Abrupt Withdrawal Research Articles

Tracking changes in touch desire and touch avoidance before and after the COVID-19 outbreak.

Touch is essential for survival, social bonding, and overall health. However, the COVID-19 pandemic calls for an abrupt withdrawal from physical contact, and the prolonged lockdown has left many people in solitude without touch for months. This unprecedented dissociation from touch has cast a shadow on people's mental and physical well-being. Here we approached the issue by examining COVID-19's impact on people's touch attitudes. We analyzed people's desire and avoidance for animate and inanimate targets based on large-scale Japanese Twitter posts over an 8-year span. We analyzed the impact of the COVID-19 outbreak with the difference-in-differences estimation method, which can estimate the impact while accounting for other changes over time such as seasonality or long-term effects. As a result, we found that people's desire for touching the human body and pet animals increased significantly after the COVID-19 outbreak and remained high afterward. In contrast, the avoidance of touching everyday objects (e.g., doorknobs and money) increased immediately after the outbreak but gradually returned to the pre-COVID-19 levels. Our findings manifest the impact of COVID-19 on human touch behavior. Most importantly, they highlight the sign of "skin hunger," a public health crisis due to social distancing, and call attention to the trend that people are becoming less aware of infection control as COVID-19 persists.

An audit of the pharmacological management of patients experiencing acute alcohol withdrawal at a large tertiary centre

Abstract Introduction Alcohol has depressant effects on the central nervous system through its effect on inhibitory GABAA receptors. In chronic excessive alcohol use, GABAA receptors undergo neuroadaptation, and so, in abrupt alcohol withdrawal upon admission into hospital, the central nervous system remains in a hyperactive state, resulting in alcohol withdrawal syndrome (AWS), and can progress to seizures and delirium tremens if not managed appropriately. National guidance recommends validated tools such as the ‘Clinical Institute Withdrawal Assessment – Alcohol, revised’ (CIWA-Ar) scale and use of benzodiazepines and thiamine for AWS management. Within our organisation, pharmacists and the Alcohol and Drug Liaison Nurse (ADLN) specialists have noted variability in AWS management. Aim This project aimed to investigate the compliance to local and national guidelines in the management of AWS. Methods A retrospective audit (for which ethical approval was not required) was conducted using the electronic health record system to identify high-risk drinkers on the acute medical unit (AMU). A report of AMU admissions from 1st to 30th April 2020 was obtained and identified 44 patients with AWS. Patient records were analysed to assess compliance to the following standards: Standard 1 was that 100% of patients must have a completed AUDIT-C form on admission; Standard 2 was that 100% with AWS must have a CIWA-Ar score recorded every 4 hours on day one; Standard 3 was that 100% must be prescribed a benzodiazepine reducing regimen as per guidelines; and Standard 4 was that 100% with malnourishment or who will continue to consume alcohol must be discharged with thiamine 200-300mg daily. Results For Standard 1, 2% of patients (n=1) had AUDIT-C forms completed. For Standard 2, 14% (n=6) had a CIWA-Ar score measured every 4 hours on day one. For Standard 3, 23% (n=10) were prescribed benzodiazepine fixed-dose reducing regimens according to their CIWA-Ar score. 23% (n=10) had no benzodiazepines prescribed and 30% (n=13) were only prescribed a ‘when required’ benzodiazepine. 48% (n=21) were prescribed a regular benzodiazepine initially rather than a reducing regimen. Of these, 62% (13/21) were commenced on an appropriate dose according to their CIWA-Ar score. For Standard 4, 34% (n=15) were discharged on oral thiamine 200-300mg daily. 27% (n=12) were discharged without thiamine. Discussion/Conclusion The use of AUDIT-C forms was not routine practice. This may lead to under-detection of patients experiencing AWS resulting in treatment delays. CIWA-Ar scores were rarely carried out every 4 hours on day one, perhaps highlighting a need for guidance on frequency of CIWA-Ar assessment. Ten patients with AWS were not prescribed a benzodiazepine. This could have been due to a lack of awareness of guidelines, or that simplification of current guidelines is required. Limitations of this audit include that it did not explore clinical reasons for deviations from guidelines or any additional specialist advice sought from ADLN. As such, it cannot be assumed that all deviations from guidelines were inappropriate. No audit standards were met, highlighting a need to improve management of AWS in a hospital setting.

Ventricular Assist Devices: Challenges of the One-device Era.

