Comorbidity Issues Research Articles

Health-related quality of life and associated factors among people living with HIV/AIDS in Sichuan, China: A cross-sectional study.

This study aimed to explore health-related quality of life (HRQoL) and its associated factors among people living with HIV/AIDS (PLWH) in Sichuan, China. A total of 401 PLWH were recruited from the city of Panzhihua between August 2018 and January 2019. Demographic characteristics and disease-related data were collected by self-administered questionnaires and medical system records. Health-related quality of life (HRQoL) was measured by the medical outcome study HIV health survey (MOS-HIV), which measured ten subdimensions and two summarized dimensions, the physical health summary score (PHS) and the mental health summary score (MHS). Logistic regression models were used to explore the variables independently associated with quality of life. The PHS and MHS measured by MOS-HIV were 53.66 ± 6.80 and 51.31 ± 7.66, respectively. Younger age, higher educational level, no methadone use, higher CD4 lymphocyte counts, less symptom counts and heathy BMI significantly were associated with higher HRQOL in the univariate χ2-test analysis. Education level was found to have a significant influence on patients' quality of life, both in physical health (P = 0.022) and mental health (P = 0.002) dimensions. Younger age (P = 0.032), higher CD4 lymphocyte counts (P = 0.007), less symptom counts (P < 0.001) and health BMI level (P < 0.001) were positively related to the PHS of quality of life in the multivariable logistic regression model. The HRQoL of PLWH in Sinchuan Province was relatively low. Age, educational level, methadone use, CD4 lymphocyte counts, symptom counts and BMI were positively related to quality of life. This study indicates that health caregivers should pay more attention to comorbidity issues and mental health in PLWH, especially for those with lower education levels, unhealthy body mass index, more symptomatic presentation and older age.

Dissociative identity disorder as interdisciplinary problem. Part I - psychiatric and psychological aspects.

Dissociative identity disorder (DID) belongs to the complicated issues of psychiatry and psychology areas. The specificity of the disorder and its clinical picture imply numerous difficulties in the diagnosis and treatment process. The diagnosis of DID can also have significant legal consequences, especially in the context of criminal liability or the general ability to be a witness. Thus, DID is an interdisciplinary problem. In practice, DID is rarely diagnosed, although it is estimated that it occurs in about 1% of the general population. In many cases, the period from the first contact with the healthcare system to a correct diagnosis exceeds several years (on average, 6.7 to 8 years). The average misdiagnosis rate is 2.8 per patient. The lack of a quick and proper diagnosis makes it impossible to undertake adequate treatment, which extends the entire therapeutic process, affects its effectiveness and significantly increases costs. There is no doubt that in educating psychiatrists and clinical psychologists, greater emphasis should be placed on correctly detecting dissociative symptoms and the use of adequate diagnostic tools. The aim of this article is to present and identify the main problems that DID implies in the diagnostic and therapeutic (psychological and psychiatric) areas. The article discusses the existing diagnostic tools, the issues of comorbidity and the causes of incorrect diagnoses. The issues of false-positive diagnoses and difficulties in differentiating patients with DID from simulators were also discussed. The primary mistakes made during the therapy, such as the strategy of minimization or the actions leading to multiple therapist disorder, were analyzed. Legal aspects will be presented in a separate article.

Metacognition and insight dynamics exploration in borderline personality disorder: Exploring the underlying dynamics

Metacognition and Insight are related to hard-to-treat disorders and among them is Borderline Personality Disorder (BPD). We recruited 190 BPD patients and measured Insight, Metacognition, Impulsivity, and BPD traits. Results showed BPD's significant links with Insight and Metacognition. Metacognition significantly correlated with two Impulsivity dimensions, whereas Insight significantly correlated with most of them. Regressions analysis revealed a significant relationship between Insight and Metacognition on Impulsivity and Borderline traits. Mediation analysis proved the indirect effect of Metacognition/Insight on Borderline traits through Impulsivity at a significative level. Both seem relevant for research and therapeutic application in BPD following different dynamics even if the limitation of our study stands in its gender ratio and possible comorbidity issues. Urgency appears as a critical factor to assess, notably with Positive emotion-based impulsivity.

