survival data were enrolled. VD/VTrest and VD/VTpeak were estimated (estVD/VTrest and estVD/VTpeak). Univariate and multivariable Cox regression with stepwise variable selection were performed to estimate hazard ratios of all-cause mortality. Results: Overall, 14,910 patients with COPD were obtained from the hospital database, and 456 were analyzed after excluding those without CLFT or meeting the lung function criteria during the follow-up period (median (IQR) 597 (331-934.5) days). Of the 456 subjects, 81% had GOLD stages 2 and 3, highly elevated dead space fractions, mild air-trapping and diffusion impairment. The hospitalized AECOPD rate was 0.60 ± 2.84/person/year. Forty-eight subjects (10.5%) died, including 30 with advanced cancer. The incidence density of death was 6.03 per 100 person-years. The crude risk factors for mortality were elevated estVD/VTrest, estVD/VTpeak, =2 hospitalizations for AECOPD, advanced age, body mass index (BMI) <18.5 kg/m², and cancer (hazard ratios (95% C.I.) from 1.03 [1.00-1.06] to 5.45 [3.04-9.79]). The protective factors were high peak expiratory flow%, adjusted diffusing capacity%, alveolar volume%, and BMI 24-26.9 kg/m². In stepwise Cox regression analysis, after adjusting for all selected factors except cancer, estVD/VTrest and BMI <18.5 kg/m² were risk factors, whereas BMI 24-26.9 kg/m² was protective. Cancer was the main cause of all-cause mortality in this study; however, estVD/VTrest and BMI were independent prognostic factors for COPD after excluding cancer. Conclusions: The predictive formula for dead space fraction enables the estimation of VD/VTrest, and the mortality probability formula facilitates the estimation of COPD mortality. However, the clinical implications should be approached with caution until these formulas have been validated. [ABSTRACT FROM AUTHOR]

Context: As per the national policy, two doses of COVID‑19 vaccine at least four weeks apart were available for administration to all HCW’s since January 2021. A small proportion of individuals will contract COVID‑19 despite complete vaccination. Healthcare workers (Health Care Providers) represent a very high‑risk group for contracting COVID‑19 infection. Aim: To determine the breakthrough infection rate of COVID‑19 among vaccinated healthcare providers and students. Methodology: The present cross‑sectional study was conducted at All India Institute of Medical Sciences, Nagpur from August to December 2022. The sample size of 308 was achieved through proportionate stratified sampling among different cadres of employees working at the institute. Statistical Analysis: Chi‑square test was used for significance. Fischer’s Exact test was used wherever necessary. A P value < 0.05 was considered statistically significant. Strength of the association was estimated using odds ratio. Results: The mean (SD) age of participants in our study was 29.26 (±8.64) years. Prevalence of COVID breakthrough infection was found to be 28.25% [95% CI: 23–33]. It was found that those participants having one or more co‑morbidities and are directly involved in COVID patient care were likely to suffer more from COVID‑19 breakthrough infection. Conclusion: Predictors of COVID‑19 breakthrough infection found to be a presence of one or more co‑morbidities, direct involvement with COVID‑19 patients and not observing respiratory hygiene. There is increased risk among participants with comorbidities and involving directly in patient care. Therefore, it is recommended that vaccine policy needs to focus on high‑risk group. [ABSTRACT FROM AUTHOR]

Objectives: Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers’ outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers’ stress, positive experiences of caregiving, and social networks Methods: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used Results: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers’ health conditions increased, their stress increased whereas their social network diminished Discussion: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks [ABSTRACT FROM AUTHOR]

