Previous Illness Research Articles

Risk factors of avascular femoral head necrosis after a pediatric femoral neck fracture: a 15-year follow up and an adjustment to the Delbet classification.

Pediatric femoral neck fractures (PFNF) are rare but associated with a high rate of serious complications such as avascular femoral head necrosis (AVN). Major risk factors and prognostic tools for an AVN are still unclear. As AVN is a devastating complication, this study aims to evaluate the predictors for AVN following a PFNF. All patients that suffered a PFNF or an AVN following a PFNF in the last 15 years that were treated at a university-level hospital with a minimum of 12 months follow-up were included in this retrospective study. Patients with a pathological fracture or closed epiphysis were excluded. Radiological outcome was evaluated based on Ratcliff criteria. The association of possible risk factors such as age, gender, traumatic mechanism, fracture type, degree of dislocation, time to surgery or type of surgical intervention with AVN was analyzed. Since not all fractures could be assigned to an exact fracture type, a new fracture type was included in the subgroup analyses. We included 37 patients in the study population. The mean age at the time of the diagnosis was 11.5 years (ranging 5-16 years). Mean follow-up was 30 months. 75% of the cases were diagnosed on the day of the trauma. Nine patients had a delayed diagnosis of which eight had a previous neurological disease (eg. cerebral palsy). A previous illness was significantly associated with a late diagnosis (p < 0.001). 17 patients suffered a high velocity trauma. 35 patients were treated operatively, the majority with a closed reduction (81%) and an internal fixation with cannulated screws (75%). In 24 patients (65%) an additional puncture of the hip joint was performed. Ten patients developed AVN, two of them ultimately had to be treated with a total hip arthroplasty. Female gender was associated with AVN, though not significantly (p = 0.051). A Delbet type IV injury and a high velocity trauma were significantly associated with an AVN (p = 0.020, p = 0.030 respectively). A type IIR fracture was significantly more likely to develop AVN compared to a Delbet type II fracture. Age, polytrauma, degree of dislocation, time to diagnosis, time to surgery and type of treatment was found were not significantly associated with AVN. Neurologically impaired patients are prone to a late diagnosis of a femoral neck fracture, mainly due to both cognitive and motor impairments. High velocity trauma is a significant risk factor for developing AVN. In contrast to literature, a Delbet type IV fracture was significantly associated with AVN. A type IIR fracture has a higher possibility to develop AVN than a normal Delbet type II fracture. As the incidence of pediatric femoral neck fractures is low, the size of a study population is limited. Nevertheless, AVN is still a life altering complication leading to additional surgical treatments, hospital stays and impairment of daily life activities. Therefore, further research is needed to better understand the mechanisms of underlying risk factors and to develop strategies for the prevention and management of AVN in the pediatric population. Hence multicenter studies with a bigger study population are crucial.

Assessing the Role of Emergency Physicians in Medical Clearance: Predictors of Diagnosing Psychiatric Illness in the Emergency Department – A Retrospective Cross-sectional Study

Abstract Background: Medical clearance for patients presenting with psychiatric-like illnesses has been a topic of debate for years. This study aimed to determine the predictors of diagnosing psychiatric illness in the emergency department (ED). Methods: The study included patients aged ≥13 years presenting to the adult ED with psychiatric-like illness over 1 year (January 01, 2019–December 31, 2019). Medical charts were reviewed, and multiple variables were coded and analyzed. Results: Our study included 361 patients, constituting 0.89% of the total ED visits. The majority (335 patients, 92.8%) were diagnosed with primary psychiatric illnesses, while 26 patients (7.2%) had underlying medical conditions contributing to their symptoms. Bivariate and multivariate logistic regression analysis identified the predictors for initial psychiatric diagnoses, including abnormal behavior (odd’s ratio [OR]: 8.29; 95% confidence interval [CI]: 2.04–33.65; P &lt; 0.01) and substance abuse (adjusted OR: 17.27; 95% CI: 3.88–76.88; P &lt; 0.01). Notable findings involved family history or previous psychiatric illness (OR: 2.32; 95% CI: 0.59–6.09; P &lt; 0.01), absence of medical comorbidities (adjusted OR: 2.47; 95% CI: 1.05–5.86; P &lt; 0.01), and no new medication initiation before illness (OR: 6.43; 95% CI: 1.52–27.18; P &lt; 0.01), normal sensorium (adjusted OR: 2.84; 95% CI: 0.81–10.00; P &lt; 0.01) and intact orientation (adjusted OR: 6.73; 95% CI: 1.24–36.42; P &lt; 0.01) demonstrated statistically significant predictors of an initial psychiatric diagnosis in the ED. Conclusion: Significant predictors of initial psychiatric illness included abnormal behavior, substance abuse, family psychiatric history, absence of major medical conditions, no recent medication changes before illness onset, normal sensorium and orientation, and normal laboratory markers at presentation.