Heart failure (HF) is linked to to high mortality rates and recurrent hospitalisations despite medical and device-based achievements. The use of left ventricular assist devices (LVADs) has improved survival among patients with advanced HF. Significant progress has been achieved with the new generation of continuous-flow devices, particularly with the fully magnetically levitated HeartMate 3. In June 2021, Medtronic announced the abrupt withdrawal of the HeartWare device from the market. This decision has introduced a new era in which the field of mechanical support for advanced HF patients is dominated by a single device - the HeartMate 3. The direct clinical and economic consequences of this change will necessitate new surgical considerations. Because of the expected need for HeartWare device replacement in small patients, new surgical techniques and device adaptation will be needed. The new single-device era will hopefully encourage scientists and engineers to create innovations in the advanced HF arena. Special considerations should be taken during the COVID-19 pandemic when treating patients with LVADs.

Bronchopulmonary Dysplasia and Impaired Neurodevelopment-What May Be the Missing Link?

Bronchopulmonary dysplasia (BPD) and poor neurodevelopmental outcome after preterm birth are closely associated. However, mechanistic links are uncertain. We are exploring the hypothesis that decreased circulating insulin-like growth factor (IGF)-1 after preterm birth due to the abrupt end of supply by the placenta impairs growth during critical windows of development in most organs, including the lung and brain. Throughout gestation, the fetus uses glycolysis as its main source of energy. Metabolism is mainly stopped at pyruvate, which serves as a "metabolic crossroad", allowing for the production of amino acids and other "building blocks" for new cells. Metabolic pathways are differentially regulated in the nucleus and the cytoplasm. The ratio between pyruvate dehydrogenase (PDH) and pyruvate dehydrogenase kinase (PDK) determines the biochemical activity which irreversibly metabolizes pyruvate to acetyl-co-A. Metabolites in the nucleus modulate epigenetic remodeling, an essential mechanism of normal growth and maturation during development. IGF-1 has been shown to contribute significantly to the development of virtually all organs, especially related to the regulation of microvascular growth, based on extensive studies of the brain, retina, lung, and intestine. With a preterm birth, the abrupt withdrawal of the placental supply of IGF-1 and its local production directly affects metabolism and microvascular development, which may contribute to a high risk for organ maldevelopment and injury after birth. We speculate that reduced bioavailability of IGF-1 is a possible link between lung and brain development disruption and increases susceptibility for major pulmonary and neurocognitive morbidities in preterm babies. KEY POINTS: · Metabolic changes inherent to prterm birth may cause epigenetic changes which cause "dysmaturational" development.. · IGF-1 may be the potential link between BPD and brain development.. · The ratio between pyruvate dehydrogenase and pyruvate dehydrogenase kinase determines the biochemical activity..

Managing Opioid Withdrawal in an Outpatient Setting With Lofexidine or Clonidine.

BackgroundThere is a need for improved strategies for managing abrupt opioid withdrawal when transitioning patients with opioid use disorder to comprehensive longitudinal care strategies such as naltrexone maintenance treatment. In addition, alpha-2 adrenergic agonists are used to ameliorate withdrawal symptoms, but current data characterizing real-world treatment are lacking.MethodsA retrospective chart review was conducted in outpatients undergoing abrupt opioid withdrawal managed with lofexidine (0.18 mg, 1-4 tablets 4x daily for 7 days, pro re nata [PRN or as needed]) or clonidine (0.2 mg, 1 tablet 3x daily for 10 days, PRN). Withdrawal outcomes were characterized at 30 days of follow-up. Binomial logistic regression was used to assess a potential association of the two treatments with different likelihoods of opioid cessation success in this real-world outpatient practice.ResultsIn cases treated with lofexidine (n=166) and clonidine (n=432), respectively, 40% and 10% were opioid-free, 6% and 2% continued long-term buprenorphine or methadone, 17% and 36% relapsed, and 37% and 52% were lost to follow-up at 30 days post-withdrawal. Among patients returning for follow-up care, 63% of patients treated with lofexidine and 21% treated with clonidine were opioid-free. Lofexidine was associated with a higher likelihood of opioid cessation success relative to clonidine (OR=6.47; Wald Chi-square=53.79, p<0.001).ConclusionAmong outpatients returning for follow-up care, nearly two-thirds of those managed with lofexidine reached opioid-free status at 30 days post-withdrawal, which was a higher likelihood than those managed with clonidine, thus allowing their transition to comprehensive care, including naltrexone.

