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Szepsenwol, Ohad, Dana Shai, Osnat Zamir, and Jeffry A. Simpson. "The effects of morbidity-mortality and economic unpredictability on parental distress: A life history approach." Journal of Social and Personal Relationships 38, no. 1 (2020): 189–209. http://dx.doi.org/10.1177/0265407520959719.
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Negative affect caused by stressful life events can carry over to parental relationships and induce parental distress. Such spillover effects, however, may not operate uniformly in men and women, and may not be the same for different types of stressful life events. Employing life history theory, we hypothesized that male parents should experience more parental distress following exposure to cues of extrinsic morbidity-mortality (illness or death of someone close) or economic unpredictability (financial or occupational changes). We tested this hypothesis in two studies. In Study 1 ( N = 207), recent exposures to morbidity-mortality and economic unpredictability were uniquely associated with parental stress, but the effect of economic unpredictability existed only in men. Stronger unpredictability beliefs partially mediated these effects. Moreover, morbidity-mortality and economic unpredictability were indirectly associated with less positive parenting through greater parental stress. Study 2 used a dyadic sample of 105 families transitioning to parenthood. Recent exposures to morbidity-mortality and economic unpredictability were uniquely associated with parental distress (parental stress and postpartum depression) in men only, whereas exposure to other sources of stress was more strongly associated with women’s parental distress. The effects of morbidity-mortality on men’s parental distress were mediated by their lower parental self-efficacy. These findings imply that men’s parental experiences are particularly vulnerable to risky and unpredictable environments.
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Robinson, Monique, Eugen Mattes, Wendy H. Oddy, et al. "Prenatal stress and risk of behavioral morbidity from age 2 to 14 years: The influence of the number, type, and timing of stressful life events." Development and Psychopathology 23, no. 2 (2011): 507–20. http://dx.doi.org/10.1017/s0954579411000241.
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AbstractThe maternal experience of stressful events during pregnancy has been associated with a number of adverse consequences for behavioral development in offspring, but the measurement and interpretation of prenatal stress varies among reported studies. The Raine Study recruited 2900 pregnancies and recorded life stress events experienced by 18 and 34 weeks' gestation along with numerous sociodemographic data. The mother's exposure to life stress events was further documented when the children were followed-up in conjunction with behavioral assessments at ages 2, 5, 8, 10, and 14 years using the Child Behavior Checklist. The maternal experience of multiple stressful events during pregnancy was associated with subsequent behavioral problems for offspring. Independent (e.g., death of a relative, job loss) and dependent stress events (e.g., financial problems, marital problems) were both significantly associated with a greater incidence of mental health morbidity between age 2 and 14 years. Exposure to stressful events in the first 18 weeks of pregnancy showed similar associations with subsequent total and externalizing morbidity to events reported at 34 weeks of gestation. These results were independent of postnatal stress exposure. Improved support for women with chronic stress exposure during pregnancy may improve the mental health of their offspring in later life.
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Kadlec, Bohdan, Jana Skrickova, Zdenek Merta, Ladislav Dusek, and Jiri Jarkovsky. "The Incidence and Predictors of Thromboembolic Events in Patients with Lung Cancer." Scientific World Journal 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/125706.
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Patients with lung cancer experience elevated risk of venous thromboembolism. Cancer patients with thrombosis have a shorter life expectancy and the occurrence of VTE worsens the quality of life and may delay, interrupt, or completely halt the cancer therapy. In a large cohort of lung cancer patients we monitored the incidence of venous thromboembolism and we identified groups of patients with the highest risk of venous thromboembolism suitable for antithrombotic prophylaxis, which could favourably affect their morbidity and mortality.
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CARR, V. J., T. J. LEWIN, R. A. WEBSTER, J. A. KENARDY, P. L. HAZELL, and G. L. CARTER. "Psychosocial sequelae of the 1989 Newcastle earthquake: II. Exposure and morbidity profiles during the first 2 years post-disaster." Psychological Medicine 27, no. 1 (1997): 167–78. http://dx.doi.org/10.1017/s0033291796004278.
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Background. A sample of 1089 Australian adults was selected for the longitudinal component of the Quake Impact Study, a 2-year, four-phase investigation of the psychosocial effects of the 1989 Newcastle earthquake. Of these, 845 (78%) completed a survey 6 months post-disaster as well as one or more of the three follow-up surveys.Methods. The phase 1 survey was used to construct dimensional indices of self-reported exposure to threat the disruption and also to classify subjects by their membership of five ‘at risk’ groups (the injured; the displaced; owners of damaged small businesses; helpers in threat and non-threat situations). Psychological morbidity was assessed at each phase using the 12-item General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES).Results. Psychological morbidity declined over time but tended to stabilize at about 12 months post-disaster for general morbidity (GHQ-12) and at about 18 months for trauma-related (IES) morbidity. Initial exposure to threat and/or disruption were significant predictors of psychological morbidity throughout the study and had superior predictive power to membership of the targeted ‘at risk’ groups. The degree of ongoing disruption and other life events since the earthquake were also significant predictors of morbidity. The injured reported the highest levels of distress, but there was a relative absence of morbidity among the helpers.Conclusions. Future disaster research should carefully assess the threat and disruption experiences of the survivors at the time of the event and monitor ongoing disruptions in the aftermath in order to target interventions more effectively.
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CARR, V. J., T. J. LEWIN, J. A. KENARDY, et al. "Psychosocial sequelae of the 1989 Newcastle earthquake: III. Role of vulnerability factors in post-disaster morbidity." Psychological Medicine 27, no. 1 (1997): 179–90. http://dx.doi.org/10.1017/s003329179600428x.
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Background. This paper examines the contributions of dispositional and non-dispositional factors to post-disaster psychological morbidity. Data reported are from the 845 participants in the longitudinal component of the Quake Impact Study.Methods. The phase 1 survey was used to construct dimensional indices of threat and disruption exposure. Subsequently, a range of dispositional characteristics were measured, including neuroticism, personal hopefulness and defence style. The main morbidity measures were the General Health Questionnaire (GHQ-12) and Impact of Event Scale (IES).Results. Dispositional characteristics were the best predictors of psychological morbidity throughout the 2 years post-disaster, contributing substantially more to the variance in morbidity (12–39%) than did initial exposure (5–12%), but the extent of their contribution was greater for general (GHQ-12) than for post-traumatic (IES) morbidity. Among the non-dispositional factors, avoidance coping contributed equally to general and post-traumatic morbidity (pr = 0·24). Life events since the earthquake (pr = 0·18), poor social relationships (pr =−0·25) and ongoing earthquake-related disruptions (pr = 0·22) also contributed to general morbidity, while only the latter contributed significantly to post-traumatic morbidity (pr = 0·15).Conclusions. Medium-term post-earthquake morbidity appears to be a function of multiple factors whose contributions vary depending on the type of morbidity experienced and include trait vulnerability, the nature and degree of initial exposure, avoidance coping and the nature and severity of subsequent events.
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Sungur, Mehmet, B. Aksin Surmeli, and Ahmet Ozcubukcuoglu. "Common Features of PTSD Cases Amongst a Group of Military Staff Referred From the Southeast Region of Turkey." Journal of Cognitive Psychotherapy 9, no. 4 (1995): 279–84. http://dx.doi.org/10.1891/0889-8391.9.4.279.
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Posttraumatic Stress Disorder (PTSD) is characterized by the typical psychiatric symptoms that emerge following a distressing event that is outside the range of usual human experience. These events include any serious threat to a person’s life or physical integrity. Similar events are experienced by the members of the Turkish Armed Forces who work in the southeastern region of Turkey and are under the threat of continual terrorist attacks, which often prove to be fatal and cause great distress and anxiety. This study investigates the possibility of a rise in the number of PTSD cases in the military staff due to the increasing life-threatening events that occur in the southeastern region of Turkey. Referrals made in 1992 from the southeast military sample to the psychiatry Department of Gulhane Military Academy, the main military hospital in Turkey, are investigated. The study compares and contrasts the role of the trauma and premorbid vulnerability factors, investigates the severity of symptoms, the degree of disability caused by the disorder, the range of concurrent psychiatric disorders along with PTSD, the different onset patterns of morbidity, and the demographical characteristics of the cases.
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Meaney-Delman, Dana, Nadia L. Oussayef, Margaret A. Honein, and Christina A. Nelson. "Plague and Pregnancy: Why Special Considerations Are Needed." Clinical Infectious Diseases 70, Supplement_1 (2020): S27—S29. http://dx.doi.org/10.1093/cid/ciz1232.
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Abstract Pregnant women are an important at-risk population to consider during public health emergencies. These women, like nonpregnant adults, may be faced with the risk of acquiring life-threatening infections during outbreaks or bioterrorism (BT) events and, in some cases, can experience increased severity of infection and higher morbidity compared with nonpregnant adults. Yersinia pestis, the bacterium that causes plague, is a highly pathogenic organism. There are 4 million births annually in the United States, and thus the unique needs of pregnant women and their infants should be considered in pre-event planning for a plague outbreak or BT event.
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Mcmurray, J. Scott, and Lauren D. Holinger. "Otolaryngic Manifestations in Children Presenting with Apparent Life-Threatening Events." Otolaryngology–Head and Neck Surgery 116, no. 6 (1997): 575–79. http://dx.doi.org/10.1016/s0194-5998(97)70230-4.
