The association between body composition and self-reported co-morbidity in subjects with chronic obstructive pulmonary disease

Background: Differences in body composition are extensively investigated in subjects with COPD as low muscle mass was independently associated with increased morbidity and mortality. Also cardio-vascular co-morbidity is often reported in COPD and the contribution of fat mass in COPD related co-morbidity is gaining interest. We hypothesized that the prevalence of low muscle mass and high fat mass is higher in subjects with COPD compared to a group of current and former smokers without COPD, which result in higher reported cardiovascular co-morbidity in the COPD group. Methods: In 954 subjects with COPD and 955 subjects without COPD, body composition was assessed by bio-electrical impedance analysis and information on self-reported co-morbidity was collected. Participants were stratified for low fat free mass index and high fat mass index (resp. fat free mass index 50th percentile of the subjects without COPD). Results: Subjects with COPD were more likely to have low fat free mass index than current and former smokers without COPD. The prevalence of high fat mass index was comparable between the groups. The percentage of self-reported co-morbidity was higher in subjects with COPD, but only reports of myocardial infarction were disease specific. Conclusion: Low fat free mass index was more common in COPD, but the prevalence of high fat mass index was comparable between subjects with and without COPD. Nevertheless, subjects with COPD reported more myocardial infarction, implying that other factors than the amount of fat mass are involved in the increased co-morbidity in COPD.

Incidence of Diabetes in Hepatitis C Patients in Remote Areas of Pakistan:Effect of Co-Morbidity on HCV Treatment Outcomes at Selected Secondary Care Hospitals

The management of Hepatitis C(HCV)varies greatly due to co-morbidities.Association of Type II Diabetes Mellitus(T2DM)and HCV infection is momentous,however,only limited studies available from remote areas of Pakistan.This study aimed to assess the incidence of T2DM in Hepatitis C patients,and to measure the treatment outcomes of anti-HCV therapy in co-morbidity of diabetic patients in remote areas of Khyber Pakhtunkhwa Pakistan.A cross-sectional retrospective analysis of HCV patients(n=449)was conducted in the District Hospitals of Bannu and Lakki Marwat,Pakistan.Patients diagnosed of HCV infection and having T2DM as comorbidity were included in the study.The demographic information and laboratory parameters,such as viral load(VL),hemoglobin(Hb),alanine amino transferase(ALT),and platelet count were collected to measure treatment outcomes.T2DM was found in 33.18%of patients and significant association(p˂0.05)was found with HCV infection as a co-morbidity.Sofosbuvir(SOF)and Ribavirin(RBV)therapy reduced the mean(SD)VL(×10^(3))from baseline 357.1±26.23 IU/mL to 14±2.3 IU/mL and 1.3±0.3 IU/mL at 3rd and 6th months of therapy,respectively.Conventional Interferon and Ribavirin(RBV)therapy reduced VL from a baseline 234.57±13.5 IU/mL to 72±7.9 IU/mL and 62±3.7 IU/mL at 3rd and 6th months of therapy,respectively.PEG-Interferon+Ribavirin(RBV)therapy reduced baseline VL from 337±16.27 IU/mL to 18±2.8 and 4±1 at 3^(rd) and 6^(th) month of therapy,respectively.Similarly,Hb,ALT,and platelet count showed variations in all the studied groups.T2DM was highly prevalent and significantly associated with HCV in patients of 40 years or above and SOF+RBV combination therapy showed a better response,both in the diabetic and non-diabetic HCV patients compared to earlier the therapies.To further confirm the finding,a study using a larger population of HCV patients with T2DM should be conducted.

Population-based study of health service deficits in US adults with depression: Does chronic disease co-morbidity and/or rural residency make a difference?

Introduction: Rural residents are at higher risk for a depressive disorder than their non-rural counterparts. Recent research has indicated that co-morbidities are also associated with depression. Health service deficits (HSDs) is an analytic concept that facilitates the examination of how a population uses health services relevant to their condition. A HSD is present when, over the preceding 12 months, an individual has had no health insurance, no specified health care provider, deferred medical care due to cost, or did not have a routine medical exam. Research has shown a high prevalence of HSDs in populations with individual chronic conditions. No study that we know of has examined if there is an association between the constellation of chronic conditions of depression and the co-morbidities of asthma, arthritis, and diabetes, with HSDs. Methods: 2011 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify important dimensions of the epidemiology of depression by ascertaining whether there were differences in the prevalence of health service deficits in rural versus non-rural adults with depression and at least one additional chronic disease (arthritis, asthma, or diabetes). Data analyses entailed both bivariate and multivariate techniques. All analyses were performed on weighted data. Results: Logistic regression analysis performed using the presence of at least one HSD as the dependent variable yielded that for US adults with lifetime depression those who were African American, Hispanic and other/multiracial in comparison to Caucasian had higher odds of having at least one health service deficit. Low socioeconomic status (SES) and middle SES in comparison to high SES were also risk factors for US adults with lifetime depression having at least one HSD. Rural residency in comparison to non-rural residency also emerged as an independent risk factor (for US adults with lifetime depression having at least one HSD. Chronic disease, however, emerged as protective against US adults with lifetime depression having at least one health service deficit. Conclusions: This study demonstrated that race/ethnicity, SES, and rural residency are important predictors of health service deficits for individuals with a lifetime diagnosis of depression while having one or more chronic conditions for these same individuals was protective.

