Nevin Manimala

Sci Rep. 2022 Sep 28;12(1):16207. doi: 10.1038/s41598-022-20550-8.

ABSTRACT

In studies evaluating the association between body mass index (BMI) and risk of tuberculosis (TB), the data for the underweight population has been limited and results were conflicting. Our study aimed to evaluate whether being underweight increases the risk of TB using a nationwide representative sample from the Republic of Korea. A large population-based cohort study of over ten million subjects who participated in the health screening in 2010 was performed using the Korean National Health Insurance database 2010-2017. We evaluated the incidence and risk of TB by BMI category (kg/m²) for Asians using a multivariable Cox regression model, adjusting for age, sex, smoking, alcohol consumption, regular exercise, low-income state, and underlying hypertension, diabetes mellitus, and dyslipidemia. To evaluate the association between BMI and TB risk, the underweight population was further subdivided according to the degree of thinness. During 70,063,154.3 person-years of follow-up, 52,615 of 11,135,332 individuals developed active TB with an incidence of 0.75 per 1000 person-years. Overall, there was a log-linear inverse relationship between TB incidence and BMI, within the BMI range of 15-30 kg/m² (R² = 0.95). The estimated adjusted hazard ratio (HR) for incident TB in the underweight population (BMI < 18.5) was 2.08 (95% confidence intervals, CI 2.02-2.15), overweight (23 ≤ BMI < 25) was 0.56 (0.55-0.58) and obese (BMI ≥ 25) was 0.40 (0.39-0.41) relative to the normal weight population. Among the underweight population, TB risk increased as the degree of thinness increased (adjusted HR = 1.98, 1.91-2.05; 2.50, 2.33-2.68; and 2.83, 2.55-3.15, for mild, moderate and severe thinness, respectively) (p for trend < 0.001). We found a significant inverse relationship between BMI and TB incidence, which was especially profound in the underweight population. Public health strategies to screen TB more actively in the underweight population and improve their weight status may help reduce the burden of TB.

PMID:36171396 | DOI:10.1038/s41598-022-20550-8

Sci Rep. 2022 Sep 28;12(1):16202. doi: 10.1038/s41598-022-20319-z.

ABSTRACT

We aimed to identify prognostic factors of cancer-specific survival (CSS) in non-metastatic castration-resistant prostate cancer (M0CRPC) patients. The final analysis of this retrospective cohort included 82 patients who were diagnosed as M0CRPC between 1998 and 2018 at the University of Tokyo Hospital. CRPC was defined as prostate-specific antigen (PSA) progression (increased PSA ≥ 25% and ≥ 2 ng/mL above the nadir or detection of a metastatic lesion). The median value of age and PSA at the time of CRPC were 76 (range 55-94) years and 2.84 (range 2.04-22.5) ng/mL, respectively. The median follow-up time from CRPC diagnosis was 38 (range 3-188) months. The prognostic factors of CSS were ‘PSA doubling time (PSADT) ≤ 3 months’, ‘time to CRPC diagnosis from the start of androgen deprivation therapy (TTCRPC) ≤ 12 months’, of which TTCRPC was a novel risk factor of CSS. In the multivariate analysis, ‘PSADT ≤ 3 months’ and TTCRPC ≤ 12 months’ remained as statistically significant predictors of CSS. Novel risk stratification was developed based on the number of these risk factors. The high-risk group showed a hazard ratio of 4.416 (95% confidence interval 1.701-11.47, C-index = 0.727).

PMID:36171391 | DOI:10.1038/s41598-022-20319-z

World J Surg. 2022 Sep 28. doi: 10.1007/s00268-022-06763-y. Online ahead of print.

ABSTRACT

BACKGROUND: Major abdominal emergency surgery (MAES) has a high risk of postoperative mortality and a high complication rate. The aim of this study was to evaluate whether the implementation of a perioperative care bundle reduced long-term mortality and the Comprehensive Complication Index (CCI) after MAES.

METHODS: This study was a single-centre retrospective cohort study. Data in the intervention group were collected prospectively and compared with a historical cohort from the same centre. It includes adult patients undergoing MAES. We implemented a care bundle under the name Abdominal Surgery Acute Protocol (ASAP). We initiated fast-track initiatives and standardised optimised care in before, during and after surgery. Data were analysed using survival analysis and multiple regression.

