Comorbidities Research Articles

Comorbid disorders and their possible prevention in patients with vestibular vertigo

Acute vestibular vertigo (AVV) is manifested by the illusion of movement of surrounding objects in front of the eyes or the sensation of movement of one's own body in space. The cause of AVV is in most cases a pathology of the peripheral vestibular analyser, in rarer cases – involvement of the brain stem. Headaches, neck pain, anxiety-depressive disorders, unsteadiness when walking, reduced cognitive abilities and general weakness often complicate AVV, significantly impair quality of life and slow down recovery. Treatment of patients with AVV should include rapid relief of an acute attack to prevent the development of these symptoms, increase patient compliance with vestibular rehabilitation and reduce the risk of developing anxiety-depressive syndrome. As a drug therapy for AVV, a fixed combination of dimenhydrinate and cinnarizine (Arlevert) is effective; it has a minimal sedative effect compared to other vestibular blockers and helps to rapidly reduce the intensity of dizziness and vegetative symptoms. Vestibular gymnastics promotes the processes of natural habituation, reduces the severity of instability and the risk of falling and increases motor activity. All patients with dizziness should have their mental state assessed and existing disorders corrected in collaboration with psychiatrists and cognitive behavioural therapists.

Beyond CPAP for Cardiovascular Risk Reduction in Patients with OSA

Abstract An accumulating body of evidence suggests a bidirectional relationship between sleep and cardiovascular (CV) health. A high level of evidence has linked obstructive sleep apnea (OSA) with cardiovascular disease (CVD). Accordingly, clinical sleep medicine emphasizes the diagnosis and treatment of obstructive sleep apnea (OSA) in the context of promoting CV health. While continuous positive airway pressure (CPAP), the main stay treatment for OSA, is effective in improving several sleep-related quality-of-life outcomes and leads to modest reductions in blood pressure, there is currently insufficient evidence to justify using CPAP alone for improving CVD outcomes in OSA. Sleep physicians are uniquely positioned to expand their focus beyond the evaluation of OSA and administering CPAP, in efforts to enhance the CV health of sleep patients. Herein, we suggest the role of sleep physicians as CV preventionists. Key focus areas for managing CV risk beyond CPAP therapy in OSA include identifying comorbid disorders that are vital for optimizing CV health. This involves risk-stratifying patients and providing appropriate counseling, referrals, and treatment as appropriate for comorbid sleep conditions such as insomnia and insufficient sleep, comorbid CV risk factors including hypertension, dyslipidemia, metabolic dysfunction-associated steatohepatitis, as well as counseling for weight management programs, smoking and alcohol cessation. We urge sleep clinicians to play an active and integral role in optimizing CV health of patients with sleep disorders.

Complex treatment of patients with chronic non-specific back pain and comorbid disorders: a prospective clinical study

A complex approach including an educational program, ergonomics, kinesiotherapy and pharmacotherapy is effective in the treatment of patients with chronic non-specific back pain (CNBP). The efficacy of complex treatment with personalized kinesiotherapy in patients with CNBP and comorbid disorders has not yet been sufficiently investigated.Objective: to evaluate the efficacy of a complex treatment including special kinesiotherapy, standard pharmacological and non-pharmacological methods in patients with CNBP and comorbid disorders.Material and methods. The study included 60 patients (12 men and 48 women, mean age 38.3±8.7 years) with CNBS and comorbid disorders (neck pain, insomnia, tension type headaches, anxiety and/or depressive symptoms). Patients were randomized into two groups: group 1 received complex treatment, including special kinesiotherapy, standard therapy (educational program, standard kinesiotherapy, non-steroidal anti-inflammatory drugs, muscle relaxers, antidepressants in some patients), group 2 – standard therapy. The clinical and psychological parameters of all patients were analyzed at baseline, and after 1, 3 and 6 months of treatment.Results. After 1 month of treatment, the clinical effect (CE) in terms of CNBS (reduction of back pain (BP) intensity according to the numerical rating scale and Oswestry questionnaire by 30% or more) was achieved in 80% of patients in group 1, which is statistically significantly (p<0.05) higher than in group 2 (46.7% of patients). By month 3 of observation, the number of patients achieving CE increased to 86.7% in group 1 and decreased to 36.6% in group 2. After 6 months, all patients in group 1 maintained the achieved CE, while in group 2 only 30% of patients maintained CE. In group 1, a complete regression of BP was observed in more than one third of patients at month 3 and 6 of observation (33.3 and 36.6%, respectively). In group 2, no regression of BP was observed in any case. In group 1, in contrast to group 2, a statistically significant (p<0.05) decrease in scores on the Beck Pain Catastrophizing Scale, the Kinesiophobia Scale, Beck Anxiety and Depression Scale, the Insomnia Severity Index, Headache Impact Index and Neck Pain Disability Index was observed. The decrease continued until the 6th month of observation.Conclusion. A complex treatment comprising special kinesiotherapy, standard non-drug and drug therapy leads to a rapid (after 1 month) positive effect in patients with CNBP and comorbid disorders that lasts over a long period of time (6 months).