Obsessive-Compulsive Symptoms in the General Population Under Stressful Conditions: Lessons Learned from the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic had a negative impact on mental health in the general population. The fear, stress, and uncertainty surrounding that traumatic period could have contributed to the aggravation or possible new onset of obsessive-compulsive symptoms. Methods: The COvid Mental hEalth Trial (COMET) is a nationwide project organized by the University of Campania "Luigi Vanvitelli", designed as an observational investigation that aimed to gather data from a representative sample of the Italian general population. The current study is a report from the main project and it focuses on obsessive-compulsive (OC) symptoms. Results: A total sample of N = 20,720 took part in the survey. N = 2332 individuals had a total Obsessive-Compulsive Inventory-Revised (OCI-R) score greater than or equal to 21 (11.3% of the entire sample), indicating the presence of clinically relevant obsessive-compulsive symptoms. By excluding patients with a history of previous mental illnesses, we still obtained a high number of individuals with an OCI-R score greater than or equal to 21 (N = 2024), representing 10.3% of the overall sample, possibly indicating a new incidence of OC symptoms during the pandemic. Discussion: Our study highlights a substantial new incidence of obsessive-compulsive symptoms in the general public. Risk factors or red flags such as being male, being of working age, living in a highly stressful environment such as one of the Italian regions most affected and severely hit by the pandemic, having higher levels of loneliness, and using substances to cope with stress, should be paid particular attention in order to prevent the development of OC symptoms during a critical and traumatic event such as the COVID-19 pandemic.

Selection Spinal Anesthesia Against an Unusual Finding: A Case Report Hairy Patch

A 34-year-old woman was admitted for an emergency cesarean section at 38 weeks of pregnancy. She had no previous surgeries or illnesses. During the pre-operative evaluation, the anesthesia team noticed that the patient had not fasted. However, they decided to use spinal anesthesia for the emergency procedure. While preparing for the spinal examination, they discovered a large mass of hair covering the 3rd, 4th, and 5th lumbar vertebrae. Despite the emergency situation, the absence of fasting, and the risk of aspiration, the anesthesia team carefully considered all aspects of the patient's safety and decided to proceed with spinal anesthesia.

Mental health symptoms and burdens after a SARS-CoV-2 infection

BackgroundPrevious studies have found adverse effects on mental health following infection with SARS-CoV-2. This study investigates whether mental health is also impaired in unknowingly infected individuals. In addition, the relevance of the severity of the infection and the time since the onset of infection were analyzed.MethodsData from the population-representative Gutenberg COVID-19 Study (GCS) were used (N = 2,267). SARS-CoV-2 infection was determined multimodally by self-report, throat swabs (acute infections) and antibody measurements (previous infections). Participants completed self-report questionnaires on mental health.ResultsNeither unknowing nor knowing SARS-CoV-2 infection had an impact on mental health. However, symptom severity and previous depression or anxiety predicted higher levels of depressiveness, anxiety and somatic complaints. Our results confirm findings suggesting that the severity of the initial infection and previous mental illness, but not knowledge of the infection, are the most important predictors of negative mental health outcomes following SARS-CoV-2 infection.ConclusionThe results suggest that mental health care should focus on individuals who suffer from a severe acute COVID-19 infection or have a history of mental illness.

