Emotional Upset Research Articles

The importance of Neuro-Cognitive Processing to the Understanding and Treatment of Child PTSD

Abstract Basic research and current clinical practice have revealed the difficulty in separating/connecting cognition and emotion and their respective localizations in the brain. Regarding Post-Traumatic Stress Disorder (PTSD), emotions (usually fear) cause a cascade of symptoms, including those impacting several cognitive processes. And it is often considered that relieving the emotional upset associated with PTSD will also improve related cognitive functioning. While it is often assumed that the relationship of emotion, cognition and PTSD is unidirectional, this may not necessarily be the case. The present article aims to describe the complex relationship between emotion and cognitive processes in those with PTSD and suggests an important role for executive functioning as a modulator of the emotion/cognition relationship, as well as the latter’s importance as a contributor to the successful treatment of PTSD. The paper concludes by stressing the importance of assessing cognitive processes in standard treatment protocols evaluating patients with PTSD and highlights the potential benefits of training executive functions as part of PTSD therapy. Keywords: PTSD, Cognitive processes, Emotion, Executive function, Neuropsychology.

SPIRAL: parents’ experiences of emotionally-based school non-attendance (EBSNA) informing a framework for successful reintegration

ABSTRACT Emotionally-based school non-attendance (EBSNA) is believed to impact one to two percent of children and young people (CYP): it is understood to present as severe emotional upset at the prospect of attending school. The aim of this study was to further understand parental experiences of EBSNA to enhance professional understanding and support. Adopting a “solution-oriented”, exploratory qualitative design, this phenomenological research gathered retrospective experiences of successful EBSNA support, aiming to uncover “what works” when supporting children and families experiencing this difficulty. Participants completed semi-structured interviews (n = 5), and transcripts were analysed using reflexive thematic analysis. Themes generated provided insights into different forms of support accessed by parents, identifying potential areas for improvement arising from their experiences of challenge and successes, as well as lessons learnt from the COVID-19 pandemic. The themes (Supporting Parents; Promoting CYP’s Sense of Belonging; Including and Informing Parents; Raising Awareness of EBSNA; Accessing External Professionals; Lessons Learnt from Covid-19) are presented as a framework for professional practice (SPIRAL), which has practical implications for schools and local authorities in providing support to families experiencing EBSNA. Recommendations for practice and future research are discussed, informing developments across multiple systems, and highlighting the potential of the EP role.

Vertiginous dizziness: A primary care approach

Dizziness is an extremely common, yet complex neurological symptom that reflects a disturbance of normal balance perception and spatial orientation. Dizziness is a non-specific, catch-all term commonly used by patients to describe a wide array of symptoms, including a sensation of motion, weakness, light-headedness, unsteadiness, emotional upset and depression. The national 1-year prevalence of dizziness is around 50%, accounting for 4% of emergency department presentations and 1% of primary care consultations in South Africa. This article will focus on a diagnostic approach to the most common cause of dizziness (vertigo).

Chronic Disease Self-Management of Post-Acute Sequelae of COVID-19 Among Older Adults: A Mixed-Methods Analysis.

Approximately 20-30% of individuals who contract acute coronavirus disease (COVID-19) infection develop longer term complications of their initial infection, referred to as Post-Acute Sequelae of SARS-CoV-2 infection (PASC). PASC is characterized by chronic, varying symptomatology. Using a mixed methods study design, we aimed to gain insight into individuals' experience with PASC, including cognitive issues, fatigue, and sleep disturbances. We explored whether our previously developed application (app), aimed at improving self-management skills among individuals with chronic diseases, is relevant for individuals with PASC and gained information to adapt the app for individuals with PASC. The study included 19 individuals, aged 40 years and older, recruited from our research participant database, Nova Southeastern University clinics, and community locations. We included this age range because older adults are more likely to have comorbid conditions, allowing us to better understand the impact of COVID-19 infection in these individuals. Participants completed seven standardized self-report questionnaires online, and an individual semi-structured interview via videoconferencing. Quantitative data were assessed using descriptive statistics and calculating individuals' scores in relation to norms. Qualitative data were analyzed using a thematic analysis approach. Triangulation of the data was accomplished by calculating correlations between participants' responses on self-report scales and themes found in semi-structured interviews. Themes included disruption of everyday life, diverse physical symptoms, and cognitive problems including brain fog, fatigue, coping, and emotional upset. Quantitative analysis demonstrated that participants experienced high levels of fatigue, negative mood, cognitive problems, and overall reduction in health-related quality of life (HRQOL). Correlation analyses revealed that individual interview responses were related to participants' self-report of symptoms on standard questionnaires. Findings indicate that self-report questionnaires may reflect the experience of individuals with PASC and its impact. Additionally, further efforts to expand our prior mobile app are warranted among individuals with PASC.

