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Efficacy of automatic pupillometry as a screening technique to detect autonomic dysfunction in bipolar disorder

Clin Exp Optom. 2022 Nov 27:1-5. doi: 10.1080/08164622.2022.2145182. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Autonomic nervous system abnormalities in the pathophysiology of bipolar disorder are controversial. Pupillary features may be affected as a result of autonomic nervous system abnormalities in bipolar disorder. Small changes in pupillary responses may not be noticeable on clinical examination. Automated pupillemetries can be helpful in demonstrating these changes reliably and quantitatively.

BACKGROUND: The aim of this study was to compare the static and dynamic pupillary responses of bipolar patients with healthy controls. In addition, pupillary response differences between mania, depression and remission stages were investigated.

METHODS: The bipolar patient group consisted of 39 eyes of 39 patients with 13 patients in each of the stages: mania, depression and remission. The control group consisted of 39 eyes of 39 healthy volunteers. After the ophthalmic examination, static and dynamic pupillometry measurements were made. The mean pupil dilatation speed was calculated according to dynamic measurements. Static pupillometry measurements including scotopic, mesopic and photopic pupil diameters; the first dynamic measurements at 0th second and pupillary dilatation speed were used for statistical analysis.

RESULTS: There was no difference static and the first dynamic pupillometry measurements between the bipolar and control groups (p > 0.05 for all parameters), but there was a significant difference in mean pupil dilatation speed (p = 0.041). No significant differences were found between the 3 groups for all static and the first dynamic pupillometry measurements and the mean pupil dilatation speed (p > 0.05).

CONCLUSION: Static and the first dynamic measurements of bipolar patients were not different from healthy controls. The mean pupil dilatation speed of bipolar patients was significantly lower, but this difference had a low effect size.

PMID:36436223 | DOI:10.1080/08164622.2022.2145182

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Mepolizumab improves quality of life and reduces activity impairments in patients with CRSwNP

Rhinology. 2022 Dec 1;60(6):474-478. doi: 10.4193/Rhin22.053.

ABSTRACT

Mepolizumab improves quality of life and reduces activity impairments in patients with CRSwNP.

PMID:36436220 | DOI:10.4193/Rhin22.053

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Internet gaming disorder, exercise and attention deficit hyperactivity disorder: The role of symptoms of depression, anxiety and stress

Psychiatriki. 2022 Nov 24. doi: 10.22365/jpsych.2022.098. Online ahead of print.

ABSTRACT

One of the issues that have risen the past few decades due to excessive use of technological advances is internet gaming disorder (IGD). Past research has concluded that there is a negative association between IGD and exercise as well as a positive association between IGD and attention deficit hyperactivity disorder (ADHD). However, the existing studies on these subjects are scarce. Furthermore, researchers have showcased that symptoms of depression, anxiety and stress are positively associated with IGD and ADHD but negatively associated with exercise. Consequently, maybe these symptoms mediate the relationships between IGD, exercise and ADHD. The purpose of the present study is to investigate the relationship between IGD and exercise as well as between IGD and ADHD. A correlational study was conducted on 515 adults through Google forms. The Internet Gaming Disorder Scale-Short-Form was used to detect IGD symptoms, the Leisure-Time Exercise Questionnaire was utilized so as to evaluate participants’ leisure – time exercise habits, and the Barkley Adult ADHD Rating Scale was used to assess ADHD symptoms. Furthermore, the Depression, Anxiety and Stress Scale-21 was utilized to evaluate symptoms of depression, anxiety, and stress. It was found that there is a negative correlation between IGD symptoms and leisure time exercise as well as a positive correlation between IGD symptoms and ADHD symptoms. Moreover, when taking all the variables that were examined into consideration, it was indicated that inattention symptoms and impulsivity symptoms were significantly associated with IGD symptoms whereas symptoms of depression were partially and significantly mediating the association between IGD symptoms and Attention deficit as well as the association between IGD symptoms and Impulsivity. The findings of the current study suggest that people who deal with IGD symptoms tend to exercise less on their free time. Additionally, people with more IGD symptoms display not only more ADHD symptoms, symptoms of inattention and impulsivity specifically, but also more symptoms of depression. Therefore, clinicians should evaluate the possible coexistence of such symptoms when treating people with IGD, in order to prevent as well as treat more efficiently IGD and its consequences.

PMID:36436217 | DOI:10.22365/jpsych.2022.098

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The effect of COVID-19 pandemic on mental health and quality of life in the Athens area – Greece

Psychiatriki. 2022 Nov 17. doi: 10.22365/jpsych.2022.095. Online ahead of print.

