Chronic Medical Illness Research Articles

Association between functional limitations and depression among community-dwelling older adults in Malaysia.

This study aimed to assess the relationship between functional limitations and depression among community-dwelling older adults in Malaysia. Data from a nation-wide community-based cross-sectional study were analyzed. This study was conducted using a two-stage stratified random sampling design. In total, 3772 older adults aged ≥60 years responded to the survey. Depression was identified using a validated Malay version of the Geriatric Depression Scale (M-GDS-14), with those scored ≥6 categorized as having depression. Functional limitations were assessed using both Barthel's Activities of Daily Living (ADL) and Lawton's Instrumental Activities of Daily Living (IADL). The relationship was determined by multivariate logistic regression, adjusted for other variables. The prevalence of depression was 11.5% (95% confidence interval [CI] 9.4, 13.4). Multiple logistic regression analysis found that older adults with limitations in ADL were 2.6 times more likely of having depression (adjusted odds ratio [aOR] 2.58, 95% CI 2.01, 3.32), while those with limitations in IADL the risk of having depression was almost doubled (aOR 1.68, 95% CI: 1.32, 2.14). Other significant factors were incontinence (aOR 3.33, 95% CI: 2.33, 4.74), chronic medical illness (aOR 1.44, 95% CI: 1.15, 1.81), current smoker (aOR 4.19, 95% CI: 1.69, 10.39), poor social support (aOR 4.30, 95% CI: 2.98, 6.20), do not have partner, ethnic minorities and low individual monthly income. Older adults with functional limitation in both basic ADL and complex IADL are independently at higher risk of having depression. Geriatr Gerontol Int 2020; 20: 21-25.

Factors Associated with Psychological Distress and Brief Resilient Coping Level During the COVID-19 Pandemic Among Health-Care Professionals in Dessie, Ethiopia.

BackgroundThe outbreak of Coronavirus Disease 2019 (COVID-19) has caused serious threats to people’s health and lives in the world. The health-care professionals are bravely fighting on the front lines of the pandemic everywhere in the world. Our study is the first to study psychological distress and coping status among health-care professionals of Dessie town, Ethiopia during the unbridled time of the COVID-19 outbreak.MethodsA cross-sectional internet-based study was conducted between June 20 and July 13, 2020. The questionnaires included the demographic information, COVID-19 related questions, Kasseler-10 to assess psychological distress level and Brief Resilient Coping Scale, and Oslo-3 social support scale questionnaire were employed.ResultsA total of 423 participants were involved in the study with a response rate of 100%. The mean age of respondents was 34.5 years (SD = ±8.45 years). The prevalence of psychological distress among participants was 42%. Of these 18%, 11%, and 13% had mild, moderate, and severe psychological distress levels. Being married, being nurses and pharmacies, current substance users, working in emergency and outpatient departments, history of chronic medical illness, brief resilient coping level, and social support level were particularly associated with high psychological distress.ConclusionHealth-care professionals are experiencing a substantial level of psychological distress. In addition to other modifying factors coping level and social support was a significant predictor of psychological distress among health-care professionals. These findings should inform the implementation of interventions that increase coping resilience and social support to mitigate the impact of psychological distress among health-care professionals.

The Magnitude of Suicidal Behavior among People Living with Diabetes Mellitus Attending an Outpatient Department of Alamata General Hospital, Mekelle, Tigray, Ethiopia 2019: A Cross-Sectional Study

Background: Globally, suicide accounts for 75% in low and middle-income countries (LMICs). Though the magnitude of suicidal behavior in High-income Countries (HIC) is higher relative to the general population, limited studies had explored suicidal behavior among medical outpatients in LMICs including this locality. Suicidal behaviors among people with the chronic medical illness are one of the commonest psychiatric emergencies that demand a major health concern by researchers and mental health task forces. People with chronic medical illnesses show suicidal ideation and attempt which are fatal problems to end life. Therefore, this study will address the gaps by determining the magnitude of suicidal behavior among Diabetes Mellitus (DM) patients in an outpatient setting of Alamata General Hospital (AGH). Methods: Institutional based cross-sectional study was conducted among medical patients attending a chronic care clinic in Alamata general Hospital from May to June 2019. A sample of 146 DM patients who were attending an outpatient chronic care clinic was included in the study. Suicidal behavior was assessed by the World Health Organization (WHO) suicidal behavior assessment through software called Statistical Package for Social Science (SPSS) Version 25. Results: The magnitude of suicidal behavior among Diabetes Mellitus patients at AGH was 30.8%, 15.8% had suicidal ideation, 14.4% had a suicidal attempt and 15.1% of them had the plan to commit suicide. Conclusion: The prevalence of suicidal behavior was found to be significantly high in Diabetes Mellitus patients. Hence, it is important to conduct more interventions to assess the suicidal behavior symptoms among Diabetes Mellitus patients.

