Presence Of Medical Illness Research Articles

Quality of life and associated factors among primary caregivers of children and adolescents with neurodevelopmental disorders attending public hospitals in Addis Ababa, Ethiopia: a cross-sectional study.

Neurodevelopmental disorders are a set of disorders that negatively affect the acquisition of skills in a variety of developmental domains, including motor function, learning, socialization, language and cognition. However, there is no information available on the standard of living of Ethiopian primary caregivers of children and adolescents with neurodevelopmental disorders. Therefore, this study aimed to assess the quality of life (QOL) and associated factors among primary caregivers of children and adolescents with neurodevelopmental disorders in Addis Ababa, Ethiopia. A cross-sectional study was conducted during 1-30 May 2022. Systematic random sampling was used to obtain 352 samples. QOL was measured using the WHO Quality of Life Brief. The gathered information was coded, entered into EpiData 4.6.0.2 and analyzed with SPSS version 26. Multiple linear regression analysis was used to identify the correlates of QOL and the strength of the correlation was measured by β coefficient with 95% CI. The mean score of the overall QOL was 62.61 with a SD of 5.17. The mean (±SD) scores for the physical health, psychological, environmental and social relationship domains of primary caregivers were 57.36±9.98, 66.98±9.39, 66.06±12.91 and 60.02±9.14, respectively. Age was significantly associated with physical domain (β=-0.25, 95% CI -0.43 to -0.07) and with environmental domain (β=-4.57, 95% CI -9.06 to -0.09). Being divorced/widowed was negatively associated with psychological health (β=-2.99, 95% CI -5.82 to -0.17) and social health (β=-0.62, 95% CI -1.33 to -0.10). The presence of medical illness was negatively associated with the physical health domain (β=-4.32, 95% CI -7.64 to -2.91) and the environmental domain (β=-3.11, 95% CI -5.71 to -0.51). Poor social support was negatively associated with psychological health (β=-3.25, 95% CI -5.89 to -0.61) and the social health domain (β=-3.39, 95% CI -11.3 to 4.6), and moderate social support (β=8.62, 95% CI 3.15 to 14.09) was positively associated with physical health. Depression (β=-6.32, 95% CI -11.96 to -0.67) and anxiety (β =-3.07, 95% CI -5.80 to -0.34) were negatively associated with physical health and the psychological health domain, respectively. The findings from this study indicate that all dimensions of QOL of primary caregivers of children and adolescents with neurodevelopmental disorders in this study setting were compromised. Being divorced or widowed, lack of formal education, age, average monthly income, poor social support, depression, anxiety and the presence of medical illness were factors associated with QOL in all domains. This requires integrating a bio-psychosocial perspective, a positive mental health strategy and pharmaceutical therapies to enhance QOL for caregivers of children and adolescents with neurodevelopmental disorders.

Early surgical outcome for Tetralogy Of Fallot In An African Setting; A Tanzanian experience using retrospective analysis of hospital data

BackgroundTetralogy of Fallot (TOF) is typically treated in infancy but often done late in many resource-limited countries, jeopardizing surgical outcomes. This study examined the early results of children undergoing primary complete TOF repair at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania, an emerging cardiac center in Eastern Africa.MethodsA retrospective cohort study of children ≤ 18 years undergoing primary TOF complete repair between 2019 and 2021 was conducted. Patients with complex TOF and those with obvious genetic syndrome were excluded. Data on socio-demography, pre-and postoperative cardiac complications, Intensive Care Unit (ICU) and hospital stay, and in-hospital and 30-day mortality were analyzed. Logistic regressions were employed to find the factors for mortality, ICU, and hospital stays.ResultsThe I02 children underwent primary TOF complete repair were majority male (65.7%; n = 67), with a median age of 3.0 years (IQR: 2–6), ranging from 3 months to 17 years.Only 20 patients (19.6%) were below one year of age. Almost all (90%; n = 92) were underweight, with a mean BMI of 14.6 + 3.1 kg/m2 Haematocrits were high, with a median of 48.7 (IQR: 37.4–59.0). The median oxygen saturation was 81% (IQR:72–93). Over a third of patients (38.2%; n = 39) needed Trans annular patch (TAP) during surgery. The median ICU stay was 72 h (IQR:48–120), with ICU duration exceeding three days for most patients. The median hospital stay was 8.5 days (IQR:7–11), with 70 patients (68.2%)experiencing an extended hospital stay of > 7 days. Bacterial sepsis was more common than surgical site infection (5.6%; n = 6 vs. 0.9%;n = 1). No patient needed re-operation for the period of follow up. The in-hospital mortality rate was 5.9%, with no deaths occurring in children less than one year of age nor after discharge during the 30-day follow-up period. No statistically significant differences were observed in outcomes in relation to age, sex, levels of hematocrit and saturations, presence of medical illnesses, and placement of TAP.ConclusionTOF repairs in this African setting at a national cardiac referral hospital face challenges associated with patients’ older age and compromised nutritional status during the surgery. Perioperative mortality rates and morbidity for patients operated at an older age remain elevated. It’s important to address these issues to improve outcomes in these settings.

