Longer Duration Of Illness Research Articles

Gastric peroral endoscopic pyloromyotomy (G-POEM) in patients with refractory gastroparesis: a review.

Gastric peroral endoscopic pyloromyotomy (G-POEM or POP) is an endoscopic therapeutic modality for treatment of refractory gastroparesis. Since the first case reported in 2013, there are more than 200 papers published on G-POEM. In this narrative review, we summarize the short-term and long-term outcomes and review other important studies. The technical success rate is 100% and the short-term (within 1 year) success rate is about 50-80%. The procedure time is between 50 and 70 min while the average length of hospital stay was 2-3 days. The adverse event rate was around 10%. Few patients need further intervention. Three studies showed that at the 4-year follow-up, the response to G-POEM was durable, but there was a yearly recurrence rate of 13% or more. Redo G-POEM is feasible and can be of benefit for some patients. Most of the studies showed that long duration of illness is associated with poor outcomes. However, reliable predictors for successful outcomes are still unknown. Current literature indicates G-POEM is superior to gastric electric stimulator and surgical pyloroplasty. Endoflip has been used at G-POEM to predict the outcome, but the result is very preliminary. A recent sham study confirms the short-term efficacy of G-POEM. G-POEM is safe and about 50% of patients can be discharged to home on the same day. G-POEM allows for direct biopsy of the gastric muscle, which is the location of the pacemaker cells, the interstitial cells of Cajal; therefore, G-POEM may provide a new path for further research on the pathogenesis of gastroparesis.

Nutritional Status of Underprivileged Indian Children and Youth with Type-1 Diabetes - A Multicentre Study.

India has the highest number of prevalent type-1 diabetes (T1D) cases in the under-20-year age population. Data on the anthropometry of underprivileged Indian children with T1D are scarce. In economically disadvantaged countries like India, poor growth in patients with T1D is a major concern due to limited accessibility and affordability. Besides, due to the double burden of malnutrition, the prevalence of obesity is increasing mirroring the global trends, which may lead to the development of insulin resistance. This study aims to assess the prevalence of malnutrition in Indian children and youth with T1D and to identify the determinants of short stature. A registry-based cross-sectional analysis of data collected from various centres across India enrolled in the Changing Diabetes in Children (CDiC) programme. We observed that 6.4% were undernourished (3.4% severe undernutrition) and 17.7% (overweight 13.2%) had combined overweight/obesity. 21.2% of participants had short stature (adjusted for mid-parental height) with 7.4% cases of familial short stature. Longer duration of illness and insulin requirement were significant positive predictors of short stature while glycaemic control, insulin regimen and mid-parental height did not have a significant relationship with short stature. Participants on basal-bolus regimen had significantly higher insulin requirements and better glycaemic control than the ones on mixed-split regimen. We report that around one-fifth of children and youth with T1D were overweight/obese and around a fourth were stunted, especially those with longer duration of diabetes and higher insulin requirements. Close monitoring of anthropometric parameters is necessary for all children with T1D to optimize growth and nutrition.

Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates.

To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention.

Cognitive adverse effects of epilepsy and its predictors attending outpatient department of South Gondar zone hospitals, Amhara Region, Ethiopia 2020 /2021.