Background: Poisoning injuries is an increasing concern among older people, and so is the repetition of intentional poisonings. To date, few studies have documented the pattern and individual risk factors for repeated poisonings. This national study aims to shed light on the burden, pattern, and health-related risk factors of repeated intentional poisoning leading to hospitalization or death among older Swedish adults (50 years and older), with a focus on the year following a first event. Methods: We conducted a nationwide register-based cohort study of people aged 50–100, hospitalized for intentional poisoning (ICD10: X60-69) during 2006–2016 (n = 15,219) and re-hospitalized by poisoning of any intent within a year (n = 1710), i.e., up to the end of 2017. We considered in turn, the distribution of the second poisoning in 30-day intervals stratified by intent; poisoning lethality within a month and a year; and the sex-specific association between health conditions and being re-hospitalized for intentional poisoning within one year as compared to being hospitalized only once using logistic regression (odds ratios (OR) with 95% confidence intervals (95% CI)). Results: Following an intentional poisoning, re-hospitalization within a year was predominantly for a new intentional poisoning (89.7%) and occurred most typically within a month (median 4 days). Death within 30 days occurred in similar proportion for the first and second poisoning (2.3% vs. 2.1% respectively). Among both men and women, comorbidity of psychiatric illness was strongly associated with re-hospitalization for intentional poisoning (adjusted ORs = 1.70; 95% CI = 1.45–2.01 and 1.89 (95% CI = 1.60–2.19) respectively). Conclusion: Most re-hospitalizations within a year after intentional poisoning are also for intentional poisoning and occur most typically within days. Re-hospitalization is associated with several conditions that are characteristic of poor mental health and there are more similarities than differences between men and women in that respect. [ABSTRACT FROM AUTHOR]

Objective Musculoskeletal pain is a common risk factor for co-morbid conditions and might increase the risk of poor outcomes. The objective was to determine whether patients with pre-existing musculoskeletal pain have an increased risk for mortality following a new diagnosis of a co-morbid condition. Methods Patients aged ≥45 years with a new diagnosis of acute coronary syndrome (ACS), stroke, cancer, dementia or pneumonia recorded in a UK electronic primary care database linked to hospital and mortality records were examined. The association of mortality with musculoskeletal pain (inflammatory conditions, OA and regional pain) was determined. Results The sample size varied from 128 649 (stroke) to 406 289 (cancer) by cohort, with 22–31% having pre-existing musculoskeletal conditions. In the ACS cohort, there was a higher rate of mortality for all musculoskeletal types. There were also higher unadjusted mortality rates in patients with inflammatory arthritis compared with those without musculoskeletal pain in the stroke, cancer and dementia cohorts and for patients with OA in the stroke and cancer cohorts. After adjustment for the number of prescribed medications and age, the increased risk of mortality remained only for patients with inflammatory arthritis in the ACS cohort (adjusted hazard ratio = 1.07; 95% CI 1.03, 1.10). Conclusion Older adults with inflammatory arthritis and OA have increased risk of mortality when they develop a new condition, which seems to be related to the prescription of multiple medicines. Pre-existing musculoskeletal pain is an indicator of a complex patient who is at risk of poorer outcomes at the onset of new illnesses. [ABSTRACT FROM AUTHOR]

Background: The co‐disease of depression and gout is becoming more common in the modern era. However, the relationship between the severity of depressive symptoms and gout prevalence and treatment rate was still unclear. Objective: This study aimed to determine the relationship between the prevalence, treatment rate of gout, and the severity of depression in the United States. Method: The cross‐sectional analysis of the 2007–2018 National Health and Nutrition Examination Survey (NHANES) for participants with depression was performed. According to their Patient Health Questionnaire‐9 (PHQ‐9) scores, participants were categorized as none, mild, moderate, moderately severe, and severe. To learn the correlation between the severity of depressive symptoms and the prevalence and treatment rate of gout using multivariate logistic regression to control for confounder interference. Results: A total of 25 022 patients were included in this study. As the severity of the depressive symptoms worsened (Mild, Moderate and Moderately severe), the risk of gout increased in non‐adjusted model and model 1,2,3 (p‐value for trend =.01 in non‐adjusted model, <.0001 in model 1, <.01 in models 2 and 3; prevalence group in Model 1, aOR1.71, 95% CI (1.40, 2.08) in the mild group, aOR1.68, 95% CI (1.19, 2.39) in the moderate group, aOR1.31,95% CI (0.82, 2.11) in the moderately severe group, aOR1.21, 95% CI (0.62, 2.38) in the severe group). However, the lower gout prevalence trend has no statistical significance after adjusting all factors in Model 4(p‐value for trend =.98). Compared with patients without depression, only a few patients received treatment, especially patients with severe depression (none, 80.1%; severe, 0.2%). The more severe the depression, the lower the treatment rate (p‐value for trend: non‐adjusted model, p <.001; model 1, p =.05; model 2, p =.02; model 3, p =.03). Conclusion: Compared with patients without depression, the patients with depression had a higher risk of gout. With the aggravation of depression, the prevalence of gout and the rate of treatment both were decreased. Patients with gout and depression need to receive multidisciplinary care after diagnosis. However, currently, treatment cannot meet the needs of the current patients. [ABSTRACT FROM AUTHOR]