ABSTRACT

This study examines the associations of the COVID -19 pandemic stressors with mental health and quality of life (QoL) of the general population in different demographic areas of Athens. The random sample of the study consisted of 602 participants, 389 (64,6%) women and 213 (35,4%) men residing in Attica (Greece). It was conducted with telephone interviews during the first wave of the pandemic. The instruments used were: World Health Organization Quality of Life Instrument (WHOQOL-BREF), Depression Anxiety Stress Scale (DASS – 21), Body Vigilance Scale (ΒVS), Dimensional Obsessive-Compulsive Scale (Category 1: contamination obsessions -decontamination compulsions) (DOCS) and a set of socio-demographic data and questions on stressors related to the COVID-19 outbreak. A range of statistical analyses were used, including descriptive statistics, examination of the questionnaires’ internal consistency, calculating Cronbach’s alpha coefficient, as well as multiple linear regression analyses with dependent variables the WHOQOL-BREF, DASS-21, DOCS, and BVS scales. According to the results of our study: a) The greater the extent of negative emotions due to the pandemic and the imposed restrictive measures, such as worry and fear, the higher the score of depression, anxiety, stress, obsessive-compulsive symptomatology, body vigilance and the lower the scores of the WHOQOL domains (Physical Health, Psychological Health, Social Relationships, Environment), b) the fear of being contaminated by the virus seems to have intensified depression-anxiety-stress (DASS-21), obsessive-compulsive (DOCS) and hypochondriacal (BVS) symptomatology. c) The independent variables of depression, stress and anxiety and obsessive – compulsive and hypochondriacal symptomatology were negatively associated with QoL d) The most vulnerable groups in terms of QoL and mental health indicators in our study were those with psychiatric or/and physical illness, the elderly, the unemployed during the lockdown period, those with low educational/ socioeconomic status and those living alone. In conclusion, the negative emotions associated with the COVID-19 outbreak and the imposed restrictive measures had a serious impact on mental health and QoL of the population. This and other similar findings should be taken into account by authorities and decision-makers to prevent and deal with the effects of the pandemic. Unfortunately, the COVID-19 pandemic is still continuing and the imposition of new restrictive measures is considered. This increases the relevance of research like the one presented here.

PMID:36436214 | DOI:10.22365/jpsych.2022.095

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Investigating predictors of well-being in type 2 diabetes mellitus patients: the role of undiagnosed depression

Psychiatriki. 2022 Nov 11. doi: 10.22365/jpsych.2022.093. Online ahead of print.

ABSTRACT

Type 2 diabetes mellitus (T2DM) is a common metabolic disorder with various medical and psychological adverse effects. Well-being in patients with T2DM is often compromised. The aim of the present study was to investigate clinicodemographic predictors of well-being in patients with T2DM with no known psychiatric history and explore the mediatory role of undiagnosed anxiety and depression. We recruited 175 outpatients with T2DM (54.3% males, aged 34-79 (mean 59.9) years) followed-up at the Diabetes Center of the General Hospital of Nikaia-Peiraeus in Athens. Patients included had no severe diabetes-related complications or known psychiatric history. Well-being was measured with the Mental Health Continuum Short-Form (MHC-SF), a novel 14-item tool measuring the emotional (EWB), social (SWB) and psychological (PWB) dimensions of well-being, as well as a total score of well-being (WBT). Hospital Anxiety and Depression Scale (HADS) was used for screening for undiagnosed anxiety (HADS-A) and depression (HADS-D). Patients’ demographics, Body Mass Index (BMI), glycemic control (HbA1c), T2DM duration, comorbid hypertension or dyslipidemia and type of antidiabetic medication were investigated as predictors of well-being or its dimensions in stepwise linear regression models, also including or excluding HADS-A and HADS-D. Mediational effects of HADS-A and HADS-D were explored in structural equation models through path analyses. Results showed that 21.1% of participants had comorbid depression (HADS-D≥11) and 5.1% comorbid anxiety disorder (HADS-A≥11). In the models without HADS, higher WBT as well as EWB and PWB were significantly predicted by lower HbA1c (all p=0.001) and lower BMI (p=0.015, 0.019 and 0.030, respectively). After being included in the model, HADS-A and HADS-D significantly predicted WBT and every dimension of well-being, but the effects of HbA1c and BMI were no longer statistically significant. In path analyses, the indirect effects of HbA1c and BMI on well-being via HADS-D were statistically significant, while the direct and indirect effects via HADS-A were not. Therefore, the effects of HbA1c and BMI on EWB, PWB and WBT were completely mediated by HADS-D. Concludingly, this is the first study using MHC-SF to measure well-being in patients with T2DM. High levels of undiagnosed depression were recorded, in agreement with other studies. Depression was predicted by HbA1c and BMI and finally predicted well-being. Undiagnosed depression fully explained the effects of HbA1c and BMI on well-being. The interplay of glycemic control and positive mental health should be further investigated.