Fatigue and somatization in shift-workers: Effects of depression and sleep

ObjectiveWe investigated the differences in fatigue and somatization between shift and non-shift workers and explored the effects of sleep and depression on fatigue and somatization in shift workers. MethodsIn total, 4543 shift workers and 2089 non-shift workers completed self-reported questionnaires. The Center for Epidemiologic Studies Depression Scale (CESD), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and Somatization subscale of the Symptom Checklist 90-item version (SCL-SOM) were used to measure depression, sleep quality, fatigue, and somatization, respectively. Fatigue and somatization were compared between shift and non-shift workers after controlling for different sets of covariates. ResultsCompared to non-shift workers, shift workers reported higher FSS (mean difference: 2.19 ± 0.30, p < 0.01) and SCL-SOM (mean difference: 1.77 ± 0.21, p < 0.01) scores after controlling for age, gender, presence of medical illness, occupational category, monthly income, length of service, and weekly working hours. The between-group difference in FSS score was no longer significant after additionally controlling for CES-D (p = 0.15) or PSQI (p = 0.18). The between-group difference in SCL-SOM score showed only non-significant trends after additionally controlling for CES-D (p = 0.09) or PSQI (p = 0.07). The group difference in SCL-SOM scores disappeared after controlling for both CES-D and PSQI scores (p = 0.99). ConclusionsShift workers had higher fatigue and somatization levels than non-shift workers and the group difference was associated with disturbed sleep and depressed mood in shift workers.

Vitamin D levels and menopause-related symptoms in postmenopausal women

BackgroundMenopause is an important period in women’s life. It is characterized by many symptoms that affect women’s quality of life. This study aimed to the evaluation of the relation between vitamin D levels and menopause-related symptoms. ResultsVitamin D insufficiency was noted in 52.4% of the studied population. There was no statistically significant difference in any of the menopausal rating scale dimensions, psychological symptoms (p = 0.16), somato-vegetative symptoms (p = 0.45), or urogenital symptoms (p = 0.59), between vitamin D sufficient and insufficient groups. The severity of the menopausal symptoms was affected by the presence of medical illness (p < 0.001).ConclusionVitamin D deficiency is an alarming issue among postmenopausal women. It was not associated with menopause-related symptoms.

Determinants of preterm birth in public hospitals in central Ethiopia: an unmatched case-control study