Depression and associated factors among old age population in Dega damot district, North West Ethiopia. A cross-sectional study

• Depression is a common disorder in late life. • Older people with other chronic medical illnesses, retired ones’ and with those having poor social support have more risk for depression. • Usual screening of depression in older people should be considered. • Integration of mental health services with other clinical services should be considered by clinician and policy makers. Depression has been recognized as a significant problem associated with undesirable outcomes such as poor functioning, increased perception of poor health, increased utilization of medical services, increased morbidity and mortality. Early diagnosis and treatment of depression reduces medical costs and reduce caregiver burden. However, limited evidence was available on the prevalence of geriatric depression and its associated factors in Ethiopia. To assess the prevalence and associated factors of depression among old ages in Dega Damot district, North West Ethiopia, 2019. A community-based cross-sectional study was conducted from September 01, 2019 to September 30, 2019. Fifteen items Geriatric depression scale was used to conduct a face-to-face interview with 813 old age people in selected areas of the district. EPI data version 3.1 software was used for data entry and SPSS version 23 for analysis. Variables with a P -value of less than 0.25 in the bivariable analysis were entered in to the multivariable analysis. Odds ratio with 95% confidence interval was calculated and statistical significance was declared at P -values < 0.05. The prevalence of depression among elders was found to be 45.9% [95% CI: 42.3%-49.4%]. This study showed that being female [AOR = 2.40, 95% CI [1.60–3.59], (age>75 years [AOR=6.78, 95% CI 3.08–14.93], age 70–74 years. [AOR=4.64, 95% CI 2.60–8.30], age 65–69 years [AOR=1.80, CI 1.12–2.88]; divorced [AOR=4.31, CI [1.53–12.17], widowed [AOR=6.56, 95% CI 2.28–18.79]; retired [AOR = 4.83, 95% CI [2.23–10.43]; having chronic disease (AOR=5.39, CI [2.70–10.76] and poor social support [AOR=7.45, CI 4.22–13.16] and medium social support [AOR=3.67, CI 2.36–5.70] were significantly associated with depression. Variables like alcohol consumption, khat chewing, and other substances are a sensitive issue in the society and might cause social desirability bias. Fail to establish cause and effect relationships because of cross-sectional study design was used. Almost half of the elders were found to be depressed which is high in prevalence. Screening of depression should be emphasized among the geriatric population.

Type of Intensive Care Unit Matters: Variations in Palliative Care for Critically Ill Patients with Chronic, Life-Limiting Illness.

Background: It is not clear whether use of specialty palliative care consults and "comfort measures only" (CMO) order sets differ by type of intensive care unit (ICU). A better understanding of palliative care provided to these patients may help address heterogeneity of care across ICU types. Objectives: Examine utilization of specialty palliative care consultation and CMO order sets across several different ICU types in a multihospital academic health care system. Design: Retrospective cohort study using Washington State death certificates and data from the electronic health record. Setting/Subjects: Adults with a chronic medical illness who died in an ICU at one of two hospitals from July 2013 through December 2018. Five ICU types were identified by patient population and attending physician specialty. Measurements: Documentation of a specialty palliative care consult during a patient's terminal ICU stay and a CMO order set at time of death. Results: For 2706 eligible decedents, ICU type was significantly associated with odds of palliative care consultation (p < 0.001) as well as presence of CMO order set at time of death (p < 0.001). Compared with medical ICUs, odds of palliative care consultation were highest in the cardiothoracic ICU and trauma ICU. Odds of CMO order set in place at time of death were highest in the neurology/neurosurgical ICU. Conclusion: Utilization of specialty palliative care consultations and CMO order sets varies across types of ICUs. Examining this variability within institutions may provide an opportunity to improve end-of-life care for patients with chronic, life-limiting illnesses who die in the ICU.

STEM Education for Children with Sickle Cell Disease: Unique Educational Outreach Program Taught By Near-Peer Undergraduate Students

