Transdiagnostic Symptom Subtypes to Predict Response to Therapeutic Transcranial Magnetic Stimulation in Major Depressive Disorder and Posttraumatic Stress Disorder.

The diagnostic categories in psychiatry often encompass heterogeneous symptom profiles associated with differences in the underlying etiology, pathogenesis and prognosis. Prior work demonstrated that some of this heterogeneity can be quantified though dimensional analysis of the Depression Anxiety Stress Scale (DASS), yielding unique transdiagnostic symptom subtypes. This study investigated whether classifying patients according to these symptom profiles would have prognostic value for the treatment response to therapeutic transcranial magnetic stimulation (TMS) in comorbid major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). A linear discriminant model was constructed using a simulation dataset to classify 35 participants into one of the following six pre-defined symptom profiles: Normative Mood, Tension, Anxious Arousal, Generalized Anxiety, Anhedonia and Melancholia. Clinical outcomes with TMS across MDD and PTSD were assessed. All six symptom profiles were present. After TMS, participants with anxious arousal were less likely to achieve MDD remission compared to other subtypes (FET, odds ratio 0.16, p = 0.034), exhibited poorer PTSD symptom reduction (21% vs. 46%; t (33) = 2.025, p = 0.051) and were less likely to complete TMS (FET, odds ratio 0.066, p = 0.011). These results offer preliminary evidence that classifying individuals according to these transdiagnostic symptom profiles may offer a simple method to inform TMS treatment decisions.

Sutureless Tragal Cartilage Island Tympanoplasty: Our Experience.

To evaluate graft take up and hearing improvement using the technique of tragal cartilage island in COM-mucosal type. Prospective study. A total of 258 type 1 tympanoplasty surgeries were done using tragal cartilage island graft from December 2013, to December 2015; in Jubilee Mission Medical College and Research Institute with a follow up of 1 year. Inclusion criteria-all the patients undergoing type 1 tympanoplasty for chronic otitis media (mucosal type, inactive) with an intact ossicular chain by the senior author. The youngest patient was 6 years old and the oldest was 64 years. This pattern was selected for getting a uniform pattern even though cartilage tympanoplasty can be done in other forms of COM also. Graft take up in our study was found to be 96.12% in 1 year of follow up. Closure of tympanic membrane was achieved in 248 of 258 cases. None of the patients showed retraction pockets or cholesteatoma during follow up. The average pre-op AB gap was 21.62 dB which was lowered to 4.22 dB post op. The mean gain in hearing was 17.37 dB. It is worthwhile to consider tragal cartilage island graft as an alternative to temporalis fascia.

Prevalence and characteristics of cigarillo smoking in Canada: results from the Canadian Tobacco Use Monitoring Survey.

OBJECTIVES: Cigarillo smoking has been associated with many adverse outcomes; however, little is known about its use in Canada. The aim of this study was to assess the prevalence and characteristics of ever and the current use of cigarillo in Canada. STUDY DESIGN: This study was a cross-sectional study. METHODS: This study was a secondary data analysis of the 2012 cycle of the Canadian Tobacco Use Monitoring Survey collected by Statistics Canada, examining tobacco use among Canadians aged 15 years or older in all 10 provinces. The two main outcomes of the present study were 'ever use' and 'current use' of cigarillos. Covariates examined included the following: demographic factors, socio-economic factors, and smoking-related factors. RESULTS: The overall prevalence of ever and current cigarillo smoking were 38.4% and 3.1%, respectively. Factors that had the highest association with cigarillo smoking included being a male and being young. Cigarette and marijuana use were also associated with increased use of cigarillo. Specifically, marijuana users were at two-fold increase of the current cigarillo smoking (odds ratio = 2.18, 95% confidence interval: 1.97-2.41). CONCLUSIONS: This study highlights the importance of correcting public perception about cigarillos and directing government resources to prevent an increase in their use.

Transdiagnostic Symptom Clusters and Associations With Brain, Behavior, and Daily Function in Mood, Anxiety, and Trauma Disorders.

