Real-world utilization pattern of dydrogesterone in 7287 Indian women with obstetric and gynecological conditions: data from multicentric, retrospective study

Abstract Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.

Associations between lifestyle and comorbid anxiety and depression in pregnant women / 环境与职业医学

Background Anxiety and depression are common perinatal mental health issues that often occur together and can have serious negative effects on both maternal and infant health. Objective To examine the relationships between lifestyle factors and comorbid anxiety and depression (CAD) among pregnant women in Shanghai. Methods The study estimated the prevalence of CAD during the first, second, and third trimesters of pregnancy using the Self-rating Anxiety Scale (SAS) and Center for Epidemiological Studies-Depression (CES-D) based on data from the China National Birth Cohort (CNBC) embryonic-derived diseases with assisted reproductive technology (ART) sub-cohort. Information on demographics, sleep status, nutritional intake, and exercise during each trimester was collected through self-made questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and the Food Frequency Questionnaire (FFQ). Lifestyle factors (such as sleep status, nutritional intake, and exercise during each trimester) were analyzed using logistic regression and generalized linear mixed models (GLMM) to determine their impacts on the prevalence of CAD (yes or no) among pregnant women. Results A total of 2876 pregnant women were included in this study. The prevalence of CAD was 10.6% (305), 3.6% (103), and 5.5% (159) in the first, second, and third trimesters of pregnancy, respectively. The logistic regression analysis revealed that poor sleep quality throughout the entire pregnancy were statistically associated with an increased prevalence of CAD, and the odds ratios (OR) with 95% confidence intervals (CI) were 2.817 (1.845, 4.301), 2.840 (1.855, 4.347), and 9.316 (5.835, 14.876) for the first, second, and third trimesters, respectively, when compared to good sleep quality. Additionally, compared to an intake frequency of 7 times per week, the frequency of egg intake ≤3 times per week in the first trimester (OR=2.025, 95%CI: 1.197, 3.425) and the frequency of egg intake of 4–6 times per week (OR=1.896, 95%CI: 1.117, 3.216) or ≤3 times per week (OR=1.906, 95%CI: 1.082, 3.357) in the third trimester were associated with an increased risk of CAD (P<0.05). Moreover, when compared to a frequency of exercise >3 times per week, never or almost never exercising in the second trimester (OR=2.218, 95%CI: 1.220, 4.035) was associated with an increased risk of CAD (P<0.05). The GLMM analysis also demonstrated a significant association between poor sleep quality, lower exercise frequency, or lower intake frequency of vegetables, eggs, or milk and an increased risk of CAD (P<0.05). Conclusion The prevalence of CAD among pregnant women in Shanghai follows a U-shaped distribution, with the highest rate occurring in early pregnancy and the lowest rate in mid-pregnancy. Factors such as poor sleep quality, inadequate intake of vegetables, eggs, or milk, and lack of exercise during pregnancy may increase the risk of CAD. Implementing lifestyle interventions during pregnancy could potentially reduce the risk of mental health problems and improve the overall health of both mothers and babies.

Socio-demographic Correlation among Patients with Deliberate Self-harm

Background: Deliberate self-harm is a complex behavior of maladaptive response to acute and chronic stress, and likely to be suffering from mental health problems as well as co-morbid general medical conditions, including several non-suicidal intentions to suicide. Deliberate self-harm was previously included in suicide. Sir Thomas Browne first used the word ‘Suicide’ in 1642 in his religion Medici. The word suicide originated from SUI (of oneself) & CAEDES (murder). According to WHO ‘Suicide’ refers to the act of killing oneself intentionally, performed by the person with full knowledge or expectation of the fatal outcome. This study aimed to analyze the pattern of psychiatric disorders among patients with deliberate self-harm. This study aimed to analyze the socio-demographic correlation among patients with deliberate self-harm. Material & Methods: This descriptive cross-sectional study was conducted at the Department of Medicine; emergency & OPD, Rangpur Medical College, Rangpur, Bangladesh. The study duration was 1 year; July 2012- June 2013. A total of 116 deliberate self-harm cases were included in this study as per the inclusion criteria. A convenience sampling technique was undertaken in this study. Results: The correlation of age, sex, economic status, religion, educational status, occupation, marital status, family history of mental illness, previous H/O mental illness, previous H/O physical illness, nature of stress factors, and the total number of DSH was significant between psychiatric disorder and co-morbid general medical condition. Conclusion: There was a significant correlation between sociodemographic parameters among the patients with deliberate self-harm. Bangladesh is a country with a cultural heritage of thousands of years. Traditional values, and social and family bonding are the characteristics of the culture. Traditional value systems are being declined gradually due to the influence of western culture. The social structure is in a period of transition that is characterized by the waning of family ties and social support as well as an increase in urbanization and modernization. This factor together with psychiatric and co-morbid general medical conditions plays an important role in deliberate self-harm