One fifth of school aged children in the US have a chronic medical illness and represent an underserved and educationally disadvantaged population. In particular, children with sickle cell disease (SCD) of all genotypes spend significant amounts of time in the medical settings and represent a potentially "captive audience" where hospitalization time can include educational activities. Accordingly, we saw an opportunity for Biomedical Engineering (BME) undergraduates at Georgia Institute of Technology, who are taught biology, medicine, engineering, and design to implement a new paradigm of K-12 Science, Technology, Engineering, and Mathematics (STEM) programming, where human physiology is used as a model framework. In collaboration with hospital school teachers at Children's Healthcare of Atlanta, we created a novel educational program where we (1) leverage the patient's own medical experience as motivation for learning, (2) develop hands-on interactive activities to teach STEM concepts that are adaptable for the patient's cognitive level, (3) provide undergraduate students with high quality meaningful patient interactions and clinical experiences, and (4) provide innovative educational programming for hospitals. The BME undergraduates enrolled in a human-centered design course focusing on iterative design, development and implementation of hands-on interactive STEM activities rooted in human physiology (Fig. 1A). Each activity contains state and national K-12 STEM standards. The BME undergraduates are well-suited to teach in the hospital environment, as they experience a strong STEM curriculum and are able to capture the true interdisciplinary nature of medical science in each activity. The undergraduates and patients are near-peer age, relationship-building occurs quickly, the patients admire them and enjoy their time together. During the 2018-19 school year we developed learning assessment questions for 2 of the most requested activities, assessing each SCD patient's mastery of the learning objectives. In the Blood Jar activity (Fig. 1B), the SCD patient builds a model of blood, learning the composition, function of each component, and importance of hydration. Sixty-five patients participated, 43% of grade K - 2, 61% of 3 - 5, 85% of 6th through High School scored Thoroughly Demonstrated. In the Bone activity (Fig. 1C), each SCD patient constructs a bone model to understand the function and structure of a bone. Twenty-nine patients participated, 28% of grade K - 2, 30% of 3 - 5, 88% of 6 - 8, and 75% of high school scored Thoroughly Demonstrated. Patient feedback (Fig. 1D) has been overwhelmingly positive, stating the activities are "fun" and "engaging" and requesting additional visits from the BME undergraduates. BME undergraduate expressed growth and learning of: disease pathophysiology, teaching and learning styles, and effective and succinct communication skills. In Georgia, Life Science is taught in 5th and 7th grade, our target demographic. Our results show at least 75% of patients in 6th grade and above demonstrated thorough understanding of the STEM topics taught, while K - 5 grade did not achieve that level of understanding. Lower scores for those patients are attributed to difficulties remembering new scientific vocabulary. Many of the BME undergraduates in our program are pre-med and use the experiences and meaningful interactions with patients in their medical school applications. As stated by a BME undergraduate after a patient interaction, "the white blood cells are like soldiers in the army! I like that! This analogy prompted the patient to think of his future. It reminded me the littlest things can make a big difference. This makes me even more excited to go into medicine." Our program represents an innovative approach to teaching STEM by: engaging SCD children, who are uniquely suited to learn important STEM concepts within the context of their own disease, provide learning to SCD patients during extended absences from school, allowing BME undergraduate students to design, develop, and teach STEM activities, provide meaningful clinical experience, and supplying quality educational programming for the hospital. This collaborative program can be straightforwardly implemented at other pediatric institutions with robust college volunteer programs and hospital school programs. Our activities can be exported and implemented at other institutions. Disclosures Lam: Sanguina, Inc: Current equity holder in private company.

Mindfulness and Behavior Change.

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

Novel Coronavirus (COVID-19): telemedicine and remote care delivery in a time of medical crisis, implementation, and challenges.

The novel Coronavirus (COVID-19) caused by the SARS-CoV-2 virus has led to many challenges throughout the world, one of which is the delivery of health care to patients while they remain home. Telemedicine, or the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, has been utilized by health care providers for many years, but its widespread implementation did not occur until the onset of the COVID-19 pandemic. Currently, it has become the primary mechanism of care delivery for patients during the COVID-19 pandemic. While obstacles are present for hospitals and providers to establish these services, most barriers exist with patient access. Patients require advanced technical support, translator services, and other measures to become comfortable engaging in a telemedicine encounter. In addition, appropriate follow-up must be provided for chronic medical illnesses and malignancies, helping to prevent the evolution of these conditions during the COVID-19 crisis. Finally, we must ensure equity for all patients seeking to access health services, including those of lower socioeconomic status. Many of these patients rely on public hotspots or library computers for their internet connectivity, but this is likely not conducive to a clinical encounter. These barriers must be addressed to ensure health equity for all patients seeking care. Telemedicine can connect patients and providers during this time of crisis and hopefully will serve as a model for continued use after the pandemic has abated.

The Feasibility and Validity of Objective and Patient-Reported Measurements of Cognition During Early Critical Illness Recovery.