An analysis of motivating factors in 1,725 worldwide cases of mass murder between 1900-2019

ABSTRACT Mass murder, particularly mass shootings, constitutes a major, growing public health concern. Specific motivations for these acts are not well understood, often overattributed to severe mental illness. Identifying diverse factors motivating mass murders may facilitate prevention. We examined 1,725 global mass murders from 1900–2019, publicly described in English in print or online. We empirically categorized each into one of ten categories reflecting reported primary motivating factors, which were analyzed across mass murderers generally, as well as between U.S- and non-U.S.-based mass-shooters. Psychosis or disorganization related to mental illness were infrequently motivational factors (166; 9.6%), and were significantly more associated with mass murder committed using methods other than firearms. The vast majority (998, 57.86%) of incidents were impulsive and emotionally-driven, following adverse life circumstances. Most mass murderers prompted by emotional upset were found to be driven by despair or extreme sadness over life events (161, 16.13% within the category); romantic rejection or loss, or severe jealousy (204, 20.44% within the category); some specific non-romantic grudge (212, 21.24% within the category); or explosive, overwhelming rage following a dispute (266, 26.65% within the category). Results suggest that policies seeking to prevent mass murder should focus on criminal history, as well as subacute emotional disturbances not associated with severe mental illness in individuals with poor coping skills who have recently experienced negative life events.

Ataque de nervios: The impact of sociodemographic, health history, and psychological dimensions on Puerto Rican adults.

Ataque de nervios (ADN) is a cultural syndrome prevalent in Puerto Ricans characterized as an episode of intense emotional upset due to overwhelming stress. The Ataque de Nervios Questionnaire, developed at the Center for the Study and Treatment for Fear and Anxiety (CETMA), served as the diagnostic tool for this retrospective secondary data analysis. We evaluated three models regarding ADN's function as a marker of (1) sociodemographic vulnerability, (2) health history risk, and (3) psychological vulnerability. This last model was subdivided to assess the scores of screening tests regarding anxiety (Anxiety Sensitivity Inventory, Beck Anxiety Inventory, and State-Trait Anxiety Inventory), affect (Beck Depression Inventory, Emotional Dysregulation Scale, Positive and Negative Affective Schedule), personality (NEO Five-Factor Inventory), and trauma (considering the responses to the Childhood Trauma Questionnaire and the Life Event Checklist). Our study sample had a total of 121 Puerto Rican adult patients from CETMA out of which 75% had ADN. We differentiated subjects according to their ADN status with t-tests and Mann-Whitney U tests and evaluated our models using logistic regressions. People with ADN showed more anxiety, depressive symptoms, emotional dysregulation, and negative affect than those without ADN. They also revealed lower positive affect and agreeableness. Highly extraverted but minimally agreeable personalities related to ADN. Living with a partner and being employed were risk factors for ADN. Having higher educational levels showed the strongest effect size: it greatly reduced the odds of an ataque. These characteristics suggest a distinct profile of ADN seen in employed, educated, adult Puerto Ricans living on the Island experiencing anxiety. Our study provides clinical tools to comprehend our patients' ADN experience, enriching our practice as culturally competent health providers.