Importance: The symptoms that define mood, anxiety, and trauma disorders are highly overlapping across disorders and heterogeneous within disorders. It is unknown whether coherent subtypes exist that span multiple diagnoses and are expressed functionally (in underlying cognition and brain function) and clinically (in daily function). The identification of cohesive subtypes would help disentangle the symptom overlap in our current diagnoses and serve as a tool for tailoring treatment choices. Objective: To propose and demonstrate 1 approach for identifying subtypes within a transdiagnostic sample. Design, Setting, and Participants: This cross-sectional study analyzed data from the Brain Research and Integrative Neuroscience Network Foundation Database that had been collected at the University of Sydney and University of Adelaide between 2006 and 2010 and replicated at Stanford University between 2013 and 2017. The study included 420 individuals with a primary diagnosis of major depressive disorder (n = 100), panic disorder (n = 53), posttraumatic stress disorder (n = 47), or no disorder (healthy control participants) (n = 220). Data were analyzed between October 2016 and October 2017. Main Outcomes and Measures: We followed a data-driven approach to achieve the primary study outcome of identifying transdiagnostic subtypes. First, machine learning with a hierarchical clustering algorithm was implemented to classify participants based on self-reported negative mood, anxiety, and stress symptoms. Second, the robustness and generalizability of the subtypes were tested in an independent sample. Third, we assessed whether symptom subtypes were expressed at behavioral and physiological levels of functioning. Fourth, we evaluated the clinically meaningful differences in functional capacity of the subtypes. Findings were interpreted relative to a complementary diagnostic frame of reference. Results: Four hundred twenty participants with a mean (SD) age of 39.8 (14.1) years were included in the final analysis; 256 (61.0%) were female. We identified 6 distinct subtypes characterized by tension (n=81; 19%), anxious arousal (n=55; 13%), general anxiety (n=38; 9%), anhedonia (n=29; 7%), melancholia (n=37; 9%), and normative mood (n=180; 43%), and these subtypes were replicated in an independent sample. Subtypes were expressed through differences in cognitive control (F5,383 = 5.13, P < .001, ηp2 = 0.063), working memory (F5,401 = 3.29, P = .006, ηp2 = 0.039), electroencephalography-recorded ß power in a resting paradigm (F5,357 = 3.84, P = .002, ηp2 = 0.051), electroencephalography-recorded ß power in an emotional paradigm (F5,365 = 3.56, P = .004, ηp2 = 0.047), social functional capacity (F5,414 = 21.33, P < .001, ηp2 = 0.205), and emotional resilience (F5,376 = 15.10, P < .001, ηp2 = 0.171). Conclusions and Relevance: These findings offer a data-driven framework for identifying robust subtypes that signify specific, coherent, meaningful associations between symptoms, behavior, brain function, and observable real-world function, and that cut across DSM-IV-defined diagnoses of major depressive disorder, panic disorder, and posttraumatic stress disorder.

Prevalence and characteristics of water-pipe smoking in Canada: results from the Canadian Tobacco Use Monitoring Survey.

OBJECTIVES: To investigate the prevalence and characteristics of water-pipe smoking (WPS) nationally in Canada. STUDY DESIGN: This study was a cross-sectional study. METHODS: Data from the Canadian Tobacco Use Monitoring Survey 2011 and 2012 was used. Outcomes investigated were ever and current WPS. Demographic, socio-economic and smoking-related variables were included in a multivariable logistic regression model to determine associations with the outcomes. RESULTS: Prevalence of WPS was 8.9% for ever and 0.8% for current WPS (1.8% among <18 years old and 4.0% among 18-24 years old). The highest prevalence of ever WPS was in Quebec (11.3%) and of current WPS in Alberta (1.2%). Age was the strongest predictor for WPS with an odds ratio = 47.86, 95% confidence interval: 37.97-60.33 for current WPS for those aged <18 years compared to 35 + years. Male gender, urban residence, being single, speaking another language at home (not English/French), higher education, cigarette smoking and marijuana use were also significantly associated with increased WPS. CONCLUSIONS: Multiple factors impact WPS, with the younger population having the highest prevalence. This necessitates further research into the attitudes of this age group to better focus health promotion efforts.

Phenolic water pollutants in a Malaysian River basin.

Phenolic chemicals with their very low taste and odour thresholds, high persistence and toxicity, are of growing concern as water pollutants. The compounds are known to exist in raw water as well as in treated water. The level of phenolic priority pollutants in water within the catchment area of the Linggi River Treatment Plant in Negeri Sembilan, Malaysia, which includes the Linggi river basin, was monitored. The 4-aminoantipyrin colourimetric method was used to determine total phenols whereas capillary column gas chromatography was used to determine the individual compounds. The results show that at most sampling stations, particularly those within the Seremban municipality, the level of phenols was found to exceed the recommended Malaysian standard of 2.0 µg/L(-1) for raw water. This is seen as the direct impact of industrial and urbanization of the area and clearly indicates the unhealthy state of the Linggi river. The results also indicate the need to improve the water quality if the river is going to be used as a source of raw water.