Cognitive outcomes are an important determinant of quality of life after critical illness, but methods to assess early cognitive impairment and cognition recovery are not established. The objective of this study was to assess the feasibility and validity of objective and patient-reported cognition assessments for generalized use during early recovery from critical illness. Patients presented from the community with acute onset of either intracerebral hemorrhage (ICH) or sepsis as representative neurologic and systemic critical illnesses. Early cognitive assessments comprised the Glasgow Coma Scale (GCS), three NIH Toolbox cognition measures (Flanker Inhibitory Control and Attention Test, List Sorting Working Memory Test and Pattern Comparison Processing Speed Test) and two Patient Reported Outcomes Measurement Information System (PROMIS) cognition measures (Cognition-General Concerns and Cognition-Abilities) performed seven days after intensive care unit discharge or at hospital discharge, whichever occurred first. We enrolled 91 patients (53 with sepsis, 38 with ICH), and after attrition principally due to deaths, cognitive assessments were attempted in 73 cases. Median [interquartile range] Sequential Organ Failure Assessment scores for patients with sepsis was 7 [3, 11]. ICH cases included 13 lobar, 21 deep and 4 infratentorial hemorrhages with a median [IQR] ICH Score 2 [1, 2]. Patient-reported outcomes were successfully obtained in 42 (58% overall, 79% of sepsis and 34% of ICH) patients but scores were anomalously favorable (median 97th percentile compared to the general adult population). Analysis of the PROMIS item bank by four blinded, board-certified academic neurointensivists revealed a strong correlation between higher severity of reported symptoms and greater situational relevance of the items (ρ = 0.72, p = 0.002 correlation with expert item assessment), indicating poor construct validity in this population. NIH Toolbox tests were obtainable in only 9 (12%) patients, all of whom were unimpaired by GCS (score 15) and completed PROMIS assessments. Median scores were 5th percentile (interquartile range [2nd, 9th] percentile) and uncorrelated with self-reported symptoms. Shorter intensive care unit length of stay was associated with successful testing in both patients with ICH and sepsis, along with lower ICH Score in patients with ICH and absence of premorbid dementia in patients with sepsis (all p < 0.05). Methods of objective and patient-reported cognitive testing that have been validated for use in patients with chronic medical and neurologic illness were infeasible or yielded invalid results among a general sample of patients in this study who were in early recovery from neurologic and systemic critical illness. Longer critical illness duration and worse neurocognitive impairments, whether chronic or acute, reduced testing feasibility.

Hydroxychloroquine in Rheumatological Disorders: The Potential Buffer Against COVID-19

Background: Hydroxychloroquine (HCQ) is a well prescribed drug in rheumatological disorders. The repurposed drug HCQ was also used for SARS-CoV-2 as prophylactic and therapeutic strategy in Indian context. The present study aimed to describe that either rheumatological disorder had threatening effect on COVID-19 or advantageous particularly with the use of HCQ.Methods: The present retrospective, observational study included 4100 COVID-19 patients of SMS Medical college and Hospitals, Jaipur, India. The patient’s data (after anonymizing and de-linking) concerning underlying chronic medical illness especially focused on rheumatological disorders was extracted from their medical records. The data from rheumatological patients concerning medical history, clinical manifestation, severity of COVID-19, extension of disease, treatment history and outcome were collected and analyzed.Results: Out of large study cohort of 4100 patients of COVID-19, rheumatological disorders found only in seven patients (0.17%) including rheumatoid arthritis (RA) in four patients, systemic lupus erythematous (SLE) in two patients and Wegener granulomatosis in one patient. All rheumatologic patients of study group had symptomatic presentations with one patient had critical, another one had severe, two had moderate and three patients had mild illness. Only one patient was on hydroxychloroquine (HCQ) treatment (200 mg daily) who presented with mild illness of COVID-19. One patient of SLE with lupus nephritis on glucocorticoids and immunosuppressive agents but not on HCQ, developed critical illness and later on succumbed to life.Conclusion: The present study showed that patients with rheumatological disorders might not be at increased risk of acquiring COVID-19 or a more severe disease. Moreover, HCQ has some protective role against COVID-19 in patients of rheumatological disorders and it also play an important role in reducing the disease severity.Funding Statement: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not for profit sectors.Declaration of Interests: All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential.Ethics Approval Statement: This study approved by ethical and research committee of SMS medical college and Hospital, Jaipur, India.

Nurses’ work-related stress and associated factors in governmental hospitals in Harar, Eastern Ethiopia: A cross-sectional study

