Course Of Illness Research Articles

B - 17 Cognition, Social and Occupational Functioning, and Symptom Severity as Predictors on Family Burden in First Episode Psychosis

Abstract Objective Individuals with first episode psychosis (FEP) are often dependent on family members to assist with recovery following diagnosis. Family members frequently become caregivers, helping with scheduling and transportation to appointments, medication management, and tasks of daily living. However, such caregiving responsibilities can impact financial resources, employment, family routine, and cause higher rates of stress within the family. The following study examined cognitive, demographic and symptom predictors of self-reported caregiver burden in FEP. Methods Participants included 61 individuals experiencing their first episode of psychosis (26.2% female; mean age = 20.7). IQ was assessed with the WASI-II. Psychosis symptom severity over the past 7 days was assessed using the Structured Clinical Interview for DSM-5 Disorders. Demographic data and social and occupational functioning were also collected. The Family Assessment Scale was completed by the primary caregiver to assess different domains of family burden (e.g., finance, employment, recreational activities, leisure time, stigma, and emotions). Results Multiple regression analyses indicated that severity of delusions was a significant predictor of caregiver burden. However, IQ, race, age, and social and occupational functioning were not significant predictors. Conclusions Current results indicate that for FEP, delusions severity is a stronger predictor of caregiver burden than other factors expected to impact burden, such as IQ and social and occupational functioning. Results provide preliminary evidence indicating that early in the course of psychotic illness, active delusions play a key role in increased caregiver burden.

Reinforcement learning processes as forecasters of depression remission

BackgroundAspects of reinforcement learning have been associated with specific depression symptoms and may inform the course of depressive illness. MethodsWe applied support vector machines to investigate whether blood‑oxygen-level dependent (BOLD) responses linked with neural prediction error (nPE) and neural expected value (nEV) from a probabilistic learning task could forecast depression remission. We investigated whether predictions were moderated by treatment use or symptoms. Participants included 55 individuals (n = 39 female) with a depression diagnosis at baseline; 36 of these individuals completed standard cognitive behavioral therapy and 19 were followed during naturalistic course of illness. All participants were assessed for depression diagnosis at a follow-up visit. ResultsBoth nPE and nEV classifiers forecasted remission significantly better than null classifiers. The nEV classifier performed significantly better than the nPE classifier. We found no main or interaction effects of treatment status on nPE or nEV accuracy. We found a significant interaction between nPE-forecasted remission status and anhedonia, but not for negative affect or anxious arousal, when controlling for nEV-forecasted remission status. LimitationsOur sample size, while comparable to that of other studies, limits options for maximizing and evaluating model performance. We addressed this with two standard methods for optimizing model performance (90:10 train and test scheme and bootstrapped sampling). ConclusionsResults support nEV and nPE as relevant biobehavioral signals for understanding depression outcome independent of treatment status, with nEV being stronger than nPE as a predictor of remission. Reinforcement learning variables may be useful components of an individualized medicine framework for depression healthcare.

Descriptives and genetic correlates of eating disorder diagnostic transitions and presumed remission in the Danish registry.

Eating disorders (EDs) are serious psychiatric disorders with an estimated 3.3 million healthy life-years lost worldwide yearly. Understanding the course of illness, diagnostic transitions and remission, and their associated genetic correlates could inform both ED etiology and treatment. The authors investigated occurrences of ED transitions and presumed remission and their genetic correlates as captured by polygenic scores (PGSs) in a large Danish register-based cohort. The sample compromised of 10,565 individuals with a diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) with at least two registered hospital contacts between 1995 and 2018. Based on medical records, occurrence of diagnostic transitions and periods of presumed remission were identified. Associations between 422 PGS and diagnostic transitions and presumed remission were evaluated using Cox proportional hazard models. A minority of ED cases (14.1%-23.1%) experienced a diagnostic transition. Presumed remission ranged between 86.9%-89.8%. Higher (one SD increase) PGS for major depressive disorder and multisite chronic pain were positively associated with transitioning from AN to either BN or EDNOS. Higher PGS on a measure of body fat percentage and financial difficulties were positively associated with presumed remission from AN. Higher PGS for mood swings was positively associated with presumed remission from EDNOS whereas higher PGS for health rating showed the opposite. The authors found that most ED patients did not experience diagnostic transitions but were more likely to experience a period of presumed remission. Both diagnostic transitions and presumed remission have significant polygenic component.