There is a high prevalence of gambling harms co-occurring with substance use harms. Where harms are co-occurring, they may be experienced as more severe. However, there is little evidence that services are systematically screening for such co-occurring harms in treatment-seeking populations. Furthermore, treatment modalities remain relatively under-developed, with treatment usually addressing only one source of harm. This scoping review looks at the current literature on screening and therapeutic interventions for co-occurring gambling and substance use harms to understand how co-occurring harms may be managed in a treatment setting. It draws together available data on the intersections of substance use harms and gambling related harms, in a treatment context. This research identifies a range of potentially useful validated tools for clinicians in substance use treatment settings to screen for gambling harms. For workers in gambling treatment settings who are seeking validated tools to screen for co-occurring substance use harms, the literature provides less guidance. The validated toolbox of therapeutic interventions for those experiencing co-occurring substance use and gambling harms is relatively sparse. Psychosocial interventions appear to offer the best outcomes on gambling measures for those experiencing co-occurring substance use harms. Further research is needed to establish the benefits of different combinations of treatment and treatment types in achieving reductions across both substance use and gambling harms, when these harms are experienced concurrently. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Elizabethkingia meningoseptica (E. meningoseptica) is an emerging pathogen that causes bloodstream infections, especially among immunocompromised or critically ill patients. Due to its multidrug resistance, limited antibiotic treatments are available. Therefore, correct identification with a proper susceptibility report is compulsory to reduce mortality and morbidity caused by this rare pathogen. Aim: To analyse the clinical features, underlying comorbidity, outcomes, and antibiotic resistance potential of E. meningoseptica causing bacteraemia. Materials and Methods: This cross-sectional study was conducted in Department of Microbiology, Rajshree Medical Research Institute (RMRI), Bareilly, Uttar Pradesh, India. The study spanned three years from August 2020 to July 2023. All patients with E. meningoseptica bacteraemia were identified from blood culture reports and included in the study. As it was a duration-based study, all consecutive patients identified with E. meningoseptica bacteraemia were enrolled. The total sample size was 43. Blood samples growing gram negative, non fermenting, non motile isolates that were positive for the oxidase reaction were further identified using the Vitek 2 compact system (Biomerieux, France). All relevant data regarding demographic and clinical characteristics, underlying diseases, and antibiotic treatments were collected from the hospital information system. Patient demographics were presented as mean ± standard deviation. Clinical characteristics and co-morbid conditions were presented as frequency and percentages. Results: The majority of patients were elderly males admitted to the Intensive Care Unit (ICU). The most common underlying co-morbidity was malignancy in 12 (27.9%), and pneumonia in 12 (48.8%) was the major diagnosis among these bacteraemic patients. A total of 10 (23.25%) infections were polymicrobial, with common concomitant pathogens being Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus aureus (MRSA). Co-trimoxazole, fluoroquinolones, and Piperacillin/Tazobactam were the most effective antibiotics. Thirty-nine (90.7%) patients recovered completely, while four patients (9.3%) died of complications. Conclusion: Improper antimicrobial therapy increases resistance and mortality among patients with E. meningoseptica infections. It is imperative that clinicians remain vigilant about this rare pathogen and advise antimicrobial susceptibility testing for appropriate treatment, leading to favourable outcomes. [ABSTRACT FROM AUTHOR]