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Apparent life-threatening event (ALTE) is a term used to characterize an event of unknown cause after an infant is found limp, cyanotic, bradycardic, and/or requiring resuscitation. Like sudden infant death syndrome (SIDS), ALTE is a general term used until a precise diagnosis can be established. The relationship between ALTE and SIDS has not been clearly defined, although 7 to 15 percent of children with ALTE die of SIDS. If children with ALTE are at greater risk for SIDS, morbidity and mortality may be prevented if the underlying pathology can be identified and corrected or closely monitored. The otolaryngologist is being consulted more frequently to evaluate children who have been through an ALTE to help elucidate any underlying pathology that may have caused the near-death experience. This retrospective chart review reports the evaluation of 30 infants with ALTE requiring consultation by the Division of Pediatric Otolaryngology at the Children's Memorial Hospital in Chicago during a 3-year period. We reviewed the literature and here compare our findings with current animal models. Of the 30 children evaluated, 53% had gastroesophageal reflux, 40% had laryngeal abnormalities, 13% had tracheal abnormalities, and 10% had pharyngeal abnormalities. Thirteen percent of the children had nonotolaryngic anomalies identified during evaluation. Surgical intervention was required in 10 patients and medical treatment was used in 18. When evaluating a child with ALTE, a complete history and physical examination, evaluation for gastroesophageal reflux, assessment for upper airway obstruction by radiographs and endoscopy, and a multidisciplinary approach are recommended. (Otolaryngol Head Neck Surg 1997;116:575–9.)
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Schiepatti, Annalisa, Maria Luisa Nicolardi, Piero Marone, and Federico Biagi. "Long-term morbidity and mortality in Whipple’s disease: a single-center experience over 20 years." Future Microbiology 15, no. 10 (2020): 847–54. http://dx.doi.org/10.2217/fmb-2019-0315.
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Background: Little is known about long-term morbidity and mortality in Whipple’s disease (WD). Aim: To describe morbidity and mortality in patients with WD on a long-term follow-up. Materials & methods: Comorbidities, mortality and causes of death were retrospectively registered. Results: A total of 35 patients with WD (9F, 54 ± 11 years) were followed-up for a median of 104 months. Nine patients developed ten complications; three patients died. A total of 31 severe comorbidities apparently unrelated to WD were found in 20 patients: preneoplastic/neoplastic disorders in seven, thromboembolic and cardiovascular events in seven, pneumonia in four, candidiasis in ten patients. Conclusion: WD is frequently complicated by potentially life-threatening infectious, neoplastic and thromboembolic disorders, thus highlighting the need for a life-long multidisciplinary follow-up.
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Jakobsen, Marianne, Melinda A. M. Demott, and Trond Heir. "Prevalence of Psychiatric Disorders Among Unaccompanied Asylum-Seeking Adolescents in Norway." Clinical Practice & Epidemiology in Mental Health 10, no. 1 (2014): 53–58. http://dx.doi.org/10.2174/1745017901410010053.
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Unaccompanied asylum-seeking children (UASC) are known to be subjected to several potentially traumatic life events, risking more mental health problems than other populations of same age. In this study, we aimed to explore the prevalence of psychiatric morbidity at an early stage after arrival to the host country. We performed structured clinical interviews (CIDI) with 160 male UASC from different countries (Afghanistan, Somalia, Iran), after four months in Norway. Most of the participants had experienced life threatening events (82%), physical abuse (78%), or loss of a close relative (78%) in their former life. Altogether 41.9% of the participants fulfilled diagnostic criteria for a current psychiatric disorder. The most prevalent diagnosis was PTSD (30, 6%), followed by MDD (9, 4%), Agoraphobia (4, 4%) and GAD (3, 8%). Implications of this vulnerability call for more mental health resources in the early stages of the asylum process. Increased awareness of psychiatric morbidity in UASC may improve the prognosis, give more appropriate care, and ease the integration process on all levels of society.
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Puslecki, Mateusz, Konrad Baumgart, Marcin Ligowski, et al. "Patient Safety during ECMO Transportation: Single Center Experience and Literature Review." Emergency Medicine International 2021 (February 22, 2021): 1–16. http://dx.doi.org/10.1155/2021/6633208.
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Background. Extracorporeal membrane oxygenation (ECMO) has been proven to support in lifesaving rescue therapy. The best outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams. Aim. The aim of this study was to analyze the safety of ECMO support during medical transfer on the basis of our experience developed on innovation cooperation and review of literature. Methods. A retrospective analysis of our experience of all ECMO-supported patients transferred from regional hospital of the referential ECMO center between 2015 and 2020 was carried out. Special attention was paid to transportation-related mortality and morbidity. Moreover, a systematic review of the Medline, Embase, Cochrane, and Google Scholar databases was performed. It included the original papers published before the end of 2019. Results. Twelve (5 women and 7 men) critically ill ECMO-supported patients with the median age of 33 years (2–63 years) were transferred to our ECMO center. In 92% (n = 11) of the cases venovenous and in 1 case, venoarterial supports were applied. The median transfer length was 45 km (5–200). There was no mortality during transfer and no serious adverse events occurred. Of note, the first ECMO-supported transfer had been proceeded by high-fidelity simulations. For our systematic review, 68 articles were found and 22 of them satisfied the search criteria. A total number of 2647 transfers were reported, mainly primary (90%) and as ground transportations (91.6%). A rate of adverse events ranged from 1% through 20% but notably only major complications were mentioned. The 4 deaths occurred during transport (mortality 0.15%). Conclusions. Our experiences and literature review showed that transportation for ECMO patients done by experienced staff was associated with low mortality rate but life-threatening adverse events might occur. Translational simulation is an excellent probing technique to improve transportation safety.
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Piccinelli, Marco, and Greg Wilkinson. "Gender differences in depression." British Journal of Psychiatry 177, no. 6 (2000): 486–92. http://dx.doi.org/10.1192/bjp.177.6.486.
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BackgroundWith few exceptions, the prevalence, incidence and morbidity risk of depressive disorders are higher in females than in males, beginning at mid-puberty and persisting through adult life.AimsTo review putative risk factors leading to gender differences in depressive disorders.MethodA critical review of the literature, dealing separately with artefactual and genuine determinants of gender differences in depressive disorders.ResultsAlthough artefactual determinants may enhance a female preponderance to some extent, gender differences in depressive disorders are genuine. At present, adverse experiences in childhood, depression and anxiety disorders in childhood and adolescence, sociocultural roles with related adverse experiences, and psychological attributes related to vulnerability to life events and coping skills are likely to be involved. Genetic and biological factors and poor social support, however, have few or no effects in the emergence of gender differences.ConclusionsDeterminants of gender differences in depressive disorders are far from being established and their combination into integrated aetiological models continues to be lacking.
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McEwen, B. "004.From molecules to mind: stress, allostasis and integration of brain and body." Reproduction, Fertility and Development 16, no. 9 (2004): 4. http://dx.doi.org/10.1071/srb04abs004.
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The mind involves the whole body and two-way communication between the brain and the cardiovascular, immune and other systems via neural and endocrine mechanisms. Stress is a condition of the mind and a factor in the expression of disease that differs among individuals. A broader view is that it is not just the dramatic stressful events that exact their toll but rather the many events of daily life that elevates activities of physiological systems so as to cause some measure of wear and tear. We call this wear and tear 'allostatic load', and it reflects not only the impact of life experiences but also genetic load' individual life-style habits reflecting items such as diet, exercise and substance abuse' and developmental experiences that set life-long patterns of behavior and physiological reactivity (1). Hormones associated with stress and allostatic load protect the body in the short-run and promote adaptation, but the long run allostatic load causes changes in the body that lead to disease. This will be illustrated for the immune system and brain regions involved in stress, fear and cognition (e.g. hippocampus, amygdala and prefrontal cortex). Besides developmental influences associated with mother–infant interactions, the most potent of stressors in adult life are those arising from competitive interactions between animals of the same species, leading to the formation of dominance hierarchies. Psychosocial stress of this type not only impairs cognitive function of lower ranking animals, but it can also promote disease (e.g. atherosclerosis) among those vying for the dominant position, as well as depressive illness. Social ordering in human society is also associated with gradients of disease, with an increasing frequency or mortality and morbidity as one descends the scale of socioeconomic status (SES) that reflects both income and education. Although the causes of these gradients of health are very complex, they are likely to reflect, with increasing frequency at the lower end of the scale, the cumulative burden of coping with limited resources and negative life events as well as differences in life style, and the allostatic load that this burden places on the physiological systems involved in adaptation and coping. (1) McEwen, B.S. (1998) Protective and damaging effects of stress mediators. New England J. Med. 238, 171–179.
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Brown, Katherine L., Christina Pagel, Deborah Ridout, et al. "What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study." BMJ Open 9, no. 9 (2019): e028533. http://dx.doi.org/10.1136/bmjopen-2018-028533.
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ObjectivesGiven the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months.DesignThe design was a prospective, multicentre, multidisciplinary mixed methods study.SettingThe setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment.ParticipantsIncluded were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy.ResultsFamilies and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001).ConclusionsEvaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement.
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Kim, JinShil, Seon Young Hwang, Seongkum Heo, Mi-Seung Shin, and Sun Hwa Kim. "Predicted relationships between cognitive function, depressive symptoms, self-care adequacy, and health-related quality of life and major events among patients with heart failure." European Journal of Cardiovascular Nursing 18, no. 5 (2019): 418–26. http://dx.doi.org/10.1177/1474515119840877.
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Background: Cognitive decline, which often occurs in heart failure, is likely to decrease health-related quality of life and increase morbidity and mortality (major events), but it has been scantly addressed. Aims: To examine whether baseline cognitive domains of global cognition, memory and executive function predict baseline health-related quality of life and 15-month major events among patients with heart failure. Methods: This prospective study included 117 patients (mean age 65.5 ± 9.42 years; men 58.1%; New York Heart Association class III/IV 25.6%), who completed questionnaires, including neuropsychological testing for cognitive evaluation, depressive symptoms, self-care and health-related quality of life measures. Their 15-month major events were extracted from medical record reviews. Results: Approximately one-third of the sample had cognitive impairment. Forty-one patients (35.0%) experienced major events. Patients with major events had significantly worse memory (immediate recall memory 13.9 vs. 11.5, P=0.030; delayed recall memory 4.3 vs. 3.1, P=0.014) and reduced executive function (trail-making test A 28.1 vs. 38.0 seconds, P=0.031). After controlling for age, sex, heart failure severity and comorbidity, memory loss with depressive symptoms was associated with worse health-related quality of life, and odds ratios of experiencing major events increased only with reduced cognitive function in global cognition and executive function. Conclusion: Cognitive function is an important factor for health-related quality of life and major events, and memory loss – worsened health-related quality of life and poor executive function was more likely to increase the risk of major events. Future studies should consider both cognitive function and depressive symptoms when designing heart failure interventions to improve patient outcomes.