Cholesterol-lowering drugs for high-risk hypercholesterolemia patients with COVID-19 while on Paxlovid™ therapy.

Paxlovid™ is a promising antiviral oral medication for patients at a high risk of a severe form of COVID-19. Regarding COVID-19 patients who have hypercholesterolemia and are at high or very high risk for an acute atherothrombotic cardiovascular event, we are highlighting patients with heterozygous familial hypercholesterolemia as an example of severe hypercholesterolemia. Unfortunately, the concomitant use of Paxlovid and a statin, which is highly dependent on cytochrome P4507A (CYP3A) for clearance, may result in significant drug interactions. Since an abrupt withdrawal of statin use may cause serious negative rebound effects on the cardiovascular system, it is essential to continue statin treatment also during the 5-day Paxlovid treatment period. During Paxlovid treatment, simvastatin and lovastatin need to be substituted with another statin, such as pravastatin or fluvastatin, while a reduction of the dose of atorvastatin and rosuvastatin is recommended.

Pandemic response: The identification of alternative clinical hours to ensure advanced practice nursing students meet program requirements.

The coronavirus (COVID-19) pandemic resulted in the abrupt withdrawal of clinical sites for advanced practice nursing students which worsened an already challenging placement process. Few studies to date have analyzed the use of alternative clinical practice experiences used to facilitate the completion of program requirements by advanced practice nursing students beyond direct hour requirements. The faculty team from one university decided to track and analyze their use of alternative clinical practice experiences for advanced practice nursing students actively enrolled during the first semester of the pandemic. The team collated student alternative hour entries within the clinical courses for review and statistical analysis. Data included input from advanced practice nursing students in family, pediatric primary care, adult gerontology primary care, adult gerontology acute care nurse practitioner concentrations, and nursing education, doctor of nursing practice, and nurse anesthesia programs. A total of 569 advanced practice nursing students participated in 15 distinct alternative clinical activities. There was a significant effect of students' program concentration on total number of virtual case study hours logged, F (6, 562) = 9.45, p < .0001, and a significant effect of students' program concentration on total number of continuing education hours logged, F (6, 562) = 7.79, p < .0001. Results can inform the use of concentration-specific alternative activities for advanced practice nursing students to address gaps in clinical experiences.

Reflecting on America’s Withdrawal from Afghanistan: The View From Southeast Asia

This essay reflects on the broad contours of the war in Afghanistan from Southeast Asia’s perspective. While the United States’ withdrawal from Kabul was calamitous, the pessimism about America’s role in Southeast Asia has been overstated. The United States’ withdrawal from Afghanistan was largely inconsequential for the region. Southeast Asian states deftly mixed their support for America’s campaign in Afghanistan and the broader war on terror without being seen as too sympathetic, including, in some instances, condemnation of America’s attacks on Islam. Regional governments balanced their domestic political interests with their foreign policy objectives. The abrupt Afghan withdrawal may instead have positive outcomes, as the United States boosted its courtship with countries of Southeast Asia and the broader Indo-Pacific region through new security arrangements such as the Quadrilateral Security Dialogue (Quad) and the Australian, U.K., and U.S. trilateral pact (AUKUS).

Multiple suicide attempts associated with addiction to tramadol

BackgroundThe opioid tramadol is used as analgesic drug, and more recently was also proposed for the management of major depressive disorder. However, growing evidence suggests a link between opioid system dysfunction and suicidal behaviors, raising the question of tramadol use in view of the high addictive and suicidal risk. Here, we present the case of a young adult woman with multiple suicide attempts related to tramadol addiction.Case presentationA 25-year-old woman was admitted for suicide attempt by phlebotomy in the Department of Psychiatric Emergency and Acute Care, Montpellier (France), in March 2020. The suicide attempt occurred 3 days after an abrupt tramadol withdrawal. In 2018, due to spinal disc herniation, she had a first prescription of tramadol to which she became addicted. The patient described an effect on psychological pain and suicidal ideation. However, she had to increase tramadol dose to obtain the desired effects, and for several months her intake was 2 000 mg per day. When she could not obtain tramadol any longer, suicidal ideation and psychological pain increased, leading to the suicide attempt. At the time of a worldwide opioid crisis that contributes to increasing suicidal behaviors, this case raises questions about tramadol prescription (often considered to be less addictive and with lower abuse potential) to individuals at risk of suicide.