Background: Around 15 million babies are born prematurely in the world every year. The most common cause of neonatal death in Ethiopia is premature birth. To reduce the rate of preterm delivery by correcting modifiable or preventable causes, the availability of local data is important. Hence, this study aimed to identify the determinants of preterm birth among women who gave birth in public hospitals in central Ethiopia. Methods: An Institutional-based unmatched case-control study was conducted at public hospitals in central Ethiopia to select 170 cases and 340 controls. The collected data were entered into EPI INFO and transferred to SPSS for analysis. Tables, graphs, and proportions were used to present the results. Binary and multiple logistic regressions analysis were computed to identify determinants of preterm birth. Adjusted Odds Ratio (AOR), 95% Confidence Interval (CI), and a p-value &lt; 0.05 were computed to determine the presence of an association between preterm birth and independent variables. Results: A total of 166 cases and 332 controls participated in the study, giving a response rate of 97.6%. Cigarette smoking (AOR=3.77, 95% CI=1.35,10.56), alcohol consumption (AOR=1.85, 95% CI=1.11,3.10), wanted but unplanned pregnancy (AOR=3,95% CI=1.68,5.34), neither wanted nor planned pregnancy(AOR=3.61% CI=1.62,8.06), lack of antenatal care (ANC) visits (AOR=4.13, 95% CI=1.95, 8.74), adverse birth outcomes (AOR=5.66, 95% CI=2.88,11.12), presence of a diagnosed illness (AOR=2.81, 95% CI=1.37, 5.76), presence of one or more of obstetrics complications(AOR=6.44, 95% CI=5.49, 3.35, 9), and hemoglobin level &lt; 11g/dl (AOR=2.78, 95% CI=1.48, 5.22) were determinants of preterm birth. Conclusion:-In this study, cigarette smoking status, alcohol drinking status, pregnancy status, adverse birth outcomes, ANC visits, obstetric complications, presence of medical illness, and anemia were identified as determinants of preterm birth. It is important to encourage such women to attend ANC visits, stop smoking, and abstain from alcohol.

Study of correlates of depression among health care workers during COVID-19 epidemic

Aim of the studyStudy aimed to find out the prevalence and risk factors of depression among the health care workers during COVID-19 outbreak.Subject or material and methodsThis was a three month, cross-sectional, observational, single center study of heath care workers of a notified COVID-19 hospital. Study objectives were explained to health care workers, and written consent was obtained. Patient health questionnaire-9 (PHQ-9), DSM-5 Criterion of major depressive disorder and Structured Clinical Interview for DSM-5 were used to diagnose the depression. Descriptive statistics, chi-square test and binary logistic regression were used for analysis of variablesResultsOverall 18.78% health workers reported major depressive disorder.Nearly three fourth of the old age participants had moderate to severe depression. 20.69% of married subjects had major depression. Medical health workers reported more depression . One third of the front line workers had major depression. 51% of the participants with medical co-morbidity reported Major depression as compared to only 12% in those without any medical co-morbidity.33% of subjects watching COVID-19 news very frequently in a day had major depressionDiscussionThe prevalence of depression ranges from 9 to 35% in various studies. . Among them living in joint family, married, elderly, presence of medical illness, frontline work, frequently watching COVID-19 news, excessive fear of COVID-19, and medical health worker emerged as statistically significant variables associated with major depressionConclusionsThe prevalence of depression is high among health care workers while performing duties during COVID-19 outbreak. Early diagnosis and treatment of depression would be crucial during this difficult time.

COVID-19 Outbreak

Context: COVID-19 outbreak has had a huge impact on health-care facilities, and challenges of health-care providers would compromise their physical and mental well-being during this epidemic. Aims: This study aimed to find out stress, anxiety, insomnia, and depression among the health-care workers during COVID-19 outbreak. Settings and Design: This was a 3-month, cross-sectional, observational, single-center study of health-care workers of designated COVID-19 hospital. Subjects and Methods: Study objectives were explained to health-care workers, and written consent was obtained. Participants were approached in their department as per their convenience and requested to fill the pro forma. Depression, Anxiety, and Stress Scale-21 and Insomnia Severity Index were used to detect psychological issues in the form of stress, anxiety, insomnia, and depression. Statistical Analysis: Descriptive statistics and Chi-square test were used for analysis of variables in the study. Results: Overall 27.41% and 29.18% of the health-care workers reported stress and anxiety symptoms, respectively, while 18.78% reported clinically significant insomnia and depression. Among them, being female, married, elderly, presence of medical illness, frontline workers, frequently watching COVID news, and excessive fear of COVID emerged as statistically significant variables associated with stress, anxiety, insomnia, and depression. Conclusions: Health-care workers experienced many mental health issues while performing duties during COVID-19 outbreak. Such issues are alarming and need to be addressed with appropriate health-care policy.