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Aléx, J., and B. Saveman. "(P2-51) Being Injured in a Cold Environment." Prehospital and Disaster Medicine 26, S1 (2011): s152. http://dx.doi.org/10.1017/s1049023x1100495x.
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BackgroundPrehospital patients, irrespective of diseases or trauma, might experience discomfort due to a cold environment and are at risk for decreasing body temperature which can increase morbidity and mortality. Research concerning experiences of being injured in a cold environment is scarce.ObjectiveThe aim of this study was to explore the patients' descriptions of being injured in a cold environment.MethodsTwenty persons who have been injured in a cold environment during wintertime in the north of Sweden were interviewed; 14 of them were treated with active heat supply. They waited on snow or ice for an ambulance between 8 minutes and 4 hours and 10 minutes. The interviews were performed face-to-face and telephone interviews were used when the participants lived far away. The interviews had a storytelling run-up and the participants were asked to narrate the injury event, from just before the event until arrival at the emergency department. The interviews were transcribed verbatim and analyzed by content.ResultsIn the preliminary results three themes were formulated: (1) waiting for an ambulance; (2) being cared for; and (3) reflecting on changes in life after the traumatic event. The cold environment influenced the experience of being injured in a negative way. More suffering from the cold than from pain of the injury was described. Those who were treated with active heat experienced it in a positive way.ConclusionsDiscomfort from cold became the largest problem independent of their injury classification. Active heat should be used in prehospital care to reduce the negative experiences from cold.
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Petrella, Robert J. "The Impact of Angiotensin-II Receptor Blockers on Cardiovascular Events in Hypertensive Patients – Evidence from Real-life Databases." European Cardiology Review 6, no. 3 (2010): 33. http://dx.doi.org/10.15420/ecr.2010.6.3.33.
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It is widely recognised that hypertension is a major risk factor for the development of future cardiovascular (CV) events, which in turn are a major cause of morbidity and mortality. Blood pressure (BP) control with antihypertensive drugs has been shown to reduce the risk of CV events. Angiotensin-II receptor blockers (ARBs) are one such class of antihypertensive drugs and randomised controlled trials (RCTs) have shown ARB-based therapies to have effective BP-lowering properties. However, data obtained under these tightly controlled settings do not necessarily reflect actual experience in clinical practice. Real-life databases may offer alternative information that reflects an uncontrolled real-world setting and complements and expands on the findings of clinical trials. Recent analyses of practice-based real-life databases have shown ARB-based therapies to be associated with better persistence and adherence rates and with superior BP control than non-ARB-based therapies. Analyses of real-life databases also suggest that ARB-based therapies may be associated with a lower risk of CV events than other antihypertensive-drug-based therapies.
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Serrano, Rosa, Guillermo J. Pons-Estel, Gerard Espinosa, et al. "Long-term follow-up of antiphospholipid syndrome: real-life experience from a single center." Lupus 29, no. 9 (2020): 1050–59. http://dx.doi.org/10.1177/0961203320933009.
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Objective The objective of this paper is to assess the prevalence of the main clinical manifestations and laboratory features at disease onset and during the ensuing 10 years of a large cohort of patients with antiphospholipid syndrome (APS) from a single center. Methods The study included all consecutive APS patients followed longitudinally in our center from 2003 to 2013. Descriptive statistics for demographics, clinical and laboratory features and mortality were performed. Results A total of 160 patients were included. Most of them, 128 (78.8%), were women and the mean (SD) age at diagnosis was 39.1 (14.0) years. The majority of them, 104 (65.0%), had primary APS, 36 (22.5%) had APS associated with systemic lupus erythematous, and 20 (12.5%) had APS associated with other autoimmune disease. During the study period, thrombotic events occurred in 27 (16.9%) patients, the most common being strokes, nonbacterial thrombotic endocarditis and deep venous thrombosis. Regarding obstetric morbidity, 18 women (14.3%) became pregnant and 90% of pregnancies succeeded in having live births. The most common obstetric complication was early pregnancy loss (15% of pregnancies). Prematurity (11.1% of live births) and intrauterine growth restriction (5.6% of live births) were the most frequent fetal morbidities. Ten (6.3%) patients died and the most frequent causes of death were severe thrombosis, hemorrhage, and cancer. Three (0.9%) cases of catastrophic APS occurred. The survival probability at 10 years was 93.8%. Conclusions Patients with APS develop significant morbidity and mortality despite current treatment. It is imperative to identify prognostic factors and therapeutic measures to prevent these complications.
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Pathiraja, P. D. M., and Asanka Jayawardane. "Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit and Its Effect on Patients’ Long-Term Physical and Mental Wellbeing: Quest Is Not Over When You Save the Life." Obstetrics and Gynecology International 2021 (February 17, 2021): 1–8. http://dx.doi.org/10.1155/2021/5720264.
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Objectives. Peripartum hysterectomy can be performed as an elective procedure or as a life-saving emergency procedure in obstetrics. It is associated with significant maternal morbidity and mortality. We report peripartum hysterectomies done during the study period in a tertiary referral centre, Colombo, Sri Lanka. Methodology. We collected data on all severe acute maternal morbidity and mortality events (SAMM) from June 01, 2014, to June 01, 2015, at De Soysa Hospital for Women (DSHW). We invited all women who underwent PPH to complete the 36-Item Short Form Health Survey questionnaire (SF-36) before hospital discharge and at six months after the hysterectomy date to assess their general and mental health before and after surgery. Focus group discussions (FGD) were used to further evaluate the patient experience and to identify service delivery improvements. Results. There were eleven peripartum hysterectomies done during the study period for 7160 deliveries. None were primigravida. Median age and gestation were 36 years and 37 weeks, respectively. The commonest indication for peripartum hysterectomy was a morbidly adherent placenta (seven). Nine of the deliveries were elective lower-segment caesarean section and two were vaginal deliveries. Four emergency peripartum hysterectomies were done for primary postpartum haemorrhage (PPH) and two for secondary PPH. All patients required intensive care and there were no maternal deaths. The analysis of SF-36 data revealed that all patients suffered a significant reduction in the quality of life at six months after the surgery. FGD highlighted that most patients needed further counselling and support to improve their physical, psychological, and social wellbeing. Some of the patients were willing to share their experience on voluntary basis to help those undergoing peripartum hysterectomies in the future. Conclusion. Peripartum hysterectomy is an important life-saving procedure associated with severe maternal morbidity and mortality. This study reveals that the physical, psychological, and social adverse effects would remain in the long term.
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Kostenko, E. V., L. V. Petrova, M. A. Eneeva, and V. G. Kravchenko. "Priorities of medical rehabilitation of patients with recent experience of transient ischemic attack." Meditsinskiy sovet = Medical Council, no. 10 (August 12, 2021): 22–33. http://dx.doi.org/10.21518/2079-701x-2021-10-22-33.
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Introduction. Transient ischemic attacks can be a predictor of a more severe cardiovascular event, the risk of which depends on many factors that requires a personalized approach. Neuropsychological disorders (cognitive, emotional) have a significant impact on quality of life and social activity and are often underestimated in patients with TIA. Comprehensive medical rehabilitation with the inclusion of antithrombotic therapy and psychocorrection measures may reduce the risk of recurrent cardiovascular events in patients with TIA.Purpose of the study: to substantiate the efficiency of complex medical and non-pharmacological rehabilitation in patients who underwent TIA by analyzing the characteristics of the main and leading concomitant diseases.Materials and methods. The morbidity of 351 TIA patients was studied and analyzed. The average age of the examined patients was 58.6 ± 2.2 years, there were 64.9% of women and 35.1% of men. All patients received an individualized medical rehabilitation program for 12 months with correction of identified neuropsychological disorders. Depending on background and concomitant diseases the antiplatelet or anticoagulants therapy was differently administrated.Results and dicussion. Psychological, cognitive, and physical disorders (based on subjective complaints) are common in patients with TIA. The prevalence of mental disorders in patients with TIA was 138.2 cases per 100 patients. The correction of cognitive impairment, depressive symptoms is associated with improved quality of life (p < 0.05). Repeated acute cerebrovascular events (TIA, ischemic stroke) were recorded during the first 6 months after TIA in 29 patients (10.4%) with severe stenosis of the brachiocephalic arteries, severe arterial hypertension and paroxysmal atrial fibrillation.Conclusion. The importance of comprehensive medical and social rehabilitation of patients with TIA is determined. The participation of a psychotherapist as a member of a multidisciplinary team is necessary. A significant role of the secondary prevention of acute cerebrovascular events is assigned to rational antithrombotic therapy.
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Arnold, Jonathan, Jianliang Dai, Lusine Nahapetyan, et al. "Predicting Successful Aging in a Population-Based Sample of Georgia Centenarians." Current Gerontology and Geriatrics Research 2010 (2010): 1–9. http://dx.doi.org/10.1155/2010/989315.
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Used a population-based sample (Georgia Centenarian Study, GCS), to determine proportions of centenarians reaching 100 years as (1) survivors (43%) of chronic diseases first experienced between 0–80 years of age, (2) delayers (36%) with chronic diseases first experienced between 80–98 years of age, or (3) escapers (17%) with chronic diseases only at 98 years of age or older. Diseases fall into two morbidity profiles of 11 chronic diseases; one including cardiovascular disease, cancer, anemia, and osteoporosis, and another including dementia. Centenarians at risk for cancer in their lifetime tended to be escapers (73%), while those at risk for cardiovascular disease tended to be survivors (24%), delayers (39%), or escapers (32%). Approximately half (43%) of the centenarians did not experience dementia. Psychiatric disorders were positively associated with dementia, but prevalence of depression, anxiety, and psychoses did not differ significantly between centenarians and an octogenarian control group. However, centenarians were higher on the Geriatric Depression Scale (GDS) than octogenarians. Consistent with our model of developmental adaptation in aging, distal life events contribute to predicting survivorship outcome in which health status as survivor, delayer, or escaper appears as adaptation variables late in life.