RESULTS: We included 120 patients in the intervention cohort and 258 in the historical cohort. The one-year mortality rate was 21.7% in the intervention cohort compared to 28.3% in the standard care cohort. Adjusted odds ratio of one-year mortality 0.81 (CI95% 0.41-1.56). The 30-day mortality was lowered from 19.0 to 6.7% (p = 0.003). The CCI in the intervention cohort was 8.7 (IQR 0-34) compared to 21 (IQR 0-36) in the control cohort (p = 0.932) The length of stay increased by two days (p = 0.021). Most cases had 71-80% protocol compliance.

CONCLUSION: Implementing bundle care in major abdominal emergency surgery lowered the 30-day postoperative mortality. The difference in mortality was preserved over time although not significant after one year. The changes in the Comprehensive Complication Index were not statistically significant.

PMID:36171351 | DOI:10.1007/s00268-022-06763-y

Psychiatr Danub. 2022 Sep;34(Suppl 8):256-261.

ABSTRACT

BACKGROUND: Up to 45% of ischemic strokes are cryptogenic, which is an impediment to proposing preventative measures. In this investigation we aimed to study underlying heart arrhythmias in patients with cryptogenic stroke, taking into consideration the context of the COVID-19 pandemic and stressful lockdown conditions.

SUBJECTS AND METHODS: In this cross-sectional study we observed 52 patients with cryptogenic stroke >1 month after acute presentation, and a control group consisting of 88 patients without stroke. All patients undewent the laboratory and instrumental investigation consisting of the following: lipid spectrum; hemostasiograms; hemoglobin A1c; transthoracic or/and transesophageal echocardiography; 24-hours monitoring of ECG; computer tomography or magnetic resonance imaging of the brain. We studied the hemodynamics of the common carotid arteries using Doppler ultrasound imaging and digital sphygmography (SG).

RESULTS: The groups were indentical with respect to the preponderance of study parameters (sex, age, comorbidities, instrumental and laboratory data). The ischemic stroke group had a statistically significant difference in the prevalence of the first type of extrasystolic arrhythmia according to our gradation of extrasystoles, which are ventricular systoles of extrasystolic contraction appearing before the transmitral blood flow peak (peak E in echocardiography). We observed that earlier ventricular systoles of extrasystole in the cardiac cycle predicted for greater growth of hemodynamic and kinetic parameters. Calculating the indices of a four-field table established the significant relationship between the moment of appearance of extrasystolic ventricular contraction in the cardiac cycle and the risk for cryptogenic stroke (normalized value of the Pearson coefficient (C`) of the two paramaters was 0.318).

CONCLUSIONS: Extrasystolic arrhythmia appeared as an additional risk factor of earlier stroke. The most dangerous type of arrhythmia was when the ventricular contraction of the extrasystole appeared before the transmitral blood flow peak in the cardiac cycle. This observation could present a risk-marker for brain-related cardiovascular complications such as stroke, which might be patients suffering from different internal diseases, especially in the context of environmental stress conditions of the current pandemic and its related lockdown measures.

PMID:36170739

Psychiatr Danub. 2022 Sep;34(Suppl 8):238-245.

ABSTRACT

BACKGROUND: The stigmatization by healthcare professionals (HP) of patients suffering from mental disorders is an important problem that interferes with the delivery of medical assistance. Social distancing by HP is an integral part of stigmatization, which differs between various mental disorders, as well as between psychiatrists (PSY) versus nonpsychiatrist healthcare professionals (NPHP).

SUBJECTS AND METHODS: The study included 141 HP: PSY (n=20; 36.2±4.2 y.o.) and NPHP (n=121; 25.9±2.2 y.o.). The NPHP group included general practitioners (GP)/physicians (n=29; 20.6%), surgeons (n=19; 13.5%), obstetrician-gynecologists (n=26; 18.4%), neurologists (n=11; 7.8%), pediatricians (n=6; 4.3%), and other subspecialists (including urologists, tuberculosis specialists, ophthalmologists and dermatologists) (n=30; 21.3%). The modified Bogardus Social Distance Self-Assessment Scale (BSDS) was used to evaluate the indicators of social distance phenomena. The assessment was performed by HP for the following groups of patients with the following mental disorders: alcohol use disorder, bipolar disorder, depression, drug addiction, epilepsy, mental retardation, personality disorder, schizophrenia. All statistical calculations were performed using IBM SPSS-27 software (IBM Corp. 2021, licensed to Samara State Medical University). P-value ≤0.05 was determined as significant for the between-group (PSY vs NPHP) comparisons using a nonparametric Mann-Whitney U-test.