Multiple Sclerosis and MEN2 Neoplasia in a Female Patient: A Unique Co-Existence with Expanded Immunological Interest and Therapeutical Challenges, before and after Patient’s COVID-19 Infection

Multiple sclerosis (MS) and its various comorbidities that may be observed are of great interest due to the complexity of MS pathophysiology and all of the immunological changes that follow. The incidence of cancer in MS has been investigated for several years, as not only does it affect ongoing therapeutical decisions, but also, certain disease-modifying treatments (DMTs) may increase the risk of tumorigenesis. For the first time, we present a case of a female patient with pediatric-onset MS (POMS) and multiple endocrine neoplasia 2B (MEN2B) and analyze the immunological impact of these diseases on the therapeutical choice, under the umbrella of her COVID-19 infection and the SARS-CoV-2 pandemic as a whole. We also review the existing literature regarding the immunogenetic and immunological correlations between these two extremely rare diseases and discuss the most suitable treatment for our case, which seems to be an anti-CD20 agent due to a better outcome in putative MS worsening and tumor progression, when killer immunoglobulin-like receptors' (KIR) expression is reduced in natural killer (NK) cells. We also broaden our concerns on this comorbidity issue, at the same time focusing on the future research needed in this unexplored field of the comorbidity of MS and cancers.

OA11 Treatment challenges and co-morbidity issues in a patient with Arthritis Mutilans

Introduction/BackgroundPsoriatic arthritis mutilans is known to be the most severe form of psoriatic arthritis1 and reported to have a prevalence of 2-21%2, depending on the classification used. Clinical features include shortening of the digits, telescoping and flail joints with radiographs showing severe osteolysis and bone resorption3. There is an increased prevalence of metabolic syndrome, cardiovascular disease and psychiatric illness among these patients4. Treatment of the disease is usually a stepwise approach starting with conventional synthetic disease modifying anti-rheumatic drug (csDMARD), combination csDMARD, biologic DMARD (bDMARD) or targeted synthetic DMARD (tsDMARD).Description/MethodThis 65-year-old gentleman has a diagnosis of psoriatic arthritis, mutilans type for more than 40 years. His other current co-morbidities include hypertension, hyperlipidaemia and depression. He was treated with methotrexate with good efficacy until this was stopped in 2012. Whilst on methotrexate, he had deranged liver function tests and the ultrasound scan of his abdomen showed fatty infiltration of the liver. Liver biopsy showed steato-hepatitis which was thought to be secondary to methotrexate and the drug was stopped. He was then started on Sulphasalazine, which was uptitrated to 1.5 g twice a day but with no benefit. He was having 12 swollen and 8 tender joints with a patient global score of 6/10 and physician global score of 7/10.The patient was started on Golimumab in August 2013. He had four doses of 50 mg and two doses of 100 mg of the drug. Each dose had resulted in severe headaches which necessitated discontinuation of the treatment. He was then commenced on Adalimumab in August 2014, which also resulted in severe headaches and sweating with no efficacy otherwise. At that point, his Alanine Transaminase (ALT) levels continued to be fluctuating between 50 to 80 U/L and he was also noted to be hypertensive.The patient was then started on Ustekinumab in October 2016 to which he tolerated well and had almost immediate noticeable improvement in his tender and swollen joints. The patient remained stable on this three monthly treatment till this day.Interestingly, the erosive changes on the x-rays of his hands and feet has not progressed since 2010, despite tolerance and efficacy challenges of his treatment.Despite stability of his disease and treatment, this gentleman sadly attempted suicide in March 2021 by consuming weed killer. He was informally admitted to a mental health ward.Discussion/ResultsWe present a case of psoriatic arthritis mutilans which was complicated by side effects and lack of efficacy of several disease modifying treatment. He had methotrexate which had to be stopped due to steato-hepatitis. Both Golimumab and Adalimumab was stopped due to side effects characterised by headaches. Ustekinumab was started four years following the cessation of methotrexate which continues to be the most effective medication for this patient.This patient also suffers with cardiovascular co-morbidities and depression. Tumour necrosis factor (TNF)-α associated endothelial dysfunction as well as interleukin (IL)-17A associated increased expression of adhesion and pro-inflammatory molecules may contribute to the association of psoriatic arthritis mutilans with cardiovascular disease5,6. It is also known that there is a higher prevalence of mental health disease in patients with psoriasis. This is thought to be due to the involvement of the same inflammatory pathway as proinflammatory IL-1 and IL-6 are increased in both psoriatic arthropathy and depression7.Key learning points/ConclusionBased on our research, there is a lack of evidence for treatment specific to arthritis mutilans, due to the relatively rare nature of the disease. However, this case report has proved that treatment should be individualised to the patient, based on their response and tolerance to the medications.It is also pertinent to be aware and manage co-morbidities associated with the disease which includes hypertension, hyperlipidaemia, diabetes mellitus and psychiatric illnesses. This requires close collaboration with the patient’s general practitioner.