Clinical, psychopathological and neurobiological aspects of affective disorders in children and adolescents with epilepsy

In order to study the clinical and psychopathological characteristics of affective disorders in childhood and adolescence and their relationship to neurophysiological and neuroimaging studies, clinical and psychopathological (using scales of comprehensive assessment of mental state and the Kovach M child depression questionnaire) and instrumental methods (MRI, VEM) examined 134 children and adolescents aged 6 to 18 years, diagnosed with epilepsy. Differences in the frequency of affective symptoms according to the SWAPS data were revealed, depending on the gender of patients and the form of epilepsy, as well as neurophysiological and neuromorphological changes that increase the likelihood of developing comorbid epilepsy affective disorders in childhood and adolescence.

Inflammation as a link between depression and metabolic syndrome

Depression makes a major contribution to the overall global burden of disease, including the increased risk of a wide range of concomitant somatic pathology. А high percentage of mortality in psychiatric patients is attributed to physical diseases, mainly cardiovascular (CVD). Metabolic syndrome (MetS) is one of the risk factors for both the CVD and a frequent comorbid depression. The purpose of this review is to systematize data on the relationship between MetS and depression, in particular, on the shared pathogenetic mechanisms as systemic inflammation. The manuscript evaluates the issue of the use of hematological indices of systemic inflammation (HISIs) in the diagnosis of both MetS and affective pathology, and also provides data on new combined indicators, including the cellular link and lipidogram parameters. The latter include the ratios of lymphocytes and high-density lipoproteins (HDL) (Lymphocyte To High-Density Lipoprotein Ratio, LHR), neutrophils/HDL (Neutrophil To High-Density Lipoprotein Ratio, NHR), platelets/HDL (Platelet To High-Density Lipoprotein Ratio, PHR) and monocytes/HDL (Monocyte To High Density Lipoprotein Ratio, MHR). Understanding the relationship between hematological indices and metabolic syndrome in patients with depression can help identify individuals at high risk and identify timely preventive measures. Various clinical trials and studies indicate a link between hematological parameters and metabolic syndrome, but the question of choosing the most effective coefficients remains open. Further study of the problem can help identify potential risks of comorbid disorders and perform adequate preventive strategies.

Labor market marginalization in individuals with bipolar disorder: a Swedish nationwide register-based sibling comparison study.

There is a lack of large-scale studies exploring labor market marginalization (LMM) among individuals diagnosed with bipolar disorder (BD). We aimed to investigate the association of BD with subsequent LMM in Sweden, and the effect of sex on LMM in BD. Individuals aged 19-60 years living in Sweden with a first-time BD diagnosis between 2007 and 2016 (n = 25 231) were followed from the date of diagnosis for a maximum of 14 years. Risk of disability pension (DP), long-term sickness absence (SA) (>90 days), and long-term unemployment (>180 days) was compared to a matched comparison group from the general population, matched 1:5 on sex and birth year (n = 126 155), and unaffected full siblings (n = 24 098), using sex-stratified Cox regression analysis, yielding hazard ratios (HRs) with 95% confidence intervals (CIs). After adjusting for socioeconomic factors, baseline labor market status, and comorbid disorders, individuals with BD had a significantly higher risk of DP compared to the general population (HR = 16.67, 95% CI 15.33-18.13) and their unaffected siblings (HR = 5.54, 95% CI 4.96-6.18). Individuals with BD were also more likely to experience long-term SA compared to the general population (HR = 3.19, 95% CI 3.09-3.30) and their unaffected siblings (HR = 2.83, 95% CI 2.70-2.97). Moreover, individuals diagnosed with BD had an elevated risk of long-term unemployment relative to both comparison groups (HR range: 1.75-1.78). Men with BD had a higher relative risk of SA and unemployment than women. No difference was found in DP. Individuals with BD face elevated risks of LMM compared to both the general population and unaffected siblings.

