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The aim of the study is to ascertain the neuropsychiatric symptoms (NPS) subtypes significantly influencing progression to mild cognitive impairment (MCI) by ethnicity. In this retrospective cohort study, we included 386 cognitively normal individuals participating in the longitudinal Texas Alzheimer's Research and Care Consortium between February 2007 and August 2014. The primary outcome was time to incident MCI. Data driven NPS subtypes at baseline were identified and the effects of these subtypes on the outcome were obtained for Hispanic and non-Hispanic ethnic cohorts and summarized with a hazard ratio (HR). Three NPS subtypes were identified and internally validated: psychomotor apathy factor (including agitation, irritability, apathy), affective mood factor (including depression, anxiety), and physical behavior factor (including nighttime behavior, eating/appetite disturbances). In adjusted analysis, a psychomotor apathy score of NPS was the best predictor for MCI (HR = 2.19, p = 0.037) among non-Hispanics whereas physical behavior score was the most predictive of MCI (HR = 2.55, p = 0.029) among Hispanics. A high score of affective mood factor also tended to increase the risk of MCI (HR = 2.09, p = 0.06) in Hispanics. Progression from normal cognition to MCI was differentially predicted by NPS subtypes in Hispanics and non-Hispanic whites. These data may inform the allocation of efforts for monitoring individuals at-risk of MCI. [ABSTRACT FROM AUTHOR]

Aim: Present systematic review and meta-analysis examined the burden of psychological reactions predominantly anxiety, depression, stress, and insomnia during the novel COVID-19 pandemic phase among the frontline healthcare, nonfrontline healthcare, and general population. Material and Methods: PubMed, EMBASE, and SCOPUS were searched for studies between January 1, 2020, and May 25, 2020. Brief protocol of the systematic review was registered with the PROSPERO database, (CRD42020186229). Any study that reported the burden of at least one of psychological reactions including anxiety or depression or stress or insomnia was eligible. Heterogeneity was assessed using I2 statistic and results were synthesized using random-effect meta-analysis. Results: Out of 49 eligible studies, 41 databases from 37 studies reported anxiety, 39 databases (35 studies) reported depression, 20 studies reported stress and 12 databases from 11 studies reported insomnia. The overall prevalence for anxiety, depression, stress, and insomnia was 26.3%, 25.9%, 26.2%, and 31.3%, respectively. Prevalence of anxiety, depression, stress, and insomnia were found highest among the frontline healthcare as compared to general healthcare workers and the general population. Conclusion: Anxiety, depression, stress, and insomnia were more prevalent among frontline health-care workers compared to general. Such increased prevalence is prompting toward the global mental health emergency. Therefore, a call of urgent attention and pan-region effective mental-health intervention are required to mitigate these psychological reactions. [ABSTRACT FROM AUTHOR]

Objective: Palindromic rheumatism (PR) is characterized by repetitive attacks of arthritis and/or periarthritis. There is inadequate data regarding the role of low dose methotrexate in patients with PR. The aim of this study was to determine the efficacy of low dose methotrexate add-on therapy in patients withPR with inadequate response to hydroxychloroquine (HCQ) monotherapy. Methods: In this observational study, between August 2016 and July 2019, 15 patients with seropositive PR with inadequate response to HCQ (= 2attacks per month even after 6 months of therapy) were included. All patients were treated with oral low dose methotrexate in addition to HCQ. The responses to therapy were monitored 3 and 6 months after adding methotrexate. Results: In our study, of the 15 patients with PR, two-third were female, with a mean age of 45.73±9.18 years. All were seropositive (Rheumatoid factor positive in eight patients; anti-cyclic citrullinated peptide [CCP] positive in 11 patients; both Rheumatoid factor and anti-CCP positive in four patients). The average number of attacks at baseline was 5.6±2.8, and the median duration of attacks was 2 years. All patients had significant response to add-on methotrexate therapy at follow-up after 3 and 6 months; none developed Rheumatoid arthritis (RA) after 2 years of follow-up. Conclusion: Low dose methotrexate is an effective add-on therapy in patients with PR having inadequate response to HCQ. [ABSTRACT FROM AUTHOR]