RESULTS: Our data analysis showed that HP achieved varying social distance scores for patients depending on the type of mental disorder, but with common trends among PSY and NPHPs. The mean (SD) scores of social distance ranged from 3.65(1.50) for depression to 5.25 (1.74) for drug addiction in the PSY, versus 3.44 (1.69), 6.19 (1.37) in NPHP, respectively. As compared to PSY, mean BSDS total scores were greater in the NPHP group, notably in the obstetricians-gynecologist – 6.27(1.40), and GP – 6.62 (0.90) groups, with similar trends of differing attitudes appeared among pediatricians – 7.00 (0.01) – regarding drug addiction, whereas the neurologists demonstrated a tendency towards lower social distance in relation to patients with depression – 2.27 (1.68), and epilepsy – 2.82 (1.47).

CONCLUSIONS: Social distance measures by PSY and NPHP groups in contemporary Russia were highest in relation to patients with drug addiction, and lowest scores for depression and epilepsy. Stigmatization among HPs seems to influence health care delivery to certain categories of patients, which calls for further investigation. Higher social distance scores for patients with drug addiction might be related to higher stigma and lack of compassion toward these patients. Conversely, lower scores of social distance and corresponding emotional acceptance of people with depression by HP might interfere in the timely diagnosis and availability of appropriate care at an early stage amenable to treatment. This might reflect the cultural context of depressive mentality in Russia, or elevated prevalence of depressive states among HP. We propose interventions aiming to destigmatize mental disorders by targeting particular subgroups of vulnerable patients and also certain representatives of HP community.

PMID:36170737

Psychiatr Danub. 2022 Sep;34(Suppl 8):231-235.

ABSTRACT

BACKGROUND: “Teen dating violence” is a poorly studied issue in the literature. Several sociodemographic and psychiatric risk factors have been identified in the literature, and the consequences are numerous. The aim of this mixed study is to establish an initial inventory of the problem in French-speaking Belgium, to establish links with the socio-demographic and overall health characteristics of the population, and to issue recommendations for the future.

SUBJECTS AND METHODS: A study by questionnaire was conducted among 103 young people aged between 14 and 18 living in French-speaking Belgium and speaking French in particular. Qualitative and quantitative (descriptive and inferential statistics) analyses were performed.

RESULTS: 29.1% of respondents experienced violence. Significant links exist between the fact of having experienced violence and consumption as well as the presence of STDs. The combination of potential risk factors predicts a considerable part of the violence in the sample. A significant link exists between the fact of being subjected to violence and a high score on the scale of depression and violence suffered and committed.

CONCLUSION: The prevalence of teen dating violence is relatively high in Belgium. A link between these and a large part of the potential consequences studied could be highlighted through the study.

PMID:36170735

Psychiatr Danub. 2022 Sep;34(Suppl 8):220-230.

ABSTRACT

The impact of diagnostic delay in mental health is significant in terms of neurocognitive impairment, comorbidities, prognostic and socio-economical cost. For this reason, diagnostical research in psychiatry and the classification methods are continuously questioned. The network theory of mental disorders aims at contributing to the improvement of psychiatric diagnosis and considers mental disorders as the results of complex sets of interactions among symptoms instead of being their common cause. In this study, we use network theory and its associate statistical methods, namely Gaussian Graphical Models, centrality, and cluster analysis, to estimate respectively the interactions among symptoms from different disorders, their relative importance, and how they overlap, in a sample of psychiatric inpatients. The community detection found nine clusters with their interactions. Many are closely related to DSM criteria but some of them share symptoms from both diagnostics. One central symptom of the construct is Insomnia. There was a significant difference in the sum scores for psychotic symptoms, but not for bipolar symptoms, across psychotic and bipolar patients. This study needs however to be replicated in a bigger sample of different patients. Computing Bayesian Network to assess causalities in the network and adding other variables (such as biomarkers or therapeutic responses) could contribute to a more personalized diagnostic. How symptoms connect to each other in a specific time frame would define a person phenotype. Network analysis allows for investigating connections, identifying which symptoms are relatively important to the self-determination of disorders as well as how network nodes predict each other and arise in communities. For instance, in psychotic and mood disorders, sleep related symptoms or altered speech features and the importance of their communities in the probable transfer of symptomatology.

PMID:36170734

Psychiatr Danub. 2022 Sep;34(Suppl 8):207-213.