Work-related stress causes poor quality of nursing care and increases the risk of medical errors. Research evidence is so limited to nurses' work-related stress in eastern Ethiopia. Therefore, this study aimed to assess work-related stress and associated factors among nurses working in governmental hospitals in Harar, Eastern Ethiopia. Institution-based quantitative cross-sectional study was conducted among 367 nurses from 15th to 30th March, 2015. Simple random sampling technique was applied to recruit study participants. Data were collected using structured self-administered questionnaire. Descriptive statistics, bivariate and multivariate logistic regressions were carried out. The statistical association was declared using adjusted odds ratio at 95% confidence interval (CI) and P-value of less than 0.05. A total of 398 study participants were involved in the study, and the response rate was 92.2% (367/398). More than half of 202(55%) of the participants were males. One third (33.8%, n = 124) of study participants' age ranged between 26 to 34 years. The prevalence of work-related stress in the current study was 66.2%. Nurses, who reared child (AOR = 2.1, 95% CI: 1.2, 3.7), working in intensive care units (AOR = 4.5, 95% CI: 1.4, 17.7), work on rotation (AOR = 2.5, 95% CI: 1.4, 4.4), and nurses who had a chronic medical illness (AOR = 2.6, 95% CI: 1.2, 5.7) were significantly associated with nurses' work-related stress. Two-thirds of nurses who were working at government hospitals had work-related stress. Work-related stress was associated with child-rearing, working units, work on rotation, and chronic medical illness. We suggested the hospital's administration, and other concerned stakeholders should design a strategy to undertake necessary measures such as hiring more nurses to minimize workload and rescheduling work shift to alleviate work-related stress among nurses.

Abnormal immunity of non-survivors with COVID-19: predictors for mortality

BackgroundThe number of coronavirus disease 2019 (COVID-19) cases has rapidly increased all over the world. Specific information about immunity in non-survivors with COVID-19 is scarce. This study aimed to analyse the clinical characteristics and abnormal immunity of the confirmed COVID-19 non-survivors.MethodsIn this single-centered, retrospective, observational study, we enrolled 125 patients with COVID-19 who were died between January 13 and March 4, 2020 in Renmin Hospital of Wuhan University. A total of 414 randomly recruited patients with confirmed COVID-19 who were discharged from the same hospital during the same period served as control. The demographic, clinical characteristics and laboratory findings at admission, and treatment used in these patients were collected. The immunity-related risk factors associated with in-hospital death were tested by logistic regression models and Receiver Operating Characteristic (ROC) curve.ResultsNon-survivors (70 years, IQR: 61.5–80) were significantly older than survivors (54 years, IQR: 37–65) (P < 0.001). 56.8% of non-survivors was male. Nearly half of the patients (44.9%) had chronic medical illness. In non-survivors, hypertension (49.6%) was the most common comorbidity, followed by diabetes (20.0%) and coronary heart disease (16.0%). The common signs and symptoms at admission of non-survivors were fever (88%), followed by cough (64.8%), dyspnea (62.4%), fatigue (62.4%) and chest tightness (58.4%). Compared with survivors, non-survivors had higher white blood cell (WBC) count (7.85 vs 5.07 × 109/L), more elevated neutrophil count (6.41 vs 3.08 × 109/L), smaller lymphocyte count (0.69 vs 1.20 × 109/L) and lower platelet count (172 vs 211 × 109/L), raised concentrations of procalcitonin (0.21 vs 0.06 ng/mL) and CRP (70.5 vs 7.2 mg/L) (P < 0.001). This was accompanied with significantly decreased levels of CD3+ T cells (277 vs 814 cells/μl), CD4+ T cells (172 vs 473 cells/μl), CD8+ T cells (84 vs 262.5 cells/μl, P < 0.001), CD19+ T cells (88 vs 141 cells/μl) and CD16+ 56+ T cells (79 vs 128.5 cells/μl) (P < 0.001). The concentrations of immunoglobulins (Ig) G (13.30 vs 11.95 g/L), IgA (2.54 vs 2.21 g/L), and IgE (71.30 vs 42.25 IU/ml) were increased, whereas the levels of complement proteins (C)3 (0.89 vs 0.99 g/L) and C4 (0.22 vs 0.24 g/L) were decreased in non-survivors when compared with survivors (all P < 0.05). The non-survivors presented lower levels of oximetry saturation (90 vs 97%) at rest and lactate (2.40 vs 1.90 mmol/L) (P < 0.001). Old age, comorbidity of malignant tumor, neutrophilia, lymphocytopenia, low CD4+ T cells, decreased C3, and low oximetry saturation were the risk factors of death in patients with confirmed COVID-19. The frequency of CD4+ T cells positively correlated with the numbers of lymphocytes (r = 0.787) and the level of oximetry saturation (r = 0.295), Whereas CD4+ T cells were negatively correlated with age (r =-0.323) and the numbers of neutrophils (r = − 0.244) (all P < 0.001).ConclusionsAbnormal cellular immunity and humoral immunity were key features of non-survivors with COVID-19. Neutrophilia, lymphocytopenia, low CD4+ T cells, and decreased C3 were immunity-related risk factors predicting mortality of patients with COVID-19.