We concur that in addition to AHI severity, discussion on polysomnography/respiratory disturbance index (RDI)[[4]] would be worth inferring more insight to understand the OSA severity incidence in RA patients with various anatomical structures. We greatly appreciate the interest and the comments made by Shu-Hao Hsu and colleagues on our systematic review and meta-analysis article on the prevalence of obstructive sleep apnea (OSA) among patients with rheumatoid arthritis (RA) and its association with age and body mass index.[1] We would like to highlight some key points about our study's aims and its design, and more specifically the study objective. With several strengths and limitations in our meta-analysis, the observed high OSA prevalence, and body mass index as its driver, cannot be ignored in diagnosed RA patients. [Extracted from the article]

Background: Women undergoing caesarean delivery present a unique set of challenges to the anesthesiologist in terms of postoperative pain management. The transversus abdominis plane block is an effective method of providing postoperative analgesia in patients undergoing abdominal wall incisions. Accordingly, this retrospective study was conducted and analyzed. Method: Patients who underwent elective lower segment caesarean section under sub arachnoid block in last 3 months were scrutinized and 100 eligible records found. Categories into who received the transversus abdominis plane block (TAP Group) at the end of surgery and another was who did not receive the TAP block (Control group). Results: From control group 26 patients complained of pain during first 4 hours, 43 during 8 hours and all 50 complained of pain within 12 hours. Similarly in TAP group 4 patients had complained of pain during first 4 hours, 16 within 8 hours, 29 within 12 hours, 42 within 16 hours. In TAP group 46 patients required rescue analgesics twice or less and 4 required thrice but none of them demanded more than three times whereas in the control group 7 patients demanded twice, 36 demanded three times and 7 of them demanded four times. The 'p' value < 0.01 was found to be statistically significant between all the groups. Conclusion: TAP block is easy to perform under ultrasound guidance with minimal complications and side effects and it provides effective analgesia and holds good as part of a multimodal analgesia regime for patients undergoing lower segment caesarean section. [ABSTRACT FROM AUTHOR]

Objective: Malignant neoplasms can be associated with a wide variety of rheumatological manifestations that may be caused by direct tumor invasion into bones and joints, as a paraneoplastic syndrome, and through altered immune surveillance. To identify the relationship between rheumatic manifestations in various malignancies. Methods: Twenty patients with various malignancies presenting with rheumatic conditions in our tertiary medical care were studied retrospectively from case records at the Kalinga Institute of Medical Sciences from 2013 to 2018. Results: In the present study, total of 20 patients including 12 males and 8 females with mean age at diagnosis of was 46.3±22.2 years with various malignancy associated rheumatic diseases were included. In total 20% of patients with were current smokers. Seven (35%) had hematological malignancies whereas 13 (65%) had solid malignancies. Most common presenting feature was arthritis (40%), followed by weight loss (20%), skin rash (10%), fever (15%) and muscle weakness (10%) at the time of diagnosis. All of them developed malignancy within 24 months of diagnosis. Among the autoantibodies, only 6 patients (30%) were positive for both ANA (n= 4, 20%) and RF (n=2, 10%), other antibodies were negative. The patients in the hematological malignancies had significantly higher serum levels of LDH, Mean±SD U/L compared to solid malignancy group (716.8±169.6 vs. 249.9±161.6, p<0.001). Conclusion: In our cohort, all the patients developed malignancies within 2 years of diagnosis of rheumatic condition. Higher serum LDH levels helpful to differentiates between hematological and solid malignancies. Hence early detection of malignancy is of major importance in these patients. [ABSTRACT FROM AUTHOR]

Background: Population aging is inevitable. Old age is marked with health problems because of aging process, long-term chronic illnesses, also associated with social and mental problems. Objectives: To determine the pattern of physical morbidities in geriatric population and to study the utilization of health services among them. Methods: A cross-sectional study was undertaken from April to September 2017, among 270 consenting elderly people, residing in urban slums under field practice area of a medical college, using a structured interview schedule. Results: Among the 270 elderly, 36.30% were males, 80% belonged to nuclear families. A total of 262 reported of some morbidity, 61.85% had hypertension, 45.19% had diabetes, 37.78% had acid peptic disease, and 51.08% reported to have 1--3 morbidities. Majority (41.85%) of them had visited a physician on an average of 4--6 times in the preceding year. A total of 84.81% went to the urban health center, whereas 24.81% to a government hospital for treatment. Reasons cited for preference of health facility were "free consultation" and "nearby location" (85.19%). A total of 90.74% received allopathic medicines. Conclusion: Prevalence of morbidity was found to be high, which can be attributed to their compromised living conditions. Health-seeking behavior was found to be good. [ABSTRACT FROM AUTHOR]