The case of coinfection with human immunodeficiency and hepatitis С viruses during hemotransfusion: clinical and socio-legal consequences

In Russia, cases of HIV transmission related to medical care are registered annually, including cases related to hemotransfusion. A clinical case of an artificial coinfection with human immunodeficiency and hepatitis C viruses in the course of medical care, as well as its clinical, social, legal and economic consequences, is presented. This clinical case is noteworthy for its relevance from both the perspective of examining the clinical course and treatment of illnesses, as well as analyzing the medical and legal implications of a iatrogenically acquired infection. The recurrence of such incidents of infection with significant social diseases in the 1990s and 2000s necessitated a serious reorganization of the national blood transfusion system and blood components. At present, with strict adherence to legal requirements in place, the risk of infection has been minimized.

Clinical profiles of Mycoplasma pneumoniae pneumonia in children with different pleural effusion patterns: a retrospective study

BackgroundThe clinical significance of the presence or absence of Mycoplasma pneumoniae (MP) in pleural effusion in Mycoplasma pneumoniae pneumonia (MPP) children has not yet been elucidated. Herein, we investigated the clinical implication of pleural fluid MP positive in children with MPP.MethodsA total of 165 MPP children with pleural effusion requiring thoracocentesis were enrolled in this study. They were subsequently divided into two groups according to the presence or absence of MP in pleural effusion, namely positive group (n = 38) and negative group (n = 127). Information on their clinical manifestations, laboratory findings, radiological characteristics and treatment modalities was retrospectively collected from medical chart reviews.ResultsThe length of hospitalization (15.00 (10.75–19.25) vs. 11.00 (9.00–14.00) days, p=0.001) and total course of illness (23.00 (18.00–28.00) vs. 20.00 (17.00–24.00) days, p=0.010) were significantly longer in the positive group than in the negative group. The occurrence of pericardial effusion (23.7% vs. 7.9%, p=0.017), atelectasis (73.7% vs. 53.5%, p=0.027) and necrotizing pneumonia (23.7% vs. 7.9%, p=0.017) were more frequent in the positive group compared to the negative group. The levels of neutrophil percentages (82.35% (75.40%-85.78%) vs. 72.70% (64.30%-79.90%), p<0.001), C-reactive protein (CRP) (71.12 (37.75–139.41) vs. 31.15 (13.54–65.00) mg/L, p<0.001), procalcitonin (PCT) (0.65 (0.30–3.05) vs. 0.33 (0.17–1.13) ng/ml, p=0.005), serum lactate dehydrogenase (LDH) (799.00 (589.00–1081.50) vs. 673.00 (503.00–869.00) U/L, p=0.009), D-dimer (6.21 (3.37–16.11) vs. 3.32 (2.12–6.62) mg/L, p=0.001) on admission were significantly higher in the positive group than in the negative group. These pronounced differences significantly contributed to the identification of MPP with MP positive pleural effusion, as evidenced by the ROC curve analysis. Marked elevations in adenosine deaminase (49.25 (36.20–60.18) vs. 36.20 (28.10–46.50) U/L, p<0.001) and LDH levels (2298.50 (1259.75–3287.00) vs. 1199.00 (707.00–1761.00) U/L, p<0.001) were observed in pleural fluid of the positive group when compared to the negative group. Meanwhile, the number of patients on low molecular weight heparin (LMWH) therapy (9 (23.7%) vs. 12 (9.4%), p=0.028) was higher in the positive group. Multivariate logistic regression analysis revealed that D-dimer > 7.33 mg/L was significantly associated with the incidence of MP positive pleural effusion in MPP (OR=3.517).ConclusionsThe presence of MP in pleural fluid in MPP children with pleural effusion indicated a more serious clinical course. D-dimer > 7.33 mg/L was a related factor for MP positive pleural effusion in MPP. The results of the present study would help in the creation of a therapeutic plan and prediction of the clinical course of MPP in children.