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Amro, Bedayah, and Ghassan Lotfi. "Spontaneous rupture of an unscarred uterus in early pregnancy: a rare but life-threatening emergency." BMJ Case Reports 12, no. 5 (2019): e228493. http://dx.doi.org/10.1136/bcr-2018-228493.
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Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.
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Linden, Stefanie Caroline. "Triggers and Clinical Presentations of Functional Neurological Disorders: Lessons from World War 1." European Neurology 83, no. 2 (2020): 174–81. http://dx.doi.org/10.1159/000507698.
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Introduction: The psychological contribution to functional neurological and somatic symptom disorders is a major topic in current medical debate. Objective: For an understanding of the processes leading to functional somatic symptoms, it is paramount to explore their relationship with stress and life events and to elucidate the contribution of cultural factors. Methods: A total of 937 case records of civilian and military patients with functional somatic disorders treated in London during World War 1 were analysed. Group differences in symptom profiles and contemporaneous diagnoses were tested with χ2 tests. Results: Paralyses and speech disturbances were significantly more common in soldiers (43.3 and 17.2% of cases) than in civilian male (28.1 and 6.5%) and female patients (32.4 and 7.5%), whereas female patients had the highest rates of pain (48.6%) and somatic symptoms (67%). Triggers were identified in around two-thirds of cases and included accidents, physical illness, and work stress, in addition to the combat experience of the soldier patients. The nature of the trigger influenced symptom expression, with acute (combat and noncombat) events being particularly prone to trigger loss of motor function. Symptom profiles showed a great deal of multi-morbidity and overlap, although some symptom clusters were more (motor and speech disturbance) or less common (pain and loss of energy) in soldiers than civilians. Triggering life events in civilians were similar to those reported by patients with somatic symptom disorders today, with an important role of physical factors. Patterns of multi-morbidity and symptom clusters also resembled those of modern cohorts. Conclusions: Analysis of historical records, illness trajectories, and treatments can enhance the understanding of the presentation, mechanisms, and course of functional neurological and related disorders and their consistency over time.
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Duncan, Debbie. "Should COVID-19 be considered an adverse child experience?" British Journal of Child Health 2, no. 2 (2021): 95–99. http://dx.doi.org/10.12968/chhe.2021.2.2.95.
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The term adverse childhood experience (ACE) covers a number of different traumatic events, including various forms of abuse, neglect, and household dysfunction, that occur before the age of 18 years. ACEs are recognised as predictors of future poor health outcomes, increased risk of mental illness and chronic diseases and reduced life expectancy. The current COVID-19 pandemic may be amplifying some ACEs in individuals by increasing social isolation or financial pressures and as a result of job loss, school closures, and exposure to the morbidity and mortality of the disease. This article considers the literature and asks the question ‘Can COVID-19 be considered an ACE itself?’ Ultimately, the long-term implications of an accumulation of risk and harm need to be considered and embedded in practice, to effectively respond to the future needs of vulnerable children.
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Subba, R., and H. K. Subba. "Level of depression among elderly in selected old age homes at Mangalore, India." Journal of Chitwan Medical College 5, no. 1 (2015): 28–32. http://dx.doi.org/10.3126/jcmc.v5i1.12568.
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Aging means so many things to so many individuals; it can be viewed as incorporating aspects of the biologic, social, psychologic, functional and spiritual domains. Throughout a person’s life, various traumatic experiences, either physical or emotional, may actually weaken the individual ability to repair or maintain himself/herself. Role changes, major life events and co morbidity contribute to an increased rate of depression in the geriatric population. A descriptive study was conducted to evaluate the level of depression among the elderly people. For this study, Purposive sampling was applied & 50 subjects were interviewed in selected old age homes by using a Modified Geriatric Depression Scale (GDS -15). The collected data were analyzed by descriptive and inferential statistics. The study findings showed that the overall mean for the depression among elderly was 6.42 with the SD of 3.21 and 38% of the elderly were suffering from mild depression where as 10% with severe depression. There was a significant association between the levels of depression and selected demographic variables such as gender, marital status, education level, family type, reasons to join old age homes & duration of stay except for age and religion. Helping older adults adjust to limitations, while accentuating positive attributes, may aid older people in remaining independent and may perpetuate a high quality of life during later years. Therefore, there is need to develop and plan the individualistic intervention to decrease depression level among elderly.DOI: http://dx.doi.org/10.3126/jcmc.v5i1.12568
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Capra, Maria Elena, Cristina Pederiva, Claudia Viggiano, Raffaella De Santis, Giuseppe Banderali, and Giacomo Biasucci. "Nutritional Approach to Prevention and Treatment of Cardiovascular Disease in Childhood." Nutrients 13, no. 7 (2021): 2359. http://dx.doi.org/10.3390/nu13072359.
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Coronary Heart Disease (CHD) is a major mortality and morbidity cause in adulthood worldwide. The atherosclerotic process starts even before birth, progresses through childhood and, if not stopped, eventually leads to CHD. Therefore, it is important to start prevention from the earliest stages of life. CHD prevention can be performed at different interventional stages: primordial prevention is aimed at preventing risk factors, primary prevention is aimed at early identification and treatment of risk factors, secondary prevention is aimed at reducing the risk of further events in those patients who have already experienced a CHD event. In this context, CHD risk stratification is of utmost importance, in order to tailor the preventive and therapeutic approach. Nutritional intervention is the milestone treatment in pediatric patients at increased CHD risk. According to the Developmental Origin of Health and Disease theory, the origins of lifestyle-related disease is formed in the so called “first thousand days” from conception, when an insult, either positive or negative, can cause life-lasting consequences. Nutrition is a positive epigenetic factor: an adequate nutritional intervention in a developmental critical period can change the outcome from childhood into adulthood.
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Skirrow, C., U. Ebner-Priemer, I. Reinhard, Y. Malliaris, J. Kuntsi, and P. Asherson. "Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability." Psychological Medicine 44, no. 16 (2014): 3571–83. http://dx.doi.org/10.1017/s0033291714001032.
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Background.Emotional lability (EL), characterized by negative emotional traits and emotional instability, is frequently reported in children and adults with attention deficit hyperactivity disorder (ADHD). However, EL is primarily assessed using retrospective self-report, which is subject to reporting bias and does not consider the potential influence of positive and negative everyday experiences.Method.Ambulatory assessment was carried out in 41 men with ADHD without co-morbidity, current medication or substance abuse, and 47 healthy control participants. Reports of negative and positive emotions (irritability, frustration, anger, happiness, excitement) and the occurrence of bad and good events were completed eight times daily during a working week. Group differences in emotional intensity and instability were investigated using multilevel models, and explored in relation to bad and good events and the Affective Lability Scale – Short Form (ALS-SF), an EL questionnaire.Results.The ADHD group reported significantly more frequent bad events, heightened intensity and instability of irritability and frustration, and greater intensity of anger. The results for positive emotions were equivocal or negative. Bad events significantly contributed to the intensity and instability of negative emotions, and showed a stronger influence in the ADHD group. However, covariation for their effect did not eliminate group differences. Small-to-moderate correlations were seen between intensity and instability of negative emotions and the ALS-SF.Conclusions.Adults with ADHD report heightened intensity and instability of negative emotions in daily life. The results suggest two components of EL in ADHD: a reactive component responsive to bad events and an endogenous component, independent of negative everyday events.
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Armstrong, Gregory T., Toana Kawashima, Wendy Leisenring, et al. "Aging and Risk of Severe, Disabling, Life-Threatening, and Fatal Events in the Childhood Cancer Survivor Study." Journal of Clinical Oncology 32, no. 12 (2014): 1218–27. http://dx.doi.org/10.1200/jco.2013.51.1055.
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Purpose The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established. Methods Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute). Results The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6%; 95% CI, 51.5 to 55.6; v 19.8%; 95% CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95% CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95% CI, 3.2 to 4.5), and the ≥ 35 years group (HR, 5.0; 95% CI, 4.1 to 6.1), with the HR significantly higher among those ≥ 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9% experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0% of siblings (P < .001). Conclusion Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.
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Arboscello, Eleonora, Elisa Molinari, Andrea Bellodi, et al. "Long Term Follow-up of 107 Patients with Essential Thrombocythemia: Role of Cardiovascular Events." Blood 124, no. 21 (2014): 5566. http://dx.doi.org/10.1182/blood.v124.21.5566.5566.
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Abstract BACKGROUND Essential Thrombocythemia (ET) is a Philadelphia-negative chronic myeloproliferative neoplasm characterized by haemorrhagic and thrombotic complications. Haemorrhagic events and arterial and venous thrombosis, including microcirculation transient occlusions, are the major causes of morbidity in ET patients. The control of these events represents the goal of standard therapeutic approaches. MATERIALS AND METHODS We retrospectively analysed data about 107 ET patients who received diagnosis between January 1980 and June 2014. Median follow-up was 80 months,16 patients were lost during follow-up. The medium age at diagnosis was 60 years, with a prevalence of female (66 patients).We recorded adverse cardiovascular events at diagnosis and during follow-up, assessing whether cytoreductive ad antiplatelet therapy could reduce such events and improve quality of life. Finally, we evaluated the impact of additional cardiovascular risk factors. OBJECTIVES to observe incidence and kind of thrombotic events in patients affected by ET at diagnosis and during follow-up. RESULTS 30 patients (27.7%) had a history of thrombosis at diagnosis (8 transient cerebral ischemia, 7 myocardial infarction/unstable angina, among them 7 patients experienced a rethrombosis during follow-up. 16 patients (15%) developed a first thrombotic event, all patients were under cytoreductive treatment. 21 patients with a history of thrombosis had more than 60 years at diagnosis, 19 patients (63%) had at least one additional cardiovascular risk factor among arterial hypertension, dyslipidemia, diabetes, obesity, hyperuricemia and smoking. Median platelet count was 813000/mm3, leukocyte count greater was more than 10000/mm3 in half of patients. Evolution to acute leukemia/myelofibrosis occurred in 3 (2,7%) and 7 (6,5%) patients of total. CONCLUSIONS The occurrence of thrombotic events even in patients with good hematologic response of disease and during antiplatelet and cytoreductive therapy, indicates the presence of a residual risk of thrombosis. This risk is not yet fully clarified by retrospective studies published until now. Prospective studies will be useful to evaluate the role and the importance of comorbidity in these patients with long-prognosis, in order to optimize therapy, reduce cardiovascular events and improve quality of life Disclosures No relevant conflicts of interest to declare.