Objective: Malignant neoplasms can be associated with a wide variety of rheumatological manifestations that may be caused by direct tumor invasion into bones and joints, as a paraneoplastic syndrome, and through altered immune surveillance. To identify the relationship between rheumatic manifestations in various malignancies. Methods: Twenty patients with various malignancies presenting with rheumatic conditions in our tertiary medical care were studied retrospectively from case records at the Kalinga Institute of Medical Sciences from 2013 to 2018. Results: In the present study, total of 20 patients including 12 males and 8 females with mean age at diagnosis of was 46.3±22.2 years with various malignancy associated rheumatic diseases were included. In total 20% of patients with were current smokers. Seven (35%) had hematological malignancies whereas 13 (65%) had solid malignancies. Most common presenting feature was arthritis (40%), followed by weight loss (20%), skin rash (10%), fever (15%) and muscle weakness (10%) at the time of diagnosis. All of them developed malignancy within 24 months of diagnosis. Among the autoantibodies, only 6 patients (30%) were positive for both ANA (n= 4, 20%) and RF (n=2, 10%), other antibodies were negative. The patients in the hematological malignancies had significantly higher serum levels of LDH, Mean±SD U/L compared to solid malignancy group (716.8±169.6 vs. 249.9±161.6, p<0.001). Conclusion: In our cohort, all the patients developed malignancies within 2 years of diagnosis of rheumatic condition. Higher serum LDH levels helpful to differentiates between hematological and solid malignancies. Hence early detection of malignancy is of major importance in these patients. [ABSTRACT FROM AUTHOR]

Context: Depression is a well-known independent risk factor for cardiovascular morbidity, mortality, and poor prognosis for a cardiac event, however, how gender effects this association is not understood. Objective: To identify the effect of gender in the association between depression and cardiovascular disease (CVD) status in the US adult population. Study design and Analysis: Survey based, unadjusted and adjusted prevalence ratios (PR) were estimated using generalized linear model with Poisson family, and log link function using a cross-sectional survey dataset. Setting or Dataset: Secondary dataset from the National Health and Nutrition Examination Survey (NHANES) conducted during 2013-2018. Population studied: Community-dwelling, non-institutionalized adults aged 20 years and older (N= 14,767). Instruments: The Patient Health Questionnaire (PHQ-9), a nine-item depression screening instrument. This instrument incorporates DSM-IV depression diagnostic criteria, subjects answered each of the nine items scoring points ranging from 0 to 3 on each item. Outcome measures: CVD event (congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, or stroke). Results: CVD events were positively associated with higher PHQ-9 scores in unadjusted (PR:1.61, p<0.001 and PR:2.01, p=0.001 for mild/moderate and severe group respectively) and adjusted analysis (PR:1.38, p= 0.002 and PR:1.61, p=0.024 for mild/moderate and severe group respectively). Females were 45% less likely to have a CVD event compared to males. However, more CVDs were reported in females with mild/moderate depression (PR:1.52, p:0.003) and with moderately severe/severe depression (PR:2.22, p=0.002) compared to no/little depression and in males. In a subgroup adjusted analysis, female sex and having depressive symptoms was associated with higher CVD events (PR:2.03, p<0.001 and PR:3.38, p<0.001 for mild/moderate and severe group respectively) as compared to males with depressive symptoms (PR:1.41, p<0.001 and PR:1.66, p<0.001 for mild/moderate and severe group respectively). Conclusion: Females with more severe depressive symptoms are more likely to experience CVD events compared to males. Results highlight the importance of looking at specific risk factors for CVD events, and having a higher suspicion in women should, be considered in primary care settings. Future studies are also needed on the characterization of possible pathophysiological mechanism of these outcomes. [ABSTRACT FROM AUTHOR]