Systemic Medical Disorders Research Articles

Verbal Autopsy of Maternal Mortality in Rawalpindi District

Objective: To identify the causes and risk factors leading to maternal mortality through verbal autopsy in the District of Rawalpindi, Pakistan. Study Design: A retrospective, descriptive study. Place and Duration of Study: The study was carried out in Community Department of Foundation University Medical College Islamabad from January 05, 2019, to December 25, 2019. Materials and Methods: Data of 105 women died of causes related to death during pregnancy/ delivery between 01 April 2013 and 30 April 2018 was retrieved from the office of District Health Officer (DHO) Rawalpindi. A Verbal Autopsy was conducted to determine cause of death and the possible risk factors, through a structured questionnaire that was filled by close relatives of the deceased women. Analysis of data was done using SPSS version 25.0. Results: The Mean age of the patients was 31 years, and it ranged from 15 to 49 years. In 26.7% of mothers cause of death could not be determined. Overall, the major and most obvious cause of maternal death was delivery related hemorrhage in 58% cases. Out of these, antepartum hemorrhage was the commonest cause occurring in 43.8% of the total cases. Postpartum hemorrhage occurred in 11.4% cases, while fatal hemorrhage during the delivery occurred in 2.8% mothers. Eclampsia was the next common cause that occurred in 11.4% mothers. Difficult and prolonged labour was found to be cause of death in 2.8% cases, while 0.95% died of Sepsis. Among the risk factors, lack of antenatal care emerged as the leading risk factor, present in 62% mothers, followed by anemia being present in 46.6% mothers. Multi-parity was found to be the next common risk factor being present in 26.6% mothers. Reduced interval in successive pregnancies was found in 21% cases. Systemic medical disorders like hypertension, renal disorders, Diabetes Mellitus, Pneumonia, hepatic failure, were found in 6.66% mothers. History of complications in previous pregnancies was present in 3.8% cases. History of lack of proper medical services in the hospital as possible factor leading to death was present in only 5 (4.8%) cases. Conclusion: Hemorrhage related with delivery, especially the antepartum hemorrhage emerged as the commonest cause of maternal mortality, followed by eclampsia. At the same time, lack of antenatal care and anaemia emerged as the commonest risk factors in this regard.

False dogmas in mood disorders research: Towards a nomothetic network approach.

The current understanding of major depressive disorder (MDD) and bipolar disorder (BD) is plagued by a cacophony of controversies as evidenced by competing schools to understand MDD/BD. The DSM/ICD taxonomies have cemented their status as the gold standard for diagnosing MDD/BD. The aim of this review is to discuss the false dogmas that reign in current MDD/BD research with respect to the new, data-driven, machine learning method to model psychiatric illness, namely nomothetic network psychiatry (NNP). This review discusses many false dogmas including: MDD/BD are mind-brain disorders that are best conceptualized using a bio-psycho-social model or mind-brain interactions; mood disorders due to medical disease are attributable to psychosocial stress or chemical imbalances; DSM/ICD are the gold standards to make the MDD/BD diagnosis; severity of illness should be measured using rating scales; clinical remission should be defined using threshold values on rating scale scores; existing diagnostic BD boundaries are too restrictive; and mood disorder spectra are the rule. In contrast, our NNP models show that MDD/BD are not mind-brain or psycho-social but systemic medical disorders; the DSM/ICD taxonomies are counterproductive; a shared core, namely the reoccurrence of illness (ROI), underpins the intertwined recurrence of depressive and manic episodes and suicidal behaviors; mood disorders should be ROI-defined; ROI mediates the effects of nitro-oxidative stress pathways and early lifetime trauma on the phenome of mood disorders; severity of illness and treatment response should be delineated using the NNP-derived causome, pathway, ROI and integrated phenome scores; and MDD and BD are the same illness.

Levels of Emotional Awareness: Theory and Measurement of a Socio-Emotional Skill.

Emotional awareness is the ability to conceptualize and describe one’s own emotions and those of others. Over thirty years ago, a cognitive-developmental theory of emotional awareness patterned after Piaget’s theory of cognitive development was created as well as a performance measure of this ability called the Levels of Emotional Awareness Scale (LEAS). Since then, a large number of studies have been completed in healthy volunteers and clinical populations including those with mental health or systemic medical disorders. Along the way, there have also been further refinements and adaptations of the LEAS such as the creation of a digital version in addition to further advances in the theory itself. This review aims to provide a comprehensive summary of the evolving theoretical background, measurement methods, and empirical findings with the LEAS. The LEAS is a reliable and valid measure of emotional awareness. Evidence suggests that emotional awareness facilitates better emotion self-regulation, better ability to navigate complex social situations and enjoy relationships, and better physical and mental health. This is a relatively new but promising area of research in the domain of socio-emotional skills. The paper concludes with some recommendations for future research.

The structure of emotional experience and its relation to trait emotional awareness: A theoretical review.