Level of Stigma Towards Mental Illness among the Caregivers of Clients With Mental Illness and Other Chronic Medical Illness

Background: Mental illness is considered to be associated with high level of stigma. The stigmatizingexperience is not only limited to the patients but is also experienced by their close relatives. Due to the stigma,people often avoid the use of mental health services because of the fear of being labeled as a “mentally illpatient” and thus avoid the negative consequences connected with the stigma of mental illness.Aim: The aim of the study was to compare the level of stigma towards mental illness between the caregiversof clients with mental illness and other chronic illness.Methods and Materials: A cross-sectional descriptive study was conducted that included 200 subjects ofwhich 100 from group I (caregivers of clients with mental illness) and 100 from group II (caregivers ofclients with other chronic illness). Convenient sampling method was used. Fear and Behavioural Intentionscale was used to assess the level of stigma.Results: Group I had positive attitude towards mental illness with the mean score of 37.21±7.13 whereasGroup II had less positive attitude towards mental illness with the mean score of 27.48±7.98.Conclusion: The study results indicate that caregivers who have their family member under treatment formental illness were more likely to have behaviourally favourable attitude towards mental illness whencomparing with the caregivers who do not have a family member with mental illness. Educating the publicon mental illness may reduce the stigma associated with mental illness.

Effect of hookah (water pipe) smoking on semen parameters.

Hookah (water pipe) smoking, an old method of tobacco smoking, is regaining widespread popularity all over the world. Although the research in this field is still deficient, it has been proven for its harmful effect on human's health by increasing the risk of cardiovascular disease, infection and lung, oral and bladder cancer (Al-Numair et al., J Food Agric Environ, 5: 17, 2007; Bou Fakhreddine et al., Respir Med, 108: 1241-1253, 2014; Chaouachi, J Negat Results Biomed, 5: 17, 2006). However, no research was found to address its effect on human fertility or reproductive outcome. In this cross-sectional study, we aim to explore the effect of smoking hookah on human semen parameters among men attending In Vitro Fertilization LABs for seminal fluid analysis testing. 104 patients aged between 25 and 45, who are noncigarette smokers and have no chronic medical illness, were enrolled in the study: 50 hookah nonsmokers and 54 hookah smokers. Their semen parameters were compared. Semen volume, normal morphology and progressive motility were slightly lower in the hookah smoker (3.21ml; 10.2%; 29.56%) versus (3.45ml; 11.5%; 33.20%), respectively, in nonhookah smokers; however, the difference was not statistically significant. The effect of hookah smoking on semen observed in our study was not statistically significant. Further studies are needed to explore more and confirm any unfavourable effect.

The role of Helicobacter pylori in preeclampsia and in gastric diseases in pregnant women

Background: Helicobacter pylori is a gastric organism was first observed more than 100 years ago. It may cause chronic gastritis, peptic ulcers and gastric adenocarcinoma and lymphoma. It can produce some extragastric disorders including preeclampsia. This study aimed to focus on the importance of H. pylori and its relationship with preeclampsia and gastric illnesses in pregnant patients.Methods: This study includeed 100 pregnant women, half of them were healthy and the other half with preeclampsia. Patients with chronic medical illnesses were excluded. Data was collected and laboratory investigations were done including that for H. pylori. Oesophagogastroduodenoscopy then was done 6 weeks post-delivery or termination of pregnancy for symptomatic H. pylori positive women.Results: 50% of the total number were healthy, 17% had mild preeclampsia, 33% suffering from severe preeclampsia. Seropositivity for H. pylori is significantly higher in preeclampsia and significantly related to severity of preeclampsia and complications of pregnancy. Positive H. pylori test in stool was seen in (45%) of total number of patients. Epigastric pain persist in 41 (91%) of patients with positive H. pylori test in stool. Gastritis, duodenal ulcer, and gastric ulcer were found in 85.3%, 12.1% and 2.4% of symptomatic patients respectively.Conclusions: Significant correlation between Helicobacter pylori seropositivity and preeclampsia may indicate the benefit of using this parameter in the prediction and management of preeclampsia and its severity. H. pylori infection plays an important role in gastric pathologies in pregnant women that can be dealt with or may be prevented more efficiently in future.