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Ma, Li, Helen Kim, Xiao-Lin Chen, et al. "Morbidity after Hemorrhage in Children with Untreated Brain Arteriovenous Malformation." Cerebrovascular Diseases 43, no. 5-6 (2017): 231–41. http://dx.doi.org/10.1159/000458731.
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Background: Children with untreated brain arteriovenous malformations (bAVM) are at risk of encountering life-threatening hemorrhage very early in their lives. The primary aim of invasive treatment is to reduce unfavorable outcome associated with a bAVM rupture. A better understanding of the morbidity of bAVM hemorrhage might be helpful for weighing the risks of untreated bAVM and invasive treatment. Our aim was to assess the clinical outcome after bAVM rupture and identify features to predict severe hemorrhage in children. Methods: We identified all consecutive children admitted to our institution for bAVMs between July 2009 and December 2014. Clinical outcome after hemorrhagic presentation and subsequent hemorrhage was evaluated using the modified Rankin Scale (mRS) for children. The association of demographic characteristics and bAVM morphology with severe hemorrhage (mRS >3 or requiring emergency hematoma evacuation) was studied using univariate and multivariable regression analyses. A nomogram based on multivariable analysis was formulated to predict severe hemorrhage risk for individual patients. Results: A total of 134 patients were identified with a mean treatment-free follow-up period of 2.1 years. bAVM ruptured in 83 (62%) children: 82 had a hemorrhage at presentation and 6 of them experienced a recurrent hemorrhage during follow-up; 1 patient had other diagnostic symptoms but bled during follow-up. Among them, 49% (41/83) had a severe hemorrhage; emergency hematoma evacuation was required in 28% of them (23/83), and 24% (20/83) remained as disabled (mRS ≥3) at last follow-up. Forty-six percent (38/82) of children with hemorrhagic presentation were severely disabled (mRS >3). Forty-three percent (3/7) were severely disabled after subsequent hemorrhage. The annual rate of severe subsequent hemorrhage was 1% in the overall cohort and 3.3% in children with ruptured presentation. All the subsequent severe hemorrhage events occurred in children with severe hemorrhage history (7%, 3/41). Periventricular location, non-temporal lobe location, and long draining vein were predictors for severe hemorrhage in pediatric untreated bAVMs. A nomogram based on bAVM morphology was contracted to predict severe hemorrhage risk for individual patients, which was well calibrated and had a good discriminative ability (adjusted C-statistic, 0.72). Conclusions: Evaluating bAVM morbidity and morphology might be helpful for weighing the risks of untreated bAVM in pediatric patients.
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Carr, Emily Rose. "Malignant Hypertension." Canadian Journal of Optometry 82, no. 4 (2020): 7–13. http://dx.doi.org/10.15353/cjo.v82i4.1350.
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Abstract:
 Case review follows a 49-year-old patient with malignant hypertension with retinopathy and resultant visual decline.
 Case Report: Severely uncontrolled hypertension manifested as malignant hypertensive retinopathy. The patient presented with substantial retinal and visual changes and was monitored over 6 months. While the patient experienced marked improvement in visual acuity, significant retinal damage occurred and the patient experienced persistent qualitative vision and visual field loss.
 Discussion: Observed fundus changes are consistent with advanced risk for morbidity and mortality associated with hypertension. Management of systemic disease is a critical step in reversing retinal manifestations and minimizing the risk for permanent vision loss. The criticality of systemic treatment also applies to lowed risk for systemic vascular events that may compromise quality of life. This case demonstrates that improvement in Snellen acuity does not always parallel functional visual improvement. Eye care providers managing these cases should consider both systemic risks and visual outcome.
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Sánchez Páez, P., J. L. Gómez Cano, L. Sánchez Flores, R. González Lucas, and P. Artieda Urrutia. "Aripiprazole once monthly outpatient experience." European Psychiatry 41, S1 (2017): S760. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1426.
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IntroductionAripiprazole once monthly (AOM) is one of the most recently introduced antipsychotics with a different mechanism of action, which seems to bring clinical and tolerability implications [1].ObjectivesWe describe the patient profile that may benefit from AOM treatment.MethodsThis is a single-centre, retrospective, one year follow-up study of 13 cases of ambulatory AOM use. We analyze clinical and functional evolution, and the tolerability profile of patients in a real clinical practice basis.ResultsMean age was 53.69; 53.8% were males and 46.2% females. The most frequent diagnosis was Schizophrenia and other chronic psychosis (69.3%). Only 7.7% had co-morbidity with substance use disorder (cocaine); 61.6% were on previous treatment with other injectable anti-psychotics; 84,6% of the sample received AOM as monotherapy. Reasons for switching to AOM are shown on Fig. 1. Events during switching are shown on Fig. 2. Outcomes with AOM long-term treatment were positive in 84.61% of cases and are shown on Fig. 3.ConclusionsSwitching to AOM could be considered as a good strategy to improve tolerability, functionality and ultimately adherence to treatment in patients in middle age of life with a chronic psychotic disorder [2].Fig. 1Reasons for switching.Fig. 2Events during switching.Fig. 3Outcomes with AOM.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Fallowfield, Lesley, Roger von Moos, Luis Costa, et al. "Weighing Bone-targeted Treatment Options for Patients with Solid Tumours and Skeletal Complications from Metastatic Disease." European Oncology & Haematology 08, no. 03 (2012): 148. http://dx.doi.org/10.17925/eoh.2012.08.3.148.
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The complications of metastatic bone disease (MBD) in advanced cancer, especially skeletal-related events (SREs), are a significant cause of morbidity that can seriously impair the quality of patients’ lives. Treatments that prevent SREs, reduce or delay the onset of pain and preserve function and activities of daily living are central to good patient care. In this article, we discuss results from clinical trials that show the relative benefits and harms of different bone-targeted agents, which may be given orally, intravenously or subcutaneously. These data, when considered alongside various patient characteristics, can provide oncologists with better opportunities to individualise care. Optimal management with treatments that enhance efficacy and adherence mean that clinicians can improve the outlook for their patients with MBD, who may consequently experience fewer SREs and less pain and enjoy a better overall quality of life.
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Linfante, Italo, Kaushik Ravipati, Amy Kathryn Starosciak, Dennys Reyes, and Guilherme Dabus. "Intravenous cangrelor and oral ticagrelor as an alternative to clopidogrel in acute intervention." Journal of NeuroInterventional Surgery 13, no. 1 (2020): 30–32. http://dx.doi.org/10.1136/neurintsurg-2020-015841.
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BackgroundDual antiplatelet therapy (DAP) is necessary to prevent thromboembolic events during carotid stenting, stent-assisted coil embolization, and implant of flow diverters (FD). However, DAP in the acute phase may be challenging. An intravenous alternative, cangrelor, has rapid onset, short plasma half-life, and more reliable antiplatelet action for acute interventions. The study objective was to evaluate feasibility and safety of IV cangrelor during acute neuroendovascular surgery procedures.MethodsWe performed a retrospective analysis of our database of patients treated with stent-assisted coil embolization, FD placement for aneurysmal subarachnoid hemorrhage (aSAH), or stenting for acute internal carotid artery (ICA) occlusion where IV cangrelor was used. Morbidity, mortality, incidence of thromboembolic events, hemorrhages, and 90-day outcomes were reported.ResultsTen patients were found in our database from June 2018 through January 2019. Four patients had aSAH, four had middle cerebral artery strokes with tandem lesions, one had an ICA occlusion, and one had a vertebral artery aneurysm. One of the ten patients experienced a thrombotic event. One patient developed new post-procedural bleeding and two had worsening intracranial hemorrhage. Five patients were discharged home in stable condition, two to acute rehabilitation, one to a nursing facility, and two others expired (likely the result of the severe and evolving strokes). Of the eight who were discharged, six (75%) had a good 90-day functional outcome (modified Rankin Scale 0–2).ConclusionAcute administration of IV cangrelor with or without oral ticagrelor is a feasible antiplatelet treatment option for acute neuroendovascular procedures.
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L. BEAUTRAIS, ANNETTE. "Suicides and serious suicide attempts: two populations or one?" Psychological Medicine 31, no. 5 (2001): 837–45. http://dx.doi.org/10.1017/s0033291701003889.
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Background. Few studies have examined the extent to which populations of suicides and attempted suicides are similar, or different. This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour.Methods. Using case–control methodology, risk factors for suicidal behaviour were examined in 202 individuals who died by suicide, 275 individuals who made medically serious suicide attempts and 984 randomly selected control subjects. Based on data from significant others, measures used spanned sociodemographic factors, childhood experiences, psychiatric morbidity and psychiatric history, exposure to recent stressful life events and social interaction.Results. Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts: current mood disorder; previous suicide attempts; prior out-patient psychiatric treatment; admission to psychiatric hospital within the previous year; low income; a lack of formal educational qualifications; exposure to recent stressful interpersonal, legal and work-related life events. Suicides and suicide attempts were distinguished in the following ways: suicides were more likely to be male (OR = 1·9, 95% CI 1·1, 3·2); older (OR = 1·03, 95% CI 1·02, 1·04); and to have a current diagnosis of non-affective psychosis (OR = 8·5, 95% CI 2·0, 35·9). Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder (OR = 3·5, 95% CI 1·6, 7·8) and to be socially isolated (OR = 2·0, 95% CI 1·2, 3·5). These findings were confirmed by discriminant function analysis, which identified two functions that described the three subject groups: the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender, non-affective psychosis and anxiety disorder.Conclusions. Suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.