Personality traits and change in depression status at 18 months: Findings from a British Psychiatric Morbidity Survey

BackgroundDepression is a common mental disorder, yet it shows low remission rates. The available evidence on personality traits as factors associated with the course of depression has common methodological limitations. Identifying personality traits linked with depression can improve understanding of the course of illness. Therefore, we aimed to investigate personality traits that are associated with the course of depression over 18 months. Methodslongitudinal data of 2366 Adult Psychiatric Morbidity Survey respondents were analysed. Assessments were applied at two-time points (baseline) and follow-up (about 18 months later). We assessed the total score on the screening questionnaire from the Structured Clinical Interview (SCID-II) for the dependent, obsessive-compulsive, and borderline personalities. Depression was measured using the revised Clinical Interview Schedule (CIS-R) version. ResultsAn increase of one score on the borderline personality scale at baseline increased the odds of experiencing persistent depression by 1.50 times (OR = 1.50, 95 % CI [1.22–1.86]), depression onset by 1.30 times (OR = 1.30, 95 % CI [1.14–1.50]), and recovery by 1.52 times (OR = 1.52, 95 % CI [1.35–1.70]), comparing to no depression group. Elevated scores of dependent personality traits significantly predicted depression persistence (OR = 1.95, 95 % CI [1.52–2.49]). An increase of one score on the obsessive-compulsive personality scale increases the odds of depression onset by 1.21 times (OR = 1.21, 95 % CI [1.04–1.39]). LimitationsThe APMS survey defined depression statuses in a limited sense, which may affect the generalisability of these results. ConclusionThe present study confirms previous findings and contributes evidence suggesting that personality dysfunctions worsen depression outcomes.

Early specialised treatment for bipolar disorder: Long-term follow-up from the early intervention in affective disorders (EIA) randomised controlled trial.

It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial. Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005-2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures. The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = -0.10, 95% CI: -0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15-0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08-4.60, p = 0.031). Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

Monitoring of myocardial injury by serial measurements of QRS area and T area: The MaastrICCht cohort.

Manually derived electrocardiographic (ECG) parameters were not associated with mortality in mechanically ventilated COVID-19 patients in earlier studies, while increased high-sensitivity cardiac troponin-T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were. To provide evidence for vectorcardiography (VCG) measures as potential cardiac monitoring tool, we investigated VCG trajectories during critical illness. All mechanically ventilated COVID-19 patients were included in the Maastricht Intensive Care Covid Cohort between March 2020 and October 2021. Serum hs-cTnT and NT-proBNP concentrations were measured daily. Conversion of daily 12-lead ECGs to VCGs by a MATLAB-based script provided QRS area, T area, maximal QRS amplitude, and QRS duration. Linear mixed-effect models investigated trajectories in serum and VCG markers over time between non-survivors and survivors, adjusted for confounders. In 322 patients, 5461 hs-cTnT, 5435 NT-proBNP concentrations and 3280 ECGs and VCGs were analyzed. Non-survivors had higher hs-cTnT concentrations at intubation and both hs-cTnT and NT-proBNP significantly increased compared with survivors. In non-survivors, the following VCG parameters decreased more when compared to survivors: QRS area (-0.27 (95% CI) (-0.37 to -0.16, p < .01) μVs per day), T area (-0.39 (-0.62 to -0.16, p < .01) μVs per day), and maximal QRS amplitude (-0.01 (-0.01 to -0.01, p < .01) mV per day). QRS duration did not differ. VCG-derived QRS area and T area decreased in non-survivors compared with survivors, suggesting that an increase in myocardial damage and tissue loss play a role in the course of critical illness and may drive mortality. These VCG markers may be used to monitor critically ill patients.

Moderating effect for illness uncertainty on the relationship of depressive and anxiety symptoms among patients with type 1 diabetes in Taif region, Saudi Arabia.

Illness uncertainty was found to be associated with the development of depressive and anxiety symptoms among patients with type 1 diabetes and chronic illness in general. However, the moderating effect of illness uncertainty was not examined in sufficient depth. The current study evaluates how the path from diabetes distress to depression and anxiety is mediated by illness uncertainty, ambiguity, symptoms and course predictability, and illness complexity. Descriptive cross-sectional survey of a large-scale sample of patients living with type one diabetes in Saudi Arabia. We utilized structural equation modelling mediation analysis to examine the effect of illness uncertainty and its subcategories (illness-related ambiguity, symptoms and course predictability, and illness complexity) on depressive and anxiety symptoms. The current survey analyzed data pertaining to (n = 536) type one diabetes patients. Mean Mishel Uncertainty of Illness Scale score was 80.8 points (Cronbach's α = 0.91) signifying moderate uncertainty among our patients. Diabetes-related uncertainty was associated with marriage (t = 3.337, P = 0.0009937), diabetes complications (t = 5.257, P < 0.00001), pain (r = 0.2247, P < 0.00001), and children count (correlation coefficient r = 0.195, P < 0.00001). The prevalence of depression was (n = 367, 68.5%) and for anxiety was (n = 173, 30.3%). Illness uncertainty correlated with depressive (r = 0.2484, P < 0.00001) and anxiety (r = 0.2548, P < 0.00001) symptoms' scores. Illness uncertainty exerted a partial moderating effect on both anxiety (β = 0.060, P < 0.001) and depressive symptoms (β =0.056, P < 0.001). We observed a partial moderating effect for diabetes-related ambiguity and diabetes-related symptom unpredictability in terms of depressive and anxiety symptoms. However, for diabetes-related course unpredictability, the moderating effect was significant only for anxiety. Diabetes-related complexity did not exert a significant moderating effect on either depressive or anxiety symptoms. We confirmed high levels of depression and anxiety among patients with type one diabetes in Saudi Arabia. Our findings suggest that illness uncertainty affects both diabetes-related distress and depression constructs and is likely to be affected by them.

