Search results for: respiratory symptoms

Authors: Hossein Barri Ghazani

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Transfusion-related acute lung injury is the main reason of transfusion-related death, and it’s assigned to white blood cell reactive antibodies present in the blood product (anti-HLA class I and class II or anti granulocyte antibodies). TRALI may occur in the COVID-19 patients who are treated by convalescent plasma. The rate of TRALI’s reactions is the same in both males and females and can happen in all age groups. TRALI’s occurrence is higher for people who receive plasma from female donors because the parous female donors have multiple HLA antibodies in their plasma. Patients with chronic liver disease have an augmented risk of transfusion-related acute lung injuries from plasma containing blood products like FFP and PRP. The condition of TRALI suddenly starts with a non‐cardiogenic pulmonary Edema, often accompanied by marked systemic hypovolemic and hypotension. The conditions occur during or within a few hours of transfusion. Chest X-ray shows a nodular penetration or bats’ wing pattern of Edema which can be seen in acute respiratory distress syndrome as well. TRALI can occur with any type of blood products and can occur with as little as one unit. The blood donor center should be informed of the suspected TRALI reactions when the symptoms of TRALI are observed. After a review of the clinical data, the donors must be screened for granulocyte and HLA antibodies. The diagnosis and management of TRALI is not simple and is best done with a professional team and a specialty skilled nurse experienced with the upkeep of these patients.

Keywords: TRALI, transfusion-related death, anti-granulocyte antibodies, anti-HLA antibodies, COVID-19

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Authors: Steven M. Sanders, April T. Berry, David W. Hollingsworth

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Previous research has shown that veterans have higher rates of mental health concerns compared to non-veteran populations. A potential risk factor for the development of mental health concerns (i.e., depression & anxiety), particularly in Black veterans, is psychological inflexibility. Psychological inflexibility, a component of Acceptance & Commitment Therapy (ACT), is a process by which behavior is expressed in ways that attempt to control emotional and psychological reactions to uncomfortable stimuli and situations rather than by direct contingencies or personal values. The present study explored the relationship between psychological inflexibility, symptoms of depression, and symptoms of anxiety in a sample of 131 Black veterans. Results demonstrated that Black veterans who endorsed psychological inflexibility also endorsed higher levels of both depression and anxiety symptomology. These findings indicate the deleterious consequences of experiencing psychological inflexibility, which could be treated through ACT.

Keywords: psychological flexibility, veteran, black, psychological distress

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Authors: Bang Haeyong

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Purpose: The objectives of this study were to determine the prevalence, incidence, and risk factors for postoperative fever after lumbar fusion. Methods: This study was a retrospective chart review of 291 patients who underwent lumbar fusion between March 2015 and February 2016 at the Asan Medical Center. Information was extracted from electronic medical records. Postoperative fever was measured at Tmax > 37.7 ℃ and Tmax > 38.3 ℃. The presence of postoperative fever, blood culture, urinary excretion, and/or chest x-ray were evaluated. Patients were evaluated for infection after lumbar fusion. Results: We found 222 patients (76.3%) had a postoperative temperature of 37.7 ℃, and 162 patients (55.7%) had a postoperative temperature of 38.3 ℃ or higher. The percentage of febrile patients trended down following the mean 1.8days (from the first postoperative day to seventh postoperative day). Infection rate was 9 patients (3.1%), respiratory virus (1.7%), urinary tract infection (0.3%), phlebitis (0.3%), and surgical site infection (1.4%). There was no correlation between Tmax > 37.7℃ or Tmax > 38.3℃, and timing of fever, positive blood or urine cultures, pneumonia, or surgical site infection. Risk factors for increased postoperative fever following surgery were confirmed to be delay of defecation (OR=1.37, p=.046), and shorten of remove drainage (OR=0.66, p=.037). Conclusions: The incidence of fever was 76.3% after lumbar fusion and the drainage time was faster in the case of fever. It was thought that the bleeding was absorbed at the operation site and fever occurred. The prevalence of febrile septicemia was higher in patients with long bowel movements before surgery than after surgery. Clinical symptoms should be considered because postoperative fever cannot be determined by fever alone because fever and infection are not significant.

Keywords: lumbar surgery, fever, postoperative, risk factor

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Authors: Xinyuan Zou, Qihui Tang, Shujian Wang, Yulin Huang, Jie Gui, Xiangping Liu, Gang Liu, Yanqiang Tao

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Childhood trauma can have a long-lasting influence on individuals and contribute to mental disorders, including depression and anxiety. The current study aimed to explore the symptomatic and developmental patterns of depression, anxiety, and stress among adolescents who have suffered from childhood trauma. A total of 3,598 college students (female = 1,617 (44.94%), Mean Age = 19.68, SD Age = 1.35) in China completed the Childhood Trauma Questionnaire (CTQ) and the Depression, Anxiety, and Stress Scales (DASS-21), and 2,337 participants met the selection standard based on the cut-off scores of the CTQ. The symptomatic network and directed acyclic graph (DAG) network approaches were used. The results revealed that males reported experiencing significantly more physical abuse, physical neglect, emotional neglect, and sexual abuse compared to females. However, females scored significantly higher than males on all items of DASS-21, except for “Worthless”. No significant difference between the two genders was observed in the network structure and global strength. Meanwhile, among all participants, “Down-hearted” and “Agitated” appeared to be the most interconnected symptoms, the bridge symptoms in the symptom network, as well as the most vital symptoms in the DAG network. Apart from that, “No-relax” also served as the most prominent symptom in the DAG network. The results suggested that intervention targeted at assisting adolescents in developing more adaptive coping strategies with stress and regulating emotion could benefit the alleviation of comorbid depression, anxiety, and stress.