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Inusa, Baba, SallyAnn Wakeford, and Fenella Kirkham. "Overnight Respiratory Support for Prevention of Morbidity in Sickle Cell Disease (POMS 2a) - Parent and Child Preferences." Blood 126, no. 23 (2015): 4457. http://dx.doi.org/10.1182/blood.v126.23.4457.4457.
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Abstract PURPOSE: Obstructive sleep apnea and nocturnal hypoxemia are common in children with sickle cell disease (SCD) and some degree of improvement has been reported following adenotonsillectomy(Finch et al., 2013). NOT and continuous positive airways pressure (CPAP) have shown some benefits in children and adolescent patients(Hargrave, 2003). While NOT and CPAP are offered to children with or without co-morbidities, there are concerns about acceptability and safety(Makani et al., 2009). The data on patient preference is limited in childhood and more so for those with SCD. To achieve optimal adherence to therapy in SCD, Auto-Adjusting Positive Airways Pressure (APAP), where airway pressure is delivered only when obstruction occurs, may be a more acceptable option than CPAP(Marshall et al., 2009). Therefore prior to designing Phase II and III trials that are adequately powered, this study sought to: i) identify parent/caregiver and child treatment preference; ii) assess whether parent/caregiver or child should manage the electronic pain diary; iii) assess any treatment effect on Health Related Quality of Life (HRQOL) in children; and iv) explore the relationship of treatment adherence to: a) experience of pain, and b) overall clinical benefit from the intervention. HYPOTHESES: 1. Treatment adherence of children or adults with would be directly related a) HRQOL quantitative measures, and b) improvement in symptoms reported through semi-structured interviews of patients; 2. Children >8 years would be able to record their experience of pain in an appropriate electronic pain diary; 3. Treatment adherence would be predictive of effect on pain frequency. METHOD: We utilised mixed-methods to explore the primary endpoint of patient experience of treatment intervention, and the secondary endpoint of pain, in a sample of 11 children (aged >8 years) with homozygous SCD. The statistician was blinded to order of intervention. Two interventions NOT and APAP were conducted for one week each in randomized order, with a washout week between interventions. Qualitative data was obtained through in-depth interviews with children and their parents/caregivers conducted by a research psychologist using content method of analysis; quantitative measures were explored employing the Pediatric Quality of Life InventoryTM (PedsQL)(Panepinto et al., 2013) including the sickle module. All analyses were preliminary, exploratory and mainly descriptive. The secondary endpoint of pain was captured utilizing a pain rating scale and symptom assessment on smart technology via an iPad(Jacob et al., 2012). Other secondary outcomes included adverse events, daytime oxygen saturation, and lung function.. All variables were reported for three time points: baseline, post-intervention 1 and post-intervention 2. RESULTS: Analysis of interviews between children and parents/caregivers revealed similarities in expectations prior to treatment, and variations in post-study perception of treatment. Parents/caregivers and children emphasised impact on other family members, practical concerns and challenges as objective criteria for treatment preference, while children additionally emphasized night time positive/negative sensory experiences: e.g. airflow, dreams, breathing, sound, as influences for treatment preference. Belief that treatment is beneficial only for children with breathing difficulties emerged as an influence on both expectation and perception of positive benefits. In 7 children for whom APAP adherence data were available, pain was noted after 3 nights with a median adherence of 5.23 (range 4.0-6.1) hours and was not noted after 38 nights with a median adherence of 8.03 (range 3.21-10.19) hours (p=0.2). For 4 children with pain recorded on 2, 2, 2 and 4 days in the pre-treatment week, 3 recorded no pain on APAP and the child with 4 days pre-treatment recorded 2 days on APAP. CONCLUSIONS: These data reveal some variation in approaches toward treatment preferences between parents/caregivers and children, and supports an inclusive approach to facilitate appropriate treatment choice. Adherence data are not available for oxygen but there is some evidence for reduction in pain in relation to APAP adherence. This trial will contribute to understanding in participant feasibility and acceptability for therapeutic intervention. Research results will be used to inform design of the Phase II and III trials. Disclosures No relevant conflicts of interest to declare.
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O'Connell, N., T. R. Nicholson, S. Wessely, and A. S. David. "Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case–control study." Psychological Medicine 50, no. 3 (2019): 446–55. http://dx.doi.org/10.1017/s0033291719000266.
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AbstractBackgroundFunctional neurological disorder (FND), previously known as conversion disorder, is common and often results in substantial distress and disability. Previous research lacks large sample sizes and clinical surveys are most commonly derived from neurological settings, limiting our understanding of the disorder and its associations in other contexts. We sought to address this by analysing a large anonymised electronic psychiatric health record dataset.MethodsData were obtained from 322 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who had an ICD-10 diagnosis of motor FND (mFND) (limb weakness or disorders of movement or gait) between 1 January 2006 and 31 December 2016. Data were collected on a range of socio-demographic and clinical factors and compared to 644 psychiatric control patients from the same register.ResultsWeakness was the most commonly occurring functional symptom. mFND patients were more likely to be female, British, married, employed pre-morbidly, to have a carer and a physical health condition, but less likely to have had an inpatient psychiatric admission or to receive benefits. No differences in self-reported sexual or physical abuse rates were observed between groups, although mFND patients were more likely to experience life events linked to inter-personal difficulties.ConclusionsmFND patients have distinct demographic characteristics compared with psychiatric controls. Experiences of abuse appear to be equally prevalent across psychiatric patient groups. This study establishes the socio-demographic and life experience profile of this understudied patient group and may be used to guide future therapeutic interventions designed specifically for mFND.
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Rapoport, Bernardo Leon, Teresa Smit, and Ronwyn van Eeden. "Experience of immune-related adverse events associated with ipilimumab and nivolumab in a single center." Journal of Clinical Oncology 35, no. 7_suppl (2017): 91. http://dx.doi.org/10.1200/jco.2017.35.7_suppl.91.
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91 Background: Anti-programmed cell death receptor-1 (PD-1) and anti-CTLA4 antibodies represent an effective anti-cancer. Ipilimumab and nivolumab can induce immune-related adverse events (IrAEs). These IrAEs affect skin, gastrointestinal tract, liver, endocrine system and other organ systems. Life-threatening and fatal irAEs have been reported; adequate diagnosis and management are essential. Methods: A retrospective review of data from 40 patients (pts) records were used to describe the IrAE’s associated with 15 pts treated with ipilimumab and 25 pts treated with nivolumab. Results: A total of 40 pts (25 males and 15 females) were included in the analysis. The median age was 63 years (range 30 - 85 years). The performance status (PS) ranged from 0 to 2, with a median PS of 1. In total, 3 pts with metastatic melanoma, 18 with non small cell lung cancer (NSCLC), 2 with renal cell carcinoma and 2 with Hodgkin’s disease were treated with nivolumab and 15 with metastatic melanoma received ipilimumab. A total of 167 cycles of nivolumab (median = 4, range 1-16) and 60 cycles of ipilimumab (median = 4 cycles, range 1-4 cycles) were administered. Seven IrAEs are described in 19 pts treated with ipilimumab. These include endocrinopathy in 3 pts (hypophysitis in pt and hyphothyroidsm in 2 pts), colitis in 3 pts (1 required infliximab) and hepatitis in 1 pt. Among the pts treated with nivolumab 7 IrAEs were documented. These included pneumonitis in 2 pts, skin rash in 3 pts, mild diarrhea in 1 pt and mild uveitis in 1 pt. Additionally, 3 chest infections were documented including a case of pulmonary tuberculosis in a pt with NSCLC. Conclusions: Anti-PD1 and anti-CTLA4 antibodies can induce a plethora of irAEs. Colitis was more common with ipilimumab while pneumonitis more common with nivolumab. The knowledge of IrAE’s will allow prompt diagnosis and improve the management resulting in decreased morbidity.
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STANSFELD, S. A., R. FUHRER, and M. J. SHIPLEY. "Types of social support as predictors of psychiatric morbidity in a cohort of British Civil Servants (Whitehall II Study)." Psychological Medicine 28, no. 4 (1998): 881–92. http://dx.doi.org/10.1017/s0033291798006746.
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Background. Few studies have examined prospectively both the direct and buffering effects of types of social support and social networks on mental health. This paper reports longitudinal associations between types of social support and psychiatric morbidity from the Whitehall II study.Methods. Social support was measured by the Close Persons Questionnaire and psychiatric morbidity by the General Health Questionnaire at baseline (1985–1988) and at first follow-up (1989) in 7697 male and female London-based civil servants aged 35–55 years at baseline. The cohort was followed up and baseline measures were used to predict psychiatric disorder measured by the General Health Questionnaire at second follow-up (1991–1993).Results. Longitudinal analyses showed that low confiding/emotional support in men and high negative aspects of close relationships in men and women were associated with greater risk of psychiatric morbidity even after adjustment for baseline General Health Questionnaire score. There was no evidence of a buffering effect among men or women who experienced life events or chronic stressors. Controlling for a personality measure of hostility did not affect the observed relations.Conclusions. The present findings illustrate that different types of support are risk factors for psychological distress and that they operate in different ways for men and women. Direct effects of emotional support are predictive of good mental health in men and negative aspects of close relations predict poor mental health in both men and women. Emotional support is predictive of good mental health in women whereas, confiding alone is not.
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Crenshaw, David A. "Clinical Tools to Facilitate Treatment of Childhood Traumatic Grief." OMEGA - Journal of Death and Dying 51, no. 3 (2005): 239–55. http://dx.doi.org/10.2190/12md-epqx-47dy-kw0x.