Psychiatric disorders and pain: The recurrence of a comorbidity.

Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance. Although pain is a common complaint among psychiatric patients, clinicians generally separate its presence from the background mental disorder and downplay its importance, trying primarily to control the psychiatric symptomatology. As a sensory modality, the presence of pain and its importance account for an impressive body of scholarly research. Cartesian methodology considered sensations of all modalities in a mechanistic form, which actually sounds obsolete. However, authors have continuously been faced with the same dilemmas plaguing scholars for centuries. We assume that a large portion of the sensory inputs might be generators of distorted perceptions, which subsequently lead to psychopathology. Auditory and visual hallucinations are incontestable examples. Somaesthetic hallucinations also exist, but pain hardly deserves such a denomination. Nevertheless, chronic pain and psychiatric comorbidity is a reality that needs explanation. Painkillers are not effective in treating psychiatric disorders, and antipsychotics do very little, perhaps nothing, to relieve pain. The pharmacological approach opens one door on the horizon and closes many others, while clinicians continue to face a high prevalence of comorbid pain and mental health issues. However, attempts to correlate altered body schemata (as distorted as it may be, for example, in phantom limb pain) with somatic delusions can simplify all these dilemmas, and the basket of psychophysiology, in fact, might be bigger than presumed.

The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours

PurposeDespite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.Design/methodology/approachThis is a conceptual paper that includes a case vignette.FindingsA DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.Research limitations/implicationsIt is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.Practical implicationsTreatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.Originality/valueThere are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.

Stroke in Patients with Schistosomiasis: Review of Cases in Literature.

Introduction Cerebral vascular comorbidities may occur in patients with schistosomiasis, as described in case reports. Aim and Methods. We have summarized general clinical and neurological features in patients with stroke associated with schistosomiasis, through a review of case reports in the literature. Investigation Outcomes. A total of eight case reports were retrieved. The mean age of patients was 36.42 ± 16.7 (19 to 56 years), four females, three males, and one anonymous sex. Eosinophilia was the most frequent feature at presentation, followed by cardiac abnormalities, confusion, fever, ataxia, hemiplegia, headache, urticaria, dysphasia, and memory impairment. Patients usually present with watershed infarction or intracranial vasculitis. In one case, extracranial carotid arteries presented with inflammation and stenosis. The patient's serology was positive on admission in five cases. Full neurological recovery was reported in three cases, and partial improvement in another three. In two cases, information on neurological outcomes was incomplete. Stroke in schistosomiasis can be caused by haemodynamic impairment, direct lesion to the arterial wall, vasa vasorum obliterative endarteritis, contiguity with a focus of inflamed tissue, or inflammatory intimal damage. Schistosomiasis needs to be included in the differential diagnosis of stroke in people living or coming back from endemic areas. Conclusions Further studies addressing the noncommunicable comorbidity issues related to this condition are needed.

Erectile Dysfunction in a U.S. National Sample of Male Military Veterans.