Keywords: symptom network, childhood trauma, depression, anxiety, stress

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Authors: O. Elkana, O Heyman, S. Hamdan, M. Franko, J. Vatine

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Objective: To investigate whether a direct link exists between perceived pain (PP) and executive functions (EF), above and beyond the influence of depression symptoms, in the context of medical rehabilitation. Design: Cross-sectional study. Setting: Rehabilitation Hospital. Participants: 125 medical records of hospitalized patients were screened for matching to our inclusion criteria. Only 60 patients were found fit and were asked to participate. 19 decline to participate on personal basis. The 41 neurologically intact patients (mean age 46, SD 14.96) that participated in this study were in their sub-acute stage of recovery, with fluent Hebrew, with intact upper limb (to neutralize influence on psychomotor performances) and without an organic brain damage. Main Outcome Measures: EF were assessed using the Wisconsin Card Sorting Test (WCST) and the Stop-Signal Test (SST). PP was measured using 3 well-known pain questionnaires: Pain Disability Index (PDI), The Short-Form McGill Questionnaire (SF-MPQ) and the Pain Catastrophizing Scale (PCS). Perceived pain index (PPI) was calculated by the mean score composite from the 3 pain questionnaires. Depression symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Results: The results indicate that irrespective of the presence of depression symptoms, PP is directly correlated with response inhibition (SST partial correlation: r=0.5; p=0.001) and mental flexibility (WSCT partial correlation: r=-0.37; p=0.021), suggesting decreased performance in EF as PP severity increases. High correlations were found between the 3 pain measurements: SF-MPQ with PDI (r=0.62, p<0.001), SF-MPQ with PCS (r=0.58, p<0.001) and PDI with PCS (r=0.38, p=0.016) and each questionnaire alone was also significantly associated with EF; thus, no specific questionnaires ‘pulled’ the results obtained by the general index (PPI). Conclusion: Examining the direct association between PP and EF, beyond the contribution of depression symptoms, provides further clinical evidence suggesting that EF and PP share underlying mediating neuronal mechanisms. Clinically, the importance of assessing patients' EF abilities as well as PP severity during rehabilitation is underscored.

Keywords: depression, executive functions, mental-flexibility, neuropsychology, pain perception, perceived pain, response inhibition

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Authors: Aamna Tufail, Kajal Kotecha, Iordanis Toursounidis, Ravinder Pabla

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Introduction/Aims: Acute Myeloid Leukaemia (AML) is a part of leukaemic group of hematopoietic disorders with a varying range of presentations, including oro-facial manifestations. Early recognition and management are essential for favourable outcomes. Materials and Methods: We present our experience, clinical presentation, and clinical photographs of a patient with previously undiagnosed AML who presented with oral symptoms to the emergency department of our hospital. An analysis of clinical characteristics, diagnostic investigations, and management modalities was performed. Results/Statistics: A 58-year-old man presented to A&E reporting an 11-day history of right sided facial swelling, acute TMJ symptoms, and oral discomfort. A dentist ruled out acute dental causes one day post onset of symptoms. Initial assessment was anatomically inconsistent and did not reveal a routine oral or maxillofacial etiology. Detailed clinical examination demonstrated fever, generalised pallor, swelling and erythema of right nasolabial region, bilateral masseteric tenderness, intraoral palatal ecchymosis, palatal ulceration, buccal and labial petechiae, cervical lymphadenopathy, and haematoma on dorsum of right hand overlying right 2nd metacarpal joint. Suspecting a systemic medical cause, we requested haematological investigations, which revealed neutropenia, thrombocytopenia, and anaemia. Flow cytometry confirmed CD34 + AML. Oral discomfort was managed symptomatically. The patient was referred to a tertiary care centre for acute haematologic care, where he was treated with IV antibiotics and continuing cycles of chemotherapy. Conclusions/Clinical Relevance: Oro-facial manifestations may be the first clinical sign of AML. Awareness of its features is vital in early diagnosis. In this context, dentists and oral medicine specialists can play an important role in detecting clinical signs of haematological disorders such as AML.

Keywords: acute myeloid leukaemia, oral symptoms, ulceration, diagnosis, management

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Authors: Aidan Ryan, Nahima Miah, Sahaj Kaur, Imogen Sutherland, Mohamed Saleh

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Pulmonary symptoms are a common presentation to the emergency department. Due to a lack of understanding of the underlying pathophysiology, chronic liver disease is not often considered a cause of dyspnea. We present three patients who were admitted with significant respiratory distress secondary to hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. The first is a 27-year-old male with a 6-month history of progressive dyspnea. The patient developed a severe type 1 respiratory failure with a PaO₂ of 6.3kPa and was escalated to critical care, where he was managed with non-invasive ventilation to maintain oxygen saturation. He had an agitated saline contrast echocardiogram, which showed the presence of a possible shunt. A CT angiogram revealed significant liver cirrhosis, portal hypertension, and large para esophageal varices. Ultrasound of the abdomen showed coarse liver echo patter and enlarged spleen. Along with these imaging findings, his biochemistry demonstrated impaired synthetic liver function with an elevated international normalized ratio (INR) of 1.4 and hypoalbuminaemia of 28g/L. The patient was then transferred to a tertiary center for further management. Further investigations confirmed a shunt of 56%, and liver biopsy confirmed cirrhosis suggestive of alpha-1-antitripsyin deficiency. The findings were consistent with a diagnosis of hepatopulmonary syndrome, and the patient is awaiting a liver transplant. The second patient is a 56-year-old male with a 12-month history of worsening dyspnoea, jaundice, confusion. His medical history included liver cirrhosis, portal hypertension, and grade 1 oesophageal varices secondary to significant alcohol excess. On admission, he developed a type 1 respiratory failure with PaO₂ of 6.8kPa requiring 10L of oxygen. CT pulmonary angiogram was negative for pulmonary embolism but showed evidence of chronic pulmonary hypertension, liver cirrhosis, and portal hypertension. An echocardiogram revealed a grossly dilated right heart with reduced function, pulmonary and tricuspid regurgitation, and pulmonary artery pressures estimated at 78mmHg. His biochemical markers showed impaired synthetic liver function with an INR of 3.2, albumin of 29g/L, along with raised bilirubin of 148mg/dL. During his long admission, he was managed with diuretics with little improvement. After three weeks, he was diagnosed with portopulmonary hypertension and was commenced on terlipressin. This resulted in successfully weaning off oxygen, and he was discharged home. The third patient is a 61-year-old male who presented to the local ambulatory care unit for therapeutic paracentesis on a background of decompensated liver cirrhosis. On presenting, he complained of a 2-day history of worsening dyspnoea and a productive cough. Chest x-ray showed a large pleural effusion, increasing in size over the previous eight months, and his abdomen was visibly distended with ascitic fluid. Unfortunately, the patient deteriorated, developing a larger effusion along with an increase in oxygen demand, and passed away. Without underlying cardiorespiratory disease, in the presence of a persistent pleural effusion with underlying decompensated cirrhosis, he was diagnosed with hepatic hydrothorax. While each presented with dyspnoea, the cause and underlying pathophysiology differ significantly from case to case. By describing these complications, we hope to improve awareness and aid prompt and accurate diagnosis, vital for improving outcomes.