Emotional Stability as Predictor of General Coping among Engineering Students

Emotional stability is defined as the ability of an individual to keep one’s emotional balance under pressure. At the same time, coping allows an individual to grow and move forward when dealing with stress. With the academic demand of engineering courses, it is essential to understand emotional stability and general coping, as education can also be stressful. Thus, the main goal of the present study was to investigate if emotional stability predicts the general coping skills among engineering students using simple linear regression. A total of 445 students, ages 18-20, participated in the study. Out of 445 students, 217 were male, and 228 were female. Results revealed that students were emotionally stable, with a mean score of 6.66 which can be interpreted as a high average. It means that participants in the current study are at ease in handling problems, can quickly recover from an emotional upset, and are generally satisfied with life. Likewise, the score in general coping also shows a high average with a mean score of 60.40 which means that engineering students have good coping skills that help them tolerate, minimize, and deal with stressful life situations. Moreover, the simple linear regression results show that emotional stability is not a strong predictor for general coping skills. For engineering students in the present study, aside from emotional stability, other factors contribute to their coping skills. Moreover, it is still good to note that emotional stability has a direct relationship with general coping as indicated by the regression model.

Experiences of racism and postpartum depression symptoms, care-seeking, and diagnosis.

Postpartum depression (PPD) is common and disproportionately affects people of color. Experiences of emotional upset due to racism (EUR) may be an important predictor of PPD outcomes. Therefore, we aimed to determine if EUR during the 12months before delivery was associated with PPD symptomology, asking for help for depression, and depression diagnosis among postpartum people of color (PPOC). We conducted a cross-sectional secondary data analysis among PPOC from 11 states and New York City using PRAMS data, 1/1/2015-12/31/2017. We assessed symptomology using an unvalidated PHQ-2. Logistic regression was performed without and with stratification by ethnicity (non-Hispanic PPOC vs Hispanic PPOC) to estimate whether EUR during 12months before delivery was associated with (1) PPD symptoms, (2) asking for help for depression, and (3) depression diagnosis. Models adjusted for age, educational attainment, timely prenatal care, payment method, stress during pregnancy, and pre-pregnancy depression. Seventy-four thousand nine hundred nine (11.8%) PPOC reported EUR in the 12months before delivery. After adjustment, EUR was associated with a 10.3 percentage point (%pt; 95% CI: 6.8, 13.8), 13.6%pt (95% CI: 8.8, 18.5), and 4.1%pt (95% CI: 1.4, 8.0) higher probability of positive PPD screening among all PPOC, non-Hispanic PPOC, and Hispanic PPOC, respectively. EUR was not associated with asking for help for depression but was associated with a higher prevalence of depression diagnosis among all PPOC (4.6%pt; 95% CI: 1.0, 8.4) and non-Hispanic PPOC (6.0%pt; 95% CI: 0.8, 11.2).Experiences of EUR are associated with an increased prevalence of PPD symptoms. Additional prospective research spanning the pre-pregnancy through postpartum periods is needed to examine the dynamic relationship between racism, symptomology, help-seeking, and diagnosis of depression.

A Clinical Study to Evaluate the Effect of Gharshana Karma (Microdermabrasion) in Mukhdushika (Acne Vulgaris)

Ayurveda classic has mentioned various diseases. Mukhdushika is explained by Acharaya Shushrut in Nidansthan. It can be correlated with Acne vulgaris. Acne vulgaris is the most common skin disease of the youth especially in the puberty age. One of the most common complication of acne is scarring. It has been found to have a significant impact on their psychological well-being and has been associated with depression and suicidal ideation. Acne causes emotional upset and impact to the patient by disfiguring face and scarring skin. Gharshan karma with Samudraphen has been described in Astang Hridya. In the modern medical science this technique closely resembles microdermabration (MDA), which is a resurfacing technique. Aim: To study the efficacy and safety of microdermabration (MDA) in managing acne vulgaris at Skin Care Unit, R.G.G.P.G. Ayurvedic College, Paprola, Kangra (H.P.). Materials and Methods: Based on inclusion and exclusion criteria 30 patients with acne scars, who visited the hospital outdoor patient department were included in the study. All patients were treated with MDA for 12 sittings, 2 weeks apart. Results: Out of 30 patients, 1 (3%) patient got excellent improvement, 18 (60%) patient got good improvement, 10 (33.3%) patient got fair improvement and 1 (3%) patient got poor improvement.

Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study.

In INTERSTROKE, we explored the association of anger or emotional upset and heavy physical exertion with acute stroke, to determine the importance of triggers in a large, international population. INTERSTROKE was a case-control study of first stroke in 32 countries. Using 13462 cases of acute stroke we adopted a case-crossover approach to determine whether a trigger within 1 hour of symptom onset (case period), vs. the same time on the previous day (control period), was associated with acute stroke. A total of 9.2% (n = 1233) were angry or emotional upset and 5.3% (n = 708) engaged in heavy physical exertion during the case period. Anger or emotional upset in the case period was associated with increased odds of all stroke [odds ratio (OR) 1.37, 99% confidence interval (CI), 1.15-1.64], ischaemic stroke (OR 1.22, 99% CI, 1.00-1.49), and intracerebral haemorrhage (ICH) (OR 2.05, 99% CI 1.40-2.99). Heavy physical exertion in the case period was associated with increased odds of ICH (OR 1.62, 99% CI 1.03-2.55) but not with all stroke or ischaemic stroke. There was no modifying effect by region, prior cardiovascular disease, risk factors, cardiovascular medications, time, or day of symptom onset. Compared with exposure to neither trigger during the control period, the odds of stroke associated with exposure to both triggers were not additive. Acute anger or emotional upset was associated with the onset of all stroke, ischaemic stroke, and ICH, while acute heavy physical exertion was associated with ICH only.

Triggers of stroke: anger, emotional upset, and heavy physical exertion. New insights from the INTERSTROKE study

Triggers of stroke: anger, emotional upset, and heavy physical exertion. New insights from the INTERSTROKE study

In their own words: The impact of subtle language and communication difficulties as described by autistic girls and boys without intellectual disability.

Subtle language and communication difficulties are persistent and pervasive for autistic individuals without intellectual disability. They are thought to impact negatively on functionality, social interrelations and emotional well-being, although this relationship is under-explored in the literature. The personal accounts of autistic children could add valuable insight into how they experience subtle language and communication difficulties and what impact this has on their daily lives. In this study, 12 autistic children (9–14 years), without intellectual disability, were interviewed on this topic, using specially developed methods/materials to facilitate rich self-reporting. Results showed the children could provide detailed insight into their difficulties and the impact of these on key aspects of functionality (education and daily living) and social interrelations (including friendship building). They also demonstrated a potentially bi-directional relationship between subtle language and communication difficulties and negative emotions; with negative emotions limiting communicative competence and subtle linguistic difficulties leading to negative emotional responses. This study indicates the need for further investigation into the subtle difficulties experienced by autistic children without intellectual disability and its likely impact. Implications for clinical practice include the need for better identification of subtle language and communication difficulties and provision of appropriate therapeutic services which may help to ameliorate negative functional, social and emotional sequelae.Lay abstractSubtle language and communication difficulties are experienced by many autistic individuals even when they do not have additional learning disabilities. These difficulties may affect a person’s day-to-day living, social relationships and emotional well-being. However, currently, there is not much research into this topic. To date, no one has asked autistic children about their own language and communication difficulties or how they feel it affects them. Asking the children could provide valuable new insights. In this study, 12 autistic children (9–14 years), without learning disability, were interviewed on this topic. We developed interview questions, resources and interview procedures with the support of the autistic community. We also worked with an autistic researcher to analyse our results. We aimed to get the most genuine report of the autistic child’s experiences. Our results showed that the children could give detailed insight into their language and communication difficulties if they were given the right support. They told us about how subtle language and communication difficulties affected their ability to learn, take part in certain activities and seek help. They talked about how subtle difficulties affect their ability to talk to new people, talk in groups and ultimately make friends. They also told us about the emotional upset that these subtle difficulties could have. They suggest that communication breakdown leads to negative feelings, but also that negative feelings can lead to more difficulties explaining themselves. The results of this study suggest that we should do more research on the effects of subtle language and communication difficulties. There are also implications for clinical practice. We should identify subtle language and communication difficulties through thorough assessment because these are often missed. We should also develop therapy and strategies that are aimed at individuals with subtle language and communication difficulties because this could help prevent additional difficulties with learning, help-seeking, friendship-making and emotional well-being.