Erectile dysfunction (ED) is one of the most prevalent sexual dysfunctions in men and often co-occurs with physical and mental health issues. Military veterans are at elevated risk for many comorbid physical and mental health issues, including ED, although little research has examined the prevalence and health burden of ED in the general U.S. veteran population. The present study calculated the weighted lifetime prevalence of ED and its association with physical and mental health conditions in a nationally representative sample of U.S. veterans. Using data from a nationally representative sample of 921 male U.S. veterans, self-report assessments assessed major depressive disorder (MDD), generalized anxiety disorder, probable post-traumatic stress disorder (PTSD), at-risk/problem gambling, and past two-week suicidal ideation and attempts, as well as 22 physical health conditions. The weighted lifetime prevalence of ED among veterans was 14.2% (95% CI = 12.0%-16.0%). Veterans with ED were more likely to be older than 60, unemployed, to have served less than four years in the military, and to have served in combat roles and in the Vietnam War. Relative to veterans without ED, veterans with ED had higher rates of sleep disorders (adjusted odds ratio [aOR] = 3.23), arthritis (aOR = 2.60), high cholesterol (aOR = 2.30), diabetes (aOR = 2.29), high blood pressure (aOR = 2.14), obesity (aOR = 2.12), heart disease (aOR = 2.10), cancer (aOR = 2.07), respiratory illness (aOR = 2.02), and chronic pain (aOR = 1.86). After adjusting for sociodemographic characteristics and physical health conditions, ED was associated with increased odds of MDD (aOR = 2.88), at-risk/problem gambling (aOR = 2.45), and suicidal ideation (aOR = 1.91) but not for generalized anxiety disorder (aOR = 1.69) or probable PTSD (aOR = 1.63). When considered in the context of all mental health variables, MDD was independently associated with ED (aOR = 3.39). This study examined both mental and physical health conditions associated with ED in a U.S. nationally representative sample of veterans. ED is prevalent in veterans and associated with elevated physical and mental health burden. Results highlight the importance of considering ED in disease prevention and treatment efforts in this population. These findings may help inform prevention approaches as well as clinical targets for early screening and treatment in vulnerable subgroups of this population. Notably, data collected relied on self-report assessments; data on race and socioeconomic status were not collected.

Psychiatric comorbidity for veterans with posttraumatic stress disorder (PTSD): A latent profile analysis and implications for treatment.

Psychiatric comorbidity is common among veterans with posttraumatic stress disorder (PTSD), but there is little known about the patterns of co-occurring mental health problems and implications for treatment. The aim of this study was to identify comorbidity profiles among veterans at treatment intake and assess associations with PTSD and quality of life (QOL) outcomes. The study included 2,522 veterans accessing outpatient treatment for PTSD in Australia who self-completed measures of comorbid issues including depression, anger, alcohol use problems, guilt, and dissociation. Latent Profile Analysis (LPA) was used to identify subgroups based on comorbidity profiles, and their association with outcomes. LPA suggested 5 comorbidity profiles: (a) low comorbidity severity, (b) moderate comorbidity severity with low alcohol, (c) moderate comorbidity severity with high alcohol, (d) high comorbidity severity with low alcohol, and (e) high comorbidity severity with high alcohol. The absence of alcohol problems was associated with improved treatment outcomes when overall comorbidity severity was high but not moderate. While all profiles evidenced symptom improvement from intake to discharge and follow-up, this did not correspond to quality of life improvements equally across classes. The highest severity comorbidity class experienced no improvement on psychological quality of life. The comorbidity profiles of veterans in treatment for PTSD can be distinguished by levels of severity and the specific presence or absence of alcohol use problems. Alcohol use problems have discernible implications for treatment in the context of comorbidity. Group treatments for PTSD should consider tailoring interventions to comorbidity profiles. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Clinical progress note: Noncardiac complications in adults with congenital heart disease.

Clinical progress note: Noncardiac complications in adults with congenital heart disease.