Effective combination therapy for telogen hair loss

Background. Telogen hair loss is one of the most common forms of alopecia, associated with a disruption in the phases of the hair growth cycle – specifically, the premature transition of the hair follicle into the telogen phase. The primary causes are the influence of triggering factors such as increased stress levels and previous illnesses. The main goal of therapy is to prolong the anagen phase and stimulate hair growth through the use of topical peptides and a multivitamin complex.Objective. To study the effectiveness of a hair growth restoration method in the treatment of telogen alopecia using cosmetic hair growth products and dietary supplements.Methods. The study involved 20 patients diagnosed with telogen alopecia who received treatment with the topical cosmetic products «Time to Grow» and the dietary supplement «Thick and Strong Hair» for 9 weeks. The effectiveness of the treatment was assessed at 3, 6, and 9 weeks after the start of therapy.Results. The analysis of the study showed statistically significant changes in trichoscopy indicators in patients with telogen alopecia, demonstrating the effectiveness of using hair growth cosmetics (p&lt;0.05). At the final assessment point, a reduction in hair loss was observed in 100 % of the subjects, along with improvements in hair quality and volume. A survey evaluating the participants’ subjective experiences demonstrated satisfaction with the treatment and adherence to the therapy.Conclusion. The use of hair growth products and the dietary supplement «Time to Grow» has proven effectiveness in the treatment of telogen hair loss.

Factors associated with intrafamily violence in pregnant women in a Peruvian mother-child center.

Introduction: Domestic violence in pregnant women is considered a serious public health problem that affects the well-being of the mother and child. Objective: To determine the factors associated with intrafamily violence in pregnant women at the Tablada de Lurín Maternal and Child Center during the period 2021-2022. Methods: Analytical cross-sectional study. The clinical histories of a first level health center were used. The main variable was domestic violence; the independent variables were demographic and social characteristics, number of children and previous illness. Results: Domestic violence occurred in 15.63%. In the first simple regression analysis, it was found that pregnant women with more than 4 children, with a confidence interval of 2.44, presented a higher frequency of suffering intrafamily violence compared to pregnant women who had less than or equal to 2 children. In the second multiple regression analysis, it was observed that pregnant women with more than 4 children presented a higher frequency of suffering intrafamily violence compared to pregnant women who had less than or equal to 2 children. Conclusions: It was found that pregnant women who suffered family violence represented 15.6%. Pregnant women with more than 4 children were 239% more likely to suffer domestic violence than women with fewer than 2 children, regardless of maternal age, being married or single, having higher education or having a previous illness.

Bilateral hip ochronosis, an unsuspected diagnosis in polyarticular pain: A case report

Alkaptonuria is a rare metabolic disorder characterized by the accumulation of homogentisic acid, leading to the deposition of blackish pigment in cartilage and soft tissue, known as ochronosis. This can mimic multiple joint pathologies and is a diagnosis of exclusion. We describe the case of a 52-year-old woman who had a total hip replacement after experiencing left hip pain for which oral medications were unable to provide relief. Unexpectedly, during the procedure, a blackish tissue was noticed. This led to a histological examination and the confirmation of the ochronosis diagnosis. The patient’s medical history revealed a number of malignancies, but no previous metabolic illness diagnoses. Subsequent follow-up revealed rapid-onset pain in other joints, leading to a similar diagnosis of polyarticular ochronosis in the right hip, knees, spine, and shoulders. This highlights how difficult it is to treat this condition. This case underscores the importance of considering ochronosis as a differential diagnosis in patients with chronic polyarticular pain. Current treatment consists of initial non-surgical measures, including physical therapy and analgesics. If there is no improvement, treatment would be joint arthroplasty. Awareness among orthopedic surgeons and histopathological examination of tissues is crucial for the accurate diagnosis and management of ochronosis.

Loneliness in the elderly and disease development in European welfare regions: a longitudinal study