Complex and underreported? A study into the prevalence of suicide by motor vehicle in the state of Queensland

While suicide is recognised as one of the leading causes of death in Australia, it is often presumed that fatal road crashes are primarily accidental in nature. However, international research has indicated that deliberate attempts at self-harm while driving may account for between 1.1% and 7.4% of road crashes. Despite the personal and financial costs associated with such events, few studies have examined the extent of motor vehicle suicides (MVS) or the circumstances surrounding such incidents in Australia. Given this, the current study reviewed coronial, police and toxicology findings of 762 motor vehicle fatalities in Queensland (Australia) during the period 2011 to 2015 to determine the frequency of confirmed cases and explore the prevalence (and characteristics) of possible MVS that remain undetected. In total, 22 confirmed cases were identified, and such events shared significant similarities with 14 possible events, including evidence of recent emotional upset, adversity and mental health diagnoses. In contrast, differences between the groups were limited to confirmed cases being more likely to involve males and contain a suicide note or evidence of past suicidality, while possible cases were more likely to involve a multiple vehicle impact with a truck. Importantly, crucial information regarding the deceased’s psychological state and life circumstances (e.g., psychological autopsy) was not reported in many cases. Corresponding qualitative analysis of the coroners final determination (between the two groups) revealed the occurrence of the word suicide to occur seven times (31.8%) among confirmed cases and five times (35.7%) for possible casers. Furthermore, the coroners final determination of intent to suicide was open or undetermined in six of the possible cases (43%), which further suggests a reluctance (or procedural uncertainty) to categorically identify MVS. The paper further reviews the main findings, illuminates core challenges associated with identifying MVS and proposes a need for future investigations to incorporate a more standardised and evidence-based approach in order to effectively identify such events.

Measuring health-related quality of life of intellectually disabled children: a narrative review

To identify currently available measures of Health-related quality of life (HRQOL) for intellectually disabled children and to describe their content. A comprehensive retrieval of the English literature from 2001 to 2021 was done in the PubMed and Google Scholar. The terms ‘Intellectual disability’, ‘Differently abled’, ‘Special children’, ‘Differently challenged’, ‘Mental retardation’, ‘Health-related quality of life’, ‘Quality of life’, ‘Burden of intellectual disability’ and ‘India’ were used to identify measures of HRQOL for children’s with intellectual disability. Several tools were identified to measure HRQOL for children with intellectual disability. Many have parent proxy as well as self-report form with good validity and reliability. Though, they were often developed with minimal involvement from families, focus on functioning rather than wellbeing, and have items that sometimes may cause emotional upset. When children with different health problems are compared, the degree of their particular health condition should be measured. Furthermore, overlap of items seems not to be a problem when the HRQOL of children with intellectually disability is studied. Hence, HRQOL assessments are useful for collecting information beyond the clinical symptoms of a health problem thus improving quality of care.

Psycho-social problems of adolescents with sickle-cell anaemia in Ekiti State, Nigeria.

