Our study aims to examine the risk factors for comorbid psychosis in pediatric patients hospitalized for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and its impact on hospital outcomes.
...We conducted a cross-sectional study using the nationwide inpatient sample (NIS 2018-2019). We included 3,405 pediatric inpatients (age 6-17 years) with a primary discharge diagnosis of anti-NMDAR encephalitis. We used binomial logistic regression model to evaluate the odds ratio (OR) of variables (demographic and comorbidities) associated with comorbid psychosis.
The prevalence of comorbid psychosis in anti-NMDAR encephalitis inpatients was 5.3%, and majorly constituted of adolescents (72.2%) and females (58.3%). In terms of race, Blacks (OR 2.41), and Hispanics (OR 1.80) had a higher risk of comorbid psychosis compared to Whites. Among comorbidities, encephalitis inpatients with depressive disorders (OR 4.60), sleep-wake disorders (OR 3.16), anxiety disorders (OR 2.11), neurodevelopmental disorders (OR 1.95), and disruptive behavior disorders (OR 2.15) had a higher risk of comorbid psychosis. Anti-NMDAR encephalitis inpatients with comorbid psychosis had a longer median length of stay at 24.6 days (vs. 9.8 days) and higher median charges at $262,796 (vs. $135,323) compared to those without psychotic presentation.
Adolescents, females, and Blacks with encephalitis have a higher risk of psychotic presentation leading to hospitalization for anti-NMDAR encephalitis. Identification of demographic predictors and comorbidities can aid in early recognition and intervention to optimize care and potentially reduce the healthcare burden.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
This study aimed to explore the relationship between vitamin D deficiency and comorbid heart disease in adult inpatients with mood disorders (depressive and bipolar disorders).
Methods
A ...cross-sectional investigation was carried out employing the nationwide inpatient dataset, which encompassed 910,561 adult inpatients aged 18 to 50 years diagnosed with depressive and bipolar disorders. Additionally, the sample was categorized based on the presence of comorbid heart disease. We utilized a logistic regression model to assess the odds ratio (OR), pertaining to demographic features and coexisting medical conditions in relation to comorbid heart disease.
Results
Comorbid heart disease was present in 1.3% of inpatients with mood disorders; they were middle-aged (mean age 42.7 years) men and White individuals. Inpatients with depressive disorder had a higher risk of comorbid heart disease (OR 1.19, 95% CI 1.15–1.24) compared to those with bipolar disorders. Inpatients with comorbid heart disease had a higher prevalence of medical and psychiatric comorbidities. The prevalence of vitamin D deficiency was 2.3% in mood disorders but higher in those with comorbid heart disease (2.9%). Vitamin D deficiency showed a notable correlation with comorbid heart disease, resulting in a 26% increased risk in the unadjusted regression model (OR 1.26, 95% CI 1.13–1.40). However, after accounting for potential confounding factors, including comorbidities, the risk did not exhibit statistical significance (OR 1.08, 95% CI 0.97–1.21). Among psychiatric comorbidities, trauma-related (OR 1.22, 95% CI 1.17–1.28) and tobacco-related (OR 1.31, 95% CI 1.26–1.37) disorders had a higher risk of association with comorbid heart disease.
Conclusion
Middle-aged men with depressive disorders and from low-income families had a higher risk of developing comorbid heart disease. Trauma-related and tobacco-related disorders were associated with an increased risk by 20–30% for comorbid heart disease in inpatients with mood disorders. Vitamin D deficiency was not associated with the risk of comorbid heart disease after controlling demographics and comorbid cardiovascular risk factors.
Objective The aim of our study was to delineate the differences in demographics, comorbidities, and hospital outcomes by eating disorder types in adolescents and transitional-age youth (15–26 years), ...and measure the association with psychiatric comorbidities. Methods We conducted a cross-sectional study using the nationwide inpatient sample (2018–2019) and included 7,435 inpatients (age 12–24 years) with a primary diagnosis of eating disorders: anorexia nervosa (AN, 71.7%), bulimia nervosa (BN, 4.7%), avoidant/restrictive food intake disorder (ARFID, 9.5%), and other. We used independent logistic regression models controlled for demographics to evaluate the adjusted odds ratio association of comorbidities with eating disorder types. Results The mean age of BN inpatients was 17.5 years, which was significantly higher compared to the total number of inpatients with eating disorders (15.9 years). Approximately four-fifths of the inpatients with AN and BN were female patients whereas ARFID was seen in a higher proportion of male patients (32.6% vs. 13.7% overall). Anxiety (57.5%) and depressive (47.3%) disorders were prevalent in the total number of inpatients with eating disorders, with suicidal behaviors seen significantly higher in BN (25.7% vs. 12.9% overall). The likelihood of obsessive compulsive–related disorder was higher in all eating disorder types, i.e., AN (OR 2.14), BN (OR 1.79), and ARFID (OR 1.74); however, anxiety (OR 1.52) and neurodevelopmental (OR 1.70) disorders were significantly higher in ARFID. In terms of hospital outcomes, inpatients with ARFID had a longer mean length of stay (13.7 days vs. 8.4 days in BN) and higher mean total charges ($87,747 vs. $44,882 in BN). Conclusion Our findings identify notable demographic and clinical distinctions within inpatients diagnosed with AN, BN, and ARFID. Specifically, inpatients with BN belonging to older age brackets manifest elevated occurrences of depressive disorders and suicidal tendencies. ARFID is linked to prolonged hospitalization and increased costs, underscoring distinctive complexities in care. This highlights the significance of personalized interventions that account for demographic variations and psychiatric comorbidities, aiming to improve outcomes for diverse populations affected by eating disorders.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), characterises illness anxiety disorder (IAD) as the preoccupation with having or acquiring a serious illness in the ...absence of somatic symptoms (or, if present, symptoms that are only mild in severity). DSM-5 includes illness anxiety disorder in the category called somatic symptom and related disorders, characterised by prominent somatic concerns, distress, and impaired functioning. More often than in psychiatric settings, individuals with illness anxiety disorder are encountered in primary care and specialist medical settings. Despite negative laboratory results, the benign course of the alleged disease over time, and adequate reassurances from specialists, their conviction of being ill persists. Illness anxiety preoccupations are heterogeneous, and the degree of insight is variable. Their illness-related preoccupation interferes with their relationships with family, friends, and coworkers. They are frequently addicted to internet searches about their feared illness, inferring the worst from the information (or false information) they uncover. Patients with illness anxiety disorder often have comorbid psychopathology, especially anxiety and depressive disorders. Typically, illness anxiety disorder is chronic. Physical symptoms are absent or mild and frequently represent a misinterpretation of normal bodily sensations. This case report presents the case of a patient diagnosed with IAD by a psychiatrist. The patient had been seen by his primary care physician and therapist for three years without any improvement in his symptoms before he was referred to a psychiatrist. After undergoing a partial thyroidectomy in 2018, this patient has been experiencing increasing symptoms of recurrent anxiety/fear consistent with IAD, despite extensive medical examinations that have consistently revealed normal results.