Association of Multimorbidity with Health Outcomes in the Chinese Middle-aged and Elderly Population / 中山大学学报(医学科学版)

ObjectiveTo analyze the multimorbidity and comorbid disease patterns among middle-aged and older adults aged 50 years and above in China and to study the prevalence， regional distribution， and relationship with health-related outcomes of major comorbid disease patterns. MethodsThe fourth national follow-up data of the China Health and Retirement Longitudinal Study （CHARLS） 2018 was used， including 13 774 respondents aged 50 years and older from 28 provincial units. We analyzed 14 patient-reported physician-diagnosed chronic diseases and multimorbidity combinations， reported prevalence， composition ratio， and regional distribution. Differences in health loss and risk factors between high morbidity groups were analyzed using chi-square tests and logistic regression. ResultsThe prevalence of multimorbidities among participants was 57.3%. The single disease with high prevalence included arthritis/rheumatism （6.47%）， hypertension （5.41%）， and gastric and digestive disorders （4.17%）； the binary multimorbidity combinations were arthritis + digestive disorders （3.06%）， arthritis + hypertension （2.61%）， and hypertension + hyperlipidemia （1.39%）； the triadic combinations were hypertension + digestive disorders + joint disorders （1.00%）. The prevalence of multimorbidity varied greatly between provinces， showing the characteristics of high in the west and north but low in the east and south China. Significant differences in the health loss caused by different multimorbidity combinations were noted， with the highest ADL loss （28.51%） and depression （77.68%） caused by the arthritis multimorbidity combinations （P<0.01）. The number of chronic diseases （OR=6.71， P<0.01）， age （OR=1.96， P<0.01）， and heavy alcohol consumption were comorbid risk factors for physical and mental health； exercise （OR=0.44， P<0.01） and sleep （OR=0.89， P<0.01） were protective factors for physical and mental health， and smoking cessation （OR=0.76， P<0.01） contributed to the relief of anxiety. ConclusionsThe prevalence of comorbid patterns showed a high clustering trend， and the health loss caused by major patterns varied greatly. Relevant health intervention strategies should prioritize the major multimorbidity combinations for targeted disease management and rehabilitation services.

Acupuncture at "umbilical four-acupoints" for chronic insomnia and its comorbid symptoms / 中国针灸

OBJECTIVE@#To observe the effects of acupuncture at "umbilical four-acupoints" on chronic insomnia and its comorbid symptoms.@*METHODS@#A total of 120 patients with chronic insomnia were randomly divided into an observation group (60 cases, 8 cases dropped off) and a control group (60 cases, 5 cases dropped off). The patients in the observation group were treated with acupuncture at regular acupoints (Baihui [GV 20] and bilateral Shenmen [HT 7], Neiguan [PC 6], Anmian [Extra]) and "umbilical four-acupoints", while the patients in the control group were treated with acupuncture at regular acupoints. Acupuncture was given once a day, 6 times a week, for a total of 3 weeks in the two groups. The Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI) scores were observed before treatment, after treatment and in follow-up of one month after treatment completion; the Beck anxiety inventory (BAI), Beck depression inventory (BDI), fatigue severity scale (FSS), and Epworth sleepiness scale (ESS) scores were observed before and after treatment; the sleep parameters of polysomnography (PSG), including sleep latency (SL), awake-up time (AT), sleep efficiency (SE) and total sleep time (TST), were observed before and after treatment using polysomnography monitor in the two groups.@*RESULTS@#Compared with those before treatment, the PSQI and ISI scores in both groups were reduced after treatment and in follow-up (P<0.05), and the PSQI and ISI scores in the observation group were lower than those in the control group after treatment and in follow-up (P<0.05). Compared with those before treatment, the BAI, BDI, FSS and ESS scores in both groups were reduced after treatment (P<0.05), and the BAI, BDI, FSS and ESS scores in the observation group were lower than those in the control group after treatment (P<0.05). Compared with those before treatment, the SL and AT in both groups were reduced after treatment (P<0.05), while SE and TST were increased after treatment (P<0.05); after treatment, the SL and AT in the observation group were lower than those in the control group (P<0.05), while SE and TST in the observation group were higher than those in the control group (P<0.05).@*CONCLUSION@#On the basis of regular acupoint selection, acupuncture at "umbilical four-acupoints" could improve sleep quality, alleviate the severity of insomnia, and improve the comorbid symptoms i.e. anxiety, depression, fatigue and lethargy in patients with chronic insomnia.