Emotional experience (EE) and trait emotional awareness (tEA) have recently become topics of considerable experimental/theoretical interest within the cognitive and neural sciences. However, to date there has been limited empirical focus on how individual differences in the factors contributing to EE (a state-based construct) might account for differences in tEA. To promote clear, well-guided empirical research in this area, in this article we first offer a concise review of the primary factors contributing to EE. We then provide a theoretical investigation into how individual differences in these factors (i.e., differences in affective response generation, affective response representation, and conscious access) could mechanistically account for differences in tEA; we also discuss plausible origins of these individual differences in light of current empirical findings. Finally, we outline possible experiments that would support (or fail to support) the role of each factor in explaining differences in tEA-and how this added knowledge could shed light on the known link between low tEA and multiple emotion-related mental and systemic medical disorders. (PsycINFO Database Record

Assessment of quality of life in patients with visual impairments using a new visual function questionnaire: the VFQ-J11.

BackgroundThe purpose of the present study was to assess the vision-related quality of life (QOL) of visually impaired patients using the Japanese 11-item National Eye Institute Visual Function Questionnaire (VFQ-J11). Comparisons with the 25-item version (VFQ-25) and the EuroQoL Index using a large group of patients with various degrees of impairments and various causative diseases were performed.MethodsA total of 232 visually impaired Japanese patients were recruited from six ophthalmology departments in Japan. Information on ophthalmic findings and patient backgrounds was collected, and information on QOL and utility assessments was collected from the patients by means of survey questionnaires.ResultsThe average age of patients was 69.6±14.3 years. Both the vision-related QOL scores (VFQ-25 composite and VFQ-J11) were significantly associated with better and worse visual acuity (VA) in visually impaired subjects (all P<0.01). VFQ-J11 was comparable to VFQ-25 regardless of causative diseases. VFQ-25 composite and the VFQ-J11 scores were concurrently associated with a range of systemic medical disorders. EuroQoL Index had a significant association with better eye VA (P<0.01), but not with worse eye VA, or any systemic disorders.ConclusionVFQ-J11 provides valid data on vision-related QOL and is less of a burden for patients with vision problems.

P82 Audit of patient-reported outcome measures (proms) in chronic musculoskeletal disease clinics

The concept of “enthesis organ” allows a new look at the nature of enthesis involvement in some rheumatic and nonrheumatic systemic disorders.To describe the various presentations of enthesopathy in the course of systemic medical disorders using the available literature data.Review of relevant articles from 1996 to 2006 retrieved by a Medline search utilizing the index terms “enthesis,” “enthesitis,” and “tendonitis.” The list of articles reviewed herein is not exhaustive, with preference given, where possible, to studies and surveys over case reports as well as the most recent literature reflecting new developments on the subject.Enthesis is defined as the site of insertion of a tendon, ligament, fascia, or articular capsule into bone. Pain originating in the free nerve endings enriched entheses (enthesalgia) may represent a potential cause of chronic musculoskeletal pain in some individuals.Enthesis involvement in the disease process is well appreciated in spondyloarthropathies and in rheumatoid arthritis, though overshadowed by synovitis in the latter. Calcium deposition diseases may constitute the most significant articular cause of enthesopathies in the general population. New data may shed light on the possible pathophysiologic role of enthesopathy in the development of osteoarthritis. Various metabolic and endocrine conditions may manifest with enthesopathy features. The pathogenic mechanisms of enthesis involvement are not uniform and differ in the diverse disorders.The concept of enthesopathy as a variety of syndromes in the course of many rheumatic, metabolic, and endocrine disorders should be appreciated. Exercise of a high level of suspicion toward enthesopathic involvement, and greater knowledge of enthesopathy’s characteristic patterns and diagnostic possibilities, may allow better management of many patients in rheumatology practice.

Tension-type Headache and Systemic Medical Disorders

Tension-type headache (TTH) is the most common form of headache in the general population. Diagnosis of TTH is based merely on clinical features and on careful exclusion of all possible causes of headache. Most of the headaches that present in the context of medical disorders (e.g., hypothyroidism, sleep disorders, and hypertensive crisis) have clinical features overlapping with those of TTH; medical history and specific features of the systemic disorder are usually the clues to establish a correct diagnosis. Some medical disorders may worsen a preexisting TTH, and is also possible the comorbidity of TTH with psychiatric disorders and fibromyalgia.

Breast diseases associated with systemic medical disorders

Benign breast lesions are associated with a wide range of systemic medical conditions. These lesions can have features that are clinically and radiologically suspicious for carcinoma. However, with the exception of diabetes mellitus-associated breast disease, these lesions are rare and the general histopathologist is unlikely to encounter them regularly. This review examines the most common benign breast lesions associated with systemic medical disorders and drugs, including the typical clinical and radiological findings, pathogenesis, and macroscopic and microscopic findings. The specific features and immunohistochemical techniques helpful in differentiating benign disease from carcinoma will be discussed and illustrated using examples from our own practice.