Positive results for patients with COVID-19 discharged form hospital in Chongqing, China

BackgroundSince December 2019, over 80,000 patients with coronavirus disease 2019 (COVID-19) have been confirmed in China. With the increasing number of recovered patients, more attention should be paid to the follow-up of these patients.MethodsIn the study, 576 patients with COVID-19 discharged from hospital in Chongqing, China from January 24, 2020, to March 10, 2020 were evaluated by viral nucleic acid tests for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) to determine if they could be released from quarantine. Among the 576 patients, 61 patients (10.6%) had positive RT-PCR test results of SARS-CoV-2. We aimed to analyze the demographics, clinical characteristics and treatment of 61 patients.ResultsThese positive patients were characterized by older age, chronic medical illness and mild conditions. 38 (62.3%) patients who were asymptomatic without abnormalities on chest radiographs were found in the positive with COVID-19. Also, they showed positive results of stool or sputum specimens with negative results of nasal and pharyngeal swab specimens. The median duration of positive result of SARS-CoV-2 was varied from 3 days to 35 days in the patients discharged from hospital with no family member infection.ConclusionsMulti-site screening of SARS-CoV-2 including nasal and pharyngeal swabs, stool and sputum specimens could be considered to improve the diagnosis, treatment and infection control in patients with COVID-19. Our findings provide the important information and clinical evidence for the improved management of patients recovered from COVID-19.

The Prevalence and Associated Factors of Suicidal Attempt Among Medical Students in Addis Ababa Ethiopia.

Although suicidal attempt is common among medical students, little is known about the prevalence estimates and the potential determining factors in low and middle-income countries including Ethiopia. To the best of our knowledge, this is the first study to estimate the prevalence and associated factors of suicidal attempts among medical students in Ethiopia. Institutional based cross-sectional study was conducted among 423 medical students selected by using a stratified random sampling technique. The World Health Organization Composite International Diagnostic Interview (CIDI) was used to assess suicidal attempts among the study participants. Binary and multivariable logistic regression analysis was performed to identify the potential determinants of suicidal attempt. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI) were calculated to assess the strength of association. In this study, the prevalence of suicidal attempt among medical students was found to be 8.2% (95% CI 5.7, 11.4%). In the adjusted model, the variables associated with suicidal attempt were female sex, history of chronic medical illness, excessive course load, psychological distress, poor social support, and daily internet use for more than 3h. In the present study, the prevalence of suicide attempts was relatively high (8.2%). Early screening is necessary to identify suicidal attempt and the potential determining factors to prevent death as well as adverse educational outcomes during the medical education program.

COVID-19 Clinical Characteristics, Complications and Comorbidity: An Updated Systemic Review and Meta-Analysis

Background: COVID-19, a novel pneumonia associated with the 2019 coronavirus infected pneumonia suddenly broke out in the world. The aim of this study is to summaries and analysis the clinical characteristics of COVID-19. Methods: Literatures have been systematically searched on Scopus, PubMed, Embase, Web of Science, and The Cochrane Library and also special databases prepared for COVID-19 such as LitCovid Hub, WHO, Elsevier, Medrxiv and CDC from inception up to May 1, 2020. Data searching, extracting and quality appraising were done by two researchers, independently. At last, Random-effects size based on Cochrane test and I2 were used. The Newcastle-Ottawa Scale was used to assess quality, and publication bias was analyzed by Egger and Begg’s test. The review protocol has been registered in PROSPERO with ID: CRD42020173639 and with ethical code IR.GUMS.REC.1398.542. Results: Out of 2464 studies, 75(3.04%) were included. A total of 111490 patients with a mean age of 49.43 years [Confidence Interval(CI)95%: 47.44-51.42] were evaluated. Most of patients was male (52.65%). The body mass index (BMI) in the most was in normal rate (23.26). 33.5% of patients were health care workers. 62.71% of patients had direct exposure history. The most common clinical symptoms were fever, cough, myalgia and dyspnea (82.72%, 57.69%; 25.20% and 20.87%, respectively). The most common comorbidities were acute respiratory distress syndrome, chronic medical illness, hypertension, and diabetes (30.4%, 22.25%, 17.47%, and 11.19% respectively). Among the laboratory abnormalities, the most patients had high levels of leucocytes (24.76%), lymphocyte (39.56%), increasing of neutrophil (14.48%), platelet (39.81%), D-dimer (30.89%), AST (22.09%), Creatinine (48.21%), troponin I (4.12%), urea nitrogen (22.94%), Creatine Kinase (48.21%), and C-reactive proteins (56.8%). About 37.35% of patients had a decreasing in the hemoglobin. CT-Scan funding shows that three fourths of patients had bilateral pneumonia involvement (78.25%), and 58.37% had GGO. Crazy-paving, vascular enlargement, air bronchus gram sign, and air trapping were seen in 22.55%, 61.79%, and 11.76%, respectively. The most common regions of the lung involvement were lower lobe 91.70%. Also, 66.34% of patients had peripheral involvement, and had punctate ground glass opacities (64.73%). Conclusion: COVID-19 is still a leading epidemic infection with comorbidities, clinical, laboratory and radiological findings, and its specific demographic characteristics. We found the rate of mortality of patients with COVID-19 is also decreasing, gradually. It could be related to the early recognition, early intervention, and early centered-quarantine of people in the world. Funding Statement: The author(s) received no specific funding for this work. Declaration of Interest: The authors have declared that no competing interests exist.