Neurostructural, Neurofunctional, and Clinical Features of Chronic, Untreated Schizophrenia: A Narrative Review.

Studies of individuals with chronic, untreated schizophrenia (CUS) can provide important insights into the natural course of schizophrenia and how antipsychotic pharmacotherapy affects neurobiological aspects of illness course and progression. We systematically review 17 studies on the neuroimaging, cognitive, and epidemiological aspects of CUS individuals. These studies were conducted at the Shanghai Mental Health Center, Institute of Mental Health at Peking University, and Huaxi MR Research Center between 2013 and 2021. CUS is associated with cognitive impairment, severe symptoms, and specific demographic characteristics and is different significantly from those observed in antipsychotic-treated individuals. Furthermore, CUS individuals have neurostructural and neurofunctional alterations in frontal and temporal regions, corpus callosum, subcortical, and visual processing areas, as well as default-mode and somatomotor networks. As the disease progresses, significant structural deteriorations occur, such as accelerated cortical thinning in frontal and temporal lobes, greater reduction in fractional anisotropy in the genu of corpus callosum, and decline in nodal metrics of gray mater network in thalamus, correlating with worsening cognitive deficits and clinical outcomes. In addition, striatal hypertrophy also occurs, independent of antipsychotic treatment. Contrasting with the negative neurostructural and neurofunctional effects of short-term antipsychotic treatment, long-term therapy frequently results in significant improvements. It notably enhances white matter integrity and the functions of key subcortical regions such as the amygdala, hippocampus, and striatum, potentially improving cognitive functions. This narrative review highlights the progressive neurobiological sequelae of CUS, the importance of early detection, and long-term treatment of schizophrenia, particularly because treatment may attenuate neurobiological deterioration and improve clinical outcomes.

Prediction of Clinical Outcomes in Psychotic Disorders Using Artificial Intelligence Methods: A Scoping Review.

Psychotic disorders are major psychiatric disorders that can impact multiple domains including physical, social, and psychological functioning within individuals with these conditions. Being able to better predict the outcomes of psychotic disorders will allow clinicians to identify illness subgroups and optimize treatment strategies in a timely manner. In this scoping review, we aimed to examine the accuracy of the use of artificial intelligence (AI) methods in predicting the clinical outcomes of patients with psychotic disorders as well as determine the relevant predictors of these outcomes. This review was guided by the PRISMA Guidelines for Scoping Reviews. Seven electronic databases were searched for relevant published articles in English until 1 February 2024. Thirty articles were included in this review. These studies were mainly conducted in the West (63%) and Asia (37%) and published within the last 5 years (83.3%). The clinical outcomes included symptomatic improvements, illness course, and social functioning. The machine learning models utilized data from various sources including clinical, cognitive, and biological variables such as genetic, neuroimaging measures. In terms of main machine learning models used, the most common approaches were support vector machine, random forest, logistic regression, and linear regression models. No specific machine learning approach outperformed the other approaches consistently across the studies, and an overall range of predictive accuracy was observed with an AUC from 0.58 to 0.95. Specific predictors of clinical outcomes included demographic characteristics (gender, socioeconomic status, accommodation, education, and employment); social factors (activity level and interpersonal relationships); illness features (number of relapses, duration of relapses, hospitalization rates, cognitive impairments, and negative and disorganization symptoms); treatment (prescription of first-generation antipsychotics, high antipsychotic doses, clozapine, use of electroconvulsive therapy, and presence of metabolic syndrome); and structural and functional neuroimaging abnormalities, especially involving the temporal and frontal brain regions. The current review highlights the potential and need to further refine AI and machine learning models in parsing out the complex interplay of specific variables that contribute to the clinical outcome prediction of psychotic disorders.