PMID:36436212 | DOI:10.22365/jpsych.2022.093

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Extract of Ficus septica modulates apoptosis and migration in human oral squamous cell carcinoma cells

Environ Toxicol. 2022 Nov 27. doi: 10.1002/tox.23716. Online ahead of print.

ABSTRACT

According to the alarming statistical analysis of global cancer, there are over 19 million new diagnoses and more than 10 million deaths each year. One such cancer is the oral squamous cell carcinoma (OSCC), which requires new therapeutic strategies. Ficus septica extract has been used in traditional medicine to treat infectious diseases. In this study, we examined the anti-proliferative effects of an extract of F. septica bark (FSB) in OSCC cells. Our results showed that FSB caused a concentration-dependent reduction in the viability of SCC2095 OSCC cells, as determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays, and was less sensitive to fibroblasts. In addition, FSB induced apoptosis by activating caspases, accompanied by the modulation of Akt/mTOR/NF-κB and mitogen-activated protein kinase signaling. Moreover, FSB increased reactive oxygen species generation in a concentration-dependent manner in SCC2095 cells. Furthermore, FSB inhibited cell migration and modulated the levels of the cell adhesion molecules including E-cadherin, N-cadherin, and Snail in SCC2095 cells. Pinoresinol, a lignan isolated from FSB, showed antitumor effects in SCC2095 cells, implying that this compound might play an important role in FSB-induced OSCC cell death. Taken together, FSB is a potential anti-tumor agent against OSCC cells.

PMID:36436203 | DOI:10.1002/tox.23716

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Orexin Receptor Antagonists in the Treatment of Depression: A Leading Article Summarising Pre-clinical and Clinical Studies

CNS Drugs. 2022 Nov 27. doi: 10.1007/s40263-022-00974-6. Online ahead of print.

ABSTRACT

The orexin (hypocretin) system comprises two neuropeptides (orexin-A and orexin-B) and two G-protein coupled receptors (the orexin type 1 and the orexin type 2 receptor). The system regulates several biological functions including appetite, the sleep-wake cycle, the stress response, and motivation and reward processing. Dysfunction of the orexin system has been implicated in the pathophysiology of depression in human and animal studies, although the exact nature of this dysfunction remains unclear. Orexin receptor antagonists (ORAs) are a class of compounds developed for the treatment of insomnia and have demonstrated efficacy in this area. Three dual orexin receptor antagonists (DORAs) have received licences for treatment of primary insomnia and some ORAs have since been investigated as potential treatments for major depressive disorder (MDD). In this leading article, we summarise the existing literature on use of ORAs in depression, in pre-clinical and clinical studies. In rodent models of depression, investigated ORAs have included the DORA almorexant and TCS1102, the selective orexin 1 receptor antagonists SB334867 and SB674042 and the selective orexin 2 receptor antagonists LSN2424100, MK-1064 and TCS-OX2-29. These pre-clinical studies suggest a possible antidepressant effect of systemic DORA treatment, however the evidence from selective ORAs is conflicting. To date, four published RCTs (one with the DORA filorexant and three with the selective orexin 2 receptor antagonist seltorexant), have compared an ORA with placebo in the treatment of MDD. Only one of these demonstrated a statistically significant difference relative to placebo.

PMID:36436175 | DOI:10.1007/s40263-022-00974-6

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Identification of Potentially Inappropriate Medications in Frail Older Adults Residing in Long-Term Care: A Retrospective Chart Review Study

Drugs Real World Outcomes. 2022 Nov 27. doi: 10.1007/s40801-022-00342-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Deprescribing is associated with positive health outcomes for older adults in long-term care (LTC), however deprescribing is not universally implemented.

OBJECTIVE: The primary aim of this study was to estimate the prevalence of potentially inappropriate medications (PIMs) prescribed to frail older adults in Irish long-term care facilities (LTCFs), as identified by the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy, version 2 (STOPPFrail v2).

METHODS: A retrospective chart review was conducted in two publicly funded LTCFs in Ireland. Eligible participants were those (1) ≥ 65 years of age; (2) resident in a LTCF; (3) eligible as per the STOPPFrail v2 criteria by the site’s Medical Officer; and (4) receiving regular medication. Data collected included age, sex, drug, dose, frequency, regular/pro re nata prescribing and indication/relevant diagnoses. Rates of polypharmacy (taking five or more medications) and excessive polypharmacy (taking 10 or more medications) were calculated. STOPPFrail v2 was used to identify PIMs; however, clinical measurements were not taken. Descriptive and association statistics were calculated.