Barriers to Follow-up for Patients With Aortic Dissection in an Academic Tertiary City Hospital

Proper follow-up after diagnosis and treatment of aortic dissection (AD) is important. Secondary problems like aneurysmal degeneration leading to rupture, stenosis, evolution of the dissection flap, and aortic remodeling can develop after treatment. Patients often have various barriers that hinder them from following up with their vascular or cardiothoracic surgeon. We sought to identify compliance with and barriers to surveillance in this population of patients. Retrospective chart review of 400 patients with AD between 2008 and 2018 at Thomas Jefferson University Hospital was performed. Of 400 patients, 313 had AD (DeBakey type I, II, or III). Demographics and risk factors were identified and recorded. After Institutional Review Board approval was obtained, patients were surveyed by telephone using an AD questionnaire assessing the type of intervention they had (open, endovascular, or medical) and whether they had seen a surgeon after treatment of their AD. Patients unable to follow up were questioned about obstacles to care. Descriptive statistics were calculated and reported on the basis of 100 preliminary patient records that were surveyed of 313. At the time of the survey, 88 patients were alive. Average age at the date of presentation to the hospital was 61.5 ± 14.9 years, with male predominance of 60%. Among these patients, 24% had DeBakey type I, 16% had type II, and 60% had type III; 33% were managed by open operation, 14% by endovascular approach, and 53% medically as deemed appropriate by diagnoses. Ninety-five patients were called (5 had missing contact information); 60 (63.2%) patients responded, 34 (35.7%) could not be reached, and 1 (1.1%) refused to participate. Twenty-five (26.3%) had been to their surgeon, and 35 (36.8%) did not follow up. Of 95 patients, 55 (57.9%) reported that they understood the need for follow-up, and 5 were unaware of the need for further care. Patients reported lack of escort (3.6%), anxiety related to diagnosis (3.6%), chronic medical illness (7.1%), age-related weakness (1.2%), lack of transportation (4.8%), transportation costs (2.4%), employment obligations (1.2%), inability to pay for visits (7.2%), and scheduling issues (9.5%). The remaining patients thought they did not need to see their surgeon (44%). Preliminary data show that a majority of patients do not seek follow-up with a surgeon after the diagnosis and management of AD. It is crucial that there are guidelines in place to address issues of access to care and to prevent potential future complications in these patients. Survey of all patients will be completed before the Vascular Annual Meeting.

Clinical Characteristics of Elderly Patients with COVID-19 in Hunan Province, China: A Multicenter, Retrospective Study

Background: The aim of this study was to analyze and summarize the clinical characteristics of elderly patients with coronavirus disease 2019 (COVID-19) and compare the differences of young-old patients (60–74 years old) and old-old patients (≥75 years old). Methods: In thisretrospective, multicenter study, the medical records of elderly patients who were diagnosed with COVID-19 in Hunan province, China, from January 21 to February 19, 2020 were reviewed. The characteristics of young-old patients and old-old patients were compared. Results: Of the 105 elderly patientsconfirmed withCOVID-19, 81.0% were young-old patients, and 19.0% were old-old patients; 54.3% of elderly patients were females. Overall, 69.5% of elderly patients had underlying diseases, and the most common comorbidities included hypertension (43.8%), diabetes (25.7%), and cardiac disease (16.2%). Of the elderly patients, 22.9% were severe and 10.5% were critical severe cases. On admission, the most frequent symptoms in elderly patients included fever (66.7%), cough (64.8%), and fatigue (33.3%). Lymphopenia (31.4%), increased D-dimer (38.1%), depressed albumin (36.2%), elevated lactate dehydrogenase (41.0%), and a high level of C-reactive protein (79.0%) were common among elderly patients with COVID-19. The median prothrombin time (PT) and the activated partial thromboplastin time (APTT) were longer in old-old patients than young-old patients (PT median 12.3 vs. 13.1 s, p = 0.007; APTT median 39.0 vs. 33.5 s, p = 0.045). Young-old patients showed fewer complications (14.1%) than old-old patients (40.0%; p = 0.0014) and fewer received invasive ventilator support (3.5 vs. 25.0%, p = 0.006). As of March 11, 2020, 85.7% of elderly patients had been discharged, 3 deaths had occurred, and 11.4% were still hospitalized. Conclusions: Elderly patients usually have chronic medical illness and are likely to have a severe or critically severe condition. They could show atypical symptoms without fever or cough and multiple organ dysfunction. Old-old patients tend to have more complications than young-old patients during hospitalization. Careful nursing, observation, and systemic treatment are very important in elderly patients.