Alcohol associated liver cirrhotics have higher mortality after index hospitalization: Long-term data of 5,138 patients

Background/Aims@#Liver cirrhosis is an important cause of morbidity and mortality globally. Every episode of decompensation and hospitalization reduces survival. We studied the clinical profile and long-term outcomes comparing alcohol-related cirrhosis (ALC) and non-ALC. @*Methods@#Cirrhosis patients at index hospitalisation (from January 2010 to June 2017), with ≥1 year follow-up were included. @*Results@#Five thousand and one hundred thirty-eight cirrhosis patients (age, 49.8±14.6 years; male, 79.5%; alcohol, 39.5%; Child-A:B:C, 11.7%:41.6%:46.8%) from their index hospitalization were analysed. The median time from diagnosis of cirrhosis to index hospitalization was 2 years (0.2–10). One thousand and seven hundred seven patients (33.2%) died within a year; 1,248 (24.3%) during index hospitalization. 59.5% (2,316/3,890) of the survivors, required at least one readmission, with additional mortality of 19.8% (459/2,316). ALC compared to non-ALC were more often (P @*Conclusions@#One-third of cirrhosis patients die in index hospitalization. 60% of the survivors require at least one rehospitalization within a year. ALC patients present with higher morbidity and mortality and at a younger age.

The dilemma of differentiating between acute hepatitisB and chronic hepatitis B with acute exacerbation: Isquantitative serology the answer?

Background/Aims@#Acute exacerbations of chronic hepatitis B (CHB-AEs) are common in endemic areas and are often presumed to be acute hepatitis B (AHB) due to their similarities in clinical and serological pictures, presenting a major diagnostic dilemma. This study aimed to identify laboratory markers for differentiating between the two groups, and to establish the cut-off value for significant markers. @*Methods@#A retrospective analysis of records was conducted for patients who presented with clinical features of acute hepatitis along with hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (IgM anti-HBc) positivity from May 2015 to May 2017. A total of 172 patients were enrolled and grouped as AHB (n=89) and CHB-AE (n=83) based on their history of hepatitis B virus infection and duration of HBsAg persistence. Virological and biochemical parameters were analyzed and compared. Cut-off values, sensitivity, and specificity of the variables were calculated. @*Results@#The median value of signal by cut-off (S/Co) ratio for IgM anti-HBc was significantly higher in AHB group (30.44) compared to CHB-AE group (8.63) with a sensitivity and specificity of 97% and 84%, respectively, at a cut-off of 20.5 (P<0.01). The mean international normalized ratio (INR) was significantly greater in CHB-AE (1.88±1.24) group compared to AHB group (1.62±0.17) with a sensitivity and specificity of 57.9% and 45.1%, respectively, at a cut-off value of 1.27. @*Conclusions@#A value of 20.5 S/Co of IgM anti-HBc and 1.27 INR could be helpful in differentiating between AHB and CHB-AE.

Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances: A randomized, placebo-controlled trial

BACKGROUND/AIMS: The aim of this study was to study the efficacy and safety of zolpidem for sleep disturbances in patients with cirrhosis. METHODS: Fifty-two Child-Turcotte-Pugh (CTP) class A or B cirrhotics with Pittsburgh Sleep Quality Index >5 were randomized to either zolpidem 5 mg daily (n=26) or placebo (n=26) for 4 weeks. RESULTS: The therapy of 4 weeks was completed by 23 patients receiving zolpidem (3 stopped treatment due to excessive daytime drowsiness) and 24 receiving placebo (2 refused to continue the study). In the zolpidem group, after 4 weeks of therapy, there was significant increase in total sleep time (TST) and sleep efficiency compared to baseline and improvement in polysomnographic parameters of sleep initiation and maintenance (i.e., decrease in sleep latency time, decrease in wake time, and decreases in number of arousals and periodic limbs movements per hour of sleep), without any significant change in sleep architecture. CONCLUSIONS: Four weeks of 5 mg daily zolpidem in CTP class A or B cirrhosis patients with insomnia led to significant increases in TST and sleep efficiency and improvement in polysomnographic parameters of sleep initiation and maintenance without any significant change in sleep architecture.

An Exploration Of Use Of Social Networking Sites Amongst Users With Psychological Problems

Objective: Social Networking Sites (SNS) are gaining popularity across different cultures and age groups with its increasing role in the day-to-day life of its users. Objective of the present investigation is to study the SNS use and its relationship with online and real-life social capital, self-esteem and interpersonal relationships in normal and clinical population. Methods: The sample consisted of 93 participants of the age range 17-37 years, 63 participants from the general population and 30 from the clinical population with a diagnosis of any depressive or anxiety spectrum disorder. The tools used for this study are Basic Data Sheet, the Facebook Intensity Scale, Internet addiction Test, Internet Social Capital Scale. Results: The Rosenberg Self-Esteem Scale and Sentence Completion Test Results show that Facebook use has a positive correlation with online bonding and bridging capital. A significantly higher percentage of participants from the clinical group met the criteria for problem use of the Internet. Compared to average users, problem users of the Internet are found to have higher mean scores for online bridging capital and conflicts in inter-personal relationships and lower mean scores for real life bonding capital and self-esteem. Conclusions: It necessitates an exploration of Facebook's use patterns in routine evaluation and management of clinical conditions and implies the need for further research to develop explanatory models and management strategies for problematic use of the Internet.

Exploration Of Technology Use Pattern Among Teenagers And Its Relationship With Psychological Variables

: Technology use is common among adolescents. It is due to availability, curiosity and as a coping method to manage boredom, fill up free time and for having pleasant experience. The present study aims to explore the pattern of information technology usage among 200 adolescents in the age group of 13-17 years and its impact on psychological distress. Methods: Semi structured interview schedule, Technology addiction survey and Strength and difficulty questionnaire on 200 randomly selected participants. Results: Addictive use of gaming was present for 39 adolescents (19.5%); addictive use of mobile/cell phone was present in 31 adolescents (15.5%) and addictive usage of Internet was present among 36 (18%) of them. It was associated with difficulties in various daily activities such as academics, sports, meeting friends, socializing and emotional difficulties. Conclusions: This study found addictive use of technology devices and social media among adolescents. This Study has implications for screening technology usage pattern among adolescents; its relation with psychological distress and need for development of intervention programme for technology addiction. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.