Obstructive Sleep Apnea with Insomnia Overlap: An Under-recognized Entity

Introduction: The association between obstructive sleep apnea (OSA) and insomnia is relatively common but is underrecognized. There are important diagnostic and therapeutic implications of comorbid OSA杋nsomnia overlap but there is no data available from India. Objectives: (1) To find out the prevalence of insomnia among patients with OSA; (2) To compare the demographic characteristics, Epworth sleepiness scale (ESS) scores and the presence of comorbidities among patients of OSA with insomnia vs OSA without insomnia. Materials and methods: It was a prospective observational study involving 250 patients with suspected OSA. A total of 189 patients had OSA based on type I polysomnography and were further analyzed. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Results: The prevalence of insomnia among OSA was 15.34% (29/189). Overlap was seen in 22.45 and 12.86% of women and men respectively among patients with OSA. The prevalence of overlap increased with decreasing severity of obesity and OSA. Those with OSA杋nsomnia overlap had significantly lower ESS scores as compared to OSA without insomnia (12.31 vs 15.24; p = 0.019). A total of 10.34% (3/29) of patients of overlap had depression whereas none from OSA alone had depression. Conclusion: There is a high prevalence of insomnia among patients with OSA (15.34%), similar to findings worldwide. Insomnia is more common among women with OSA. Overlap patients have lower ESS scores and are likely to be depressed.

Sleep hygiene practices in patients with major depression with comorbid insomnia, primary insomnia, and good sleepers / Prácticas de higiene de sueño en pacientes con depresión mayor con insomnio comórbido, insomnio primario y buenos durmientes

Abstract Introduction Inadequate sleep hygiene (SH) is considered factor contributing to insomnia. However, the practice of SH by depressed patients with comorbid insomnia has not been explored. Objective We aimed to compare the practice of SH between patients with major depression, comorbid insomnia, primary insomnia, and good sleepers. Method One hundred and eighty-two adult individuals participated: 62 outpatients with major depressive disorder with comorbid insomnia (MDD), 56 outpatients with primary insomnia (PI), and 64 good sleepers (GS). All participants were assessed with a structured psychiatric interview, an insomnia interview, the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Sleep Hygiene Practice Scale. We compared the practice of SH as a whole and by domains between the groups and the relation between SH practice, insomnia, and sleep quality. Results Patients with PI and MDD showed a significantly worse practice of global SH. In the comparison by SH domains, MDD and PI groups had significantly worse scores than GS in all domains. Individuals with MDD showed a significantly worse practice of sleep schedule and arousal related behaviors than PI group. Although, SH practice was significantly related with insomnia and sleep quality in the whole sample, this association remained significant only in the PI. The arousal-related behaviors domain was the main predictor of insomnia and sleep quality. Discussion and conclusion Although patients with insomnia comorbid with MDD or with PI have a worse SH practice than GS, only arousal-related behaviors and drinking/eating habits contribute significantly to insomnia severity and sleep quality.