Eating Disorders, Co-Morbid Disorders and Early Risk Factors Amongst Post-9/11 Veteran Men and Women.

To assess, by interview, the rates of eating disorders in a nationally representative sample of recent veterans, describe their DSM-5 eating disorder diagnoses and the occurrence of comorbid psychiatric disorders. To conduct an exploratory case-control analysis of previously documented and additional specific military risk factors before eating disorder onset to inform studies of prospective risk. Using a two-stage design, probable cases and controls were identified by screening questionnaires from a sample of 1494 veterans who completed a survey study and interviewed to establish case status and confirm probable co-morbid psychiatric diagnoses. Previously documented risk factors and military risk factors occurring before disorder onset were investigated. Ninety-one cases and 51 controls were confirmed. Weighted prevalence for any eating disorder was 5.2%, with estimates for anorexia nervosa, bulimia nervosa, binge eating disorder and other specified eating disorder being 0.01%, 0.6%, 1.4%, and 1.6%, respectively. Seventy-nine (86.8%) confirmed cases had a diagnosis of one or more co-morbid psychiatric disorders. Previously documented risk factors were associated with subsequent case status, while in this sample, military risk factors were not. Rates of eating disorder and co-occurring psychiatric disorders in recent veterans were comparable to those reported for non-veterans, with levels of posttraumatic stress disorder likely higher. As co-occurring psychiatric disorders, particularly posttraumatic stress disorder, may complicate achieving good outcomes with existing evidence-based treatments, there is an urgent need to adapt them where necessary to improve outcomes. Military risk factors may maintain or exacerbate pre-existing problems and need to be investigated alongside other maintaining factors in longitudinal studies. Rates of eating disorder and co-occurring psychiatric disorders in recent veterans were comparable to those reported for non-veterans, highlighting a need to detect eating problems and address unmet treatment need. Co-occurring psychiatric disorders may complicate achieving good outcomes with existing treatments, emphasising a need to adapt them to improve outcomes. Investigating maintaining factors, including military factors in longitudinal studies will likely aid treatment development.

Comorbidity of problematic substance use and other addictive behaviors and anxiety, depression, and post-traumatic stress disorder: a network analysis.

Among those with common mental health disorders (e.g. mood, anxiety, and stress disorders), comorbidity of substance and other addictive disorders is prevalent. To simplify the seemingly complex relationships underlying such comorbidity, methods that include multiple measures to distill which specific addictions are uniquely associated with specific mental health disorders rather than due to the co-occurrence of other related addictions or mental health disorders can be used. In a general population sample of Jewish adults in Israel (N = 4002), network analysis methods were used to create partial correlation networks of continuous measures of problematic substance (non-medical use of alcohol, tobacco, cannabis, and prescription sedatives, stimulants, and opioid painkillers) and behavioral (gambling, electronic gaming, sexual behavior, pornography, internet, social media, and smartphone) addictions and common mental health problems (depression, anxiety, and post-traumatic stress disorder [PTSD]), adjusted for all variables in the model. Strongest associations were observed within these clusters: (1) PTSD, anxiety, and depression; (2) problematic substance use and gambling; (3) technology-based addictive behaviors; and (4) problematic sexual behavior and pornography. In terms of comorbidity, the strongest unique associations were observed for PTSD and problematic technology-based behaviors (social media, smartphone), and sedatives and stimulants use; depression and problematic technology-based behaviors (gaming, internet) and sedatives and cannabis use; and anxiety and problematic smartphone use. Network analysis isolated unique relationships underlying the observed comorbidity between common mental health problems and addictions, such as associations between mental health problems and technology-based behaviors, which is informative for more focused interventions.