Insomnia, its Prevalence, Associated Factors and Effects on Old Age: A Cross-Sectional Study

Introduction: Insomnia is a common problem among old age population. Almost half of all old age adults report difficulty in initiating and maintaining sleep. The objective of this study was to assess the prevalence of insomnia, its associated factors and effects in old age adults. Methods: This was an observational analytical study where adults above 60 years of age from a ward of a village development committee were included. Data were collected for a period of four months. Insomnia was measured by Athens Insomnia Scale and structured questionnaires were used to assess the effects of insomnia. Descriptive statistics were presented as frequency and percentages. Association between variables was assessed with Chi-square test or Fisher's Exact test as appropriate. Results: There were a total of 55 participants in the study. Insomnia was prevalent in 56.4% (n=31) of the study population. Among the studied socio-demographic variables, presence of medical illness was significantly associated with insomnia. Insomnia was significantly associated with morning headache, irritability, unhappiness, fatigue, lack of concentration, day time sleepiness, avoiding interaction with people, and need of sedative for sleep. Conclusion: Majority of the old age adults suffer from insomnia with night awakenings as the most common symptom. Insomnia significantly affects various aspects of life at an old age.

Initiation of complementary feeding and associated factors among children of age 6-23 months in Sodo town, Southern Ethiopia: Cross-sectional study.

Timely introduced complementary foods, which are appropriate for age, safe and nutrient dense are vital for child growth and development. The aim of the study was to identify associated factors that hampered timely introduction of complementary feeding practices among children 6-23 months. A community-based cross-sectional study was carried out. The data were collected from March 02-20, 2015 in seven-selected Kebeles of Wolaita Sodo town. Systematic sampling technique was employed to select 623 mothers/caregivers with children. The analysis was done using SPSS version 21. Principal component analysis was used to measure household economic status. Binary logistic regression was used to identify predictors of timely initiation of complementary feeding practice. The proportion of timely (at six months) introduction of complementary feeding was 71.2% [95% CI: 66.4%-75.3%], and 25.5% [95% CI: 21.7%- 30%] of children were experienced delayed introduction of complementary feeding. Variables like maternal education [AOR=0.33; 95% CI (0.14-0.78)], household economic status [AOR=0.40;95% CI(0.17-0.85)], history of child medical illness [AOR= 0.63; 95% CI (0.40-0.98)], early initiation of breastfeeding [AOR=2.59; 95% CI (1.02-7.35)] and having source of information about child feeding practices [AOR=0.41; 95% CI (0.24- 0.73)] were identified as independent predictors of introduction of complementary foods at the age of six months. The study came up with nearly three-fourth of children were initiated complementary food just at six months of age. It is not much higher than the target of the current national health sector development program. Maternal illiteracy, low socioeconomic status, presence of medical illness and lack of source of information about complementary feeding practices were associated with timely initiation of complementary feeding. Unreserved support and encouragement should be made to raise level of timely introduction of complementary foods and to diminish delayed introduction of complementary food.

Functional Vision Disorder.

Functional vision disorder (FVD) is a common problem seen in many neurologic and ophthalmologic practitioners' offices and may occur in isolation or in the presence of medical illness. This disorder presents with visual or oculomotor symptoms and manifests as vision loss in one or both eyes, visual field loss, double vision, oscillopsia, anisocoria, blepharospasm, or ptosis. Manual perimetry is the most effective method for determining functional visual loss, and the presence of a central scotoma in a functional visual field signifies that a neuropathophysiologic process is almost certainly present. The exact neuropathophysiologic mechanism of this disorder is unknown; however, information can be drawn from the small studies of FVD samples and studies examining neuropsychiatric factors in other conversion disorder semiologies. Psychological and psychiatric interventions can be useful in treating these patients.