Resumen Introducción Una inadecuada higiene de sueño (HS) se considera como un factor que contribuye al insomnio, incluido el insomnio comórbido con trastornos mentales. Sin embargo, no se ha estudiado la práctica de HS en pacientes con depresión e insomnio comórbido. Objetivo Comparar la práctica de HS entre pacientes con depresión mayor con insomnio comórbido, insomnio primario y buenos durmientes. Método Participaron 182 individuos: 62 pacientes ambulatorios con trastorno depresivo mayor con insomnio comórbido (TDM), 56 pacientes con insomnio primario (IP) y 64 buenos durmientes (BD). A todos se les realizó una entrevista psiquiátrica estructurada, una entrevista sobre insomnio, el Índice de Calidad de Sueño de Pittsburgh, el Índice de Severidad de Insomnio y la Escala de Prácticas de Higiene de Sueño. Comparamos la práctica de HS tanto global como por dominios entre los grupos, y la relación entre la práctica de HS, el insomnio y la calidad de sueño. Resultados Los pacientes con IP y con TDM mostraron una práctica global de la HS significativamente peor. En la comparación por dominios, los grupos con TDM e IP alcanzaron peores calificaciones que los BD en todos. La práctica de HS se relacionó significativamente con el insomnio y calidad de sueño en la muestra total, sin embargo, solamente en el grupo con IP se mantuvo significativa. El dominio de conductas relacionadas con el alertamiento fue el principal predictor de insomnio y calidad de sueño. Discusión y conclusión Aunque los pacientes con insomnio comórbido con TDM o con IP tienen peores hábitos de HS que los BD, solamente las conductas relacionadas con el alertamiento y los hábitos de alimentación contribuyen significativamente a la gravedad del insomnio y calidad de sueño.

Experiences of psychiatric nurses caring for mental healthcare users with a comorbid disorder

Background: Caring for mental healthcare users (MHCUs) with a comorbid disorder of human immunodeficiency virus (HIV) and schizophrenia has always been challenging and requires expertise, skill, intuition and empathy. Objectives: The objective of this study was to explore and describe the experiences of psychiatric nurses caring for MHCUs with a comorbid disorder of HIV and schizophrenia. Method: A qualitative, exploratory, descriptive and contextual research design was used. Eight participants were selected through purposive sampling for individual in-depth interviews to collect data. Thematic analysis was used to analyse data. Results: Three themes emerged from this study. The first theme is that the psychiatric nurses experienced deep frustration because they were capable but unable to manage MHCUs with HIV and schizophrenia because of poor infrastructure and other contributing barriers. The second theme identified that the psychiatric nurses experienced discrimination against MHCUs compromising their holistic recovery. Lastly, the psychiatric nurses identified the need for health care workers in general hospitals and communities and families of MHCUs with a comorbid disorder to be educated in mental health issues to ensure continuous medical care. Conclusion: The results of this study showed that psychiatric nurses became exhausted when trying to cope with difficult nursing situations. The challenges they faced had negative consequences for the mental health of the psychiatric nurses and compromised patient care. Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by implementing recommendations to mitigate the challenges of psychiatric nurses caring for MHCUs with HIV and schizophrenia.

A case report on complex Post-Traumatic Stress Disorder and Comorbid Bipolar II Disorder

@#This is a case of a 22-year-old female who presented with labile mood, impulsivity and persistent suicidality. Despite numerous pharmacologic and psychotherapeutic regimens, she only had minimal improvement. Subsequently, she revealed traumatic events in younger years.She has been experiencing recurrent intrusive thoughts, low self-worth, guilt and avoidance behavior. Pharmacotherapeutic management was revised as well as her psychotherapy, which resulted in a positive outcome. However, recurrence occurred after she encountered negative life events. Electroconvulsive therapy and revision of pharmacologic treatment eventually led to significant improvement. This case highlights the importance of underlying psychological trauma that caused persistent symptoms. The intensity of impact and the chronic recurrent negative effect of the trauma on the patient influenced the treatment outcome. It is important to optimize therapeutic management with the use of pharmacologic agents, psychotherapy and somatic therapies.

Mechanism of attention deficit hyperactivity disorder accompanied with obesity in children / 中华实用儿科临床杂志

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children and adolescents, and it is commonly accompanied with other developmental and psychological disorders.The prevalence of obesity in children continues to rise, and it is also a major social public concern that threatens human health.As a somatic comorbidity with ADHD, obesity is characterized by a high incidence.In this paper, the focus would be placed on the underlying mechanisms of ADHD accompanied with obesity from the aspects of genetics, perinatal period, environmental and neurobiological factors, which could provide a theoretical basis and intervention strategies for the early identification, rational treatment and long-term comprehensive management, as well as prevention and treatment effects of ADHD and its comorbidities.