Background: There is a scarcity of national population-based studies on polymyositis (PM)/dermatomyositis (DM) readmissions in the USA. In this study, we aim to describe the rates, reasons for readmissions, and characteristics of readmissions for adults hospitalized for PM/DM in the USA. Methods: We analyzed the 2018 Nationwide Readmissions Database (NRD). We included index hospitalizations for all adult DM/PM patients with a principal diagnosis of PM/DM using ICD-10 codes. We excluded elective and traumatic readmissions. Using a "rank" command in STATA, the most common specific principal diagnosis of readmissions was outlined. Chi-square tests were used to compare baseline characteristics between readmissions and index hospitalizations. STATA 16 was used for analysis. Results: A total of 1610, 1286, and 842 index hospitalizations with a principal diagnosis of PM/DM, that were discharged alive, were included in the 30-, 90-, and 180-day readmission analysis, respectively. Among these, 193 (12%), 276 (21.5%), and 240 (28.5%) were readmitted within 30, 90, and 180 days, respectively. PM and sepsis were the most common reasons for reasons across the 3 timeframes. 30-day readmissions were responsible for an aggregate of 4.1 million US dollars in total hospital cost and 1518 hospital days in 2018. Compared to index hospitalizations, 30-day readmissions have higher Charlson Comorbidity Index scores, severe-extreme loss of function, obesity, and deep venous thrombosis. Conclusion: About a third of PM/DM hospitalized patients are readmitted within 180 days. Readmissions constitute a significant economic burden to the health care system. PM and sepsis are the main reasons for readmissions. Key points • About a third of polymyositis (PM)/dermatomyositis (DM) hospitalized patients are readmitted within 180 days • PM and sepsis are the main reasons for readmissions. • Readmissions of PM/DM Patients constitute a significant economic burden to the health care system. • Compared to index hospitalizations, 30-day readmissions have higher Charlson comorbidity index scores, severe-extreme loss of function, obesity, and deep venous thrombosis. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the effect of Alpha-Stim Anxiety, Insomnia and Depression (AID) cranial electrotherapy stimulation (CES) on anxiety, depression and health-related quality of life for primary care social prescribing service patients with anxiety symptoms. Design/methodology/approach: Open-label patient cohort design with no control group. A total of 33 adult patients (average age 42 years) completed six weeks of Alpha-Stim AID use. Pre- and post-intervention assessment with participant self-report measures: Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) and European Quality of Life Five Dimension (EQ-5D-5L). Findings: Reliable improvement and remission rates, respectively, were 53.39% and 33.3% for GAD-7; 46.7% and 29.5% for PHQ-9. There was a significant improvement in GAD-7 and PHQ-9 with large effect sizes. EQ-5D-5L results showed significant improvements in health-related quality of life. Perceived quality of life increased by 0.17 on the health index score, with the intervention adding 1.68 quality-adjusted life years (QALYs). Practical implications: Alpha-Stim AID can be delivered through a primary health-care social prescribing service and most patients will use as prescribed and complete treatment course. Alpha-Stim AID CES may be an effective anxiety and depression treatment for people with anxiety symptoms. The widespread roll-out of Alpha-Stim AID in health-care systems should be considered. Originality/value: To the best of the authors' knowledge, this is the first study to respond to the UK's National Institute for Health and Care (NICE) request for the collection of real-world data to understand better Alpha-Stim AID in relation to people's treatment uptake, response rates and treatment completion rates (NICE, 2021). [ABSTRACT FROM AUTHOR]

Background: Decedents with late-life dementia are often found at autopsy to have vascular pathology, cortical Lewy bodies, hippocampal sclerosis, and/or TDP-43 encephalopathy alone or with concurrent Alzheimer's disease (AD) lesions. Nonetheless, it is commonly believed that AD neuropathologic changes (NC) are the dominant or exclusive drivers of late-life dementia. Objective: Assess associations of end-of-life cognitive impairment with any one or any combination of five distinct NC. Assess impairment prevalence among subjects having natural resistance to each type of NC. Methods: Brains from 1,040 autopsied participants of the Honolulu-Asia Study, the Nun Study, and the 90 + Study were examined for NC of AD, Lewy body dementia, microvascular brain injury, hippocampal sclerosis, and limbic predominate TDP-43 encephalopathy. Associations with impairment were assessed for each NC and for NC polymorbidity (variable combinations of 2-5 concurrent NC). Results: Among 387 autopsied decedents with severe cognitive impairment, 20.4% had only AD lesions (ADNC), 25.3% had ADNC plus 1 other NC, 11.1% had ADNC plus 2 or more other NC, 28.7% had no ADNC but 1-4 other NC, and 14.5% had no/negligible NC. Combinations of any two, three, or four NC were highly frequent among the impaired. Natural resistance to ADNC or any other single NC had a modest impact on overall cohort impairment levels. Conclusion: Polymorbidity involving 1-5 types of concurrent NC is a dominant neuropathologic feature of AD and related dementias. This represents a daunting challenge to future prevention and could explain failures of prior preventive intervention trials and of efforts to identify risk factors. [ABSTRACT FROM AUTHOR]