The US withdrawal from Afghanistan and its impacts on the Pak-Afghan relationship

How to fix Afghanistan's challenges is one of the most talked-about issues of the 21st century. With its incredible nature and immense scale of being a safe haven for terrorists, the Afghanistan conundrum warrants all the thought it gets. The US hasty attack and abrupt withdrawal from Afghanistan affected the neighbouring states somehow and others. Pakistan is the most affected among these countries because of its chaotic past relationship. In the latest situation since the US retreat from Afghanistan, bordering countries have been trying to pull Afghanistan out of its misery. To achieve this goal, Pakistan had been trying to peacefully give passage to the US to leave and help the Taliban to assume control of Kabul. This is an uphill task because other regional and global powers have agendas to reshape Afghanistan’s future. On the other hand, for Afghanistan, common players, for instance, Pakistan, India, China, and Russia, have consistently been reconsidering their ways of meeting their national points of interest or terminations. This study investigates the Afghan harmony procedure and regional and global players waiting for the US withdrawal procedure and how it would affect Pakistan's future relationship with Afghanistan.

Assessment of Strategies for Safe Drug Discontinuation and Transition of Denosumab Treatment in PMO-Insights From a Mechanistic PK/PD Model of Bone Turnover.

Denosumab (Dmab) treatment against postmenopausal osteoporosis (PMO) has proven very efficient in increasing bone mineral density (BMD) and reducing the risk of bone fractures. However, concerns have been recently raised regarding safety when drug treatment is discontinued. Mechanistic pharmacokinetic-pharmacodynamic (PK-PD) models are the most sophisticated tools to develop patient specific drug treatments of PMO to restore bone mass. However, only a few PK-PD models have addressed the effect of Dmab drug holidays on changes in BMD. We showed that using a standard bone cell population model (BCPM) of bone remodelling it is not possible to account for the spike in osteoclast numbers observed after Dmab discontinuation. We show that inclusion of a variable osteoclast precursor pool in BCPMs is essential to predict the experimentally observed rapid rise in osteoclast numbers and the associated increases in bone resorption. This new model also showed that Dmab withdrawal leads to a rapid increase of damage in the bone matrix, which in turn decreases the local safety factor for fatigue failure. Our simulation results show that changes in BMD strongly depend on Dmab concentration in the central compartment. Consequently, bone weight (BW) might play an important factor in calculating effective Dmab doses. The currently clinically prescribed constant Dmab dose of 60 mg injected every 6 months is less effective in increasing BMD for patients with high BW (2.5% for 80 kg in contrast to 8% for 60 kg after 6 years of treatment). However, bone loss observed 24 months after Dmab withdrawal is less pronounced in patients with high BW (3.5% for 80kg and 8.5% for 60 kg). Finally, we studied how to safely discontinue Dmab treatment by exploring several transitional and combined drug treatment strategies. Our simulation results indicate that using transitional reduced Dmab doses are not effective in reducing rapid bone loss. However, we identify that use of a bisphosphonate (BP) is highly effective in avoiding rapid bone loss and increase in bone tissue damage compared to abrupt withdrawal of Dmab. Furthermore, the final values of BMD and damage were not sensitive to the time of administration of the BP.

US WITHDRAWAL &amp; TALIBAN REGIME IN AFGHANISTAN: IMPLICATIONS FOR REGIONAL STABILITY

After the United States leaves, Afghanistan, a nation decimated by a four-decade prolonged conflict, will experience much more anarchy and a humanitarian calamity. The United States' abrupt withdrawal has left a political vacuum that has spread to all of the regional states, and the state system has also disintegrated. The purpose of this study was to determine the effects of the US withdrawal and the Taliban's resurgence in Afghanistan. This study specifically sought to comprehend the prospects for peace in Afghanistan in relation to regional peace, current regional blocs, and those blocs' policies. The United States' plan to combat terrorism and restore peace to war-torn nations has serious flaws, as evidenced by the U.S. withdrawal from Afghanistan and the Taliban's subsequent takeover. To comprehend the breakdown of the state apparatus, the U.S. withdrawal, the Taliban regime, and its implications for regional stability, secondary data has been used. This research paper used the theoretical perspective of conflict resolution and management to highlight the shortcomings in American management of the Taliban and Afghanistan issues, as well as their effects Key words: United State Withdrawal, Political Vacuum, Taliban, Conflict Resolution and Management Theory, Discourse Analysis.