Modelos neuropsicobiológicos para estudo da dor e das emoções / Neuropsychobiological models for the study of pain and emotions / Modelos neuropsicológicos para el estudio del dolor y las emociones

Dor é uma experiência pessoal e subjetiva que pode apenas ser sentida pelo sofredor. A dor aguda tem a finalidade de avisar o indivíduo que algo está errado. Contudo, a dor crônica (DC) é um problema global de saúde, que afeta a qualidade de vida e torna o indivíduo parcial ou totalmente incapacitado. A pesquisa básica utiliza diversos modelos animais para o estudo da dor aguda ou crônica, bem como para o estudo das principais comorbidades oriundas de sua cronificação como a ansiedade e a depressão. Esta revisão aborda os modelos animais mais comumente utilizados neste contexto.

Pain is a personal and subjective experience that can only be felt by the sufferer. Acute pain is intended to warn the individual that something is wrong. However, chronic pain (CP) is a global health problem, affecting the quality of life and making the individual parts or disabled. Basic research uses several animal models for the study of acute or chronic pain, as well as for the study of the main comorbidities arising from their chronicity, such as anxiety and depression. This review focuses on the animal models most commonly used in this context.

El dolor es una experiencia personal y subjetiva que solo puede sentir la víctima. El dolor agudo está destinado a advertir al individuo que algo está mal. Sin embargo, el dolor crónico (EC) es un problema de salud global, que afecta la calidad de vida y hace que el individuo esté parcial o totalmente discapacitado. La investigación básica utiliza varios modelos animales para el estudio del dolor agudo o crónico, así como para el estudio de las principales comorbilidades resultantes de su cronicidad, como la ansiedad y la depresión. Esta revisión se centra en los modelos animales más utilizados en este contexto.

Prevalence of Post Traumatic Stress Disorder among School-age Adolescent

Aim: After a traumatic event, the person can develop post-traumatic stress disorder (PTSD), the purpose of the study is to assess the prevalence of PTSD in adolescents in public middle schools of the prefecture of Salé in Morocco and study anxiety and depression which are the comorbid disorders of the PTSD. The survey was carried out from March to June 2017.Methods: 523 students were selected by the cross-sectional method from fifteen schools that were randomly selected, the age of the students vary between 12 and 17 years. For the survey, standardized questionnaires (the socio-demographic data, the Life Events Checklist, the CPTS-RI (Children's Post Traumatic Stress Reaction Index), the STAIY (State Trait Inventory Anxiety Form Y) and the CDI (Children Depression Inventory) were used which were filled in by the students Results: The prevalence of PTSD was 70.4% in the students who have PTSD. We found that the prevalence in boys was 46.74%, while in girls it was 53.26%. In addition to that, 81% of students found to be anxious and 51.8% of students have depression. Conclusion: There is a high prevalence of post traumatic stress disorder among adolescents, there are practical implications for the support and care of these adolescents

Immunomodulatory effect of Quercetin on dysregulated Th1/Th2 cytokine balance in mice with both type 1 diabetes and allergic asthma

T-helper subtype imbalance is intricate in type 1 diabetes (T1D) and asthma initiation. The role of quercetin in immunedysregulation in comorbid conditions of T1D and asthma is not available. In this study, it was thought worthy toevaluate the role of quercetin on modulating Th1/Th2 cytokine dysregulation in comorbid diabetic asthma. Male Balb/cmice were injected intravenously with alloxan (80 mg/kg) to persuade T1D. Succeeding diabetes introduction, twointraperitoneal sensitizing doses of ovalbumin emulsion (50 µg ovalbumin blended with 2.5 mg alum/sensitization) weregiven on days 3 and 8. Mice were given intranasal challenges of ovalbumin (100 µg ovalbumin/25 µl of sterile saline) ondays 13–15. Oral quercetin treatment (10–30 mg/kg) was given daily on days 3–15. Nasal hyperresponsiveness (NHR)was recorded immediately after Ova challenge on day 16. Bronchoalveolar lavage fluid (BALF), blood, and lungs werecollected 1-hour post NHR for further analysis. Quercetin treatment significantly decreased eosinophils, interleukin-4while increasing interferon-gamma in blood, and BALF and reduced the allergic airway inflammation by inhibitinginflammatory cell infiltration and mucous cell metaplasia. Furthermore, quercetin with a dose of 30 mg/kg demonstrateda significant glucose reduction. Thus, quercetin exerted dose-dependent anti-asthma activity by modulating Th1/Th2balance with glucose-lowering potential in comorbid mice.