Depression among emergency room physicians and its associated factors in Makkah Al-Mokarramah Hospitals

Background: Several studies indicated that medical community might exhibit a relatively high level of certain mental health problems, particularly depression. Knowledge about the predictors of such problems among physicians constitutes a basis for adequate prevention and management. Aims & Objectives: Determination of prevalence of depression among physicians working in hospital ER in Makkah Al-Mokarramah city and evaluation of factors associated with depression among them. Materials and Methods: This is a cross-sectional study included a sample of 100 physicians, (68%) males and (32%) females. The tool of the study was self-administered questionnaire, which consist of two main parts, each part had separate instructions. First part was consisted of personal data, Second part included 21 questions of Beck Depression Inventory Scale. Results: Main result showed that the prevalence of depression among ER Physicians was 47%. The mild form represented 51 %, moderate form was 40.4 % and severe form was 8.5%. Important factors significantly affecting the prevalence of depression among ER physicians were smoking, absence of recreational activity and previous history of depression. Factors insignificantly associated with depression were age, gender, nationality, marital status, number of children, income, job, medical qualification, duration of work in ER, fixed work to ER, number of patient seen per shift, number of physicians per shift, relative loss in past 6 month, not having exercise activity and presence of medical illnesses. Conclusion: Depression is a common problem among ER physicians. The main recommendations to high authority are to give more care to recreational activity for physicians, healthy lifestyle particularly smoking cessation through a planned programme, frequent assessment of stressor facing ER physicians which may predispose to depression. Finally; screening, diagnosis and treatment of depression among ER physicians seems of help to them. Furthermore, enough support to ER physicians suffering from depression through arrangement of follow up visit to prevent relapse.

Venous Lower-Limb Evaluation in Patients With Acute Pulmonary Embolism

Compressive ultrasonography (CUS) of the lower limbs is the first choice for identifying deep venous thrombosis (DVT) in patients with symptomatic pulmonary embolism (PE). The aim of this study was to uncover clinical characteristics and CUS findings in patients with proven PE and their correlations with PE extent. A total of 524 consecutive cases of proven symptomatic PE diagnosed between January 1996 and December 2006 were reviewed. Mean age was 71.06 ± 14.43 SD years; 244 patients (46.6%) were men. DVT signs or symptoms were present in 30.9% of patients and were associated with the femoral site (P = 0.029). CUS was performed in 383 patients (73.1%) and DVT was found in 75.5%. In 94.1% of patients DVT was proximal (popliteal and/or femoral), which would have been then identified by simplified CUS. CUS was performed significantly more often in presence of signs or symptoms of DVT (P < 0.001), less often in presence of medical illnesses (P = 0.040), age ≥75 years (P = 0.001) and death in hospital (P < 0.001). Signs or symptoms of DVT were predictors of positive CUS (P < 0.001), presence of medical illnesses (P = 0.020), central venous catheter (P = 0.035), death in hospital (P = 0.032) were predictors of negative CUS findings. Neither clinical findings nor CUS were associated with PE extent. In patients with proven symptomatic PE, signs or symptoms of DVT are present only in 1/3 of cases and are significantly more frequent when DVT is extended to the femoral vein. Simplified CUS of the lower limbs has a high sensitivity in finding proximal DVT. CUS is not able to predict PE extent.

The cognitive and behavioral treatment of PTSD, what is known and what is known to be unknown: How not to fall into the practice gap.

[Clin Psychol Sci Prac 17: 134–143, 2010] Posttraumatic stress disorder is a serious potential consequence of suffering severe trauma. Effective treatments exist, and these include both cognitive and behavioral, mainly exposure-based treatments. How clinical practice can be guided by the research evidence is a difficult question given the research-practice gap, and clinicians have a duty of care to provide the optimum treatment for their individual patients. Such duty includes not only taking into account the evidence from clinical trials but also a recognition that there is considerable potential heterogeneity in trauma patients. Factors that influence which treatment is recommended and where future development lies include the following: any potential advantage one treatment has when there is equivalent efficacy; the persistence of physical injury, pain, and disability; presence of medical illness; persistent or long-term exposure to traumatic stress; comorbidity of psychological disorders; suicide risk and exposure to aversive psychosocial environments. Lastly, the development of positive psychology may offer further treatment options.

Determinants of Early Postpartum Psychological Reaction among Mothers in Kuala Lumpur Hospital

Introduction: Maternal psychological well-being determines early mother-infant relationship and baby’s health. Paying attention on this aspect is essential particularly in early postpartum period. This study aimed to determine early psychological reactions toward socioeconomic profiles, delivery methods and delivery outcomes among postpartum mothers in Kuala Lumpur Hospital. Materials and Methods: A total of 150 twoweek-postpartum mothers participated in this cross sectional study and their psychological perspective was measured by using the Depressive, Anxiety and Stress Scale (DASS). Results: 4%, 16% and 4.7% of respondents had significant depressive, anxiety and stress levels respectively. Conclusion: Socioeconomic variables such household income, level of education and presence of medical illness were statistically significant to determine early postpartum psychological reactions but not the modes or outcomes of delivery.