Abstract Healthy ageing research has brought a recent focus on the association between loneliness and disease. Regional differences on loneliness prevalence in the elderly across welfare systems, and its association with varying mortality rates, have recently been demonstrated. We hypothesise loneliness affects disease development in the elderly, impacted by socio-economic policies that characterise welfare systems in the EU. We use logistic regression models to assess the association between loneliness (R-UCLA scale) and onset of new chronic disease and disease events, in a European sample of people aged &amp;gt;50 (n = 40840), using the SHARE database, during 2013 - 22 (waves 5 to 9). Preliminary results from two subsequent waves (2015-17, n = 11870) show a statistically significant effect of persistent loneliness on disease onset (increase in new disease events), when adjusting for sex, age, previous illness, and other socio-economic covariates (AOR 1.22, 95%CI 1.08-1.39, p &amp;lt; 0.01). Notably, comparing to the Scandinavian welfare group, only Eastern European countries show higher odds of disease development (AOR 1.52, 95%CI 1.32-1.77, p &amp;lt; 0.001), while also having the highest incidence of new disease in our sample. Age and welfare group show the strongest association with the outcome of interest, followed by change in occupation (no longer employed). Our current analyses span a larger period (2013-22), and we are exploring additional mediators of this effect, such as behavioural and social activity-related variables. Additional analyses to control for unrelated disease (low biological plausibility) and a social isolation index, described in the literature, are added. Furthermore, we analyse the longitudinal association between loneliness and healthcare use, such as polypharmacy and consults. With this study, we aim to contribute decision-making in health in all policies, by increasing integration between health and social sectors, while considering different regional and welfare policies. Key messages • Understanding socio-economic and welfare mechanisms which impact health in the elderly allows for better cross-sector policy design, promoting healthier ageing. • Persistent feelings of loneliness affect disease development in the elderly, which appear to be worsened in some EU welfare groups, independently of socio-economic status.

Psychological distress among healthcare providers during the COVID-19 pandemic: patterns over time

BackgroundCOVID-19 added to healthcare provider (HCP) distress, but patterns of change remain unclear. This study sought to determine if and how emotional distress varied among HCP between March 28, 2021 and December 1, 2023.MethodsThis longitudinal study was embedded within the 42-month prospective COVID-19 Cohort Study that recruited HCP from four Canadian provinces. Information was collected at enrollment, from annual exposure surveys, and vaccination and illness surveys. The 10-item Kessler Psychological Distress Scale (K10) was completed approximately every six months after March 28, 2021. Linear mixed effects models, specifically random intercept models, were generated to determine the impact of time on emotional distress while accounting for demographic and work-related factors.ResultsBetween 2021 and 2023, the mean K10 score fell by 3.1 points, indicating decreased distress, but scores increased during periods of high levels of mitigation strategies against transmission of SARS-CoV-2, during winter months, and if taking antidepression, anti-anxiety or anti-insomnia medications. K10 scores were significantly lower for HCP who were male, older, had more children in their household, experienced prior COVID-19 illness(es), and for non-physician but regulated HCP versus nurses. A sensitivity analysis that included only those who had submitted at least five K10 surveys consisted of the factors in the full model excluding previous COVID-19 illness, occupation, and season, after adjustment. Models were also created for K10 anxiety and depression subscales.ConclusionsK10 scores decreased as the COVID-19 pandemic continued but increased during periods of high mitigation and the winter months. Personal and work-place factors also impacted HCP distress scores. Further research into best practices in distress identification and remediation is warranted to ensure future public health disasters are met with healthcare systems that are able to buffer HCP against short- and long-term mental health issues.

Preinjury and Event-Related Characteristics of Pediatric Firearm Injuries: The American College of Surgeons Firearm Study, United States, March 2021‒February 2022.

Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm Study database (March 1, 2021-February 28, 2022) for patients aged 18 years or younger. We stratified preinjury, firearm-related, and event-related factors by intent and compared them by using Fisher exact, χ2, or 1-way analysis of variance testing. Secondary analysis estimated the adjusted odds of missingness by using generalized linear modeling with binominal logit link. Results. Among 17 395 patients, 2974 (17.1%) were aged 18 years or younger; 1966 (66.1%) were injured by assault, 579 (19.5%) unintentionally, and 76 (2.6%) by self-inflicted means. Most contextual factors differed by intent, including proportion of youths with previous adverse childhood experiences, mental illness, and violent assaults or injury, firearm type and access, perpetrator relationship, and injury location. In adjusted analyses, age, trauma center designation, intent, and admission status were associated with missingness. Conclusions. Contextual factors related to pediatric firearm injury vary by intent. Specific predictors associated with missingness may inform improved future data collection. Public Health Implications. Contextual factors related to pediatric firearm injury can be obtained in a systematic manner nationally to inform targeted interventions. (Am J Public Health. 2024;114(10):1097-1109. https://doi.org/10.2105/AJPH.2024.307754).