Sickle-cell disease comprises a group of genetic disorders characterized by the inheritance of sickle haemoglobin from both parents. Sickle-cell disease carries a huge psycho-social burden which has impacts on the physical, psychological, social and occupational well-being as well as levels of independence on adolescents. To investigate the psycho-social problems of adolescents with sickle-cell anaemia in Ekiti State. The study also examined whether the variables of age and educational level would influence the psycho-social problems of adolescents with sickle-cell anaemia in Ekiti State. Descriptive survey design was adopted for the study. Purposive sampling technique was adopted to draw a total of 121 respondents. A questionnaire was used to collect data for the study. Mean and rank order was used to answer the research question while Analysis of Variance was used to test the hypotheses at 0.05 level of significance. Findings revealed that psycho-social problems of adolescents with sickle-cell anaemia are limited in the choice of career, find it difficult to get suitable partner in marriage and SCD adolescents usually manifest emotional upset, misbehaviour, and have learning problems. Findings also revealed that there were significant differences in the psycho-social problems of adolescents with sickle-cell anaemia based on age and educational level. Majority of the respondents attested to the psycho-social problems facing adolescents with sickle-cell anaemia. Based on the findings of the study, it was recommended that social workers should be employed in health sectors; government should offered standard health care for all adolescents with sickle cell disease.

Taking offense: An emotion reconsidered

Taking offense: An emotion reconsidered

Shared decision-making attitudes and practices in multidisciplinary cancer care teams.

180 Background: Patients who engage in decision making are more likely to experience confidence in treatment decisions, satisfaction with treatment, and trust in clinicians. The Association of Community Cancer Centers (ACCC) conducted a survey to explore multidisciplinary team attitudes and practices around shared decision-making (SDM) and health literacy. Methods: ACCC convened a steering committee of multidisciplinary specialists and advocacy representatives to guide this research. The survey included 26 mostly closed-ended questions and was open to multidisciplinary cancer programs from 10/29/19 to 2/20/20. Exploratory analysis was performed on this data set of 305 complete responses. Results: While most respondents reported engaging patients in decision-making to some degree, only 50% reported that SDM is a top organizational priority. 33% reported organizational efforts to formally integrate SDM into the clinical workflow, with only 15% indicating staff opportunities for basic SDM training. The three most frequently cited perceived barriers to engaging in SDM were patients feeling overwhelmed (53%), wanting to defer decisions to clinicians (46%), and having limited health literacy (46%). Only 13% indicated that lack of time was a barrier. Less than half (41%) of respondents reported using patient decision aids to support SDM. Respondents represented a wide range of multidisciplinary team members, though surgical oncologists and general surgeons (20% and 16% respectively) are overrepresented in the results. Conclusions: SDM is commonly accepted as essential to patient engagement but clarity in terminology and prioritizing formal integration of SDM into practice is limited. Strategies to improve integration of SDM into oncology practice should include: 1) Educational initiatives and tools to overcome barriers to SDM, including patient decision aids and SDM training, 2) Initiatives to address health literacy as it relates to patient and caregiver engagement in decision making, 3) Psychosocial support for patients whose emotional upset is a barrier to SDM, 4) Healthcare policies that encourage and incentive providers to engage in SDM. Future analyses will require concurrent assessment of patient, caregiver, healthcare professional, and administrator perspectives.

Therapeutic effects of rosemary (Rosmarinus officinalis L.) and its active constituents on nervous system disorders.

Rosemary (Rosmarinus officinalis L.) is an evergreen bushy shrub which grows along the Mediterranean Sea, and sub-Himalayan areas. In folk medicine, it has been used as an antispasmodic, mild analgesic, to cure intercostal neuralgia, headaches, migraine, insomnia emotional upset, and depression. Different investigations have highlighted rosemary neuropharmacological properties as their main topics. Rosemary has significant antimicrobial, anti-inflammatory, anti-oxidant, anti-apoptotic, anti-tumorigenic, antinociceptive, and neuroprotective properties. Furthermore, it shows important clinical effects on mood, learning, memory, pain, anxiety, and sleep. The aim of the current work is to review the potential neuropharmacological effects of different rosemary extracts and its active constituents on nervous system disorders, their relevant mechanisms and its preclinical application to recall the therapeutic potential of this herb and more directions of future research projects. The data were gathered by searching the English articles in PubMed, Scopus, Google Scholar, and Web of Science. The keywords used as search terms were ‘Rosmarinus officinalis’, ‘rosemary’, ‘nervous system’, ‘depression’, ‘memory’, ‘Alzheimer’s disease’ ‘epilepsy’, ‘addiction’, ‘neuropathic pain’, and ‘disorders’. All kinds of related articles, abstracts and books were included. No time limitation was considered. Both in vitro and in vivo studies were subjected to this investigation. This review authenticates that rosemary has appeared as a worthy source for curing inflammation, analgesic, anti-anxiety, and memory boosting. It also arranges new perception for further investigations on isolated constituents, especially carnosic acid, rosmarinic acid, and essential oil to find exquisite therapeutics and support drug discovery with fewer side effects to help people suffering from nervous system disorders.