Protective and Risk Factors at the Intersection of Chronic Pain, Depression, Anxiety, and Somatic Amplification: A Latent Profile Approach

ObjectiveResearch indicates a complex nexus between chronic pain, depression, anxiety, and somatic amplification (PDAS) symptoms, marked by high rates of co-morbidity and mutually maintaining mechanisms. Although recent frameworks have attempted to explain co-occurrence rates of pain and other comorbid disorders, the interrelations between PDAS and their impacts on pain outcomes have not been adequately examined with a person-centered approach. Using nationally representative data, this study assessed the heterogeneity in PDAS symptomatology and examined links among risk and protective factors in different profiles.MethodsData were derived from 1027 participants in the National Survey of Midlife Development in the United States (MIDUS) who completed telephone interviews or self-report measures that assessed PDAS, various sources of social supports (family, friends, spouses/partners, religion, coworkers, and supervisors), and the number of healthcare visits.ResultsWe found heterogeneity in symptom severity rather than symptom type across classes over time. Regardless of comorbidity severity, people reported similar levels of somatic symptoms, which may help clinicians more effectively diagnose comorbidity issues among chronic pain patients. As PDAS symptomatology increased by group, the perceived levels of social support decreased. Membership in a higher symptom severity class was associated with being female, younger age, and an increase in medical, but not mental health visits.LimitationsLimitations included the use of a cross-sectional design, reliance on self-report measures, and a sample largely comprised of Whites.ConclusionPDAS co-occurs across classes, which may relate to shared risk and protective factors. This study lays the foundation to investigate similar questions for overlapping symptoms that occur during the same period, which would shed light on whether—among middle to older age adults—these disorders are attributable to a common mechanism and if they may inform transdiagnostic treatments.

Emerging Opportunities to Improve Treatment Access for Substance Use Disorders and Other Comorbid Health Issues Among Women Enrolled in WIC.

Women living in underserved communities are at an increased risk for substance use disorders and other comorbid health issues, a public health concern that was exacerbated as the COVID-19 pandemic took hold. In response to the challenges the pandemic presented, services delivered by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) adapted nimbly, including WIC nutrition managers' and counselors' efforts to provide reactive referrals of clients raising concern about substance misuse and related consequences. This adaptation signaled an opportunity to consider integrating more proactive, evidence-based strategies for substance use disorders such as standardized brief assessments, advice, and referral procedures (i.e., Screening, Brief Interventions, and Referral to Treatment [SBIRT]), as part of routine WIC operations. Integration of such routine practice would improve the quality of care WIC provides to their clients and families, while addressing a major gap in public health by connecting clients at high risk for substance use disorders and substance-related problems to much needed services. Given the adaptability of WIC to reactively manage the wide array of psychosocial and mental health problems that increased during the pandemic, opportunities exist for future research to examine the feasibility, acceptability, and efficacy of proactive implementation of brief screening, advice, and treatment referral to reduce substance-related harm among women living in underserved communities.

Issues of Depression and Comorbidity in Rehabilitation

Aim: To analyze data on the presence of comorbidity in patients with depression and to determine the strength of the relationship between the degree of depression and related diseases. Materials and Methods: The study involved 67 women with depression. We determined the level of depression according to the Patient Health Questionnaire-9 (PHQ-9). Correlation relationship was assessed by Spearman’s rank correlation coefficient (r) at significance level of p≤0,01. Results: According to the obtained data, only 17.9% of depressive patients with depression had no concomitant diseases. The most frequent ones were: diseases of the traumatic organs (32.8%), neurological disorders (22.4%), and respiratory disorders (19.4%). Two or more comorbidities were found in 44.8% of depressed patients. The study of the interdependence between the degree of depressive disorders and related diseases revealed a positive correlation of significant strength between significant depressive disorders and respiratory diseases (r=0,59); positive correlation of significant strength to a mild degree of depression and respiratory disorders (r=0,36) as well as to significant depressive disorders and protein exchange disorders (r=-0,36). Conclusions: Comorbidity occurs in the majority (82,1%) of depressive patients. Correlations of varying strength between the degree of depressive disorder and related diseases were found. The findings confirm the importance of taking into account the presence of concomitant pathology when planning a course of treatment and rehabilitation. Moreover, the necessity of screening for depression is confirmed when depressed patients ask for medical treatment.