Formulation and evaluation of Dapagliflozin -Loaded Ethosomes as Transdermal Drug Delivery Carriers: Statistical Design

Diabetes that includes risk factors for noncommunicable diseases like hypertension are only one example of the various situations in which chronic disease is connected with other conditions. Due to the challenges in overcoming the adverse effects of a complicated therapeutic treatment regimen, the treatments available for such chronic comorbid disorders are restricted and tough. The purpose of this research was to create and refine Dapagliflozin nano vesicular ethosomal gel for use in the treatment of patients with diabetes and cardiovascular disease. Different parameters, such as in-vitro skin permeation, skin irritation, in-vivo antidiabetic, and antihypertensive activities, were used to characterise the developed formulations. Dapagliflozin is a potent, oral, reversible, highly selective, and competitive inhibitor of human SGLT2 used to treat type 2 diabetes. The ethosomes that contain dapagliflozin are the focus of our current study. By incorporating this medication inside lipid nanocarriers, we were able to generate ethosomes, where the vesicular size and lipid used for formulation controlled the sustained release of medicines. The purpose of this study is to create Dapagliflozin-loaded ethosomes for the management of diabetes, and then to statistically optimise and characterise them. For ethosome improvement, we used a 33-level factorial design with three factors. The entrapment efficiency (Y1), vesicle size (Y2), zeta potential (Y3), and % CDR (Y4) were selected as the dependent variables, whereas phosphatidylcholine (X1), cholesterol (X2), and ethanol (X3) were selected as the independent factors. Following incorporation of the optimised ethosomes into Carbopol® 940 gel, their rheological behaviour, in-vitro release, and ex-vivo skin permeation studies were characterised. When compared to drug solutions, in vitro and ex vivo permeation studies yielded more positive results. All things considered, the ethosomal vesicles showed promise as a carrier, allowing for improved topical administration of Dapagliflozin. Keywords: Dapagliflozin, Diabetes, SGLT2, in-vitro release, and ex-vivo, phosphatidylcholine, topical administration, 33-level factorial design.

The Prevalence and Particularities of Psychiatric Comorbidity

Among the most widespread resistance factors of psychiatric disorders, psychiatric comorbidities occupy an important place, they represent a major problem in the field of mental health. It is the coexistence, in the same individual, of at least two mental disorders. 56% of patients who suffer from a mental health problem have been affected at least once in their life by another problem of this nature. These problems can appear at different times or at the same time. Some people sometimes suffer from three or more comorbid disorders. The clinical picture motivating the consultation, can hide other disorders less visible at first glance. Whether it is anxiety disorders comorbid with depression, personality disorders that are the bed of decompensations of different types, or addictive disorders interfering with the psychiatric picture, these situations often pose a problem for the practitioner, and deserve special attention from the first consultation, in order to adapt the treatment by taking into consideration these comorbidities, both clinically and therapeutically. In this work, we will evaluate the comorbidities in patients consulting at the Arrazi hospital in Salé, trying to establish a profile of the most comorbid disorders, in order to raise awareness among practitioners about the simultaneous detection and management of these disorders.

Functional Impairment Related to ADHD From Preschool to School Age.

Children with ADHD often experience functional impairments across various aspects of daily life. This study addresses the dearth of longitudinal research on functional impairment trajectories from preschool to school age in children with symptoms of ADHD and comorbid disorders. We investigated the extent to which functional impairments were associated with ADHD symptoms, along with behavioral and anxiety symptoms, from age 3.5 to 8 years. Utilizing parent- and teacher-reported data, we analyzed associations between global impairment, and dimension scores (e.g., family; child quality of life (QoL); learning; play/leisure activities; and friends) and symptoms at ages 3.5 and 8 years (n = 783). The mean parent global impairment score increased from 0.31 (standard deviation (SD) = 0.40) to 0.83 (SD = 0.63) from 3.5 to 8 years, while the teacher impairment scores slightly decreased. Specific parent impairment dimension scores, particularly QoL, learning, and friends, significantly increased. Preschool ADHD and comorbid behavioral symptoms reported by parents weakly predicted impairment at 8 years. By age 8 years, impairment and symptoms exhibited moderate to strong correlations for all impairment dimensions. Parents reported greater child impairment during school age across settings compared to preschool, while teachers' impairment profiles remained consistent across ages. These findings suggest that parents perceive impairment as more pronounced at age 8 years and more strongly associated with symptoms of both ADHD and comorbid disorders than at age 3.5 years. Notably, for teachers, a robust correlation between inattention symptoms and learning impairment was observed, with substantially higher impairment scores reported for boys compared to girls.