Keywords: dyspnea, hepatic hydrothorax, hepatopulmonary syndrome, portopulmonary syndrome

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Authors: G. R. Constantine, M.C.K. Thilakasiri, V.S. Mohottala, T.V. Soundaram, D.S. Rathnayake, E.G.H.E. De Silva, A.L.S. Mohamed, V.R. Weerasekara

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Orthostatic hypotension is prevalent in the elderly population, and it is an important risk factor contributing to falls in the elderly. This study aims to evaluate the prevalence of orthostatic hypotension in hospitalized elderly patients, changes in blood pressure during the hospital stay, morbidities associated with it and its association with falls in the elderly. A cross-sectional descriptive study was conducted in the National Hospital of Sri Lanka (NHSL) in a sample of 120 patients of age 65 years or above who were admitted to the medical wards. The demographic, clinical data was obtained by an interviewer-administered questionnaire. Two validated questionnaires were used to assess symptoms and effects of orthostatic hypotension and risk factors associated with falls. Orthostatic hypotension on admission and after 3 days of hospital stay was measured by bed-side mercury sphygmomanometer. Prevalence of orthostatic hypotension among the study population was 63.3%(76 patients). But no significant change in the orthostatic hypotension noted after 3 days of hospital admission (SND 0.61, SE= 5.59, p=0.27). There was no significant association found between orthostatic hypotension and its symptoms (dizziness and vertigo, vision problems, malaise, fatigue, poor concentration, neck stiffness), impact on standing or walking and non-communicable diseases. Falls were experienced by 27.5 % (33 patients) of the study population and prevalence of patients with orthostatic hypotension who had experienced falls was 25.9% (28 patients). In conclusions, orthostatic hypotension is more prevalent among elderly patients, but It wasn’t associated with symptoms, and non-communicable diseases, or as a risk factor for falls in elderly.

Keywords: orthostatic hypotension, elderly falls, emergency geriatric, Sri Lanka

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: N. Anand, P. S. Nayyer, V. Rana, S. Verma

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Background: Diabetes mellitus is a group of disorders characterized by hyperglycemia and associated with microvascular and macrovascular complications. Among the lesser known complications is the involvement of respiratory system. Changes in pulmonary volume, diffusion and elastic properties of lungs as well as the performance of the respiratory muscles lead to a restrictive pattern in lung functions. The present study was aimed to determine the changes in various parameters of pulmonary function tests amongst patients with Type 2 Diabetes Mellitus and also try to study the effect of duration of Diabetes Mellitus on pulmonary function tests. Methods: It was a cross sectional study performed at Dr Baba Saheb Ambedkar Hospital and Medical College in, Delhi, A Tertiary care referral centre which included 200 patients divided into 2 groups. The first group included diagnosed patients with diabetes and the second group included controls. Cases and controls symptomatic for any acute or chronic Respiratory or Cardiovascular illness or a history of smoking were excluded. Both the groups were subjected to spirometry to evaluate for the pulmonary function tests. Result: The mean Forced Vital Capacity (FVC), Forced Expiratory Volume in first second (FEV1), Peak Expiratory Flow Rate(PEFR) was found to be significantly decreased ((P < 0.001) as compared to controls while the mean ratio of Forced Expiratory Volume in First second to Forced Vital Capacity was not significantly decreased( p>0.005). There was no correlation seen with duration of the disease. Conclusion: Forced Vital Capacity (FVC), Forced Expiratory Volume in first second (FEV1), Peak Expiratory Flow Rate(PEFR) were found to be significantly decreased in patients of Diabetes mellitus while ratio of Forced Expiratory Volume in First second to Forced Vital Capacity (FEV1/FVC) was not significantly decreased. The duration of Diabetes mellitus was not found to have any statistically significant effect on Pulmonary function tests (p > 0.005).

Keywords: diabetes mellitus, pulmonary function tests, forced vital capacity, forced expiratory volume in first second

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Authors: A. Venkatakrishnan, M. Juneja, S. Kapoor

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Background: Gastrointestinal dysfunction is an emerging co morbidity seen in autism and may further strengthen the association between autism and celiac disease. This is supported by increased rates (22-70%) of gastrointestinal symptoms like diarrhea, constipation, abdominal discomfort/pain, and gastrointestinal inflammation in children with the etiology of autism is still elusive. In addition to genetic factors, environmental factors such as toxin exposure, intrauterine exposure to certain teratogenic drugs, are being proposed as possible contributing factors in the etiology of Autism Spectrum Disorders (ASD) in cognizance with reports of increased gut permeability and high rates of gastrointestinal symptoms noted in children with ASD, celiac disease has also been proposed as a possible etiological factor. Despite insufficient evidence regarding the benefit of restricted diets in Autism, GFD has been promoted as an alternative treatment for ASD. This study attempts to discern any correlation between ASD and celiac disease. Objective: This cross sectional study aims to determine the proportion of celiac disease in children with ASD. Methods: Study included 155 participants aged 2-12 yrs, diagnosed as ASD as per DSM-5 attending the child development center at a tertiary care hospital in Northern India. Those on gluten free diet or having other autoimmune conditions were excluded. A detailed Performa was filled which included sociodemographic details, history of gastrointestinal symptoms, anthropometry, systemic examination, and pertinent psychological testing was done using was assessed using Developmental Profile-3(DP-3) for Developmental Quotient, Childhood Autism Rating Scale-2 (CARS-2) for severity of ASD, Vineland Adaptive Behavior Scales (VABS) for adaptive behavior, Child Behavior Checklist (CBCL) for behavioral problems and BAMBI (Brief Autism Mealtime Behavior Scales) for feeding problems. Screening for celiac was done by TTG-IgA levels, and total serum IgA levels were measured to exclude IgA deficiency. Those with positive screen were further planned for HLA typing and endoscopic biopsy. Results: A total of 155 cases were included, out of which 5 had low IgA levels and were hence excluded from the study. The rest 150 children had TTG levels below the ULN and normal total serum IgA level. History of Gastrointestinal symptoms was present in 51 (34%) cases abdominal pain was the most frequent complaint (16.6%), followed by constipation (12.6%). Diarrhea was seen in 8 %. Gastrointestinal symptoms were significantly more common in children with ASD above 5 yrs (p-value 0.006) and those who were verbal (p = 0.000). There was no significant association between socio-demographic factors, anthropometric data, or severity of autism with gastrointestinal symptoms. Conclusion: None of the150 patients with ASD had raised TTG levels; hence no association was found between ASD and celiac disease. There is no justification for routine screening for celiac disease in children with ASD. Further studies are warranted to evaluate association of Non Celiac Gluten Sensitivity with ASD and any role of gluten-free diet in such patients.