Pathogenetic mechanisms of chronic obstructive pulmonary disease in comorbidity with gastroesophageal reflux disease

The issue of comorbidity of chronic obstructive pulmonary disease with gastroesophageal reflux disease as mutually determined pathological conditions is attracting more and more attention. The aim of the research: to study the pathogenetic mechanisms of the combined course of chronic obstructive pulmonary disease with gastroesophageal reflux disease. Materials and methods: We formed 3 groups of patients: 1 group (n=60) – patients with COPD in combination with GERD, 2 group (n=42) – patients with COPD without signs of GERD, who were treated in the pulmonology department for exacerbation of the disease and group 3 (n=36) – patients with GERD who were treated on an outpatient basis. All patients underwent general clinical examinations and determination of IL-4, IL-6, IFNγ, IFNγ/IL-4, TNF-alpha, pepsinogen and bilirubin levels in saliva Results and Discussion. In patients with concomitant GERD, a significant increase in acute phase indicators in blood serum was found. An increase in the activity of IL-6 and IFNγ cytokines indicates the activation of the cellular link of immunity, with an unregulated immune response that supports chronic inflammation in the bronchi even during remission. The detection of correlations between the concentration of total bilirubin in saliva with a decrease in external respiratory function indicators, namely FJEL, FEV-1, as well as with the presence of shortness of breath allows considering bilirubin as one of the possible markers of reflux and respiratory inflammation in the bronchi, up to the development of obstruction . The positive correlation of pepsinogen-1 in saliva with an allergic history, and pepsinogen-2 with cough, shortness of breath, and smoking, and the negative correlation of pepsinogen-1 with the value of FEV1/FJEL, allows us to consider pepsinogen-1 and pepsinogen-2 as markers of non-acid reflux and respiratory inflammation. Conclusions: Determination of the content of pepsinogens 1 and 2 and bilirubin in saliva are non-invasive methods of detecting duodenogastroesophageal and laryngo-pharyngeal reflux in patients with existing GERD.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases.

Psychosomatic Approach to Fibromyalgia Syndrome: Concept, Diagnosis and Treatment

&lt;p&gt;Fibromyalgia syndrome (FMS) has chronic widespread pain (CWP) as a core symptom and a variety of associated somatic and psychological symptoms such as fatigue, sleep problems, cognitive disturbances, multiple somatic pain, and depression. FMS is the subject of considerable controversy in the realm of nosology, diagnosis, pathophysiology, and treatment. Moreover, the fact that FMS and mental illness are closely associated with each other might intensify the confusion for the distinction between FMS and mental disorders. This narrative literature review aims to provide the concept, diagnosis, and treatment of FMS from the integrative biopsychosocial and psychosomatic perspective. This article first explains the concepts of FMS as a disease entity of biopsychosocial model, and then summarizes the changes of diagnostic criteria over past three decades, differential diagnosis and comorbidity issue focused on mental illnesses. In addition, an overview of treatment of FMS is presented mainly by arranging the recommendations from the international guidelines which have been developed by four official academic associations.&lt;/p&gt;

Miniaturized Percutaneous Nephrolithotomy in the Supine Position under Regional Anesthesia to Remove Large Renal Calculi: A Case Report

Background: Percutaneous nephrolithotomy (PCNL) is traditionally performed under general anesthesia, with the patient in the prone position. However, various concerns have been raised regarding the prone position, especially in morbidly obese patients with compromised cardiopulmonary status and comorbidity issues. Our aim was to demonstrate our experience with supine miniaturized PCNL performed under spinal anesthesia in a high-risk patient. Case Report: A 76-year-old Thai woman with obesity and severe hyperglycemia presented with two large right kidney stones. She was scheduled for prone PCNL. During admission, she was in a severe hyperglycemic state, with a blood glucose level of 537 mg/dL. She required an intravenous insulin infusion and was monitored until stable. Because she had significant potential risk for general anesthesia, we decided to remove the stone by supine miniaturized PCNL under spinal anesthesia. She was placed in the Galdakaomodified supine Valdivia position. Cystoscopy was performed and a ureteric catheter was inserted into right ureteric orifice. The lower pole access was carefully punctured under ultrasonographic guidance. The tract was dilated with a metallic one-step dilator and a 12 Fr nephroscope was used. Lithotripsy was undertaken using a holmium laser through a 550 micron laser fiber. The procedure was completed with no deterioration of the patient. Conclusion: A patient with kidney stones, obesity, and poor glycemic control has an increased risk of perioperative complications. We report the first case of supine miniaturized PCNL performed under spinal anesthesia in Thailand. It is a safe and feasible method that provides satisfactory positive clinical outcomes. Keywords: Supine; Miniaturized percutaneous nephrolithotomy; Regional anesthesia