Epilepsy is the most common neurologic disorder which is further complicated by neurobehavioral co-morbidities, cognitive impairment, psychiatric disorders, and social problems. However, assessments of cognitive status of epileptic patients are far too low during clinical visits. This calls for early neuropsychological assessment soon after the diagnosis of epilepsy for a better treatment plan and outcome for epileptic patients. This study aimed to assess the cognitive adverse effects of epilepsy and its predictors attending outpatient departments of South Gondar Zone hospitals Amhara region Ethiopia 2020/2021. A multi-center institutional-based cross-sectional study was conducted. A total of 509 respondents were included with a response rate of 93.9%. Previously adapted pretested structured questionnaire was used containing, socio-demographic, clinical, and seizure related factors. Mini-Mental State Examination (MMSE) was used to measure cognitive impairment. A systematic random sampling technique was applied. Data were entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive statistics, bivariable and multivariable binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05. Prevalence of cognitive impairment in this study was 69.2% (95%CI; 65.4, 73.1). Rural residents (AOR = 4.16,95%CI, 1.99,8.67), respondents who couldn't read and write (AOR = 2.62, 95%CI; 1.24, 5.5,) longer duration of seizure disorder (AOR = 4.59,95%CI; 2.01,10.52), taking combined Phenobarbital and Phenytoin (AOR = 4.69,95%CI; 1.88,11.69), having history of head injury (AOR = 3.29,95%CI;1.30,8.32), having depression (AOR = 4.76,95%CI;2.83,7.98), and anxiety (AOR = 3.11,95%CI; 1.58,6.12) were significantly associated with cognitive impairment. Prevalence of cognitive impairment in this study was high. Regular neuropsychiatric assessment of patients with epilepsy should be encouraged especially for those participants with longer durations of illness, who are rural residents, who take combined Phenobarbital and Phenytoin, participants who had a history of head injury, depression, and anxiety.

Women with mental illness seeking conception counselling at a specialist perinatal psychiatry service in India.

To study the clinical and sociodemographic profile of women with mental illness seeking conception counselling at perinatal psychiatry service. To compare women seeking preconception counselling (PCC) to that of those who sought help after unplanned pregnancy with exposure (UPE) to psychotropics. Data was extracted from the clinical records of women between the year 2014-2017 who attended perinatal outpatient services. The details collected included sociodemographic details, illness details, contraception, infertility treatment and detailed treatment history. Of the 766 women who consulted perinatal psychiatry services (2014-17), 179 (23.37%) had consulted for conception counselling. Out of that 104 (58.1%) sought PCC, and 75 (41.9%) had UPE to psychotropics. PCC was sought by women with higher education, those having a severe mental illness, and a longer duration of illness. Women with medical comorbidities and receiving infertility treatment also sought PCC. Also, women who had earlier undergone PCC been more likely to seek PCC for further pregnancies. Women with mental illness should be counselled regarding planned pregnancies, contraception, and the impact of psychotropics on pregnancy and foetus. Also, liaison with other specialities like obstetricians, sonologist and paediatricians is essential.

Assessment of disease knowledge gaps among beta thalassemia major patients and their caregivers

BackgroundThalassemia constitutes a major health issue in Egypt. It is associated with significant mortality and morbidity that arise mainly from iron overload secondary to blood transfusions.MethodsWe conducted this cross-sectional study at Cairo University children hospitals aiming at assessing the patients’ and their caregivers’ knowledge about thalassemia, and to identify factors affecting their knowledge in the period from December 2020 to August 2021.ResultsThe study included 45 thalassemia patients aged 10–14 years and 45 caregivers of patients who were less than 10 years of age. A knowledge questionnaire was generated from an educational script prepared by the investigators and translated into Arabic language. Thirty-one patients and 44 caregivers responded to the questionnaire individually, while 15 patient/parent pairs worked on the questionnaire together at their request. Age of patients ranged from 2 to 14 years, majority were males. Disease duration ranged from 0 to 13 years and the majority were following in the pediatric hematology clinic on a monthly basis. Candidates showed strong knowledge in areas related to symptoms and signs. On the other hand, they showed critical knowledge gaps in the areas of blood transfusions complications and iron chelation. Patients and caregivers scored similarly in various questionnaire topics with no significant difference. Gender, consanguinity, similar conditions in the family and frequent follow-up did not affect the score of the study participants, though longer duration of illness was positively correlated with the overall scores.ConclusionsThalassemia patients and their caregivers have significant knowledge gaps in areas of chelation therapy and transfusion complications.

A multimodal neuroimaging study of brain abnormalities and clinical correlates in post treatment Lyme disease.