Case identification and healthcare utilization in the years prior to a first mania diagnosis

BackgroundThere is limited evaluation of approaches to identify patients with new onset bipolar affective disorder (BPAD) when using administrative datasets. MethodsUsing the Massachusetts All-Payer Claims Database (APCD), we identified individuals with a 2016 diagnosis of bipolar disorder with mania and examined patterns of psychiatric and medical care over the preceding 48 months. ResultsAmong 4806 individuals aged 15–35 years with a 2016 BPAD with mania diagnosis, 3066 had 48 months of historical APCD data, and of those, 75 % involved information from ≥2 payors. After excluding individuals with historical BPAD or mania diagnoses, there were 583 individuals whose 2016 BPAD with mania diagnosis appeared to be new (i.e., 34 new diagnoses per 100,000 individuals aged 15–35 years). Most individuals received medical care, e.g., 98 % had outpatient visits, 76 % had Emergency Department (ED) visits, and 50 % had mental health-related ED visits during the 48 months prior to their first mania diagnosis. One-third (37.2 %) had a depressive episode before their initial BPAD with mania diagnosis. LimitationsStudy was conducted in one state among insured individuals. We used administrative data, which permits evaluation of large populations but lacks rigorous, well-validated claims-based definitions for BPAD. There could be diagnostic uncertainty during illness course, and clinicians may differ in their diagnostic thresholds. ConclusionsCareful examination of multiple years of patient history spanning all payors is essential for identifying new onset BPAD diagnoses presenting with mania, which in turn is critical to estimating population rates of new disease and understanding the early course of disease.

The role of genetic and epigenetic factors on the development of cognitive deficits in patients with severe trauma after repeated anesthesia (literature review)

Introduction. When a severe combined injury occurs in a patient, various biochemical, humoral, cellular and pathophysiological mechanisms of protection against death occur. Immediately after receiving an injury, the patient is hospitalized in a hospital for medical care, where every effort is made to stabilize the condition, resorting to the appointment of various instrumental and laboratory tests. The development and course of traumatic illness, and treatment outcomes in patients with similar injuries are sometimes dramatically different. Based on this, it was suggested that there is a genetic basis for the regularity of the disease, as well as that exogenous factors themselves can affect certain molecular genetic markers, primarily telomere length.The objective was to summarize the current literature data on the study of changes in telomere length, as well as the influence of exogenous and endogenous factors on their shortening. To determine the prospects of studying the effect of polymorphic alleles of various genes on the development of a pathological condition in a certain cohort, namely the development of cognitive dysfunction in patients with severe trauma after repeated anesthesia.Materials and methods. The literature search and analysis was performed in the medical information systems PubMed and eLibrary, using the keywords «telomere», «trauma», «cognitive», and «anesthesia».Results. Since 1950, data on the study of human telomeres began to be published abroad. Between 2002 and the present, 39 articles were published on PubMed when searching for the keywords «anesthesia» and «telomeres»; by keywords «cognitive», «trauma», «telomeres» – 27. Most articles are devoted to the effect of childhood trauma on changes in telomere length, as well as the assessment of short telomeres in patients with various cognitive deficits. However, there are no articles devoted to studying the effect of repeated anesthesia, as an exogenous factor, on the genetic apparatus of a patient with severe combined trauma.Conclusion. The literature highlights the influence of various exogenous factors on the shortening of telomere length, especially in the context of childhood trauma, cognitive impairment in various observed groups. The section related to the effects of anesthesia and their number, the consequences for the genetic apparatus of a particular person, is open for study.

Computational Analysis of Boerhavia diffusa Plant Extracts Targeting Alpha actinin4 against Focal Segmental Glomerulosclerosis