Keywords: autism, celiac, gastrointestinal, gluten

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Authors: Neusa Fernanda Torres, Buyisile Chibi, Lyn E. Middleton, Vernon P. Solomon, Tivani P. Mashamba-Thompson

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Background: Self-medication with antibiotics (SMA) is a global concern, with a higher incidence in low and middle-income countries (LMICs). Despite intense world-wide efforts to control and promote the rational use of antibiotics, continuing practices of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and other undesirable antibiotic side effects. Moreover, it increases the health systems costs of acquiring more powerful antibiotics to treat the resistant infection. This review thus maps evidence on the factors influencing self-medication with antibiotics in these settings. Methods: The search strategy for this review involved electronic databases including PubMed, Web of Knowledge, Science Direct, EBSCOhost (PubMed, CINAHL with Full Text, Health Source - Consumer Edition, MEDLINE), Google Scholar, BioMed Central and World Health Organization library, using the search terms:’ Self-Medication’, ‘antibiotics’, ‘factors’ and ‘reasons’. Our search included studies published from 2007 to 2017. Thematic analysis was performed to identify the patterns of evidence on SMA in LMICs. The mixed method quality appraisal tool (MMAT) version 2011 was employed to assess the quality of the included primary studies. Results: Fifteen studies met the inclusion criteria. Studies included population from the rural (46,4%), urban (33,6%) and combined (20%) settings, of the following LMICs: Guatemala (2 studies), India (2), Indonesia (2), Kenya (1), Laos (1), Nepal (1), Nigeria (2), Pakistan (2), Sri Lanka (1), and Yemen (1). The total sample size of all 15 included studies was 7676 participants. The findings of the review show a high prevalence of SMA ranging from 8,1% to 93%. Accessibility, affordability, conditions of health facilities (long waiting, quality of services and workers) as long well as poor health-seeking behavior and lack of information are factors that influence SMA in LMICs. Antibiotics such as amoxicillin, metronidazole, amoxicillin/clavulanic, ampicillin, ciprofloxacin, azithromycin, penicillin, and tetracycline, were the most frequently used for SMA. The major sources of antibiotics included pharmacies, drug stores, leftover drugs, family/friends and old prescription. Sore throat, common cold, cough with mucus, headache, toothache, flu-like symptoms, pain relief, fever, running nose, toothache, upper respiratory tract infections, urinary symptoms, urinary tract infection were the common disease symptoms managed with SMA. Conclusion: Although the information on factors influencing SMA in LMICs is unevenly distributed, the available information revealed the existence of research evidence on antibiotic self-medication in some countries of LMICs. SMA practices are influenced by social-cultural determinants of health and frequently associated with poor dispensing and prescribing practices, deficient health-seeking behavior and consequently with inappropriate drug use. Therefore, there is still a need to conduct further studies (qualitative, quantitative and randomized control trial) on factors and reasons for SMA to correctly address the public health problem in LMICs.

Keywords: antibiotics, factors, reasons, self-medication, low and middle-income countries (LMICs)

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Authors: Abigail Bentley, Audrey Prost, Nayreen Daruwalla, Apoorwa Gupta, David Osrin

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BACKGROUND: Intimate partner violence (IPV) can impact a woman’s physical, reproductive and mental health, including common mental disorders such as anxiety and depression. However, people other than an intimate partner may also perpetrate violence against women in the family, particularly in India. This study aims to investigate the relationship between experiences of violence perpetrated by the husband and other members of the wider household and symptoms of common mental disorders in women residing in informal settlement (slum) areas of Mumbai. METHODS: Experiences of violence were assessed through a detailed cross-sectional survey of 598 women, including questions about specific acts of emotional, economic, physical and sexual violence across different time points in the woman’s life and the main perpetrator of each act. Symptoms of common mental disorders were assessed using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 scores were divided into four groups and the relationship between experiences of each type of violence in the last 12 months and GHQ-12 score group was analyzed using ordinal logistic regression, adjusted for the woman’s age and clustering. RESULTS: 482 (81%) women consented to interview. On average, they were 28.5 years old, had completed 7 years of education and had been married 9 years. 88% were Muslim and 47% lived in joint and 53% in nuclear families. 44% of women had experienced at least one act of violence in their lifetime (33% emotional, 22% economic, 23% physical, 12% sexual). 7% had a high GHQ-12 score (6 or above). For violence experiences in the last 12 months, the odds of being in the highest GHQ-12 score group versus the lower groups combined were 13.1 for emotional violence, 6.5 for economic, 5.7 for physical and 6.3 for sexual (p<0.001 for all outcomes). DISCUSSION: The high level of violence reported across the lifetime could be due to the detailed assessment of violent acts at multiple time points and the inclusion of perpetrators within the family other than the husband. Each type of violence was associated with greater odds of a higher GHQ-12 score and therefore more symptoms of common mental disorders. Emotional violence was far more strongly associated with symptoms of common mental disorders than physical or sexual violence. However, it is not possible to attribute causal directionality to the association. Further work to investigate the relationship between differing severity of violence experiences and women’s mental health and the components of emotional violence that make it so strongly associated with symptoms of common mental disorders would be beneficial.