Lyme disease is the most common vector-borne infectious disease in the United States. Post-treatment Lyme disease (PTLD) is a condition affecting 10–20% of patients in which symptoms persist despite antibiotic treatment. Cognitive complaints are common among those with PTLD, suggesting that brain changes are associated with the course of the illness. However, there has been a paucity of evidence to explain the cognitive difficulties expressed by patients with PTLD. This study administered a working memory task to a carefully screened group of 12 patients with well-characterized PTLD and 18 healthy controls while undergoing functional MRI (fMRI). A subset of 12 controls and all 12 PTLD participants also received diffusion tensor imaging (DTI) to measure white matter integrity. Clinical variables were also assessed and correlated with these multimodal MRI findings. On the working memory task, the patients with PTLD responded more slowly, but no less accurately, than did controls. FMRI activations were observed in expected regions by the controls, and to a lesser extent, by the PTLD participants. The PTLD group also hypoactivated several regions relevant to the task. Conversely, novel regions were activated by the PTLD group that were not observed in controls, suggesting a compensatory mechanism. Notably, three activations were located in white matter of the frontal lobe. DTI measures applied to these three regions of interest revealed that higher axial diffusivity correlated with fewer cognitive and neurological symptoms. Whole-brain DTI analyses revealed several frontal lobe regions in which higher axial diffusivity in the patients with PTLD correlated with longer duration of illness. Together, these results show that the brain is altered by PTLD, involving changes to white matter within the frontal lobe. Higher axial diffusivity may reflect white matter repair and healing over time, rather than pathology, and cognition appears to be dynamically affected throughout this repair process.

Complex polypharmacy in bipolar disorder: Results from a real-world inpatient psychiatric unit

BackgroundMultiple medications are frequently prescribed to patients with bipolar disorder (BD). The aim of the present study was to identify sociodemographic and clinical characteristics associated with complex polypharmacy in patients affected by BD. Methods556 patients with BD were included. A semi-structured interview was used to collect sociodemographic and clinical characteristics, as well as pharmacological treatment. Participants were divided in two groups, abased on the use of complex polypharmacy (i.e., a combination of 4 or more psychotropic medications). Differences between the two groups were evaluated with t-test and chi-squared test. A stepwise logistic regression was then applied to identify factors significantly associated with complex polypharmacy. ResultsPatients with BD and complex polypharmacy were more likely to be single and unemployed. Moreover, earlier age at onset, longer duration of illness, higher number of hospitalizations, higher prevalence of medical and psychiatric comorbidity, and the use of illicit substances (except heroin) were associated with complex polypharmacy. In the logistic regression model, single status, older age, number of hospitalizations, and the presence of psychiatric comorbidities were regarded as factors significantly associated with complex polypharmacy. ConclusionsOur findings reflect the need to develop clear guidelines for the long-term management of BD, especially when pharmacological discontinuation is needed.

Case Study and Patient Counseling for Elderly Patient on Psoriasis Vulgaris

The origin is characterised by skin and nail spots. It is considered a serious skin condition that affects around 100 million people worldwide. In 2016 - 2017, around 2% of the global population and 0.44-2.8% of the Indian population were affected with psoriasis. The five most common kinds of psoriasis are plaque, guttate, inverted, pustular, and erythrodermic. Plaque psoriasis, also known as psoriasis vulgaris, is the most prevalent type of illness (about 90% of cases) and is characterised by red patches covered with white scales. A 75-year male case with raised lesions on both legs from 6 months with fever arrived at the hospital on 03-MAR-2022. He had a history of raised scaly lesions on both the legs, trunk and upper limbs for 6 months. Multiple hyperpigmented scaly plaques of varying sizes on a trunk, back, both upper limbs, and huge plaques on both the lower limbs. Due to psoriasis, young adults with relatively stable plaque psoriasis experience feelings of embarrassment, impairments in daily activities, deteriorating physical health and decreased work productivity. Female patients, those with a high BMI, and those with a longer duration of illness appeared to be more severely impaired. The observations suggest that the clinical patterns and pathogenesis of psoriasis in the elderly may differ from those in the middle-aged onset group. To fully understand psoriasis that occurs in this age group, additional epidemiological and genetic research is required.