Incidence of Hypotension Associated With Two Different Vasopressin Discontinuation Strategies in the Recovery Phase of Septic Shock

Introduction: Safe and effective vasopressor withdrawal strategies during the recovery phase of septic shock lack consensus and are not addressed in clinical practice guidelines. The purpose of this study was to compare the incidence of clinically relevant hypotension associated with different vasopressin (AVP) discontinuation strategies. Methods: This was a single-center, retrospective, cohort study, conducted at a university medical center over a three-year period. Adult patients ≥18 years with septic shock were included in the study. Patients were stratified into two groups; patients incrementally weaned from AVP and patients in which AVP was abruptly discontinued. The primary endpoint was to compare the incidence of clinically relevant hypotension between study groups up to 24 hours following discontinuation. Secondary analyses included the incidence of any hypotensive event up to 24 hours after AVP cessation, intensive care unit and hospital length of stay, and in-hospital mortality. Results: A total of 74 patients (n = 46 AVP wean and n = 28 AVP no-wean) met inclusion criteria and were included in the study. The primary outcome was not statistically different between groups. Clinically relevant hypotension occurred in 24 patients (52.3%) and 16 patients (57.1%) in the AVP wean and AVP no-wean groups, respectively (P = .68). There were no significant differences in any secondary clinical outcome between the two study groups. Conclusion: No differences were found in the incidence of clinically relevant hypotension, length of stay, or mortality between AVP weaning and no-weaning discontinuation strategies. These findings suggest incremental weaning and abrupt withdrawal of AVP are both acceptable discontinuation strategies.

Effect of Abrupt and Gradual withdrawal of Acrylamide on Acrylamide Induced Hepatic and Renal Cortical Injury of Adult Male Albino Rats: Histological and Immunohistochemical Study.

Effect of Abrupt and Gradual withdrawal of Acrylamide on Acrylamide Induced Hepatic and Renal Cortical Injury of Adult Male Albino Rats: Histological and Immunohistochemical Study.

Innovative Opportunities for Nurse Practitioner Education Uncovered by the Pandemic.

The coronavirus disease 2019 pandemic resulted in the abrupt withdrawal of clinical sites for nurse practitioner (NP) students during the Spring semester of 2020. This situation necessitated the identification of innovative clinical opportunities to ensure advanced practice nursing students met course objectives and program requirements. This article describes innovative clinical opportunities that met the needs of the community, including those impacted by the pandemic, and enabled NP students' progression toward completing clinical requirements. Participation in these unique opportunities provided more than 130 NP students with meaningful clinical experiences to increase competence in the care of vulnerable populations and communities during a public health crisis. Experiences supported competency development in the areas of leadership, clinical management, population health and infection control, policy and advocacy, informatics, telehealth, and ethical considerations while providing essential services to the community. These innovative clinical opportunities may be useful for graduate clinical programs worldwide. [J Nurs Educ. 2022;61(3):153-155.].

HOSPITAL BASED STUDY ON OCCURRENCE AND RISK FACTORS OF RETINOPATHY OF PREMATURITY

Retinopathy of prematurity, previously known as retrolental broplasia is a vasoproliferative disease that affects premature infants. Premature retina when exposed to high oxygen concentration , followed by abrupt withdrawal ,easily undergoes uncontrolled vasculo brotic proliferation and eventually results in retinal detachment.. AIM: 1.To determine the incidence of ROPin neonates of gestational age less than 34 completed weeks; weighing less than 2000g 2.To determine its association with various clinical risk factors. MATERIALS AND METHODS: This hospital based, prospective study was done in Regional Institute of Ophthalmology, Guwahati Medical College and Hospital. A total of 168 eyes of 84 babies were evaluated and the results were statistically analysed. The period of study was from June 2020 to May 2021. The results were statistically analysed using sher's exact test or chi square test for independence. RESULTS: In a total of 84 babies(168 eyes) the incidence of ROP was found to be 14.28%. The risk factors which had signicant association with ROP in this study are: Prematurity, low birth weight, supplemental oxygen, respiratory distress syndrome. In addition, however, risk factors like gestational diabetes, phototherapy and sepsis also show signicant association with ROP.