Varied Presentations of Enthesopathy

The concept of "enthesis organ" allows a new look at the nature of enthesis involvement in some rheumatic and nonrheumatic systemic disorders. To describe the various presentations of enthesopathy in the course of systemic medical disorders using the available literature data. Review of relevant articles from 1996 to 2006 retrieved by a Medline search utilizing the index terms "enthesis," "enthesitis," and "tendonitis." The list of articles reviewed herein is not exhaustive, with preference given, where possible, to studies and surveys over case reports as well as the most recent literature reflecting new developments on the subject. Enthesis is defined as the site of insertion of a tendon, ligament, fascia, or articular capsule into bone. Pain originating in the free nerve endings enriched entheses (enthesalgia) may represent a potential cause of chronic musculoskeletal pain in some individuals. Enthesis involvement in the disease process is well appreciated in spondyloarthropathies and in rheumatoid arthritis, though overshadowed by synovitis in the latter. Calcium deposition diseases may constitute the most significant articular cause of enthesopathies in the general population. New data may shed light on the possible pathophysiologic role of enthesopathy in the development of osteoarthritis. Various metabolic and endocrine conditions may manifest with enthesopathy features. The pathogenic mechanisms of enthesis involvement are not uniform and differ in the diverse disorders. The concept of enthesopathy as a variety of syndromes in the course of many rheumatic, metabolic, and endocrine disorders should be appreciated. Exercise of a high level of suspicion toward enthesopathic involvement, and greater knowledge of enthesopathy's characteristic patterns and diagnostic possibilities, may allow better management of many patients in rheumatology practice.

Modifying muscle mass – the endocrine perspective

This review describes the major hormonal factors that determine the balance between human skeletal muscle anabolism and catabolism in health and disease, with specific reference to age-related muscle loss (sarcopenia). The molecular mechanisms associated with muscle hypertrophy are described, and the central role of the satellite cell highlighted. The biological dynamics of satellite cells, varying between states of quiescence, proliferation and differentiation are strongly influenced by local endocrine factors. The molecular mechanisms of muscle atrophy are examined focussing on the causes of sarcopenia and associations with systemic medical disorders. In addition, evidence is provided that the mechanisms of atrophy and hypertrophy are unlikely to be simple opposites. Novel endocrine mechanisms underpinning mechano-transduction include IGF-I subtypes that may differentiate between endocrine and mechanical signals; their interaction with classical endocrine factors is an active area of translational research. Recently acquired knowledge on the mechanism of anabolic effects of androgens is also reviewed. The increasingly recognised role of myostatin, a negative regulator of muscle function, is described, as well as its potential as a therapeutic target. Strategies to counter age-related sarcopenia thus represent an exciting field of future investigation.

Differential Diagnosis of Trigger Points

SUMMARYObjective: A number of medical and structural conditions produce muscular pain associated with myofascial trigger points [TrPs]. These conditions should be considered when evaluating a patient with muscle pain.Thesis: Myofascial pain syndrome is characterized by regional or widespread myalgia with muscle TrPs. Trigger points are also common in fibromyalgia. The TrP is a physical sign that occurs in a variety of myalgic conditions. Acute or chronic muscle stress creates an “energy crisis” that can result in a TrP. A muscle-related nociceptive stimulation of the peripheral and central nervous system results in hypersensitivity. Both mechanical and systemic medical disorders stress muscle. Mechanical problems can be structural or postural. Static [postural] or acute [trauma] muscle overload occurs in mechanical disorders which results in physical and biochemical changes including hypoxia and ischemia, and neuromuscular junction dysfunction. Delayed onset muscle pain is seen in unaccustomed eccentric e...

Somatization Disorder.

There are many new developments regarding somatization disorder, which is among the most difficult and cumbersome of the psychiatric disorders encountered in neurology practice. Diagnostic criteria have been revised to facilitate clinical care and research. The differential diagnosis includes neurologic disorders (eg, multiple sclerosis, epilepsy), systemic medical disorders, and other psychiatric disorders (eg, mood and anxiety disorders, conversion disorder, malingering, and factitious disorder). Many patients have one or more of these illnesses comorbid with somatization disorder. Finally, somatization disorder demands creative biopsychosocial treatment planning by the neurologist, psychiatrist, and other health professionals.

Brain atrophy on computerized axial tomography scans: interaction of age, diabetes and general morbidity.

We evaluated, retrospectively, the occurrence of brain atrophy in all patients (n = 416) with a brain CT scan performed during a 3-month period in 1989 at the Tampere University Central Hospital. Age, diabetes, hypertension, chronic cerebrovascular disorders and an increasing number of medications were associated with brain atrophy in the log-linear models. We suggest that the effect of various systemic medical disorders on the brain requires consideration when evaluating and assessing physiological ageing of the brain.

Suction-assisted lipectomy in the older patient

A retrospective study of 158 suction-assisted lipectomy patients ranging in age from 50 to 81 years was completed in order to determine the success of the technique in this subset of older patients. These were primarily cosmetic procedures of the trunk and extremities. The patients presented with a typical wide spectrum of systemic medical disorders as one would expect in this age group. The study revealed no mortalities and limited suboptimal aesthetic results consisting of insufficient fat removal, requiring secondary suctioning, and waviness or asymmetry. We feel that with adequate preoperative explanation and planning suction-assisted lipectomy can be a rewarding procedure in patients of all ages.