Personality traits as predictors of OCD remission: A longitudinal study

BackgroundPersonality traits may confer vulnerability to psychopathology. However, few studies have examined the association between personality traits and obsessive-compulsive disorder (OCD) course. The present study investigates personality traits, OCD symptom severity, and illness duration as a predictor of OCD remission. Methods166 treatment-seeking adults with OCD, recruited as part of the Brown Longitudinal Obsessive-Compulsive Study, completed the NEO Five-Factor Inventory 3 (NEO-FFI) and were in episode for OCD at time of NEO-FFI completion. Participants were followed for up to 3 years. ResultsResults suggest individuals with OCD had a 21 % likelihood of reaching remission over the course of 3 years. Greater OCD symptom severity and longer illness duration were associated with a decreased likelihood of remission. Among the five factors of personality, only low extraversion was associated with a decreased rate of remission. Neuroticism, openness, agreeableness, and conscientiousness were not associated with remission. LimitationsAs this was an observational study, treatment was not controlled precluding examination of treatment on course. Further, data collected on age of onset and symptom severity during follow up were retrospective and therefore are also subject to recall bias. ConclusionsOur findings provide preliminary support that personality traits are potential factors impacting course and symptom presentation. Future research is necessary to determine the mechanisms in which personality traits may influence the presentation and course of OCD.

Patient characteristics and changes in anxiety symptoms in patients with panic disorder: Post-hoc analysis of the PARADIES cluster randomised trial.

Anxiety disorders are among the most common mental health problems in primary care. The PARADIES (Patient Activation foR Anxiety DIsordErS) intervention combined elements of cognitive behavioural therapy with case management and has demonstrated efficacy. Our aim was to explore patient characteristics, which may influence the course of anxiety symptoms over a 12 months period. Multiple linear regression was used to quantify associations of baseline characteristics (demographics, clinical parameters, medication use) with changes in anxiety symptoms as measured by the Beck anxiety inventory. Treatment modalities (e.g. adherence to appointment schedules) were considered as confounders. We examined univariate associations between dependent and independent variables before considering all independent variables in a multivariate final model. To find the best model to explain BAI score changes, we performed step-wise selection of independent variables based on Akaike information criteria. We tested for interaction terms between treatment allocation (intervention vs control) and independent variables using the multivariate model. We repeated these analyses in control vs intervention groups separately. From the original trial (N = 419), 236 patients (56.3%) were included. In the multivariate model, receiving the intervention (p<0.001), higher anxiety symptom severity (p<0.001) and longer illness duration at baseline (p = 0.033) were significantly associated with changes in anxiety symptom severity to the better while depression severity at baseline (p<0.001) was significantly associated with changes in anxiety symptoms to the worse. In stratified analyses, the control group showed significant associations between depression symptom severity and illness duration with anxiety symptom changes while baseline severity of anxiety symptoms remained significantly associated with anxiety symptom changes in both groups. A brief primary-care-based exposure training combined with case management is effective in a broad range of patients with panic disorder with/without agoraphobia, including those with longer illness duration and co-existing symptoms of depression at baseline.

Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review.

BACKGROUNDLifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.AIMTo examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODSThe Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTSThis systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSIONThough psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.

KNOWLEDGE AND ATTITUDE OF ANTIBIOTIC PRESCRIPTION AMONG IMPLANTOLOGISTS: AN OBSERVATIONAL STUDY

This article discusses the knowledge and attitude of antibiotic prescription among implantologists performing implant surgery and how we contribute to over prescription of antibiotics. Antimicrobial resistance is a substantial catastrophic threat to International Public Health. Antibiotic-resistant infections carry a burden in longer duration of illness, higher rates of mortality and increased treatment costs. Antibiotic resistance has become one of the substantial threats to the successful treatment of infections. A self-administered questionnaire was distributed to a sample of 200 participants and filled by the periodontist, oral surgeon, prosthodontist or dentist who were placing dental implants. The questionnaire comprises of knowledge and attitude of the implantologist related to antibiotic prescription patterns.