Context: Collaborative care models for depression have been successful in a variety of settings, but their success may differ by patient engagement. We conducted a post-hoc analysis of the INDEPENDENT trial to investigate the role of differential engagement of participants on health outcomes over 3 years. Settings and Design: INDEPENDENT study was a parallel, single-blinded, randomised clinical trial conducted at four socio-economically diverse clinics in India. Participants were randomised to receive either active collaborative care or usual care for 12 months and followed up for 24 months. Method: We grouped intervention participants by engagement, defined as moderate (≤7 visits) or high, (8 or more visits) and compared them with usual care participants. Improvements in composite measure (depressive symptoms and at least one of three cardio-metabolic) were the primary outcome. Statistical Analysis: Mean levels of depression and cardio-metabolic measures were analysed over time using computer package IBM SPSS Statistics 25. Results: The composite outcome was sustained the highest in the moderate engagers [27.5%, 95% confidence interval (CI): 19.5, 36.7] and the lowest in high engagers (15.8%, 95% CI: 8.1, 26.8). This pattern was observed for individual parameters – depressive symptoms and glycosylated haemoglobin. Progressive reductions in mean depressive symptom scores were observed for moderate engagers and usual care group from baseline to 36 months. However, in high engagers of collaborative care, mean depressive symptoms were higher at 36 months compared to 12 months. Conclusion: Sustained benefits of collaborative care were larger in participants with moderate engagement compared with high engagement, although a majority of participants relapsed on one or more outcome measures by 36 months. High engagers of collaborative care for co-morbid depression and diabetes may need light touch interventions for longer periods to maintain health and reduce depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54–94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population level. We therefore studied the prevalence of co-occurring psychiatric and neurological conditions in autistic individuals in a national sample. Methods: This retrospective case-control study utilised the SAIL Databank to examine anonymised whole population electronic health record data from 2001 to 2016 in Wales, UK (N = 3.6 million). We investigated the prevalence of co-occurring psychiatric and selected neurological diagnoses in autistic adults' records during the study period using International Classification of Diseases-10 and Read v2 clinical codes compared to general population controls matched for age, sex and deprivation Results: All psychiatric conditions examined were more common amongst adults with autism after adjusting for age, sex and deprivation. Prevalence of attention-deficit hyperactivity disorder (7.00%), bipolar disorder (2.50%), obsessive-compulsive disorder (3.02%), psychosis (18.30%) and schizophrenia (5.20%) were markedly elevated in those with autism, with corresponding odds ratios 8.24–10.74 times the general population. Depression (25.90%) and anxiety (22.40%) were also more prevalent, with epilepsy 9.21 times more common in autism. Conclusions: We found that a range of psychiatric conditions were more frequently recorded in autistic individuals. We add to understanding of under-reporting and diagnostic overshadowing in autism. With increasing awareness of autism, services should be cognisant of the psychiatric conditions that frequently co-occur in this population. [ABSTRACT FROM AUTHOR]

Endometriosis (ENDO) is a chronic estrogen-dependent gynecological condition that affects reproductive-age women, causing pelvic pain, infertility, and increased risk for ovarian cancer. Diabetes mellitus (DM) is a metabolic disease with significant morbidity and mortality and rising incidence worldwide. The occurrence of DM among ENDO patients remains understudied, despite commonalities in these conditions' immune, inflammatory, and metabolic dysfunctions. This pilot study evaluated whether a subset of women with ENDO manifests DM co-morbidity and if so, whether DM promotes ENDO status. Archived ectopic lesions obtained at ENDO surgery from non-diabetic (ENDO-N; n = 11) and diabetic (ENDO-DM; n = 15) patients were identified by a search of an electronic health database. Retrieved samples were analyzed by immunohistochemistry for markers of proliferation (Ki67, PTEN), steroid receptor signaling (ESR, PGR) and macrophage infiltration (CD68). Immunostaining data were expressed as percentages of immune-positive cells in lesion stroma and epithelium. In lesion stroma, the percentages of nuclear immune-positive cells were higher for ESR2 and lower for PGR-T, in ENDO-DM than ENDO-N patients. The percentages of nuclear immune-positive cells for ESR1 and PTEN tended to be higher and lower, respectively, in ENDO-DM than ENDO-N groups. In lesion glandular epithelium, the percentages of nuclear immune-positive cells were higher for ESR1 and ESR2, in ENDO-DM than ENDO-N groups. ENDO-N lesions had lower percentages of stromal CD68 immune-positive cells than ENDO-DM Type 1 lesions. Findings demonstrate DM in a subset of women with ENDO, which was associated with significant changes in lesion stromal and epithelial nuclear steroid hormone receptor levels, suggestive of disease progression. [ABSTRACT FROM AUTHOR]