EPIDEMIOLOGICAL AND CLINICAL PROFILE OF HOSPITALIZATIONS IN THE MEDICAL CLINIC WARD OF THE CEILÂNDIA REGIONAL HOSPITAL

The objective of this work is to describe the quantitative and descriptive form of the profile of patients who were admitted to the Internal Medicine Infirmary unit of the Regional Hospital of Ceilândia in the Federal District between 01/07/2021 e 31/12/2021. The retrospective study will be carried out from the analysis of records. For a statistical analysis, the Excel® 2019 program will be used. Patients will export epidemiological data on sex, age, marital status, hometown, city of domicile, previous chronic illness, cause, and duration of immediate outcomes. It should be noted that the financial information acquired in the study can contribute to assistance and permanent education in the planning of the service.

Antipsychotic Drugs: A Concise Review of History, Classification, Indications, Mechanism, Efficacy, Side Effects, Dosing, and Clinical Application.

The introduction of the first antipsychotic drug, chlorpromazine, was a milestone for psychiatry. The authors review the history, classification, indications, mechanism, efficacy, side effects, dosing, drug initiation, switching, and other practical issues and questions related to antipsychotics. Classifications such as first-generation/typical versus second-generation/atypical antipsychotics are neither valid nor useful; these agents should be described according to the Neuroscience-based Nomenclature (NbN). Antipsychotic drugs are not specific for treating schizophrenia. They reduce psychosis regardless of the underlying diagnosis, and they go beyond nonspecific sedation. All currently available antipsychotic drugs are dopamine blockers or dopamine partial agonists. In schizophrenia, effect sizes for relapse prevention are larger than for acute treatment. A major unresolved problem is the implausible increase in placebo response in antipsychotic drug trials over the decades. Differences in side effects, which can be objectively measured, such as weight gain, are less equivocal than differences in rating-scale-measured (subjective) efficacy. The criteria for choosing among antipsychotics are mainly pragmatic and include factors such as available formulations, metabolism, half-life, efficacy, and side effects in previous illness episodes. Plasma levels help to detect nonadherence, and once-daily dosing at night (which is possible with many antipsychotics) and long-acting injectable formulations are useful when adherence is a problem. Dose-response curves for both acute treatment and relapse prevention follow a hyperbolic pattern, with maximally efficacious average dosages for schizophrenia of around 5 mg/day risperidone equivalents. Computer apps facilitating the choice between drugs are available. Future drug development should include pharmacogenetics and focus on drugs for specific aspects of psychosis.

ASSESSMENT OF MORTALITY RISKS FROM COVID-19 IN HOSPITALISED VACCINATED PATIENTS AND PATIENTS AFTER A PREVIOUS ILLNESS DEPENDING ON AGE

Background. According to numerous studies, vaccination is an effective method in preventing hospitalisation and mortality from COVID-19. However, COVID-19-related deaths have also been reported among fully vaccinated individuals. Aim: to compare the risks of mortality from coronavirus disease 2019 in hospitalised vaccinated patients and patients who have not been vaccinated before after a previous illness of different sexes and different age groups. Materials and methods. the study included 220 hospitalised patients who were divided into two groups: vaccinated patients (n=129) and patients with a history of COVID-19 (n=91). All patients were divided into three groups by age: ≤39 years, 40-69 years, ≥70 years. All patients were admitted with laboratory-confirmed SARS-CoV-2 by PCR or a rapid qualitative antigen test. Results. in the age group ≤39 years, no deaths from COVID-19 were recorded. When comparing the incidence of deaths among hospitalised patients after a previous illness (n=36) and vaccinated patients (n=58) in the age group 40-69 years, no statistically significant risk difference was found (p=0.742). The risks of mortality among hospitalised patients with a history of COVID-19 (n=46) and vaccinated patients (n=58) in the age group ≥70 years were statistically significantly different (p=0.011). At the same time, the risk in patients after a previous illness was 22.3% higher than in the vaccinated group (95%CI 6.5-37.7).