Differences in impulsivity between adolescents with ADHD and those with comorbidity of ADHD and IGD

BackgroundNumerous studies have demonstrated that patients with attention deficit hyperactivity disorder (ADHD) have high impulsivity. However, few studies have been published on the differences in impulsivity between patients presenting with comorbidity of ADHD and Internet gaming disorder (IGD) and ADHD alone. AimThe present study designed an experiment to address this significant question, to explore the differences in impulsivity between individuals with ADHD and those with comorbid ADHD and IGD, specifically focusing on various dimensions of impulsivity. MethodsA total of 81 adolescents with ADHD alone and 59 patients with comorbidity of ADHD and IGD were included in this study, and all of them were assessed using the Stop-signal Task (SST), Delay Discount Task (DDT), and Balloon Analogue Risk Task (BART). ResultsPatients with comorbid ADHD and IGD had higher impulsivity than those with only ADHD, and it was expressed in different dimensions. Additionally, response inhibition, delayed discount rate, risky decision-making behavior, inattention, and hyperactivity were identified as risk factors for comorbid ADHD and IGD. ConclusionThese findings can help distinguish whether ADHD is comorbid with IGD in clinical settings. They will also be helpful in the implementation of more precise treatments.

Investigation of psychopathology in patients with chronic idiopathic urticaria

Aims: Aim of this study is, to establish the frequency of axis I and axis II comorbidity and post-traumatic stress disorder (PTSD) and coping ability of patients who admitted to allergy policlinics of Dermatology and Respiratory Diseases departments and who were diagnosed as chronic idiopathic urticaria. Methods: Study population divided into three groups consisted of fifty patients each, chronic urticaria, contact dermatitis and control groups, respectively. All patients underwent SCID-I (Structured Clinical Interview for DSM-IV Axis-I Disorders) and SCID-II (Structured Clinical Interview for DSM-III-R Personamy Disorders) for determining axis I and axis II diagnosis and trauma evaluation form for traumatic life events. Patients who showed high scores in this test also underwent SCID-I PTSD module. Coping scale (COPE) was applied in order to evaluate patients’ coping ability for problems which he encounters. Results: In our study, when axis I diagnosis were compared; major depression (%48) and anxiety disorder (%48) were significantly more frequent in chronic idiopathic urticaria group than other two groups. When it came to comparison of axis II diagnosis, avoidant personal disorder (%20) and dependent personality disorder (%16) were significantly more frequent in chronic idiopathic urticaria group than other two groups. Urticaria group also showed significantly higher frequency for PTSD (%42) than other two groups. Patients with chronic idiopathic urticaria used religious (%64), denial (%26), substance abuse (%40), adoption (%40), emotional social support (%32) and abstaining (%26) maladaptive coping methods which were incoherent, significantly more than other two groups. Conclusion: Probability of mental disorders is high among patients with chronic idiopathic urticaria. It is important to consider existence of PTSD and coping methods for life events. Studies enrolling larger patient groups are needed for detailed investigation of cause-and-effect relationship.

Schema-Therapeutic Exposure for Treatment Resistant Anxiety and Obsessive-Compulsive Disorders: A Multiple Baseline Case Series Design Study

Exposure is effective for patients with anxiety disorders or obsessive-compulsive disorders (OCD). Yet, a significant minority does not recover with current guideline treatments due to comorbid personality disorder symptoms. For these patients, no further guideline treatments exist. Schema therapy (ST) is an evidence-based treatment for personality disorders and integrating ST and exposure could provide a solution. We tested a new schema-therapeutic exposure treatment in patients with treatment-resistant anxiety or OCD. Using the latest methodological and statistical insights in a well-powered single-case experimental design (SCED; N = 6), we administered weekly measures of psychological malfunctioning, anxiety/OCD symptoms, and schema modes over the course of treatment (29-32 weeks). Schema-therapeutic exposure was effective for 33.33% of our sample, with improvement on all or most outcome measures. Another 33.33% demonstrated partial improvements, and 33.33% remained stable. Given the historical chronicity of symptoms in our sample, these effects are highly encouraging. Secondary findings showed that changes in schema modes did not precede changes in anxiety/OCD symptoms or psychological malfunctioning, and that 66.66% of the sample continued to improve in the second half of the treatment. Future research is wanted to unravel the interactive and additive effects of schema-therapeutic exposure to further optimize treatment.