Relationship between comorbid factors and mortality of inhalation trauma patients in Wahidin Sudirohusodo Hospital, Makassar

Background: Inhalation trauma is the leading cause of death in burn patients. Inhalation trauma is caused mainly by inhalant poisons such as smoke, gas and steam. Many patients die immediately at the scene due to inhalation trauma. The purpose of this study was to determine the relationship between comorbid factors and mortality rates in patients with inhalation trauma.Methods: The research design was analytical research method with cross sectional design. The study sample consisted of 26 people (51.0%) inhalation trauma and 25 people (49.0%) without inhalation trauma obtained by consecutive sampling.Results: There was a significant relationship between inhalation trauma and death outcomes (p<0.001). The proportion of deaths in inhalation trauma (65.4%) was significantly higher than in nonhaled trauma (16.0%). There was no significant relationship between DM and outcome (p>0.05). There was no significant relationship between hypertension and outcome of death (p>0.05). There is a significant relationship between onset and outcome (p<0.05). The proportion of deaths at <24 hours onset (35.6%) was significantly lower than at onset >24 hours (83.3%). The mean blood glucose level of dead patients was higher than that of alive, which was 124.4 compared to 114.9 but was not statistically significant (p>0.05). Both the mean systole and diastole pressures of the dead patients showed significantly lower results than that of alive, i.e., the mean systole was 101.2 compared to 114.1 (p<0.05) and the mean diastole was 62.2 versus 71.4 (p<0.05).Conclusions: According to the results of the study, it was found that there was a relationship between the onset of more than 24 hours, high GDS levels, and lower blood pressure to mortality.

Mortality profile of confirmed cases of swine flu attending a tertiary care center of Udaipur region of Rajasthan, India

Background: Mortality profile is an analytical tool used to identify the various factors responsible for poor outcome of disease and it can also use to evaluate quality and efficiency of healthcare providers. The aim of this study is to summarise the clinical and epidemiological factors as well as to identify the risk factors associated with mortality among swine flu cases.Methods: It is a cross-sectional, descriptive, hospital-based study conducted on 62 deceased patients due to swine flu reported at Maharana Bhupal Government Hospital, Udaipur, Rajasthan during the outbreak of influenza A H1N1 in the year 2015. A standardized pre-structured questionnaire with consent was filled by help of bed head tickets and by interview of attendants of deceased patients.Results: Deaths were higher among age group of 31-45 years (35.48%). Case fatality rate for male patients (13.88%) was higher. Mortality was highest in females of rural background 27(43.55%). Majority of deceased patients (70.97%) had delay of 4-7 days in admission after onset of symptoms. Diabetes, cardiovascular diseases and pregnancy was the major risk factors for poor outcome.Conclusions: Delay in diagnosis and admission may be the reason for higher mortality rate. The most common co morbid illness was Diabetes mellitus, cardiovascular diseases (Ischemic heart disease, Rheumatic heart disease, Hypertension) and pregnancy.

El efecto de algunos factores sociodemográficos y psicosociales en los síntomas de ansiedad que presenta una muestra de personas con diabetes mellitus tipo 2 en una comunidad del área Oeste de Puerto Rico / The effect of some socio-demographic and psychosocial factors on anxiety symptoms in a sample of type 2 diabetes mellitus patients in a community in the western region of Puerto Rico / O efeito de alguns fatores sociodemográficos e psicossociais nos sintomas de ansiedade que tem um grupo de pacientes com diabetes mellitus tipo 2 em uma comunidade da área oeste do Porto Rico