Factors influencing health service utilization among mothers for under-five children: A cross-sectional study in Khulna district of Bangladesh.

Although Bangladesh has made significant progress in reducing child mortality, proper utilization of health services for under-five children among mothers remains one of the major challenges. Hence, this study was designed to investigate the factors influencing health service utilization among mothers for under-five children in the Khulna district of Bangladesh. Administering a semi-structured interview schedule, data were collected from 364 randomly selected mothers from the study area between June and August 2021. At first, Pearson’s Chi-square test was conducted to measure the association between outcome and predictor variables. Multivariable logistic regression model was used to identify the factors associated with utilization of health services. Overall, about 59 percent of the mother received health services from unqualified doctors during their children’s illness and the rest of them (41.5%) seek care from the qualified doctors. Results of regression analysis revealed that long duration of illness (AOR = 2.338; CI: 1.175–4.649; p = 0.015), the severity of illness (AOR = 6.402; CI: 3.275–12.513; p<0.001), and higher cost of treatment (AOR = 7.371; CI: 3.297–16.480; p<0.001) were the significant predictors of utilization of health services from the qualified doctors for under-five children. Thus, the study suggests that to reduce under-five child mortality by ensuring proper utilization of health services, it is necessary to raise awareness among mothers, improve transport facilities, establish need-based health care centers, and lower treatment costs.

P16.19: Omicron COVID-19 in Kidney Transplant Recipients

Introduction: In Brazil covid-19 caused more than 22 millions cases and 600 thousands of COVID-19 related deaths at the end of the second year. In 2022 the Omicron variant wave caused millions of cases worldwide and 7.4 million reported cases by March 23 in Brazil. This last variant is associated with a high infectivity and evasion from immune response, but less severe disease and hospitalization compared to previous variants. The better outcome is probably due to lower pathogenicity and immunization rates in 2022. However, reported data have shown that kidney transplant recipients (KTR) remain as a vulnerable group associated with worse outcome. The aim of this study is to evaluate the clinical presentation and outcome of covid-19 among hospitalized KTR with COVID-19. Methods: We performed a retrospective description of 297 KTR with confirmed COVID-19 pneumonia by positive real-time reverse transcription–polymerase chain reaction (rRT-PCR) for SARS-CoV-2 in a respiratory specimen (n = 289 patients); or positive antigen test (n = 8 patients). The patients were hospitalized in a tertiary university public hospital in São Paulo metropolitan city from the beginning of the pandemic - March-2020 until February-2022. Periods were defined according to epidemiological surveillance of cases, and the three well-characterized periods also overlap with predominant variants circulation in Brazil. The first period represents Wuhan variant, the second period Gama and Delta variants and the third and last period Omicron variant. Baseline characteristics, management, and outcomes were stratified by periods. Results: The baseline characteristics are similar between the three periods. In the third period more than half of the cohort had already completed immunization (62.7%). Cough, dyspnea, and fever were the most common presenting symptoms through the three periods. Although there was no statistical significance, there is a trend to less respiratory symptoms and fever at hospital admission in the third period and more atypical clinical presentations such as diarrhea. Also, we found a statistically significant longer time until patient admission at the hospital. ICU hospitalization reduced with statistical significance over time as well as there was a downward trend in death rate. However, among patients admitted to ICU, the mortality rates are similar through the study. In the multivariate analysis, age, creatinine at hospital admission and multiple comorbidities are associated with higher risk of mortality, an complete immunization was a protector factor for mortality. Conclusion: KTR with COVID-19 caused by omicron apparently were admitted with a longer duration of illness, less pronounced symptoms, and lower ICU hospitalization rates. However, among those admitted to ICU, the mortality rates are similar independent of the study period. Complete immunization was associated with lower mortality risk.