Dealing with depression and medical illness

Depressive illness in the presence of medical illness is common and the relationship between them is complex. Often the medical illness can cause the depression.

Neuropsychiatric symptoms and medical illness in patients with dementia: an exploratory study.

To determine the association between neuropsychiatric symptoms and the presence of medical illness among outpatients with mild dementia. The Neuropsychiatric Inventory (NPI) was used to assess neuropsychiatric symptoms, and the Cumulative Illness Rating Scale (CIRS) was used to evaluate physical impairment, in 44 outpatients diagnosed as having dementia (Alzheimer disease, n=22; vascular dementia, n=13; mixed dementia, n=9). The tests used were standard parts of a memory assessment program at a college of osteopathic medicine. Pearson product moment correlations were used to assess any associations between NPI and CIRS scores. Significant associations were identified between several NPI-assessed symptoms and degree of medical illness as measured by the CIRS. Neurobehavioral problems were significantly correlated (P<.05) with illness in the following body organ systems: gastrointestinal (lower), genitourinary, neurologic, ophthalmologic/otolaryngologic, psychiatric, and respiratory. The authors' preliminary data underscore the importance of primary care physicians assessing patients with dementia for comorbidity of psychiatric illnesses when conducting medical examinations.

Treatment of geriatric depression

The author reviews clinical issues regarding the treatment of late-life depression. Accurate diagnosis is complicated by the presence of medical illness, dementia syndromes, and heterogeneity of patient populations. Older depressed patients are often sensitive to drug toxicity resulting from age-related pharmacokinetic changes and polypharmacy. Thus, modification in the use of antidepressant drugs is needed to avoid side effects. Numerous antidepressant drugs are safe and efficacious in elderly depressed patients, and newer agents such as the selective serotonin reuptake inhibitors are often preferred over tricyclic antidepressants because of side effect profiles. Nonpharmacological approaches, alone and in combination with antidepressant drugs, are also useful, and maintenance treatments appear to reduce the likelihood of relapse.

LIFE-THREATENING CONDITIONS ASSOCIATED WITH MALE INFERTILITY

Most urologists' clinical experience is that infertility is a rare presenting sign of life-threatening medical disorders in men. Considering the current practice of infertile couples presenting to the gynecologist for initial evaluation and the popularity of assisted reproductive technology, many men are evaluated with a semen analysis alone and treatment instituted without urologic consultation. This may cause a delay in the diagnosis of a significant medical illness or misdiagnosis of a potentially treatable cause of male factor infertility. We reviewed the records of 1236 new male infertility patients presenting to Bowman Gray School of Medicine and Baylor Medical College in an attempt to determine the frequency of significant medical disease in men presenting with infertility and whether any pattern of semen analysis findings was predictive of these disorders. Thirteen men, or 1.1% of the total population, were found to have a significant medical illness upon full urologic evaluation (Table 5). Testicular tumors were found in six, spinal cord tumor in one, brain tumors in three, genitourinary malformation in two, and a chromosomal abnormality in one. Interestingly, one of these patients was a physician with bilateral testicular cancer who had an abnormal semen analysis and had undergone multiple cycles of intrauterine insemination before referral. We could not identify a pathognomonic pattern on semen analysis that would allow us to predict the presence of medical illnesses in these 13 patients. Sperm counts ranged from azoospermic to almost normal semen parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

The use of lithium in the medically ill

Many patients taking lithium for the treatment of mood disorders suffer from concomitant medical illnesses. Because of its effects on multiple organ systems, extra caution is required when lithium is used in the presence of medical illness. Available data regarding the use of lithium in the presence of thyroid, renal, cardiovascular, dermatologic, and respiratory disease as well as in the presence of disorders of glucose and calcium metabolism are reviewed. In addition, recommendations regarding safe use, serum monitoring, and potential drug interactions are discussed.