Feasibility and structural prerequisites for conversion to outpatient treatment in proctology

Despite the introduction of the diagnosis-related groups (DRG) system, costs in the German healthcare system have risen continuously for years. In order to reduce costs the federal government is aiming to shift inpatient services to the outpatient sector. Outpatient services affect many areas of medicine, including proctological operations as these are common and can often be carried out on an outpatient basis. The aim of the present work is to discuss which areas of proctology are suitable for outpatient treatment and which structural requirements are necessary. The present article is intended to provide anarrative overview with reference to the literature on the topic of outpatient care in proctology. Aliterature search was carried out using the following keywords: outpatient care, selective sector-level remuneration, day care, proctological operations, AOP catalog and hybrid DRG. In proctology, outpatient surgical care is implementable in many cases; however, not every patient is suitable for this. In addition to previous illnesses, patient compliance and the possibility of postoperative care from relatives must also be taken into account. In addition, emergency treatment must be guaranteed. Contraindications include severe heart and circulatory diseases as well as severe coagulation or organ dysfunction. Extensive abscesses, complex fistulas or sphincter reconstructions should be surgically treated in an inpatient setting. The prerequisite for successful outpatient care is to make the sector boundaries between outpatient and inpatient patient care more permeable and to adequately remunerate the interventions. In addition to the surgical indications, the prerequisites for successful proctological operations are the correct assessment of the operational capability and compliance. From an organizational and economic perspective, better networking between outpatient and inpatient treatment and equal remuneration across the sector boundaries are crucial.

Breastfeeding experiences of women with perinatal mental health problems: a systematic review and thematic synthesis

BackgroundDespite its known benefits, breastfeeding rates among mothers with perinatal mental health conditions are staggeringly low. Systematic evidence on experiences of breastfeeding among women with perinatal mental health conditions is limited. This systematic review was designed to synthesise existing literature on breastfeeding experiences of women with a wide range of perinatal mental health conditions.MethodsA systematic search of five databases was carried out considering published qualitative research between 2003 and November 2021. Two reviewers conducted study selection, data extraction and critical appraisal of included studies independently and data were synthesised thematically.ResultsSeventeen articles were included in this review. These included a variety of perinatal mental health conditions (e.g., postnatal depression, post-traumatic stress disorders, previous severe mental illnesses, eating disorders and obsessive-compulsive disorders). The emerging themes and subthemes included: (1) Vulnerabilities: Expectations versus reality; Self-perception as a mother; Isolation. (2) Positive outcomes: Bonding and closeness; Sense of achievement. (3) Challenges: Striving for control; Inconsistent advice and lack of support; Concerns over medication safety; and Perceived impact on milk quality and supply.ConclusionsPositive breastfeeding experiences of mothers with perinatal mental health conditions can mediate positive outcomes such as enhanced mother/infant bonding, increased self-esteem, and a perceived potential for healing. Alternatively, a lack of consistent support and advice from healthcare professionals, particularly around health concerns and medication safety, can lead to feelings of confusion, negatively impact breastfeeding choices, and potentially aggravate perinatal mental health symptoms. Appropriate support, adequate breastfeeding education, and clear advice, particularly around medication safety, are required to improve breastfeeding experiences for women with varied perinatal mental health conditions.

Fisioterapia pulmonar pós-COVID-19: um estudo de caso

The COVID-19 pandemic emerged in Wuhan in late December 2019, spreading across the world with a high rate of contamination. The COVID-19 covers a large number of sequelae in the respiratory system, which entails a need for intense physiotherapy intervention. Thus, it was objected in the present study to evaluate the effectiveness of post-COVID-19 pulmonary physiotherapy in a patient at a Physiotherapy Clinic School in the city of Montes Claros, MG. For this, it was used the case study as a methodology, which was carried out with a male patient, 62 years old, brown, divorced, with one child, with no report of previous illnesses, coming from the city of Montes Azul-MG, admitted in a Physiotherapy Clinic School with Severe Acute Respiratory Syndrome, post-COVID-19, being submitted to tests to assess their perceptions of exertion through the modified Borg scale, that is, the Six-Minute Walking Test and the muscle strength based on the Kendall scale. In view of the conduct performed, it is concluded that physiotherapy rehabilitation is an important resource in post-Covid-19 treatment, with regard to the proportion of sequelae caused by such infection.