Anaemia in Chronic Kidney Disease

Objective: To gauge the frequency of iron deficiency anaemia among chronic renal disease patients and factors related to the presence of anaemia at our hospital.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of nephrology Pak Emirates Military Hospital Rawalpindi Pakistan, Nine months, Sep 2019 to May 2020.&#x0D; Methodology: Three hundred patients suffering from the chronic renal disease were included in the study. Iron deficiency anaemia was diagnosed based on haemoglobin and ferritin levels. In addition, the relationship between age, gender, duration of chronic kidney disease and stage of chronic kidney disease was assessed with the presence of iron deficiency anaemia among the patients suffering from chronic kidney disease.&#x0D; Results: Out of three hundred patients studied, 139 were males, and 161 were females. Out of 300 patients with chronic kidney disease included in our study, 159 (53.0%) showed the presence of iron deficiency anaemia, while 141 (47.0%) had no anaemia. Chi-square analysis showed that female gender, long duration of illness and more severe illness had a significant association with iron deficiency anaemia among the patients with chronic kidney disease.&#x0D; Conclusion: High frequency of iron deficiency anaemia among the patients of chronic kidney disease in a tertiary care hospital of Pakistan. Routine screening for anaemia should be done, especially on female patients and patients with more severe and long-standing illnesses.

What can lifestyle factors tell us about cognitive dysfunction in bipolar disorder?

Affective disorders represent psychopathological entities lying on a continuum, characterized by high prevalence and functional impairment. A delay in treatment initiation might increase the burden associated with affective spectrum disorders. The present study was aimed at analyzing the correlates of a long duration of untreated illness (DUI) in these conditions. We recruited subjects diagnosed with affective disorders, both in- and outpatients, and collected information concerning socio-demographic, clinical, and psychopathological characteristics. Long DUI was defined according to previous research criteria as >2 years for Bipolar Disorders or >1 year for Depressive Disorders. Bivariate analyses were performed to compare subjects with a long and short DUI (p<0.05). A logistic regression was operated to evaluate the correlates of long DUI. In the present sample (n=135), 34.1% (n=46) subjects showed a long DUI. This subgroup presented with more physical comorbidities (p=0.003), higher body mass index (BMI) (p<0.001), more frequent anxiety onset (p=0.018), younger onset age (p=0.042), and more severe depressive symptoms (Hamilton Depression Rating Scale item 1-depressed mood (p=0.032) and item 2-guilt feelings (p=0.018)). At the logistic regression, higher severity of depressed mood (OR 1.568), higher BMI (OR 1.264), and younger age at onset (OR 0.935) were associated with long DUI. The present study confirmed a possible role of DUI as a construct underpinning higher clinical severity in affective spectrum disorders, possibly linked to worse illness course and unfavorable outcomes. Intervention strategies targeting physical comorbidities and depressive symptoms severity may decrease disease burden in subjects with a long DUI.

Neuroanatomical subtypes of schizophrenia and relationship with illness duration and deficit status

BackgroundThe heterogeneity of schizophrenia (SCZ) regarding psychopathology, illness trajectory and their inter-relationships with underlying neural substrates remain incompletely understood. In a bid to reduce illness heterogeneity using neural substrates, our study aimed to replicate the findings of an earlier study by Chand et al. (2020). We employed brain structural measures for subtyping SCZ patients, and evaluate each subtype's relationship with clinical features such as illness duration, psychotic psychopathology, and additionally deficit status. MethodsOverall, 240 subjects (160 SCZ patients, 80 healthy controls) were recruited for this study. The participants underwent brain structural magnetic resonance imaging scans and clinical rating using the Positive and Negative Syndrome Scale. Neuroanatomical subtypes of SCZ were identified using “Heterogeneity through discriminative analysis” (HYDRA), a clustering technique which accounted for relevant covariates and the inter-group normalized percentage changes in brain volume were also calculated. ResultsAs replicated, two neuroanatomical subtypes (SG-1 and SG-2) were found amongst our patients with SCZ. The subtype SG-1 was associated with enlargements in the third and lateral ventricles, volume increase in the basal ganglia (putamen, caudate, pallidum), longer illness duration, and deficit status. The subtype SG-2 was associated with reductions of cortical and subcortical structures (hippocampus, thalamus, basal ganglia). ConclusionsThese replicated findings have clinical implications in the early intervention, response monitoring, and prognostication of SCZ. Future studies may adopt a multi-modal neuroimaging approach to enhance insights into the neurobiological composition of relevant subtypes.

Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome: An evidence-based survey in a Chinese population.

BACKGROUNDTourette syndrome (TS) is a complex neurodevelopmental condition marked by tics, as well as a variety of psychiatric comorbidities, such as obsessive-compulsive disorders (OCDs), attention deficit hyperactivity disorder (ADHD), anxiety, and self-injurious behavior. TS might progress to treatment-refractory Tourette syndrome (TRTS) in some patients. However, there is no confirmed evidence in pediatric patients with TRTS.AIMTo investigate the clinical characteristics of TRTS in a Chinese pediatric sample. METHODSA total of 126 pediatric patients aged 6-12 years with TS were identified, including 64 TRTS and 62 non-TRTS patients. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Child Behavior Checklist (CBCL) were used to assess these two groups and compared the difference between the TRTS and non-TRTS patients.RESULTSWhen compared with the non-TRTS group, we found that the age of onset for TRTS was younger (P < 0.001), and the duration of illness was longer (P < 0.001). TRTS was more often caused by psychosocial (P < 0.001) than physiological factors, and coprolalia and inappropriate parenting style were more often present in the TRTS group (P < 0.001). The TRTS group showed a higher level of premonitory urge (P < 0.001), a lower intelligence quotient (IQ) (P < 0.001), and a higher percentage of family history of TS. The TRTS patients demonstrated more problems (P < 0.01) in the “Uncommunicative”, “Obsessive-Compulsive”, “Social-Withdrawal”, “Hyperactive”, “Aggressive”, and “Delinquent” subscales in the boys group, and “Social-Withdrawal” (P = 0.02) subscale in the girls group. CONCLUSIONPediatric TRTS might show an earlier age of onset age, longer duration of illness, lower IQ, higher premonitory urge, and higher comorbidities with ADHD-related symptoms and OCD-related symptoms. We need to pay more attention to the social communication deficits of TRTS.

Adherence to Self-Care Behaviors and Associated Factors among Adult Heart Failure Patients Attending Chronic Follow-Up Care at Jimma University Medical Center, Southwest Ethiopia

Background: Optimal outcomes and quality of life in patients with heart failure (HF) depend on effective self-care activities. However, patients may experience difficulties, and their performance may be inconsistent. Aim: To determine the level of adherence to self-care behaviors and associated factors among adult HF patients attending chronic follow-up care at Jimma University Medical Center (JUMC). Methods: A cross-sectional study was conducted between August and September 2021. Data were collected through face-to-face interviews and by reviewing patients’ medical records. The collected data were analyzed using SPSS version 25 and the findings were presented in frequency, percentage, mean (SD), and median (IQR). Multivariate logistic regression was performed to determine factors associated with adherence to self-care behaviors. Odds ratios with 95% confidence intervals and p-values were used to report the findings. Results: Out of 266 HF patients, 50.0% had good adherence towards self-care behavior recommendations. The highest following recommendation was taking medication as prescribed (75.5%), followed by a dietary recommendation of a low-salt diet (45.2%). Participants who could not read and write (adjusted odds ratio (AOR) = 0.30 (95% confidence interval (CI) 0.13, 0.71), P = 0.006), had an illness duration greater than or equal to ten years (AOR = 0.31 (95% CI 0.12, 0.82), P = 0.02), in the NYHA class II HF (AOR = 0.33 (95% CI 0.15, 0.73), P = 0.007) were negatively associated with good adherence to self-care behavior recommendations. Conclusion: In this study, only half of the respondents had good adherence to self-care behaviors. Lower educational level, longer illness duration, and NYHA class II HF were predictors of poor adherence to self-care. Therefore, nurses should devise strategies to counsel or educate the HF patients on self-care practice recommendations, particularly patients with a lower education level and who lived longer with HF.