Resumen Introducción Este estudio pretende hacer un análisis de cómo y por qué la diabetes mellitus tipo 2 afecta psicológicamente a los pacientes. No obstante, somos conscientes del amplio espectro de condiciones mentales que puede desencadenar el padecimiento de esta condición y hemos decidido enfocar esta investigación en la relación existente entre este tipo de diabetes y la ansiedad comórbida. Materiales y Métodos Estudio descriptivo correlacional de corte transversal. Se utilizó un cuestionario semiestructurado y validado internacionalmente para medir la ansiedad y el análisis estadístico de regresión múltiple. Resultados Nuestra muestra estuvo compuesta por sesentaicinco pacientes diagnosticados con la condición en el área oeste de Puerto Rico. Los resultados revelaron que la edad (p = .014) y la actividad física (p = .031) tienen efectos significativos sobre los síntomas de ansiedad. Discusión La ansiedad en pacientes de diabetes mellitus tipo 2 pudiera estar influenciada por otras variables intervinientes y moderadoras. Conclusiones Los profesionales de enfermería al momento de controlar los síntomas de ansiedad en el paciente diabético debe considerar la importancia del entorno y el contexto cultural y psicosocial en la atención del cuidado holístico.

Abstract Introduction This study aims to analyze how and why type 2 diabetes mellitus affects patients psychologically. However, we are aware of the broad spectrum of mental conditions that can trigger this condition and have decided to focus this research on the relationship between this type of diabetes and comorbid anxiety. Materials and Methods A descriptive, correlational, cross-sectional study was conducted. A semi-structured and internationally validated questionnaire was used to measure anxiety and statistical multiple regression analysis. Results Our sample was composed of sixty-five patients diagnosed with this condition in the western area of Puerto Rico. The results revealed that age (p =.014) and physical activity (p =.031) have significant effects on anxiety symptoms. Discussion Anxiety in type 2 diabetes mellitus patients may be influenced by other intervening and moderating variables. Conclusions Nursing professionals in managing anxiety symptoms in the diabetic patient should consider the importance of the environment and the cultural and psychosocial context in the holistic care.

Resumo Introdução Esta pesquisa pretende fazer uma análise de como e porque a diabetes mellitus tipo 2 afeta psicologicamente os pacientes. No entanto, somos conscientes do amplo espectro de condições mentais que podem ser desencadeadas por esta doença, por isso decidimos abordar nesta pesquisa a relação entre ela e a comorbidade na ansiedade. Materiais e Métodos Pesquisa descritiva correlacional de tipo transversal. Foi utilizado um questionário semiestruturado e validado internacionalmente para medir a ansiedade e a análise estatística de regressão múltipla. Resultados Nossa amostra esteve constituída por sessenta e cinco pacientes com o diagnóstico da condição exposta anteriormente na área oeste do Porto Rico. Os resultados revelaram que a idade (p= .014) e a atividade física .031) têm efeitos significativos em relação aos sintomas de ansiedade. Discussão A ansiedade em pacientes com diabetes mellitus tipo 2 poderia ser influenciada por outras variantes que intervêm e que a moderam. Conclusões Os profissionais da enfermagem, quando controlam os sintomas de ansiedade no paciente diabético, devem levar em conta a importância do entorno e do contexto cultural e psicossocial quando o paciente estiver recebendo um cuidado holístico.

Markers of alcohol use disorder-its impact on the comorbid diseases and outcomes in patients admitted into tertiary care hospital

Background: The treatment for medical complications of alcohol misuse has been restricted by primary care providers recently by referring patients to specialized alcohol treatment. Aim: The proposed study aimed to identify the patients with alcohol use disorder and estimation of selected biomarkers like Gamma-glutamyl transferase (GGT) and Carbohydrate-deficient transferrin (CDT) in selected patients with objective of comparing its impact on co-morbid condition, assessment of its outcomes in selected patients. Materials and Methods: This was a multi-arm observational, interventional study, in which patients of alcohol use disorder were selected as the study population. This study was conducted in Department of General Medicine, Mahatma Gandhi Memorial Hospital, Warangal, Telangana. Results: In alcoholic patients, age in years was 55.1±8.5 and in non-alcoholic patients’ age in years was 58.4±11.6, in alcoholic patients males were 50% and females were 5% and in non-alcoholic patients, males were 40% and females were 4%. In hepatic encephalopathetic alcoholic patients 40% was seen and in hepatic encephalopathetic non-alcoholic patients, 36% was seen. In the alcoholic patients, Ascitis was observed in 49% and 48% of the non-alcoholic patients. 48% of the alcoholic patients had upper gastro-intestinal bleeding and it was 3% in non-alcoholic patients. Conclusion: The heavy use of alcohol prevalence was very high and was associated with poor prognosis in hospitalised patients which further increased the risk of infection and death.