Tidligere kriminalitet og psykisk helsehjelp hos personer med soningserfaring som blir dømt til tvungent psykisk helsevern

In the period 2002-2020, a total of 431 people were sentenced to coercive mental health care. Many of these had served time in prison, either previously or in connection with the criminal acts that led to the current sentences. This study examines the background, criminal history and mental health status of individuals before they committed the offences that led to their imprisonment. Data from the Norwegian Correctional Service's Register of Imprisonments, the Register of Convictions, the Norwegian Patient Registry and Statistics Norway were used to study former prisoners who were sentenced to coercive mental health care in the period 2002-2020, who had served prison terms. Among 286 former prisoners who were sentenced to coercive mental health care, 246 (86.0%) had previous convictions, and 140 (49.0%) had previously had criminal charges dropped due to doubt as to criminal culpability. Previous psychiatric illness in the last two years was studied in 186 individuals. Of these, 151 (81.2%) had undergone treatment in the mental health service, with psychotic disorders (106/186 (57.0%)) and substance use disorders (109/186 (58.6%)) being the most common diagnoses. Former prisoners who are sentenced to coercive mental health care tend to have an extensive criminal and mental health care history prior to committing criminal acts that lead to coercive mental health care.

Bezoar as a cause of gastric perforation in young female patient: A case report.

Introduction: Bezoars are rare accumulations of indigestible contents within the gastrointestinal tract. These are commonly found in patients with previous psychiatric illness, learning disabilities and gastric surgery. Computed tomography (CT) is non invasive imaging modality of choice as it can not only diagnose but recognize associated complications as well. Case discussion: We present a case of young 16 years old female who presented with nausea, dull abdominal pain and distension. She underwent Contrast enhanced CT scan and was diagnosed as a case of gastric bezoar with gastric perforation and frank pneumoperitoneum. Patient underwent exploratory laparotomy and repair of stomach. Per operative findings were consistent with trichobezoar. Patient recovered well after surgery. Discussion: Bezoar is accumulation of partially digested foreign material in the gastrointestinal (GI) tract. Bezoar can occur in any part of GIT, however, are most common in stomach. Muliple risk factors are recognized however can occur without risk factor. Bezoars are classified into several main types. Proper clinical history, examination and imaging can play important role in its diagnosis. Conclusion: Non specific abdominal pain in young female patients with psychiatric disorder can result from uncommon causes such as bezoars and is important for clinician and radiologist to be aware of this uncommon entity.

Gender differences in patients with corona virus disease-2019 presenting with psychiatric disturbances: a multicentre study

BackgroundThe coronavirus disease known as COVID-19 (2019) pandemic may increase the likelihood of psychological symptoms that can reach the level of psychiatric disorders.AimWe aimed to study psychiatric morbidity in patients with COVID-19 concerning gender differences and disease severity in the acute phase of infection and after 6 months.MethodsThis is a multicenter follow-up study registered in ClinicalTrials.gov (NCT04459403). Patients were recruited consecutively from three quarantine hospitals in Egypt. Data were collected through a questionnaire built using Google Forms including the Arabic versions of General Health Questionnaire (GHQ-12), Beck Depression Inventory (BDI), and Taylor Manifest Anxiety Scale (TMAS). Depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms were assessed after 6 months.ResultsThe study questionnaire was offered to 400 patients and 199 patients agreed to fill it. BDI and TAMS were higher in mild than moderate and severe COVID-19 (14, 8, 8, P-value = 0.009, 17, 13.5, 14, P-value = 0.04, respectively). Females showed a higher prevalence of depression, anxiety, sleep problems, and insomnia due to anxiety than males. Education level, marital status, previous psychiatric illness, and severity of COVID-19 independently affected depression. Marital status, family history of psychiatric illness, and chronic medical illness independently affected anxiety. On 6-month follow-up, BDI significantly decreased in males but not females. TMAS showed no significant changes, but the severity of anxiety was still higher in females. PTSD was more frequent in females (26 (37.1%) versus 4 (9.5%), respectively, P-value = 0.02).ConclusionThe prevalence and severity of depression and anxiety were higher in females than male participants, suggesting that females are more affected by the COVID-19 pandemic.