Keywords: common mental disorders, family violence, India, informal settlements, mental health, violence against women

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Authors: Ibrahim Alshunaibir

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Infection with Helicobacter pylori is common worldwide but few studies focus on the prevalence and spread of the infection in Saudi Arabia. This study was undertaken to observe the epidemiology of Helicobacter pylori infection in patients suffering from gastrointestinal sign and symptoms in one of the largest hospitals in the capital of Saudi Arabia, Riyadh. Methods: Enzyme-linked immunosorbent assay (ELISA) was undertaken for this study with nearly 6000 samples collected and examined for patients suffering from (dyspeptic) symptoms ranging in their age from 5 to 75 years. Results: The prevalence of helicobacter infection was 67% increasing with age. Female shows higher percentage of H. pylori infection than male. Conclusions: The percentage rate was higher in female than male. This study shows a high percentage of helicobacter infection in Saudi Arabia.

Keywords: Helicobacter pylori, percentage, dyspeptic, Saudi Arabia

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Authors: Aicha Akrout, Amira Echtioui, Mohamed Ghorbel

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Pneumonia remains a significant global health concern, posing a substantial threat to human lives due to its contagious nature and potentially fatal respiratory complications caused by bacteria, fungi, or viruses. The reliance on chest X-rays for diagnosis, although common, often necessitates expert interpretation, leading to delays and potential inaccuracies in treatment. This study addresses these challenges by employing transfer learning techniques to automate the detection of lung diseases, with a focus on pneumonia. Leveraging three pre-trained models, VGG-16, ResNet50V2, and MobileNetV2, we conducted comprehensive experiments to evaluate their performance. Our findings reveal that the proposed model based on VGG-16 demonstrates superior accuracy, precision, recall, and F1 score, achieving impressive results with an accuracy of 93.75%, precision of 94.50%, recall of 94.00%, and an F1 score of 93.50%. This research underscores the potential of transfer learning in enhancing pneumonia diagnosis and treatment outcomes, offering a promising avenue for improving healthcare delivery and reducing mortality rates associated with this debilitating respiratory condition.

Keywords: chest x-ray, lung diseases, transfer learning, pneumonia detection

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Authors: F. Arıkan, Z. Karakus

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Cancer is a widespread disease in the world and is the third reason of deaths among the chronic diseases. Educating patients and caregivers has a vital role for empowering them in managing disease and treatment's symptoms. Informing of the patients about their disease and treatment process decreases patient's distress and decisional conflicts, improves wellbeing of them, increase success of the treatment and survival. In this era, technological education methods are used for patients that have different chronic disease. Many studies indicated that especially web based patient education such as chronic obstructive lung disease; heart failure is more effective than printed materials. Web based education provide easiness to patients while they are reaching health services. It also has more advantages because of it decreases health cost and requirement of staff. It is thought that web based education may be beneficial method for cancer patient's empowerment in coping with the disease's symptoms. The aim of the study is evaluate the effectiveness of web based education for cancer patients' clinical outcomes.

Keywords: cancer patients, e-learning, nursing, web based education

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Authors: Anvikshaa Bisen, Krish Makkar

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Professionals misdiagnose autism by ticking off symptoms on a checklist without questioning the causes of said symptoms, and without understanding the innate neurophysiology of the autistic brain. A dysfunctional cingulate gyrus (CG) hyperfocuses attention in the left frontal lobe (logical/analytical) with no ability to access the right frontal lobe (emotional/creative), which plays a central role in spontaneity, social behavior, and nonverbal abilities. Autistic people live in a specialized inner space that is entirely intellectual, free from emotional and social distractions. They have no innate biological way of emotionally connecting with other people. Autistic people process their emotions intellectually, a process that can take 24 hours, by which time it is too late to have felt anything. An inactive amygdala makes it impossible for autistic people to experience fear. Because they do not feel emotion, they have no emotional memories. All memories are of events that happened about which they felt no emotion at the time and feel no emotion when talking about it afterward.

Keywords: autism, Asperger, Asd, neuropsychology, neuroscience

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Authors: Jinil Patel, Sarthak Patel, Sarthak Thakkar, Deepti Saraswat

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Recently, the COVID-19 outbreak has spread across the world, leading the World Health Organization to classify it as a global pandemic. To save the patient’s life, the COVID-19 symptoms have to be identified. But using an AI (Artificial Intelligence) model to identify COVID-19 symptoms within the allotted time was challenging. The RT-PCR test was found to be inadequate in determining the COVID status of a patient. To determine if the patient has COVID-19 or not, a Computed Tomography Scan (CT scan) of patient is a better alternative. It will be challenging to compile and store all the data from various hospitals on the server, though. Federated learning, therefore, aids in resolving this problem. Certain deep learning models help to classify Covid-19. This paper will have detailed work of certain deep learning models like VGG19, ResNet50, MobileNEtv2, and Deep Learning Aggregation (DLA) along with maintaining privacy with encryption.

Keywords: federated learning, COVID-19, CT-scan, homomorphic encryption, ResNet50, VGG-19, MobileNetv2, DLA

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Authors: Fatemeh Abdollahi, Munn-Sann Lye, Jamshid Yazdani Charati, Mehran Zarghami

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Fathers are at risk of depression during the postpartum period. Some studies have been reported maternal depression is the key predictor of paternal postpartum depression (PPD). This study aimed to estimate the prevalence and predictors of parental PPD and its association with maternal PPD. In a cross-sectional study, via a stratified random and convenience sampling method, participants referring to health centers during 2-8 weeks postpartum were recruited from March to October 2017. Paternal PPD and its relation to maternal PPD and other related factors were assessed using multiple logistic regression. Participants were 591 literate couples who referred to Mazandaran province primary health centers during to study period. Couples were screened for depression using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ) as well. Data on mothers ‘demographic characteristics and obstetrics factors was also gathered. Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age [OR=1.20, (95%CI: 1.05- 1.36)], maternal depressive symptoms [OR=1.15, (95%CI: 1.04-1.27)], higher GHQ scores [OR=1.21, (95%CI: 1.11-1.33)] and increased recent life events [OR=1.42, (95%CI: 1.01-1.2.00)] were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD [OR=0.20, (95%CI: 0.07-0.53)]. Depressive symptoms, especially in first-time fathers following the birth of a child, are not uncommon. Maternal depressive symptoms and paternal well-being were strong predictors of parental PPD. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease the suffering of depression for both depressed parents are recommended.