Comparison of comorbidities between rheumatoid and psoriatic arthritis in a tertiary care rheumatic center

Introduction: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have key differences in clinical presentation, radiographic findings, comorbidities and pathogenesis to distinguish between these common forms of chronic inflammatory arthritis Joint involvement is typically, but not always, asymmetric in PsA, while it is predominantly symmetric in RA Bone erosions, without new bone growth, and cervical spine involvement are distinctive of RA, while axial spine involvement, psoriasis, and nail dystrophy are distinctive of PsA Aim of the study: To Compares the comorbidities between Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PSA) Materials and methods: This was a prospective observational study conducted for a period of 6 months at Institute of Rheumatology, Government KAPV Medical College and MGM Government Hospital Totally 241 patients who were fulfilling inclusion criteria has been included Patients diagnosed with and treated for PsA on the basis of clinical, radiological and laboratory findings and expert opinion was monitored using standardized examination methods and jointly prepared forms Clinical status, accompanying systemic diseases and surgical history was recorded Routine clinical examination and basic comorbid findings have been assessed by standardized methods

Clinical Factors Related to the Response of IV Ferric Carboxymaltose Treatment in Patients with Restless Legs Syndrome

OBJECTIVES: Significant benefit of intravenous ferric carboxymaltose (FCM) for restless legs syndrome (RLS) has been demonstrated. However, clinical indicators to expect treatment response of RLS are not clarified. The aim of this study is to find out determinant factors to predict treatment outcome of FCM. METHODS: We enrolled consecutive 108 patients with RLS who visited sleep clinic and received FCM from April 2016 to November 2017. Obtained data were detailed history including international restless legs scale (IRLS) and questionnaires, comorbid diseases, medication. Complete blood cell count, serum iron, ferritin, and total iron-binding capacity were sampled before and after treatment. Treatment response was assessed about four weeks after FCM administration. Patients with more than 40% decrease on IRLS were classified into the responders. RESULTS: 99 patients (mean 54.5 y and 79 females) were included. 58 patients (58.6%) were classified to be responders. There were substantial differences in post-treatment IRLS and symptom reduction rate between responders (7.4±6.4, 77.5±18.6%) and non-responders (29.7±8.7, 7.4±10.3%). No significant differences were found in demographics, baseline IRLS, sleep, and mood status between two groups. Serum ferritin and transferrin saturation was significantly lower in responders (37.6 ng/mL, 25.0%) than non-responders (55.1 ng/mL, p=0.014 and 36.5%, p=0.001). Patients with a history of gastrectomy (n=8) showed an excellent response to FCM (83.8% of symptom reduction). Comorbid lumbosacral radiculopathy had lower response rate (29.4%). CONCLUSIONS: Peripheral iron compromised state and gastrectomy history may indicate good response to intravenous FCM in patients with RLS. Patients with lumbosacral radiculopathy tend to be poor responders to intravenous FCM.

Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population

OBJECTIVE: This study aimed to investigate the longitudinal effects of anxiety, depression, and their comorbidity on physical disorders and disability in an elderly Korean population. METHODS: In total, 1,204 community-dwelling elders were evaluated at baseline, and of these 909 (75%) were re-assessed two years later. Anxiety and depression were identified at baseline using questions from the community version of the Geriatric Mental State diagnostic schedule (GMS-B3). Participants were assessed for functional disability and for 11 physical disorders both at baseline and at follow-up. RESULTS: Anxiety alone was associated with the incidence of heart disease, depression alone with the incidence of asthma, and comorbid anxiety and depression with incidence of eyesight problem, persistent cough, asthma, hypertension, heart disease, and gastrointestinal problems. Comorbid anxiety and depression were associated with an increase in the number of physical disorders and the degree of disability during the two-year follow-up, compared to anxiety or depression alone or the absence of anxiety or depression. CONCLUSION: Anxiety, depression, and particularly their comorbidity should be assessed in the elderly population considering their longitudinal effects on physical disorders and disability. Future study is required to determine whether interventions aimed at these disorders can mitigate their impacts.