The most common protein lost in urine (proteinuria) is albumin, which is a symptom of the kidney illness focal segmental glomerulosclerosis (FSGS). It causes damage to podocyte foot processes, resulting in effacement of foot processes, and injury to foot processes leads to the leaking of plasma proteins into the urine, resulting in nephrotic syndrome. Alpha actinin (ACTN4) is extensively produced in glomerular podocytes, has a function in non-muscle cytoskeletal activity, and is enhanced early in the course of nephrotic illness in various types. Mutations in ACTN4 induce autosomal and sporadic steroid-resistance nephritic syndrome, which causes disturbance in podocyte foot process and function. All of the FSGS-causing mutations are situated on actin actin-binding domain of the ACTN4 protein. FSGS is typically treated by decreasing dietary salt and using immune-suppressing medications such as glucocorticoids. There is a risk associated with these drugs for cancer patients. Several studies have found that up to 80% of individuals with primary FSGS are resistant to steroid therapy, even though all other therapeutic options have been exhausted. Patients with steroid-resistant FSGS have a higher incidence of end-stage renal failure. Therefore, several new treatment strategies were put forward to cure the disease form of which use of phytochemicals is one such sustainable modality. In addition to this, our study intended to predict the stability of mutant protein’s structure as compared to wild type structure through molecular dynamic simulation analysis. With this, we extend our study to predict the potency of phytochemicals of Boerhaviadiffusa against FSGS by using molecular docking analysis. From our study, we conclude that the actin-binding domain of ACTN4 protein becomes more unstable or loses its stability after the mutation at position W59R among all the studied mutation positions. The boeravinone F phytochemical of the Boerhaviadiffusa plant shows the best inhibitory effect on the mutant actin-binding domain of ACTN4 protein and it confirms a stable binding confirmation at minimum energy of -7.5 kcal/mol. Hence it may be taken into consideration for future research work.

Clinical profile, complications, outcome and predictors of intensive care for paediatric scrub typhus: a tertiary hospital-based study from Southern Rajasthan, India

Background: Scrub typhus is an endemic acute febrile zoonotic disease and one of the most neglected tropical illnesses. In 2019, its outbreak was reported from Mewar region of Rajasthan, India. It is caused by Orientia tsutsugamushi which is intra cellular gram-negative coccobacilli. Methods: It is retrospective descriptive study conducted on children diagnosed positive for scrub typhus by IgM enzyme-linked immunosorbent assay (ELISA) admitted in ward and paediatric intensive care unit at tertiary care centre during 1 year of study period from April 2023 to March 2024. Clinical profile, laboratory parameters, course of illness and outcome data were collected in predesigned case records proforma for analysis. Results: Mean age of presentation was 10.5±3.2 years with female preponderance (F:M 1.21:1). 78.5% belong to rural areas. Environmental exposure was living close to forests, bushes in 38%, crop fields in 26% and cattle shed with pets in 30%. All cases had fever (100%, n=42) followed by vomiting (62%), cough-cold (42.8%), myalgia (40.4%), altered sensorium (35.7%), breathlessness (31%), oliguria (16.6%), conjunctival redness (11.9%). Most common signs were temperature &gt;101’F (90.4%), hepatomegaly (62%), hypotension (21.4%), edema (23.8%), meningeal signs (14.2%). Tachypnoea (n=14) (p value &lt;0.0001), CRT&gt;3 seconds (n=13) (p value &lt;0.0003), altered sensorium (n=15) (p value=0.0003) and SpO2 &lt;90% (n=7) (p value=0.004) were found significant predictors of pediatric intensive care unit (PICU) admission. Eschar and rash seen in 3 cases (7.1%). 16 (38%) children requiring intensive care unit admission had statistically significant anaemia (85.7%) (p=0.013), thrombocytopenia (78.5%) (p=0.042) and raised C-reactive protein (CRP) (50%) (p&lt;0.0001). Conclusions: Scrub typhus is common in Rajasthan and should be suspected in any child with acute febrile encephalopathy, signs of shock, breathlessness, hepatomegaly, anaemia and thrombocytopenia in the monsoon season with the history of exposure. Early diagnosis and prompt treatment with doxycycline can prevent mortality.

Post-COVID cognitive impairment, level of depression and anxiety in university students

Recently, a significant amount of research has focused on the impact of COVID-19 on mental health. One of the increasingly common long-term consequences of COVID-19 is its effect on cognitive function, even in patients with an initially mild course of the acute illness. The article presents the results of a study of cognitive impairment and anxiety and depression levels among students of a higher medical educational institution. The study consisted of a continuous screening survey of students who had and had not experienced COVID-19 using an original questionnaire, as well as psychometric scales: Montreal Cognitive Assessment (MoCA), Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Based on the screening results, two groups were formed (those who had COVID-19 and those who did not), and a comparative analysis was carried out. It was found that a third (32.4%) of young people who had COVID-19 developed cognitive impairment. In students who were not ill, cognitive impairment was detected half as often – 16.8%. It was revealed that regardless of the fact of having suffered an infectious disease, a quarter of students experienced increased anxiety and decreased mood. Affective experiences, in turn, negatively affected cognitive functioning and caused young people to be more attentive to their health, including mental health, which was accompanied by a large number of positive responses when using the PHQ-9 and GAD-7 screening questionnaires.