Keywords: depression, men, postpartum, risk factors, women

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Authors: James Boag

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The needs of people with a diagnosis of dementia and their carers and families are physical, psychosocial, and psychological and begin at the time of diagnosis. There is frequently a lack of emotional support and counselling. Care- giving support is required from the presentation of the first symptoms of dementia until death. Alzheimer's disease begins decades before the clinical symptoms begin to appear, and in many cases, it remains undiagnosed, or diagnosed too late for any possible interventions to have any effect. However, if an incorrect diagnosis is given, it may result in a person being treated, without effect, for a type of dementia they do not have and delaying the interventions they should have received. Being diagnosed with dementia can cause emotional distress to the person, and physical and emotional support is needed, which will become more important as the disease progresses. The severity of the patient's dementia and their symptoms has a bearing of the impact on the carer and the support needed. A lack of insight and /or a denial of the diagnosis, grief, reacting to anticipated future losses, and coping methods to maximise the disease outcome, are things that should be addressed. Because of the stigma, it is important for carers not to lose contact with family and others because social isolation leads to depression and burnout. The impact on a carer's well- being and quality of life can be influenced by the severity of the illness, its type of dementia, its symptoms, healthcare support, financial and social status, career, age, health, residential setting, and relationship to the patient. Carer burnout due to lack of support leads to people diagnosed with dementia being put into residential care prematurely. Often dementia is not recognised as a terminal illness, limiting the ability of the person diagnosed with dementia and their carers to work on advance care planning and getting access to palliative and other support. Many carers have been satisfied with the physical support they were given in their everyday life, however, it was agreed that there was an immense unmet need for psychosocial support, especially after diagnosis and approaching end of life. Providing continuity and coordination of care is important. Training is necessary for providers to understand that every case is different, and they should understand the complexities. Grief, the emotional response to loss, is suffered during the progression of the disease and long afterwards, and carers should continue to be supported after the death of the person they were caring for.

Keywords: dementia, caring, challenges, needs

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Authors: Boris Ershov

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Depression is the most common mood disorder experienced by patients who have sustained a traumatic brain injury (TBI) and is associated with poorer cognitive functional outcomes. However, in some cases, similar cognitive impairments can also be observed in depression. There is not enough information about the features of the cognitive deficit in patients with TBI in relation to patients with depression. TBI patients without depressive symptoms (TBInD, n25), TBI patients with depressive symptoms (TBID, n31), and 28 patients with bipolar II disorder (BP) were included in the study. There were no significant differences in participants in respect to age, handedness and educational level. The patients clinical status was determined by using Montgomery–Asberg Depression Rating Scale (MADRS). All participants completed a cognitive battery (The Brief Assessment of Cognition in Affective Disorders (BAC-A)). Additionally, the Rey–Osterrieth Complex Figure (ROCF) was used to assess visuospatial construction abilities and visual memory, as well as planning and organizational skills. Compared to BP, TBInD and TBID showed a significant impairments in visuomotor abilities, verbal and visual memory. There were no significant differences between BP and TBID groups in working memory, speed of information processing, problem solving. Interference effect (cognitive inhibition) was significantly greater in TBInD and TBID compared to BP. Memory bias towards mood-related information in BP and TBID was greater in comparison with TBInD. These results suggest that depressive symptoms are associated with impairments some executive functions in combination at decrease of speed of information processing.

Keywords: bipolar II disorder, depression, neurocognitive deficits, traumatic brain injury

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Authors: Shinta Stri Ayuda Nur Setyaningsih

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Anterior uveitis is often triggered by viral infections such as herpes simplex virus (HSV) and cytomegalovirus (CMV). This study aims to provide an overview of the demographic and clinical characteristics of patients with anterior uveitis caused by CMV and HSV infection at PMN Cicendo Eye Hospital Bandung. This study used a retrospective observational method. Data were collected from the medical records of patients who visited the PMN Infection and Immunology Polyclinic at Cicendo Eye Hospital between February and July 2023. The results showed that anterior uveitis associated with HSV and CMV viruses often occurs in the elderly and more in women. The most common clinical symptoms are red eyes and decreased visual acuity, with a gradual onset of symptoms. Complications that often arise are cataracts and glaucoma. This study provides a deeper understanding of anterior uveitis caused by infection with HSV and CMV viruses.

Keywords: uveitis anterior, cytomegavirus, herpes simplex virus type I ELISA

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Authors: M. Kuzhko, M. Gumeniuk, D. Butov, T. Tlustova, O. Denysov, T. Sprynsian

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Background: The aim of the research was to determine the effectiveness of chemotherapy using intravenous antituberculosis drugs compared with their oral administration during the intensive phase of treatment. Methods: 152 tuberculosis patients were randomized into 2 groups: Main (n=65) who received isoniazid, ethambutol and sodium rifamycin intravenous + pyrazinamide per os and control (n=87) who received all the drugs (isoniazid, rifampicin, ethambutol, pyrazinamide) orally. Results: After 2 weeks of treatment symptoms of intoxication disappeared in 59 (90.7±3.59 %) of patients of the main group and 60 (68.9±4.9 %) patients in the control group, p<0.05. The mean duration of symptoms of intoxication in patients main group was 9.6±0.7 days, in control group – 13.7±0.9 days. After completing intensive phase sputum conversion was found in all the patients main group and 71 (81.6±4.1 %) patients control group p < 0.05. The average time of sputum conversion in main group was 1.6±0.1 months and 1.9±0.1 months in control group, p > 0.05. In patients with destructive pulmonary tuberculosis time to sputum conversion was 1.7±0.1 months in main group and 2.2±0.2 months in control group, p < 0.05. The average time of cavities healing in main group was 2.9±0.2 months and 3.9±0.2 months in the control group, p < 0.05. Conclusions: In patients with newly diagnosed destructive pulmonary tuberculosis use of isoniazid, ethambutol and sodium rifamycin intravenous in the intensive phase of chemotherapy resulted in a significant reduction in terms of the disappearance of symptoms of intoxication and sputum conversion.