Background. The development of COVID-19 vaccines holds great potential for controlling the spread of SARS-CoV-2. Vaccines, irrespective of the disease are generally fraught with hesitancy, and Nigeria has a history of vaccine hesitancy. Objective. This study aimed at determining the perception of community members about the COVID-19 vaccine and their readiness to accept the vaccine in South West, Nigeria. Methods. A descriptive cross-sectional study design was employed to collect data from consenting adults using a structured online questionnaire for a period of three weeks. Data were subjected to a Chi-square test and logistic regression for bivariate and multivariate analysis, respectively. Results. A total of 807 respondents participated in the survey with 57.7% males and 42.3% females. Forty-five respondents (5.6%) had previously been diagnosed with COVID-19 while 11.5% of the respondents had co-morbidity. The overall perception of COVID-19 vaccines was good. Fifty-nine (59%) percent of the respondents were willing to accept the vaccine and will also encourage their family members to take the vaccine. Vaccine origin and cost were determinants of vaccine acceptability. Nonacceptability of the vaccine (61.6%) was based on possible adverse effects of the vaccine and mistrust of the government. Educational level, skill status, type of employment, and sector of employment were associated (P<0.001) with the acceptability of the COVID-19 vaccine. Conclusions. Citizens were willing to take COVID-19 vaccines, however, a lack of trust in government programs might undermine the vaccine campaign. Hence, the government needs to rebuild trust with the citizens towards achieving a high vaccination rate for COVID-19. [ABSTRACT FROM AUTHOR]

Background and objectives: Death and disability are both common results of perforative peritonitis. Most patients' postoperative recovery periods are uncertain even if they get to the hospital as soon as possible. Post-operative outcomes for patients are greatly influenced by the existence of these elements. We can determine whether patients are at a higher risk of mortality or complications through this prospective trial and treat them accordingly. Methods: 40 patients hospitalized to Department of General Surgery, Ayaan Institute of Medical Sciences, Moinabad, Telangana, India with perforative peritonitis provided the clinical data for this study. Consent to participate in the study was acquired after patients were given information about it. The trial lasted for a full year, from December 2021 to November 2022, and the postoperative follow-up lasted for a full four weeks. Results: The mortality rate was found to be 1.1 times the expected rate, and the morbidity rate was found to be 1.1 times the actual rate, all as a result of using linear analysis. Mortality and morbidity rates were similar to what was predicted by the data. The results were consistent with those of earlier research efforts. Perforation-to-operation time and the existence of co-morbidities were the two parameters investigated separately. There was shown to be a statistically significant relationship between these two factors and the end result. Conclusion: In perforative peritonitis surgeries, POSSUM rating predicted post-operative outcomes. It could identify high-risk patients for specialist care. That's why it's crucial to adjust the scoring system to each surgical type: improved results and patient-centered treatment. [ABSTRACT FROM AUTHOR]