Psychometric properties of the Bipolar Spectrum Diagnostic Scale in depressed youth.

Youth with depression may be at a higher risk of developing bipolar disorder (BD). Self-reported, dimensional measures, like the Bipolar Spectrum Diagnostic Scale (BSDS), aim to assess for BD in these groups. We explored properties of this instrument within a cohort of depressed, help-seeking youth. We used baseline data from two randomized controlled trials for depressed youth (aged 15-25 years) who had no history of BD or psychosis and who completed the BSDS (n = 240; mean Age = 19.9 years, SD = 2.7; Female = 57 %). Structured diagnostic assessments were repeated at 26-weeks to detect new-onset BD. We examined false-positive rates for concurrent BD using established thresholds on the BSDS, utilised factor analyses to determine its underlying structure, and explored associations between the BSDS and demographic, clinical, and personality variables using linear regressions. False-positives rates were high. Most (60 %) participants scored above BSDS thresholds at baseline, though none developed BD over the 26-week study period. A three-factor model best fit BSDS items, representing depression, mania, and lability factors. BSDS total, mania and lability sub-scale scores were associated with similar characteristics, with a different pattern of association for the BSDS depression subscale. With no long-term follow-up of the current sample nor a separate bipolar youth sample, we were unable to determine the overall discriminant validity, sensitivity, or longer-term predictive validity of the BSDS. At recommended thresholds, BSDS has high false positive rates for detecting current BD in youth with moderate to severe depression, especially with mental state or personality disorder comorbidities.

Psychiatric problems in psoriasis: A descriptive case series study

Introduction: Previous studies have emphasized the relation between psoriasis and psychological disorders. This study was conducted to investigate the frequency of psychiatric disorders in patients with Psoriasis in the region of Azerbaijan. Methods: In a descriptive cross-sectional study, all patients with a confirmed diagnosis of Psoriasis were examined by a dermatologist recorded each patient’s Psoriasis type, disease status (local-general), site of involvement (in cases with local psoriasis), and disease severity based on Psoriasis Area and Severity Index (PASI), disease duration, and demographic information. Data was statistically analyzed by SPSS/Ver 22 software. Results: Fifty-four patients were enrolled in the study with a mean age of 41.76±16.17 years. The mean PASI index was 13.8±16.8. Twenty-seven patients (50%) were normal in psychiatric examinations. Among people with psychiatric disorders (50%), the most common was Generalized Anxiety Disorder (GAD) which was seen in 13 patients (24.1%). There was no statistically significant relationship between types of psychiatric disorders and gender (P=0.515), age (P=0.506), and duration of disease (P=0. 471). Nevertheless, there was a significant difference between patients with co-morbidity of psychiatric disorders and PASI rate (P= 0.020). Conclusion: Half of the Psoriasis patients generally had a psychiatric disorder. The most frequent was GAD. There was no significant relationship between psychiatric disorders in Psoriasis patients and gender, age, and duration of disease. However, the rate of psychiatric disorders increased with the severity of Psoriasis skin lesions.

Personality Disorders and Clinical Disorders: The Challenge of Comorbid Autism Spectrum Disorder (ASD), Eating Disorders (EDs), Posttraumatic Stress Disorder (PTSD), or Somatic Symptom Disorder (SSD).

The purpose of this review is to report on prevalence of co-occurrence, possible etiologic mechanisms, and course and treatment implications of each of these challenging clinical disorders (Autism Spectrum Disorder, Eating Disorders, Posttraumatic Stress Disorder) comorbid with Personality Disorders. These comorbidities often increase the symptom severity, worsen the course and outcome, and increase the risk of self-harm and suicidal behavior. For EDs and PTSD, existing therapies may prove somewhat helpful but novel approaches are needed and under investigation in the context of comorbid PDs and ASD, EDs and PTSD to address common underlying diatheses. Treatments for these comorbid disorders need to incorporate interventions addressing suicide risk, emotion dysregulation, be trauma-informed and attend to patient engagement. Future research should prioritize studying the course and outcome of ASD comorbid with PDs, novel therapies for EDs comorbid with PDs; refining the concept of Complex PTSD and commencing study of SSD comorbid with PDs.