Keywords: intravenous chemotherapy, tuberculosis, treatment efficiency, tuberculosis drugs

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Authors: Claudia Cedeno Nadal, Mei-Ling Villafana, Griela Rodriguez, Jessica Martin, Jennifer Martin, Megan Patel

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This study systematically examines the impact of Transcendental Mindfulness Meditation on anxiety symptoms in young females aged 18-25. Through a comprehensive literature review, we found consistent evidence supporting the positive influence of Transcendental Mindfulness Meditation on reducing anxiety, enhancing overall well-being, and decreasing perceived stress levels within this demographic. The mechanisms underlying these effects include heightened self-awareness, improved emotional regulation, and the development of effective stress-coping strategies. These findings have significant implications for mental health interventions targeting young females. However, the reviewed studies had some limitations, such as small sample sizes and reliance on self-report measures. To advance this field, future research should focus on larger sample sizes and utilize a broader range of measurement methods, including neuroscience assessments. Additionally, investigating the temporal relationships between Transcendental Mindfulness Meditation, proposed mediators, and anxiety symptoms will help establish causal specificity and a deeper understanding of the precise mechanisms of action. The development of integrative models based on these mechanisms can further enhance the effectiveness of Transcendental Mindfulness Meditation as an intervention for anxiety in this demographic. This study contributes to the current knowledge on the potential benefits of Transcendental Mindfulness Meditation for reducing anxiety in young females, paving the way for more targeted and effective mental health interventions in this population.

Keywords: mindfulness, meditation, anxiety, transcendental mindfulness

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Authors: Tina Naser Torabi

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Prevalence of allergy is affected by different factors according to its base and seasonal weather changes, and it also needs various treatments.Although reasons of allergy existence are not clear but generally, allergens cause reaction between antigen and antibody because of their antigenic traits. In this state, allergens cause immune system to make mistake and identify safe material as threat, therefore function of immune system impaired because of histamine secretion. There are different reasons for allergy, but herbal reasons are on top of the list, although animal causes cannot be ignored. Important point is that allergenic compounds, cause making dedicated antibody, so in general every kind of allergy is different from the other one. Therefore, most of the plants in herbal allergenic category can cause various allergies for human beings, such as respiratory allergies, nutritional allergies, injection allergies, infection allergies, touch allergies, that each of them show different symptoms based on the reason of allergy and also each of them requires different prevention and treatment. Geographical condition is another effective factor in allergy. Seasonal changes, weather condition, herbal coverage variety play important roles in different allergies. It goes without saying that humid climate and herbal coverage variety in different seasons especially spring cause most allergies in human beings in Iran and India that are discussed in this article. These two countries are good choices for allergy prevalence because of their condition, various herbal coverage, human and animal factors. Hay fever is one of the allergies, although the reasons of its prevalence are unknown yet. It is one of the most popular allergies in Iran and India because of geographical, human, animal and herbal factors. Hay fever is on top of the list in these two countries. Significant point about these two countries is that herbal factor is the most important factor in prevalence of hay fever. Variety of herbal coverage especially in spring during herbal pollination is the main reason of hay fever prevalence in these two countries. Based on the research result of Pharmacognosy and Phytochemistry, pollination of some plants in spring is major reason of hay fever prevalence in these countries. If airborne pollens in pollination season enter the human body through air, they will cause allergic reactions in eyes, nasal mucosa, lungs, and respiratory system, and if these particles enter the body of potential person through food, they will cause allergic reactions in mouth, stomach, and other digestive systems. Occasionally, chemical materials produced by human body such as Histamine cause problems like: developing of nasal polyps, nasal blockage, sleep disturbance, risk of asthma developing, blood vasodilation, sneezing, eye tears, itching and swelling of eyes and nasal mucosa, Urticaria, decrease in blood pressure, and rarely trauma, anesthesia, anaphylaxis and finally death. This article is going to study the reasons of hay fever prevalence in Iran and India and presents prevention and treatment Method from Phytochemistry and Pharmocognocy point of view by using local natural products in these two countries.

Keywords: hay fever, India, Iran, natural treatment, phytochemistry

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Authors: Bhavna Rajagopal, Mrinmoyi Kulkarni

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Today women experience more menstrual cycles than their ancestors did a hundred years ago, owing to early puberty, fewer pregnancies and dietary changes. Much of the research in menstruation is located in the medical domain with a focus on physical symptoms. The research in psychology is largely concerned with premenstrual syndrome (PMS), whereas the focus in sociology is on social and cultural practices relating to menstruation. Research that simultaneously studies the physical, psychological, social and cultural aspects is lacking. Therefore, in this study, an attempt has been made to identify socio-cultural, psychological and physical factors that interact to influence a woman’s experience of menstruation in the urban setting. The study included seven unmarried women in the age group of 24-30 and data was obtained through a focus group discussion. The transcript of the focus group discussion was thematically analysed. Two major themes relating to the self and social experience of menstruation emerged. Themes relating to the self included menarcheal experiences, self-perception, mood and management of menstrual hygiene and symptoms while themes relating to social experience included the construction of menstruation by family and peers, and cultural factors. Attitudes towards the menstrual cycle appeared to be primarily influenced by severity of symptoms and the resulting disruption to daily life. Outcomes of this study have indicated that future research needs to study menstruation and its impact on women’s wellbeing by adopting a socio-ecological approach and by collecting data using the whole cycle approach across a woman’s reproductive years.

Keywords: India, menstrual cycle, psychosocial approach, wellbeing

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Authors: Sireen Irsheid, Stephanie Keeney Parks, Michael A. Lindsey

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The medical and mental health field have been organized as reactive systems to respond to symptoms of mental health problems and disability. This becomes problematic particularly for those harmed by structural violence and racism, typically pushing us in the direction of alleviating symptoms and personalizing structural problems. The current paper examines how we assess, diagnose, and treat mental health and disability challenges in clinical spaces. We provide the readers with some context to think about the problem of racism and mental health/disability, ways to deconstruct the problem through the lens of structural violence, and recommendations to critically engage in clinical assessments, diagnosis, and treatment for young people impacted by structural violence and racism.