A Case Report on Alcohol Dependence Syndrome with Cannabis Addiction

Background: Alcohol dependence syndrome (ADS) and Cannabis use disorder (CUD) are every now and again co-happening or comorbid substance issues in the two young people and grown-ups. Indications of cross-over between ADS and CUD in people as they slowly move from pre-adulthood to adulthood. The researchers reasoned that the two substance-related issues are comorbid, albeit the closeness of their association ordinarily shifts over the long haul.&#x0D; Aim and Objective: The purpose of this case report is to determine the first-line approach for a person with alcohol dependence syndrome with cannabis addiction who has been referred to a public mental health facility for treatment. To identifying symptoms of ADS with cannabis addiction early, providing treatment and preventing possible complications.&#x0D; Methods: Knowledge used to write this case description was gathered from PubMed outlets, search hand, searching college and personal libraries looking for research techniques and case report texts, engaging in or writing many case reports with experience. &#x0D; Results: The patient was taken psychopharmacological treatment Anti- Anxiety drugs Lorazepam along with Tab. Benalgis, Tab. Neurobion fort and psycho social therapy, coping strategies, family therapy, yoga, cognitive behavioural therapy, medication. After those symptoms was minimized.&#x0D; Conclusion: Patients achieve positive outcomes not only through the support of their treatment management, but also through adaptation and family support. Then, with appropriate psychophysiological treatment, the patient gave a positive response and gradually all the planned goals were achieved. Finally, the patient was discharged and he is currently being monitored.

The role of &lt;i&gt;Helicobacter pylori&lt;/i&gt; in complex human comorbidity

One of the main features of modern medicine is the fact that the majority of somatic diseases lose their mononosological nature and acquire the status of comorbidity. Examining complex comorbidity is a priority for specialists in various medical disciplines. Accomplishing scientific research and obtaining nessesary data as well as their further comprehension allowed to formulate major directions for investigating a comorbidity issue. Primarily, it concerns studying rate and general patterns for combination of pathologies, determining features of clinical course and strategy for using drug therapy. Comorbidity issue is rarely considered among infectious diseases. It should be understood that a term “comorbidity” refers to the state of the concomitant detection of several diseases. This terminology may and should be applied to combined somatic and infectious pathology envisioned as a complex pathological condition, but with some additions. The term “complex comorbidity”, in our opinion, is also valid both in case of either simultaneous or sequential presence of psychosomatic pathology and monoetiological infection, as well as somatic pathology and polyetiological infection. After H. pylori was discovered, over the past decades a significant number of studies have emerged regarding a role of helicobacter in etiology and pathogenesis of a large number of somatic diseases. The accumulated knowledge has determined that Helicobacteriosis is the most common bacterial infection in human, and H. pylori is considered as the cause for developing pathology of the gastrointestinal tract as well as other host organs and systems. At the current stage in the development of medicine, H. pylori is not only associated with occurrence of gastric and duodenal ulcers, because the microbe-linked pathogenic effect is not limited only to diseases of the gastroduodenal area. Helicobacter pylori infection can be considered as a trigger in emerging somatic pathology such as chronic gastritis, gastric and duodenal ulcer, MALT lymphoma, and gastric adenocarcinoma. These conditions may be referred to the status of complex comorbidity. To date, association links between Helicobacter pylori and idiopathic iron deficiency anemia, as well as idiopathic thrombocytopenic purpura, have been reliably determined. Thus, various clinical aspects of H. pylori infection are heterogeneous and have a wide range of pathological conditions, which evidence base is replenished with data both in terms of pathogenesis and clinical components.