ABSTRACT

The Levenson Self-Report Psychopathy Scale (LSRPS) is a psychometric tool composed of 26 items to assess psychopathic traits. This study aims to perform a network analysis of this scale in a large sample composed of 100 hospitalized psychiatric patients and 256 French-speaking Belgian university students in medicine and to compare the network structure. We estimated a regularized partial correlation network for the 26 items of the questionnaire. Node predictability is used to assess the connectivity of items. The network comparison test (NCT) and statistical inference on sum scores are conducted to compare networks from the inpatients and the university students. The networks composed of LSRPS are mostly connected positively, but some negative interconnections were observed in both inpatients and university students, and node connectivity varies. Although the scores from inpatients are substantially higher than those of university students, network analysis didn’t show any statistical difference in the overall connectedness. Network analysis is a valuable tool for exploring psychopathic traits and offers new insight into how they interact. In the network estimation, we concluded that the two domains of psychopathy are interrelated. This interconnectivity was observed in both subject groups. We hypothesize that such interconnectivity was present because environmental and genetic factors are intricately intertwined in the appearance of primary and secondary psychopathy. Meanwhile, although inpatients may have higher scores of psychopathic traits, those traits’ connectedness isn’t different from that of the general population. This finding aligns well with the theory of hysteresis in network analysis, which states that the connections among components of mental disorders do not disappear or reappear over time, but their importance may vary. Further studies may replicate our findings using different sample groups.

PMID:36170732

Psychiatr Danub. 2022 Sep;34(Suppl 8):100-104.

ABSTRACT

Alterations in the metabolic profile are one of the main consequences of the use of drug therapies in psychiatric patients. In particular, dysfunction of the metabolic profile (lipid and glycidic) is very frequent in patients taking antipsychotics, especially second-generation ones, and antidepressants. Similar alterations, albeit, to a lesser extent, were highlighted with the use of mood stabilizers. There are some clinical conditions in which clinicians add antipsychotics and mood stabilizers. Our study analyzed this interaction in 116 inpatients. Data showed an overall increase in metabolic parameters in all patients analyzed. However, no statistically significant differences were found in some subgroups of patients. The correlation between metabolic alterations and cognitive dysfunctions in these patients was also analyzed (not statistically significant).

PMID:36170711

Psychiatr Danub. 2022 Sep;34(Suppl 8):96-99.

ABSTRACT

BACKGROUND: In March 2020, the Belgian population was exposed to a confinement situation that it had never experienced before associated with the collapse in access to psychiatric care. Initially, only emergencies and constrained care continued to operate. In these specific circumstances, where both the overall population and the psychiatric population, was exposed to unique stress factors, what was the role of forced psychiatric internments in the treatment of mood disorders?

SUBJECTS AND METHODS: We have measured the number of detentions for observation with and without suicide attempt over the two years prior to the pandemic in order to obtain theoretical reference values. We have compared these values with the measures over the 12 months following the start of the confinement period, which constitute the Crisis values. The continuation of measures, with an equal number of observation measures, constituted the Post-Crisis values. For these same cases, we compared in suicide attempt cases, whether the criteria for Severe Major Depressive Disorder were met or not. Lastly we compared the number of observation measures that were lifted, or not, within ten days of patient care.

RESULTS: There was no significant increase in Detentions for Observation following a suicide attempt during the Crisis period. However a significant increase was observed during the Post-Crisis period. As regards cases of attempted suicide during the Crisis period, the number of patients suffering from Major Depressive Disorders reduced significantly in terms of statistics. This confirms our impression of a change in population. The Post-Crisis values dropped to the Theoric values. The number of Observation measures lifted increased quite significantly during the Crisis period, while there was a return to values in terms of statistics similar to the Theoric values during the Post-Crisis period.

CONCLUSIONS: Although the population, both the healthy population and those suffering from a psychiatric condition, was subject to stress that it had never before experienced coinciding with a collapse of healthcare provision, there was no increase in patients meeting the criteria to benefit from constrained care during the Crisis period. On the other hand, there was a significant change in statistical terms in the population of patients who attempted suicide. We have seen a collapse in the number of patients suffering from depressive disorders and an equivalent increase in the number of patients with personality disorders or adjustment disorders. The number of Observation measures lifted during the Crisis period also grew quite significantly. Constrained care was available to help manage reactive suicide attempts. All other things being equal, they indirectly showed a reduction in Major Depressive Disorders requiring constrained care in the population.

PMID:36170710