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Cohen and Mannarino (2004) define childhood traumatic grief (CTG) as “a condition in which trauma symptoms impinge on children's ability to negotiate the normal grieving process” (p. 819). Brown and Goodman (2005) add further clarification, “According to our current understanding of CTG and normal grief, thoughts and images of a traumatic nature are so terrifying, horrific, and anxiety provoking that they cause the child to avoid and shut out these thoughts and images that would be comforting reminders of the person who died. In contrast, a child who does not have intrusive reminders, or who did not experience the death as traumatic, is able to access the person in memory in a manner that is positive and beneficial to integrating the death in his or her total life experience” (pp. 255, 257). The distressing and intrusive images, reminders, and thoughts of the traumatic circumstances of the death, along with the physiological hyperarousal associated with such re-experiencing, prevent the child from proceeding in a healthy way with the grieving process. In addition, while such children are ordinarily excluded from studies of empirically validated treatment studies because of severity and co-morbidity of their conditions, clinicians often see youngsters where traumatic death has been superimposed on a history of multiple losses and in some cases socio-cultural trauma and/or major psychiatric disorders in the child or family. The projective drawing and storytelling strategies and the evocative technique described in this article are intended to offer clinicians additional tools to deal with such seriously impacted youth so that the trauma work can be approached in the relative safety of symbolism and metaphor prior to directly confronting the trauma events.
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Tenney, Jonathan S. "Babylonian Populations, Servility, and Cuneiform Records." Journal of the Economic and Social History of the Orient 60, no. 6 (2017): 715–87. http://dx.doi.org/10.1163/15685209-12341440.
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Abstract To date, servility and servile systems in Babylonia have been explored with the traditional lexical approach of Assyriology. If one examines servility as an aggregate phenomenon, these subjects can be investigated on a much larger scale with quantitative approaches. Using servile populations as a point of departure, this paper applies both quantitative and qualitative methods to explore Babylonian population dynamics in general; especially morbidity, mortality, and ages at which Babylonians experienced important life events. As such, it can be added to the handful of publications that have sought basic demographic data in the cuneiform record, and therefore has value to those scholars who are also interested in migration and settlement. It suggests that the origins of servile systems in Babylonia can be explained with the Nieboer-Domar hypothesis, which proposes that large-scale systems of bondage will arise in regions with plentiful land but few workers. Once established, these systems persisted and were reinforced through Babylonia’s high balance mortality, political ideologies, economic incentives, and social structures.
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Bhatia, Sanjiv, Faiz Ahmad, Ian Miller, et al. "Surgical treatment of refractory status epilepticus in children." Journal of Neurosurgery: Pediatrics 12, no. 4 (2013): 360–66. http://dx.doi.org/10.3171/2013.7.peds1388.
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Object Refractory status epilepticus (RSE) is a life-threatening neurological emergency associated with high morbidity and mortality. Affected patients often require prolonged intensive care and can suffer multiple complications. Surgical intervention to control RSE is rarely used but can obviate the risks of prolonged seizures and intensive care treatment. Authors of the present study analyzed their experience with the surgical management of patients suffering from RSE. Methods The Epilepsy Surgery Database at Miami Children's Hospital was reviewed for patients who had undergone surgery for RSE. Clinical presentation, electrophysiological profile, radiological data, surgical details, and postoperative course were evaluated. Results Between 1990 and 2012, 15 patients underwent surgery for uncontrolled seizures despite high-dose medical suppressive therapy. The mean preoperative duration of status epilepticus was 8 weeks. Ictal SPECT and FDG-PET imaging in conjunction with intraoperative electrophysiological studies helped to outline the extent of resection. Surgical intervention controlled seizures in all patients and facilitated the transition out of intensive care. Adverse events related to a prolonged intensive care unit stay included sepsis and respiratory complications. Four patients had worsened neurological function, developing hemiparesis and dysphasia. There was no operative mortality. Conclusions Surgical intervention can successfully control refractory partial status epilepticus, prevent associated morbidity, and decrease intensive care unit stay. Ictal SPECT and PET are valuable in guiding resection.
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Foster, Emma, Patrick Carney, Danny Liew, Zanfina Ademi, Terry O’Brien, and Patrick Kwan. "First seizure presentations in adults: beyond assessment and treatment." Journal of Neurology, Neurosurgery & Psychiatry 90, no. 9 (2019): 1039–45. http://dx.doi.org/10.1136/jnnp-2018-320215.
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Almost 10% of people will experience at least one seizure over a lifetime. Although common, first seizures are serious events and warrant careful assessment and management. First seizures may be provoked by acute or remote symptomatic factors including life-threatening metabolic derangements, drug toxicity or structural brain lesions. An unprovoked first seizure may herald the onset of epilepsy and may be accompanied by medical and psychiatric illnesses. Accidents, injuries and death associated with first seizures are likely under-reported. The cognitive and emotional impact of first seizures is often neglected. Evaluation of a patient presenting with a first seizure requires careful history-taking and early specialist assessment, however optimal management strategies have not been extensively investigated. Further, advances in technology and the role of eHealth interventions such as telemedicine may be of value in the care of patients who have experienced a first seizure. This article reviews the impact and implications of first seizures beyond the scope provided in current guidelines which tend to focus on assessment and management. It examines the effect of first seizures on the well-being of patients; assesses morbidity and premature mortality in first seizures and discusses current and future directions to optimise safety and health of people with first seizures, with a focus on adult patients. Recognition of these issues is essential to provide adequate care for people with first seizures.
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Cepas-Guillen, Pedro Luis, Juan Carlos de la Fuente Mancera, Joan Guzman Bofarull, et al. "Initial Results after the Implementation of an Edge-To-Edge Transcatheter Tricuspid Valve Repair Program." Journal of Clinical Medicine 10, no. 18 (2021): 4252. http://dx.doi.org/10.3390/jcm10184252.
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Transcatheter tricuspid valve repair (TTVr) has emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). We report our initial experience with an edge-to-edge TTVr system in a high-volume institution. Methods: We included consecutive patients who underwent edge-to-edge TTVr systems. The primary efficacy endpoint was a reduction in the TR of at least one grade. The primary safety endpoint was procedure-related clinical serious adverse events. Results: A total of 28 patients underwent TTVr with edge-to-edge systems. All patients presented with at least severe TR with a high impact on quality of life (82% of patients in NYHA class ≥ III). The Triclip system was the most used device (89%). The primary efficacy endpoint was met in all patients. Only one patient experienced a procedural complication (femoral pseudoaneurysm). At three-month follow-up, 83% of patients were in NYHA I or II (18% baseline vs. 83% 3 months follow-up; p < 0.001). Echocardiography follow-up showed residual TR ≤ 2 in 79% of patients (paired p < 0.001). At the maximum follow-up (median follow up = 372 days), no patients had died. Conclusions: Edge-to-edge TTVr systems seem to represent a very valid alternative to prevent morbidity and mortality associated with TR as depicted by the favorable efficacy and safety.
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Yu, Liang, Xin Lei, and Ying Lin. "Proper dosage of primary pegylated G-CSF prophylactic use for breast cancer patients receiving adjuvant or neo-adjuvant chemotherapy." Journal of Clinical Oncology 37, no. 15_suppl (2019): e18354-e18354. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18354.
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e18354 Background: Myelosuppression during chemotherapy can lead to life-threatening infections, dose reductions, treatment delays, as well as prolonged hospitalizations, early morbidity, and early mortality. According to NCCN guideline, Pegfilgrastim 6mg per cycle is recommended for breast cancer patients receiving chemotherapy, and dosage modification based on body weight is not required. However, primary PEGylated G-CSF prophylaxis comes with significant extra cost, which has a great impact on health care resources, especially for patients without insurance coverage. Methods: We analyzed clinical data of patients, weighing between 45 and 65 kilogram, received a single subcutaneous PEGylated recombinant human G-CSF injection at fixed doses of either 3 mg or 6 mg per chemotherapy cycle approximately 24 hours after completion of each cycle of chemotherapy. Data for this retrospective study were obtained from Thyroid and Breast Surgical Department of the First Affiliated Hospital of Sun Yat-sen University between July 1, 2017, and October 31, 2017. Results: 41 cycles in 33 patients were included in 3mg PEGylated G-CSF group, and 46 cycles in 39 patients were included in 6mg PEGylated G-CSF group. Among chemotherapy cycles, the incidence of neutropenic event was19.5%and 2.2% in 3mg PEGylated G-CSF group and 6mg PEGylated G-CSF group, respectively. No patients experienced dose reductions or treatment delays in both groups. Using single-factor Logistic Regression Analysis, we found that dose of PEGylated G-CSF(3mg vs 6mg) was significantly associated with occurrence of neutropenic event(p = 0.028). Multi-factor Logistic Regression Analysis also showed that dose of PEGylated G-CSFwas significantly associated with occurrence of neutropenic event (p = 0.031). Conclusions: Our study showed that dose of prophylactic PEGylated G-CSF was significantly associated with occurrence of neutropenic events. So adequate dose of PEGylated G-CSF is important to reduce chemotherapy induced neutropenic events and to guarantee the quality of chemotherapy in patients with breast cancer.
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Logan, C., D. Koura, and R. Taplitz. "Updates in infection risk and management in acute leukemia." Hematology 2020, no. 1 (2020): 135–39. http://dx.doi.org/10.1182/hematology.2020000098.
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Abstract Patients with hematologic malignancies are at increased risk of infection, with associated morbidity and mortality. Patients with acute myeloid leukemia (AML) have qualitative and quantitative deficits in granulocytes predisposing to bacterial and fungal infections. Acute lymphoblastic leukemia results in qualitative deficits in lymphocytes, resulting in hypogammaglobulinemia and reduced cell-mediated immunity predisposing to certain bacterial and viral as well as fungal infections. Chemotherapeutic regimens often compound these deficits, result in prolonged periods of severe neutropenia, and disrupt mucosal barriers, further elevating infection risk. Despite advances in antimicrobial therapies and prophylaxis, acute leukemia patients with disease- and treatment-related immunosuppression remain at risk for life-threatening infection, including with resistant organisms, antimicrobial-related adverse events, and higher treatment costs. Additionally, our knowledge of infection risk and drug-drug interactions with new immune-targeted cancer therapeutics is evolving. Here, we review 3 areas in which standard practice is evolving as challenges arise and new experience is gained, including antibiotic use in febrile neutropenia, fungal prophylaxis, and use of targeted therapies.