Clinical Manifestation, Timing Course, Precipitating Factors, and Protective Factors of Ventricular Free Wall Rupture Following ST-Segment Elevation Myocardial Infarction.

Ventricular free wall rupture (FWR) is a catastrophic complication of that occurs after acute myocardial infarction (AMI), and at present, its clinical characteristics are unclear. We analyzed a total of 6,712 consecutive patients who presented with ST-segment elevation myocardial infarction (STEMI), and 78 patients with FWR after STEMI were enrolled in the study. Patients' demographic data, clinical manifestation, laboratory test results, and angiographic features were then collected and analyzed. FWR occurred in 78 cases (1.16%), and the inhospital mortality of FWR was up to 92.3%. Among the 78 FWR patients, 72 obtained accurate rupture time. FWR typically occurred within the first week after the infarct. Compared to late-phase FWR (more than 48 hours after STEMI) patients, early-phase FWR (during 48 hours after STEMI) patients showed significantly higher random glucose and higher percentage of anterior myocardial infarction. Besides, dual antiplatelet therapy (DAPT), β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) were used less frequently in early-phase FWR patients. Moreover, we first reported the precipitating factors of FWR. Defecating, transporting, acute emotional upset, diets, and invasive treatment turned out to be the main triggers for FWR. Furthermore, we found that patients who survived from FWR were younger, had higher β-blocker coverage in the inhospital treatment, and had a higher frequency of primary PCI. FWR remains an infrequent but devastating complication of STEMI. We have found several factors related to the occurrence and prognosis of FWR. This study provides evidence for a better understanding of FWR.

Clinico-Epidemiological Profile and Treatment Pattern of Vitiligo in Selected Dermatological Clinics of Mekelle City, Northern Ethiopia.

Background Vitiligo is not a well-studied disease in Ethiopia. Therefore, this study assessed its clinico-epidemiological profile and treatment patterns. Methods An institutional-based cross-sectional study was conducted in conveniently selected dermatologic clinics of Mekelle city, Ethiopia. A two-phased study was conducted, in which the first was to determine prevalence of vitiligo while the second phase was to describe the clinico-epidemiological profile and treatment pattern of vitiligo. Four-hundred three randomly selected dermatological patients were included in the first phase study. The second phase study included vitiligo cases from the first phase study and additional vitiligo cases found in a two months period prospective study. Results Of the 403 randomly selected dermatological patients who presented in the year 2017 to 2019, the prevalence of vitiligo was 13.15%. Of the 79 cases with vitiligo, nearly two-thirds (50, 63.3%) were males with five years as the median age at onset of the disease. Positive family history of vitiligo was recorded in about one-third (25, 31.6%) of the cases. Limbs (48, 44.5%) followed by the head and neck (26, 24%) were the most commonly affected parts of the body at the onset of the disease. The most prevalent clinical form of vitiligo was vulgaris (39.2%) followed by the focal type (26.6%). Emotional upset (24, 33.8%) and physical traumas (23, 32.4%) were the frequently reported triggering factors of vitiligo. Three-fourths (75.5%) of the cases had prescriptions of topical corticosteroids, and 24.5% of them had prescriptions of sun screen lotion. Conclusion The prevalence of vitiligo was found to be high. The clinico-epidemiological profile of vitiligo in Ethiopia was similar with that found globally. However, treatment options of vitiligo were very limited in Ethiopia.