Mood instability metrics to stratify individuals and measure outcomes in bipolar disorder.

Clinical care for bipolar disorder (BD) has a narrow focus on prevention and remission of episodes with pre/post treatment reductions in symptom severity as the 'gold standard' for outcomes in clinical trials and measurement-based care strategies. The study aim was to provide a innovative method for measuring outcomes in BD that has clinical utility and can stratify individuals with BD based on mood instability. Participants were 603 with a BD (n=385), other or non-affective disorder (n=71), or no psychiatric history (n=147) enrolled in an longitudinal cohort for at least 10 years that collects patient reported outcomes measures (PROMs) assessing depression, (hypo)mania, anxiety, and functioning every two months. Mood instability was calculated as the intraindividual standard deviation (s.d.) of PROMs over one-year rolling windows and stratified into low, moderate, and high thresholds, respectively. Individuals with BD had significantly higher one-year rolling SDs for depression, (hypo)mania, and anxiety compared to psychiatric comparisons (small - moderate effects) and healthy controls (large effects). A significantly greater proportion of scores for those with BD fell into the moderate (depression: 50.6%; anxiety: 36.5%; (hypo)mania: 52.1%) and high thresholds (depression: 9.4%; anxiety: 6·1%; (hypo)mania: 10·1%) compared to psychiatric comparisons (moderate: 32.3 - 42·9%; high: 2.6% - 6·6%) and healthy controls (moderate: 11.5% - 31.7%; high: 0.4% - 5.8%). Being in the high or moderate threshold predicted worse mental health functioning (small to large effects). Mood instability, as measured in commonly used PROMs, characterized the course of illness over time, correlated with functional outcomes, and significantly differentiated those with BD from healthy controls and psychiatric comparisons. Results suggest a paradigm shift in monitoring outcomes in BD, by measuring intraindividual SDs as a primary outcome index.

Long Term Health Problems and Associated Factors among COVID-19 Recovered Patients

A cross-sectional, descriptive study was conducted among 181 individuals recovered from COVID-19 infection and had been missing infection (negative rt-PCR test) or signs-symptoms for minimum three months. The study aims determine newly developed health problems in patients, which was conducted at Post-COVID Unit of Anwer Khan Modern Medical College Hospital, Dhaka, Bangladesh, between July 2021 and June 2022. Through convenient sampling, data were collected by face-to-face interview and history of signs/ symptoms during the infection were recorded from reviewing prescription and interview as well by using a semi-structured questionnaire. The mean age of the participants was 39.56±6.92 years and male-female ratio was 1.45:1. The mean monthly family income of the participants was 36,022.09±4130.56 BDT which represents lower middle to middle class family in terms of Bangladesh context. During COVID-19 infection most of the (97%) respondents had fever, and 87%, 79% of the patients had sore throat and cough respectively as common symptoms; in addition, more than one-third (34%) had diarrhea. Several constitutional symptoms also recorded during their course of illness like headache (74%) and malaise (54%). More than one-third (34%) of the respondents required admission in hospital. During the course of infection, 41%, 26% and 31% participants were suffered from mild, moderate and severe form of COVID-19 illness. Most of the respondents developed long term health problems following COVID infection and post-viral fatigue was the most prevalent (85%) among the post COVID individuals and this long-term health problem-post viral fatigue was found to be associated with monthly income and it was statistically significant (p&lt;0.05). Others long term health problems including shortness of breath (74%), loss of memory (38%), difficulty in concentration (41%), loss of hair (30%), fast beating or pounding heart (33%) were also noticed. Insomnia (56%), persistent cough (35%), loss of taste (32%) and change of bowel habit (28%) were other health problems revealed in this study. Association between loss of memory and gender (p&lt;0.0001), diabetes mellitus and severity of COVID-19 (p&lt;0.05), sore throat, cough and severity of COVID-19 (P&lt;0.05) were also found significant. diabetes mellitus (35%), hypertension (34%) and bronchial asthma (24%) were observed to be most common comorbidities. Shortness of breath – one of the post-COVID consequence was found significantly associated with diabetes mellitus and bronchial asthma (p&lt;0.05). Our study found that persistence of various signs and symptoms from COVID-19 infection and newly yield complications in individual who recovered from COVID-19 infection are collectively comprise long term health problems of post-COVID patients. This long-term health problem of post-COVID people is a major public health concern. Fatigue, dyspnea, difficulty to concentrate, memory loss, persistent cough, fast beating or pounding heart, loss of smell, loss of taste, insomnia are the most common long term health problems in COVID-19 recovered people. Long-term follow up may be recommended to understand future consequences of COVID-19 patients and well-being for the post-COVID people. CBMJ 2024 July: vol. 13 no. 02 P: 158-168