Our study aims to examine the risk factors for comorbid psychosis in pediatric patients hospitalized for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and its impact on hospital outcomes. ...We conducted a cross-sectional study using the nationwide inpatient sample (NIS 2018-2019). We included 3,405 pediatric inpatients (age 6-17 years) with a primary discharge diagnosis of anti-NMDAR encephalitis. We used binomial logistic regression model to evaluate the odds ratio (OR) of variables (demographic and comorbidities) associated with comorbid psychosis. The prevalence of comorbid psychosis in anti-NMDAR encephalitis inpatients was 5.3%, and majorly constituted of adolescents (72.2%) and females (58.3%). In terms of race, Blacks (OR 2.41), and Hispanics (OR 1.80) had a higher risk of comorbid psychosis compared to Whites. Among comorbidities, encephalitis inpatients with depressive disorders (OR 4.60), sleep-wake disorders (OR 3.16), anxiety disorders (OR 2.11), neurodevelopmental disorders (OR 1.95), and disruptive behavior disorders (OR 2.15) had a higher risk of comorbid psychosis. Anti-NMDAR encephalitis inpatients with comorbid psychosis had a longer median length of stay at 24.6 days (vs. 9.8 days) and higher median charges at $262,796 (vs. $135,323) compared to those without psychotic presentation. Adolescents, females, and Blacks with encephalitis have a higher risk of psychotic presentation leading to hospitalization for anti-NMDAR encephalitis. Identification of demographic predictors and comorbidities can aid in early recognition and intervention to optimize care and potentially reduce the healthcare burden.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Sertraline is one of the most commonly used selective serotonin re-uptake inhibitors (SSRIs) in both adults and children. It acts by blocking presynaptic serotonin re-uptake, thereby increasing ...serotonin level within the synaptic cleft. It also blocks uptake of serotonin in platelets and inhibit platelet aggregation, which could increase the risk of gastrointestinal (GI) bleeding. Prior research evidenced that SSRI-induced GI bleed is common in high risk adults and elderly population. However, limited research is done on the effect of SSRI in young adolescents. Therefore, this case study fills the gap in literature by exploring the effect of SSRI use and GI bleeding in children. In this case study, a 13-year-old boy with depression experienced two episodes of severe upper GI bleeding in two weeks after initiating Sertraline. The patient also had a history of occasional use of Non-Steroidal Anti-Inflammatory Drugs (NSAID). During the first Emergency Department (ED) visit, the patient's lab reports showed that Hemoglobin and RBCs were normal and the patient responded well to intravenous fluids, Omeprazole and Sucralfate. However, a week after ED discharge, the patient returned back to ED due to hematemesis with dark colored stools and hemoglobin of 6.6 gm/dl requiring a blood transfusion. Endoscopy and other investigations ruled out other causes and referred to psychiatry for evaluation. Sertraline was stopped and was changed to Bupropion which helped stop the bleeding and the patient recovered well. This case is a preliminary example of how antidepressants with low serotonin activity such as Bupropion can be used as an alternative to SSRI in a patient who experiences GI bleeding.
Coronary Artery Diseases(CADs) though preventable are one of the leading causes of death and disability. Diagnosis of these diseases is often difficult and resource intensive. Segmentation of ...arteries in angiographic images has evolved as a tool for assistance, helping clinicians in making accurate diagnosis. However, due to the limited amount of data and the difficulty in curating a dataset, the task of segmentation has proven challenging. In this study, we introduce the idea of using pseudolabels as a data augmentation technique to improve the performance of the baseline Yolo model. This method increases the F1 score of the baseline by 9% in the validation dataset and by 3% in the test dataset.
Coronary Artery Diseases although preventable are one of the leading cause of
mortality worldwide. Due to the onerous nature of diagnosis, tackling CADs has
proved challenging. This study addresses ...the automation of resource-intensive
and time-consuming process of manually detecting stenotic lesions in coronary
arteries in X-ray coronary angiography images. To overcome this challenge, we
employ a specialized Convnext-V2 backbone based Mask RCNN model pre-trained for
instance segmentation tasks. Our empirical findings affirm that the proposed
model exhibits commendable performance in identifying stenotic lesions.
Notably, our approach achieves a substantial F1 score of 0.5353 in this
demanding task, underscoring its effectiveness in streamlining this intensive
process.