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Kabir, AKM Humayon, SK Jakaria Been Sayeed, Prodip Kumar Biswas, et al. "Sociodemographic, Clinico-Laboratory Characteristics with Short Outcome among Acute Heart Failure Patients Admitted for First Time in a Tertiary Care Hospital: a Real Life Experience." Journal of Dhaka Medical College 28, no. 2 (2021): 192–98. http://dx.doi.org/10.3329/jdmc.v28i2.51157.
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Acute heart failure is one of the common causes of morbidity & mortality among the patients admitted in hospital. This prospective observational study was done to characterize sociodemographic, clinical & laboratory characteristics with short clinical outcome. Total 110 patients of acute heart failure were included in this study where mean age was 53.88 (± 14.6) years. Majority of the patients were aged between 51-60 years 35 (32%). 79(72%) of them smoker and 12(11%) were alcoholic. Major comorbidities were hypertension 59 (53.63%), ischemic heart disease 42 (38.18%), DM 39(35.45%), chronic kidney disease 25(22.72%). Most common symptoms at presentation were shortness of breath110(100%) along with palpitation 96(87.27%), orthopnea 85(77.27%), paroxysmal nocturnal dyspnea 59(53.63%), ankle edema 71(64.54%), raised JVP 75(68.18%), bilateral basal crepitation on auscultation 80(72.72%), anemia 19 (17.27%) & oliguria 23(20.90%) where mean duration of symptoms was 11 ± 2 days. Lab investigations revealed decreased Hemoglobin (10.71 ± 1.49) g/dl, proteinuria in 31 (28.18%), ketone body 5 (4.5%), raised creatinine in 23(20.93%), hyponatremia 38 (34.54%), hypernatremia 6 (5.45%), hypokalemia 6 (5.45%), hyperkalemia 3 (2.72%). Regarding cardiac events 37(33.63%) encounter myocardial infarction, cardiogenic shock 29(26.36%), Cardiac arrhythmia 27 (24.5%), cardiac arrest 6 (5.45%), non-cardiac events like stroke 6(5.45%), hyperosmolar hyperglycemic state 2(1.8%), diabetic ketoacidosis 5(5.45%), acute kidney injury 23(20.90%). However, among cardiac arrhythmia atrial fibrillation found 13(11.81%) followed by multiple ventricular ectopic 12 (10.90%), ventricular tachycardia 7 (6.36%), Complete heart block 6 (5.45%), variable heart block 4 (3.63%), long QT 2(1.8%). Regarding short clinical outcome 52(47.27%) were improved, 40 (36.36%) had persistent symptoms & rest 18 (16.36%) expired. Most common causes of those deceased person were cardiogenic shock 9(50%) followed by cardiac arrest 6 (6.33%). In conclusion we can say clinical characteristics are more or less similar but those who have reduced ejection fraction with comorbidities are very prone to develop cardiac arrhythmia causing sudden cardiac death in heart failure.
 J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 192-198
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Carrière, I., A. Farré, C. Proust-Lima, J. Ryan, M. L. Ancelin, and K. Ritchie. "Chronic and remitting trajectories of depressive symptoms in the elderly. Characterisation and risk factors." Epidemiology and Psychiatric Sciences 26, no. 2 (2016): 146–56. http://dx.doi.org/10.1017/s2045796015001122.
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Background.In elderly general population sub-syndromal clinically significant levels of depressive symptoms are highly prevalent and associated with high co-morbidity and increased mortality risk. However changes in depressive symptoms over time and etiologic factors have been difficult to characterise notably due to methodological shortcomings. Our objective was to differentiate trajectories of depressive symptoms over 10 years in community-dwelling elderly men and women using statistical modelling methods which take into account intra-subject correlation and individual differences as well as to examine current and life-time risk factors associated with different trajectories.Methods.Participants aged 65 and over were administered standardised questionnaires and underwent clinical examinations at baseline and after 2, 4, 7 and 10 years. Trajectories over time of the Center for Epidemiologic Studies Depression scores were modelled in 517 men and 736 women separately with latent class mixed models which include both a linear mixed model to describe latent classes of trajectories and a multinomial logistic model to characterise the latent trajectories according to baseline covariates (socio-demographic, lifestyle, clinical, genetic characteristics and stressful life events).Results.In both genders two different profiles of symptom changes were observed over the 10-year follow-up. For 9.1% of men and 25% of women a high depressive symptom trajectory was found with a trend toward worsening in men. The majority of the remaining men and women showed decreasing symptomatology over time, falling from clinically significant to very low levels of depressive symptoms. In large multivariate class membership models, mobility limitations [odds ratio (OR) = 4.5, 95% confidence interval (CI) 1.6–12.9 and OR = 4.9, 95% CI 2.3–10.7, in men and women respectively], ischemic pathologies (OR = 2.9, 95% CI 1.0–8.3 and OR = 3.1, 95% CI 1.0–9.9), and recent stressful events (OR = 4.5, 95% CI 1.1–18.5, OR = 3.2, 95% CI 1.6–6.2) were associated with a poor symptom course in both gender as well as diabetes in men (OR = 3.5, 95% CI 1.1–10.9) and childhood traumatic experiences in women (OR = 3.1, 95% CI 1.6–5.8).Conclusions.This prospective study was able to differentiate patterns of chronic and remitting depressive symptoms in elderly people with distinct symptom courses and risk factors for men and women. These findings may inform prevention programmes designed to reduce the chronic course of depressive symptomatology.
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Stephens, Jennifer M., Sarah Y. Liou, Kimbach T. Tran, and Marc F. Botteman. "Economic Burden of Hematologic Adverse Events in Cancer Patients Undergoing Chemotherapy: A Systematic Review." Blood 108, no. 11 (2006): 3350. http://dx.doi.org/10.1182/blood.v108.11.3350.3350.
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Abstract OBJECTIVES: Hematologic adverse events such as neutropenia, thrombocytopenia, and anemia are commonly experienced by cancer patients receiving chemotherapy. These cytopenias are associated with increased morbidity and mortality, high healthcare costs, and decreases in quality of life. The objective of this study was to review the economic burden of these hematologic adverse events associated with chemotherapy in cancer patients. METHODS: A systematic search of the English-language medical literature published between 1990 and 2006 was conducted. Online conference proceedings and a review of article bibliographies were included in the review. Articles selected included prospective or retrospective studies specifically designed to examine burden of illness, direct medical costs, indirect costs, or cost drivers associated with neutropenia, thrombocytopenia, and anemia in adult cancer patients treated with chemotherapy. All original costs were reported, with adjusted figures (to 2006 US dollars) presented in parentheses using the medical care component of the consumer price index from the US Bureau of Labor Statistics. RESULTS: Of 160 studies initially identified, 64 met selection criteria and were reviewed in detail. The cost of neutropenia ranged from $1,893 (2006 US $2,632) per episode in the outpatient setting to $38,583 ($54,807) for a febrile neutropenia hospitalization. The cost of treating thrombocytopenia ranged from $1,037 ($1,395) to $7,550 ($9,336) per cycle or episode. Costs attributable to treating anemia ranged from $18,418 ($22,775) to $69,478 ($93,454) per year. Key cost drivers include hospitalization, drugs (e.g., granulocyte colony-stimulating factors and antibiotics), and diagnostic tests for neutropenia; hospitalization, major bleeding episodes, and platelet transfusions for thrombocytopenia; and inpatient and outpatient services, erythropoietic agents, and red blood cell transfusions for anemia. Another finding was that the costs of hematologic adverse events for patients with hematologic malignancies were up to twice that of patients with solid tumors. CONCLUSIONS: Chemotherapy-related cytopenias result in a substantial economic burden on patients, payers, caregivers, and society in general. This burden is particularly high for patients with hematologic malignancies due to the underlying malignancy. Furthermore, AEs affect the ability to deliver planned treatments, resulting in potentially suboptimal clinical outcomes. An evaluation of both clinical outcomes of chemotherapy and economic consequences as a result of chemotherapy-induced toxicities is recommended in determining optimal treatments for patients with cancer.
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Genton, L., W. van Gemert, C. Pichard, and P. Soeters. "Physiological functions should be considered as true end points of nutritional intervention studies." Proceedings of the Nutrition Society 64, no. 3 (2005): 285–96. http://dx.doi.org/10.1079/pns2005434.
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With the beginning of this millennium it has become fashionable to only follow ‘evidence-based’ practices. This generally-accepted approach cruelly negates experience or intelligent interpretation of pathophysiology. Another problem is that the great ‘meta-analysts’ of the present era only accept end points that they consider ‘hard’. In the metabolic and nutritional field these end points are infection-related morbidity and mortality, and all other end points are considered ‘surrogate’. The aim of this presentation is to prove that this claim greatly negates the contribution of more-fundamentally-oriented research, the fact that mortality has multifactorial causes, and that infection is a crude measure of immune function. The following problems should be considered: many populations undergoing intervention have low mortality, requiring studies with thousands of patients to demonstrate effects of intervention on mortality; nutrition is only in rare cases primary treatment, and in many populations is a prerequisite for survival rather than a therapeutic modality; once the effect of nutritional support is achieved, the extra benefit of modulation of the nutritional support regimen can only be modest; cost–benefit is not a valid end point, because the better it is done the more it will cost; morbidity and mortality are crude end points for the effect of nutritional intervention, and are influenced by many factors. In fact, it is a yes or no factor. In the literature the most important contributions include new insights into the pathogenesis of disease, the diminution of disease-related adverse events and/or functional improvement after therapy. In nutrition research the negligence of these end points has precluded the development and validation of functional end points, such as muscle, immune and cognitive functions. Disability, quality of life, morbidity and mortality are directly related to these functional variables. It is, therefore, of paramount importance to validate functional end points and to consider them as primary rather than surrogate end points.