Neopioidni analgetici u terapiji bola kritično obolelih pacijenata - prijatelji, neprijatelji ili dobri saradnici?

Patients in intensive care units (ICUs) experience pain, which they describe as a significant cause of stress during treatment. It can progress to chronic pain and significantly affect the quality of life. Opioids have long been the backbone of ICU pain therapy. The consequences of their long-term use are known today, such as prolonged ICU stay and mechanical ventilation, resulting in increased treatment costs. Additionally, abstinence syndrome is a consequence of abrupt opioid withdrawal. Also, there is a risk of tolerance and hyperalgesia after prolonged opioid use. Globally, opioid dependence after hospital opioid treatment is alarming, although there is still a lack of data on its incidence after ICU. Multimodal analgesia enables comfort to the patient, opioid-sparing, and avoidance of side effects of non-opioid analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a broad group of drugs recommended with paracetamol to treat mild to moderate acute postoperative pain. Although often prescribed by intensivists, their use in treating painful conditions in ICU is controversial due to the possible consequences on the organs of critically ill patients. Due to the inhibition of cyclooxygenases, NSAIDs indirectly cause vasoconstriction of the renal arteries and arterioles, leading to kidney damage. NSAIDs inhibit platelet aggregation and may predispose to bleeding. Analgesia of a critically ill patient is a important part of their treatment, however it can be challenging in certain patients. Numerous combinations of pharmacological and non-pharmacological approaches can be adapted to the patient's current characteristics.

Case of Seizures With Sudden Discontinuation of Zolpidem.

Zolpidem has been used to treat insomnia due to its reported lower risk of tolerance and withdrawal. In this report, the authors present a case of zolpidem dependence that caused seizures upon abrupt withdrawal.

Gradual Glucocorticosteroid Withdrawal Is Safe in Clinically Quiescent Systemic Lupus Erythematosus.

ObjectivesPatients with systemic lupus erythematosus (SLE) are usually treated with glucocorticosteroids even during periods of clinically quiescent disease. A recent study showed that abrupt glucocorticoid withdrawal was associated with an increased likelihood of flare in the next 12 months. The aim of the present study was to assess clinical flare rates and damage accrual in patients who tapered glucocorticosteroids gradually.MethodsPatients from the Toronto Lupus Clinic with 2 consecutive years of clinically quiescent disease were retrieved from the database. Individuals who maintained a low prednisone dose (5 mg/day) comprised the maintenance group, whereas patients who gradually tapered prednisone within these two years comprised the withdrawal group. All individuals were followed for 2 years after prednisone discontinuation or the corresponding date for the maintenance group. Propensity score matching was implemented to adjust for certain baseline differences. Outcomes included clinical flares and damage accrual.ResultsOf 270 eligible patients, 204 were matched (102 in each group). Flare rate (any increase in clinical SLE Disease Activity Index 2000) was lower in the withdrawal group both at 12 (17.6% versus 29.4%; P = 0.023) and 24 months (33.3% versus 50%; P = 0.01). Moderate to severe flares (requiring systemic treatment escalation) were not different at 12 months (10.8% versus 13.7%; P = 0.467) but were less frequent at 24 months (14.7% versus 27.5%; P = 0.024). Damage accrual was less frequent in the withdrawal group (6.9% versus 17.6%; P = 0.022). No predictors for clinical flares were identified.ConclusionGradual glucocorticoid withdrawal is safe in clinically quiescent SLE and is associated with fewer clinical flares and less damage accrual at 24 months.

Afghanistan Post US Withdrawal: Security Challenges and Future Prospects

After 9/11, the mission “Operation Enduring Freedom” was to root out terrorists from Afghanistan and to establish good governance in shape of democracy. However, the current internal law and order situation is worse even after years of US forces staying in Afghanistan. While President Trump has directed Pentagon to decrease nearly half of the more than 14,000 troops stationed in Afghanistan. All the regional and global powers have their interest in Afghanistan, have no clear policies for peace and development, but everyone is in struggle to solve the Afghan problem according to their own interest. To establish democracy, improve governance, rule of law and security situation in Afghanistan, the US withdrawal without proper homework will create more problems and lead to chaos. It is believed that the abrupt withdrawal may further strengthen the Taliban and increase violence in Afghanistan. This paper aims to investigate those internal and external factors which may become the cause of insecurity for Afghanistan. Furthermore, the research work enlightens over the solution of security problems in Afghanistan and suggests possible option.