Keywords: mental health, disability, race and ethnicity, structural violence, structural racism, young people

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Authors: Teresa Rushe, Nicole Devlin, Tara O Neill

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In this study, we sought to examine associations between childhood experiences of community and collective violence and psychological functioning in young people who grew up in post-conflict Northern Ireland. We hypothesized that those who grew up with such experiences would demonstrate internalizing and externalizing difficulties in early adulthood and, furthermore, that these difficulties would be mediated by adverse childhood experiences occurring within the home environment. As part of the Northern Ireland Childhood Adversity Study, we recruited 213 young people aged 18-25 years (108 males) who grew up in the post-conflict society of Northern Ireland using purposive sampling. Participants completed a digital questionnaire to measure adverse childhood experiences as well as aspects of psychological functioning. We employed the Adverse Childhood Experience -International Questionnaire (ACE-IQ¬) adaptation of the original Adverse Childhood Experiences Questionnaire (ACE) as it additionally measured aspects of witnessing community violence (e.g., seeing someone being beaten/killed, fights) and experiences of collective violence (e.g., war, terrorism, police, or gangs’ battles exposure) during the first 18 years of life. 51% of our sample reported experiences of community and/or collective violence (N=108). Compared to young people with no such experiences (N=105), they also reported significantly more adverse experiences indicative of household dysfunction (e.g., family substance misuse, mental illness or domestic violence in the family, incarceration of a family member) but not more experiences of abuse or neglect. As expected, young people who grew up with the community and/or collective violence reported significantly higher anxiety and depression scores and were more likely to engage in acts of deliberate self-harm (internalizing symptoms). They also started drinking and taking drugs at a younger age and were significantly more likely to have been in trouble with the police (externalizing symptoms). When the type of violence exposure was separated by whether the violence was witnessed (community violence) or more directly experienced (collective violence), we found community and collective violence to have similar effects on externalizing symptoms, but for internalizing symptoms, we found evidence of a differential effect. Collective violence was associated with depressive symptoms, whereas witnessing community violence was associated with anxiety-type symptoms and deliberate self-harm. However, when experiences of household dysfunction were entered into the models predicting anxiety, depression, and deliberate self-harm, none of the main effects remained significant. This suggests internalizing type symptoms are mediated by immediate family-level experiences. By contrast, significant community and collective violence effects on externalizing behaviours: younger initiation of alcohol use, younger initiation of drug use, and getting into trouble with the police persisted after controlling for family-level factors and thus are directly associated with growing up with the community and collective violence. Given the cross-sectional nature of our study, we cannot comment on the direction of the effect. However, post-hoc correlational analyses revealed associations between externalising behaviours and personal factors, including greater risk-taking and young age at puberty. The implications of the findings will be discussed in relation to interventions for young people and families living with the community and collective violence.

Keywords: community and collective violence, adverse childhood experiences, youth, psychological wellbeing

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Authors: K. Pankaj, R. K. Chaudhary, B. P. Mishra, S. Kochar

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Introduction: Consultation-Liaison psychiatry is a branch of psychiatry that includes clinical service, teaching and research. A consultation-liaison psychiatrist plays a role in having an expert opinion and linking the patients to other medical professionals and the patient’s bio-psycho-social aspects that may be leading to his/her symptoms. Consultation-Liaison psychiatry has been recognised as 'The guardian of the holistic approach to the patient', underlining its pre-eminent role in the management of patients who are admitted in a tertiary care hospital. Aims/ Objectives: The aim of the study was to analyse the utilization of psychiatric services and reasons for referrals in a tertiary care hospital. Materials and Methods: The study was done in a tertiary care hospital. The study included all the cases referred from different Inpatient wards to the psychiatry department for consultation. The study was conducted on 300 patients over a 3 month period. International classification of diseases 10 was used to diagnose the referred cases. Results: The majority of the referral was from the Medical Intensive care unit (22%) followed by general medical wards (18.66%). Majority of the referral was taken for altered sensorium (24.66%), followed by low mood or unexplained medical symptoms (21%). Majority of the referrals had a diagnosis of alcohol withdrawal syndrome (21%) as per International classification of diseases criteria, followed by unipolar Depression and Anxiety disorder (~ 14%), followed by Schizophrenia (5%) and Polysubstance abuse (2.6%). Conclusions: Our study concludes the importance of utilization of consultation-liaison psychiatric services. Also, the study signifies the need for sensitization of our colleagues regarding psychiatric sign and symptoms from time to time and seek psychiatric consult timely to decrease morbidity.

Keywords: consultation-liaison, psychiatry, referral, tertiary care hospital

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Authors: Nurullah Buker, Ezgi Karagoz, Yesim Salik Sengul, Sevay Alsen Guney, Gokhan Yoyler, Aylin Ozbek

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Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders with heterogeneous clinical features such as inattention, hyperactivity, and impulsivity. Many different types of exercise interventions were employed for children with ADHD. However, previous studies have usually examined the effects of non-specific exercise programs or short-term effects of exercise. The aim of this study is to investigate the effect of the Neurocognitive Exercise Program (NEP), which is a structured exercise program derived from Life Kinetik, and a relatively new for children with ADHD, on symptoms, attention, and dynamic balance in medication-naïve children with ADHD. Fourteen medication-naive children (7-12 years) with ADHD were included in the intervention group. NEP was performed once a week for ten weeks. The intervention group also performed a structured home exercise program for another six days, for ten weeks. The children in the intervention group were assessed at baseline, in the third month, in the sixth month, and in the twelfth month regarding ADHD-related symptoms, attention, and dynamic balance. Fifteen age-matched typically developing children were assessed once for establishing normative values. Hyperactivity-Impulsivity score and dynamic balance were found to improve after NEP in the ADHD group in the 3rd month (p<0.05). In addition, these results were similar for both groups after NEP and at the end of the 12th month (p>0.05). The NEP may provide beneficial effects on hyperactivity-impulsivity, oppositional defiant, and dynamic balance in children with ADHD, and the improvements may be maintained in the long term.

Keywords: ADHD, attention problems, dynamic balance, neurocognitive exercise

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