Cardiovascular and nonalcoholic fatty liver disease: Sharing common ground through SIRT1 pathways.

As a non-communicable disease, cardiovascular disorders have become the leading cause of death for men and women. Of additional concern is that cardiovascular disease is linked to chronic comorbidity disorders that include nonalcoholic fatty liver disease (NAFLD). NAFLD, also termed metabolic-dysfunction-associated steatotic liver disease, is the greatest cause of liver disease throughout the world, increasing in prevalence concurrently with diabetes mellitus (DM), and can progress to nonalcoholic steatohepatitis that leads to cirrhosis and liver fibrosis. Individuals with metabolic disorders, such as DM, are more than two times likely to experience cardiac disease, stroke, and liver disease that includes NAFLD when compared individuals without metabolic disorders. Interestingly, cardiovascular disorders and NAFLD share a common underlying cellular mechanism for disease pathology, namely the silent mating type information regulation 2 homolog 1 (SIRT1; Saccharomyces cerevisiae). SIRT1, a histone deacetylase, is linked to metabolic pathways through nicotinamide adenine dinucleotide and can offer cellular protection though multiple avenues, including trophic factors such as erythropoietin, stem cells, and AMP-activated protein kinase. Translating SIRT1 pathways into clinical care for cardiovascular and hepatic disease can offer significant hope for patients, but further insights into the complexity of SIRT1 pathways are necessary for effective treatment regimens.

Patient-reported outcome measures-use in diagnosing depression, anxiety, and stress

Patient-reported outcome measures (PROMs) is an umbrella term for various self-report instruments used to assess subjective health-related impressions and treatment success from the patient's perspective. In psychosomatic medicine, PROMs are often used to record subjective symptoms, psychosocial distress, and changes in health status, particularly in patients with comorbid (affective) disorders and frequent contact with physicians, but also in preventive health care and to monitor the effectiveness of treatment. In otolaryngology (ENT), self-report questionnaires (PROMs) are used, among other things, to assess the impact of hearing, speech, swallowing, and breathing disorders on patients' quality of life. Such scientifically validated tools make it possible to better understand the needs and priorities of patients and to integrate them into clinician-patient communication and treatment to promote individual, patient-centered care. Three dimensions for the assessment of subjective health-related experiences (depression, anxiety, stress) with corresponding instruments for the German-speaking area for use in clinical and research settings are presented in more detail, specifically for otolaryngology.

Expansion of phenotypic and genotypic data in autism spectrum disorders due to variants in the CHD8 gene.

Autism spectrum disorders are a group of the most common disorders of neuropsychiatric development, characterized by difficulties in social interaction and adherence to stereotypic behavioral patterns. This group of conditions frequently co-occurs with intellectual disability, epilepsy, attention-deficit hyperactivity disorder, connective tissue disorders and others. Among the most common molecular-genetic causes of autism spectrum disorders are pathogenic variants in the CHD8 gene. CHD8 codes for chromodomain-helicase-DNA-binding protein 8 - a chromatin remodeler that regulates cellular proliferation and brain development in embryogenesis. 6 children and 1 adult (mother of 1 of the children) and were found to have clinically significant variants in CHD8 on whole genome sequencing (3 children and 1 adult had likely pathogenic variants, 3 children- variants of unknown significance). Their phenotype consisted of autism spectrum disorders, developmental delay, ataxia, overgrowth and other signs typically observed in patients with pathogenic variants in CHD8, as well as common comorbidities of autism spectrum disorders, such as attention-deficit hyperactivity disorder and connective tissue disorders. Additionally, 4 patients had hepatomegaly and 2- hyperbilirubinemia (1 had both) - clinical features have not been previously associated with pathogenic variants in CHD8. 2 patients also presented with cardiovascular abnormalities, primarily arrythmias and, in 1 case, cardiomyopathy- also uncharacteristic of patients with pathogenic variants in CHD8. Further research is required to determine the mechanisms underlying the abovementioned clinical features, which are likely carried out through complex interactions between CHD8 and other regulatory proteins.