Introduction: Parkinson's Disease (PD) is the second most frequent neurodegenerative disease and dopaminergic agents are frequently used as a treatment while 'end of dose deterioration' or 'Wearing-Off (WO)' phenomenon is common with these agents. Treatment reconciliation may be helpful in this situation and there is dearth of studies especially in India. Aim: To study the WO effects in patients of PD, their pharmacotherapy and outcome. Materials and Methods: This registry-based, prospective, observational, outcomes-based study was conducted in the Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, India, in collaboration with Department of Neuromedicine of Kolkata Medical College and private clinics of a Neurologist from January 2020 to December 2021. An attempt was also undertaken to make a registry of Idiopathic Parkinson's Disease (IPD) patients. WO Questionnaire 19-items (WOQ-19), Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS Scale), The 39-items Parkinson's Disease Questionnaire (PDQ-39 questionnaire), The 8-items Morisky Medication Adherence Scale (MMAS scale), suspected Adverse Drug Reaction (ADR) Reporting Form of Indian Pharmacoepia commission (version 1.3), World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) Scale, Naranjo causality assessment scale, Hartwig and Seigel's Severity Assessment Scale were used in the present study. The study was commenced after obtaining approval from institutional ethics committee. The data was then analysed with parametric or non parametric tests using (mean±Standard Deviation (SD), median, Fisher's-exact test, Friedman's Analysis of Variance (ANOVA) test, Wilcoxon matched pair signedrank test). Data collected and then statistically analysed by using WPS Excel version 2021 and GraphPad Prism version 9 software. Results: Total IPD patients were found to be 111 in the present study with a mean age of IPD patients as 61.85±7.20 years. Incidence of WO in the present study was found to be 40.5% among IPD patients. Most common characteristic of WO was found to be tremor in 104 (28.8%) patients followed by slowness of movement in 63 (17.5%) patients. WHO-UMC scale and Naranjo causality assesment scale both revealed 36.4% ADRs were probable category and 63.6% were possible category. MDS-UPDRS Score, PDQ-39 Score, MMAS-8 score significantly (p-value<0.05) improved during the course of treatment. Conclusion: Dose adjustment of syndopa was mostly used in the management of WO phenomenon and significant improvement in the quality of life of the patients was seen. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the impact of co-morbidities on health-related quality of life (HRQoL) for people with idiopathic pulmonary fibrosis (IPF). We aimed to investigate the relative contribution of co-morbidities to HRQoL of people with IPF. Methods: N = 157 participants were recruited from the Australian IPF Registry (AIPFR). Health state utilities (HSUs), and the super-dimensions of physical and psychosocial scores were measured using the Assessment of Quality of Life-8-Dimensions (AQoL-8D). The impact of co-morbidities on HRQoL was investigated using linear regression and general dominance analyses. Results: A higher number of co-morbidities was associated with lower HSUs (p trend = 0.002). Co-morbidities explained 9.1% of the variance of HSUs, 16.0% of physical super-dimensional scores, and 4.2% of psychosocial super-dimensional scores. Arthritis was associated with a significant reduction on HSUs (β = − 0.09, 95% confidence interval [CI] − 0.16 to − 0.02), largely driven by reduced scores on the physical super-dimension (β = − 0.13, 95% CI − 0.20 to − 0.06). Heart diseases were associated with a significant reduction on HSUs (β = − 0.09, 95% CI − 0.16 to − 0.02), driven by reduced scores on physical (β = − 0.09, 95% CI − 0.16 to − 0.02) and psychosocial (β = -0.10, 95% CI − 0.17 to − 0.02) super-dimensions. Conclusions: Co-morbidities significantly impact HRQoL of people with IPF, with markedly negative impacts on their HSUs and physical health. A more holistic approach to the care of people with IPF is important as better management of these co-morbidities could lead to improved HRQoL in people with IPF. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus Disease-2019 (COVID-19) emerged as a global pandemic and was associated with various haematologic abnormalities. There are very few studies from India regarding the association between anaemia and disease severity of COVID-19. Aim: To check the prevalence of anaemia and its association with severity of disease among hospitalised COVID-19 patients. Materials and Methods: This was a cross-sectional study involving 203 patients admitted in general ward and Intensive Care Unit (ICU) of a tertiary care hospital in eastern India. Complete blood count at admission along with other relevant clinical and laboratory parameters was noted. Haematological parameters of the patients were described and then correlated with disease severity and death. Spearman's correlation and Chi-square test were used to determine the associations. Results: Out of 203 patients with COVID-19,145 (71.4%) had anaemia. The study included 107 males (52.7%) and 96 females (47.3%), of which 77 (80%) females had anaemia compared to 68 (63.5%) males. Co-morbidities were present in 73 patients. Haemoglobin levels were significantly negatively correlated with disease severity (p<0.001). This was even true for patients without any other co-morbidities (p<0.05). Haemoglobin was also negatively correlated with deaths in this study (p<0.05). Conclusion: The prevalence of anaemia in admitted patients of COVID-19 was very high and low haemoglobin levels were associated with more severe disease and death. So, low haemoglobin levels in COVID-19 may be considered as a risk factor for more severe disease and death. [ABSTRACT FROM AUTHOR]

The current study explored similarities and differences in parenting stress (PSI) and behaviours in parent reports of autism spectrum disorder (ASD) and attachment disorder (AD). 155 parents whose children had developmental delays and disorders completed the social communication questionnaire, Randolph attachment questionnaire, strengths and difficulties questionnaire, PSI, and parent–child relationship inventory. Parents of children with AD reported greater levels of PSI than parents of children with ASD. Parents of children reaching criteria for both disorders reported the greatest levels of PSI. Limit setting was poorest in parents of children with both classifications, followed by parents of children with AD, and then ASD. Limit setting mediated the relationship between PSI and child behaviour problems for parents of children with ASD < but not for parents of children with AD. These findings suggest different areas of difficulty for parents of children with these conditions, which may be of help in designing interventions. [ABSTRACT FROM AUTHOR]