RESULTS: Of the 103 residents, 89 were ≥ 65 years of age and categorised as frail and were therefore eligible for inclusion in the study. Of those eligible, 85 (95.5%) had polypharmacy and 57 (64%) experienced excessive polypharmacy. The mean number of regular medications was 10.8 (± 3.8), total medications 17.7 (± 5) and diagnoses 5.5 (± 2.5). The mean number of PIMs per resident was 4.8 (± 2.6). Of the eligible participants, 59.6% had at least one medicine without a documented indication, while 61.8%, 42.7% and 30.3% had at least one PIM from the vitamin D, antihypertensives and proton pump inhibitors drug classes, respectively.

CONCLUSION: Medication and PIM use was high among LTC residents, with inappropriate polypharmacy of concern. Lack of clear indication for prescribing medications appears to be an issue in LTC, potentially affecting healthcare professionals’ engagement with deprescribing. The prevalence of PIMs may be overestimated in the antihypertensives/antidiabetic classes due to the lack of clinical measurements.

PMID:36436174 | DOI:10.1007/s40801-022-00342-2

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Analysis of risk factors for dry eye disease and effect of diquafosol sodium ophthalmic solution on the tear film after vitrectomy in patients with type 2 diabetes mellitus: a preliminary study

Int Ophthalmol. 2022 Nov 27. doi: 10.1007/s10792-022-02584-z. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to investigate the risk factors of DM associated dry eye syndrome (DMDES) and to explore the effect of diquafosol sodium ophthalmic solution (DQS) on patients with DMDES after vitrectomy.

METHODS: Totally 107 patients (107 eyes) received vitrectomy. The data of age, gender, left/right eye, duration of DM, duration of vitrectomy, fasting blood glucose and glycosylated hemoglobin were collected and analyzed for correlation between these factors and DMDES. Postoperatively, DQS was instilled in experimental group and sodium hyaluronate was instilled in control group. The noninvasive breakup time (NIBUT), tear meniscus height (TMH), Schirmer I test (SIT), corneal fluorescence staining score (CFSS) and ocular surface disease index (OSDI) were recorded before vitrectomy and 1, 2 and 3 months after vitrectomy. All data were used for statistical comparison.

RESULTS: Gender, duration of DM and glycosylated hemoglobin were relevant factors of DMDES (P < 0.05). At 1, 2 and 3 months postoperatively, NIBUT and TMH of experimental group were significantly higher than control group (P < 0.05). Postoperatively, CFSS of experimental group was lower than that before vitrectomy, and CFSS at 2 and 3 months after vitrectomy was significantly different between the two groups (P < 0.05). At 1, 2 and 3 months postoperatively, SIT increased in both groups, but there was no significant difference between the two groups (P > 0.05). OSDI was significantly lower in experimental group at 1, 2 and 3 months postoperatively, compared with that of the control group (P < 0.05).

CONCLUSION: These results suggest that gender, duration of DM and glycosylated hemoglobin are risk factors for DMDES. Postoperative instillation of DQS can improve the tear film quality in patients with DMDES after vitrectomy.

PMID:36436170 | DOI:10.1007/s10792-022-02584-z

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Acute retinal necrosis: clinical features, management and outcomes

Int Ophthalmol. 2022 Nov 27. doi: 10.1007/s10792-022-02598-7. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the clinical features, treatment, and visual outcome of patients with acute retinal necrosis (ARN).

METHODS: The data of patients were retrospectively reviewed. Factors associated with visual loss and factors affecting the risk for retinal detachment (RD) development were evaluated.

RESULTS: Twenty-four eyes of 24 patients (7 female/17 male, mean age 43.7 years, mean follow-up period 31.0 months) were included. In ocular fluid samples of 15 (83%) out of 18 eyes, polymerase chain reaction (PCR) tests were positive for herpes simplex virus (seven eyes; 39%), varicella zoster virus (six eyes; 33%), cytomegalovirus (one eye; 6%), and adenovirus (one eye; 6%). Central retinal occlusive vasculitis was observed in three (13%) eyes. Systemic antiviral therapy was given to all patients, and additional intravitreal ganciclovir was administered in seven eyes (29%). The most common complication was RD (46%). There was no statistically significant difference in the frequency of RD between herpes simplex virus- and varicella zoster virus-positive patients (p = .617). The rate of RD was similar in eyes undergoing prophylactic laser photocoagulation (LPC), eyes undergoing vitrectomy + LPC, and eyes not undergoing LPC (p = .237). The number of eyes with final visual acuity below 20/200 was significantly higher in eyes with RD than without RD (p = .047).

CONCLUSION: Prophylactic LPC and vitrectomy did not show clear benefits in terms of preventing RD development. RD was the most common complication and a major factor for a poor visual prognosis.

PMID:36436167 | DOI:10.1007/s10792-022-02598-7