Clinical profiling, treatment characteristics and outcome in Behcet's Disease (BD)-A retrospective cohort study from Karnataka Rheumatology Association (KRA).

Behcet's disease (BD) has a heterogeneous and unpredictable phenotype that differs in various geographical areas. To describe the clinical phenotype & outcome of Behcet's disease(BD) from Karnataka, India and compare them with large cohorts from endemic regions. Databases of practising rheumatologists from Karnataka were reviewed to retrieve clinical characteristics, course of illness, prescribing information and outcome at last follow-up of patients clinically diagnosed as BD. The classification criteria, namely revised International criteria for Behcet's disease (rICBD) and International study group (ISG) criteria were applied. Outcome was defined as complete or partial remission, persistent disease or relapse. We included 72 patients, equal gender distribution and mean age 37.4 ± 12.8years from 8 rheumatology centres. Commonest presentations were recurrent oral aphthosis 58(80.6%), genital ulcers 36(50%) and ocular manifestations 40(55.6%). Three-quarters [51/72(70.8%)] fulfilled rICBD criteria whereas only half [36/72(50%)] fulfilled ISG criteria. Apart from glucocorticoids [53/72(73.6%)], frequently prescribed therapies were colchicine 39(54.2%) and azathioprine 35(48.6%). Eleven-patients received biologics(anti-TNF-α) and JAK inhibitors to treat severe organ involvement. HLA-B*51 and pathergy tests were positive in 27/45(60%) and 12/34(35.3%) patients respectively. Outcomes were documented in 94.4%(68/72) patients at median follow-up of 24 (12;36) months. Majority [46/68(67.6%)] had complete remission, 17/68(25%) had partial remission, 4/68(5.9%) had persistent while 1/68(1.5%) had relapsing course. Majority of BD patients had orogenital aphthosis and ocular manifestations and an excellent response to treatment. Key Points • In our region, Behçet's Disease primarily manifests with recurrent oral aphthae and ocular involvement, with comparatively lower incidence of severe genital ulcers and neurological involvement than in endemic regions. • Apart from glucocorticoids, colchicine and azathioprine are the most commonly used agents. Biologics and JAK inhibitors are prescribed infrequently, primarily in cases of severe organ involvement. • A significant proportion of patients achieved either complete or partial remission during follow-up, with no observed mortality suggesting a milder disease course and better outcome compared to endemic regions. • Gender, HLA-B*51 status, and pathergy response did not exert any significant influence on the clinical profile or outcome in BD patients in Karnataka.

Altered learning from positive feedback in adolescents with anorexia nervosa.

Anorexia nervosa (AN) is characterized by severe restriction of calorie intake, which persists despite serious medical and psychological sequelae of starvation. Several prior studies have identified impaired feedback learning among individuals with AN, but whether it reflects a disturbance in learning from positive feedback (i.e., reward), negative feedback (i.e., punishment), or both, and the extent to which this impairment is related to severity and duration of illness, has not been clarified. Participants were female adolescents with AN (n = 76) and healthy teen volunteers (HC; n = 38) between the ages of 12-18 years who completed a probabilistic reinforcement learning task. A Bayesian reinforcement learning model was used to calculate separate learning rates for positive and negative feedback. Exploratory analyses examined associations between feedback learning and duration of illness, eating disorder severity, and self/parent reports of reward and punishment sensitivity. Adolescents with AN had a significantly lower rate of learning from positive feedback relative to HC. Patients and HC did not differ in learning from negative feedback or on overall task performance measures. Feedback learning parameters were not significantly associated with duration of illness, eating disorder severity, or questionnaire-based reports of reward and punishment sensitivity. Adolescents with AN showed a circumscribed deficit in learning from reward that was not associated with duration of illness or reported sensitivity to reward or punishment. Subsequent longitudinal research should explore whether differences in learning from positive feedback relate to course of illness in youth with AN.