Psychiatric Co-Morbidity and Quality of Life in Egyptian Type 2 Diabetic Patients

Background: Diabetes is a risk factor for depression, but little is known about anxiety and other psychiatric disorders and quality of life. The aim of this study was to assess the prevalence of depression, anxiety in diabetic patients in our locality and to assess the quality of life in type 2 DM. Subjects & Methods: This study was a cross-sectional study and was carried out in outpatient clinics of specialized medical hospital, Mansoura university for a period of one year. From 217 diabetes mellitus subjects, only 202 patients were matched with 247 healthy people as a control group. All subjects were examined by using socioeconomic data, clinical data, and anthropometric examinations to assess body mass index and waist circumference. All patients were interviewed by using the Mini-International Neuropsychiatric Interview (MINI) version 5, MINI, Hospital Anxiety and Depression scale (HAD) and health-related quality of life (HRQOL) scales. Laboratory investigation in the form of fasting and two-hour postprandial blood sugar (FBS & 2hpp) and HbA1C levels were done. Results: 18.3% were found to be major depressive disorder;and 2.5% panic disorder, 1% other phobia. Generalized anxiety disorder and obsessive-compulsive disorder were found in one patient, no patients were found to be diagnosed as Bipolar disorder, schizophrenia, or substance abuse. Although there was no statistically significant difference between subjects and control groups regarding height, there was statistically significant difference between weights, BMI, with more scores among DM group. Moreover our study showed that HbA1c, fasting blood sugar, two hours post prandial blood sugar were more among DM patients and control groups. Anxiety, depression, and poorer quality of life were found to be more prevalent among DM patients than control groups. Conclusion: DM is associated with depression anxiety disorder with poorer quality of life.

Effect of awareness,quarantine and vaccination as control strategies on COVID-19 with Co-morbidity and Re-infection

In this paper,a deterministic compartmental model is presented to assess the impact of vaccination and non-pharmaceutical interventions(social distance,awareness,face mask,and quarantine)on the transmission dynamics of COVID-19 with co-morbidity and reinfection.An expression for the basic reproduction number is then derived for this model.Theoretical analysis shows that the model exhibits backward bifurcation phenomenon when the basic reproduction number is less than unity.But for the case of no reinfection,the model has a globally asymptotically stable disease-free equilibrium(DFE)when the basic reproduction number is less than unity.Furthermore,it is shown that in the case of no re-infection,a unique endemic equilibrium point(EEP)of the model exists which is globally asymptotically stable whenever the reproduction number is greater than unity.From the global sensitivity and uncertainty analysis,we have identified mask coverage,mask efficacy,vaccine coverage,vaccine efficacy,and contact rate as the most influential parameters influencing the spread of COVID-19.Numerical simulation results show that the use of effective vaccines with proper implementation of non-pharmaceutical interventions could lead to the elimination of COVID-19 from the community.Numerical simulations also suggest that the control strategy that ensures a continuous and effective mass vaccination program is the most cost-effective control strategy.The study also shows that in the presence of any co-morbidity and with the occurrence of re-infection,the disease burden may increase.

Dynamics of novel COVID-19 in the presence of Co-morbidity

A novel coronavirus(COVID-19)has emerged as a global serious public health issue from December 2019.People having a weak immune system are more susceptible to coronavirus infection.It is a double challenge for people of any age with certain underlying medical conditions including cardiovascular disease,diabetes,high blood pressure and cancer etc.Co-morbidity increases the probability of COVID-19 complication.In this paper a deterministic compartmental model is formulated to understand the transmission dynamics of COVID-19.Rigorous mathematical analysis of the model shows that it exhibits backward bifurcation phenomenon when the basic reproduction number is less than unity.For the case of no re-infection it is shown that having the reproduction number less than one is necessary and sufficient for the effective control of COVID-19,that is,the disease free equilibrium is globally asymptotically stable when the reproduction threshold is less than unity.Furthermore,in the absence of reinfection,a unique endemic equilibrium of the model exists which is globally asymptotically stable whenever the reproduction number is greater than unity.Numerical simulations of the model,using data relevant to COVID-19 transmission dynamics,show that the use of efficacious face masks publicly could lead to the elimination of COVID-19 up to a satisfactory level.The study also shows that in the presence of co-morbidity,the disease increases significantly.

Reconsidering Co-Morbid Traits in Explanatory Models of High Dental Anxiety Using a Comparison of Psychiatric and Normal Patient Samples

Explanatory models of co-morbid traits related to dental anxiety (DA) as described in the literature were tested and relative strengths analyzed in two groups of Danish adults, one with psychiatric diagnoses (n = 108) and the other healthy incoming patients at a large dental school teaching clinic (n = 151). Dental Anxiety Scale (DAS) and self-report measures representing three co-morbidity explanatory models, 1) presence of other fears;2) anxiety sensitivity and 3) feelings of vulnerability specific to dental treatment, were collected in subscales of a 53-item questionnaire. Other items identified gender, age, education, income, avoidance behavior and dental symptoms. Frequency, chi-square, odds ratio and logistic regression analyses were performed. Results: All individuals with high DA (DAS > 13) regardless of group, demonstrated significant differences in avoidance of treatment (>2 yr.) versus lower or no anxiety. Patients with psychiatric diagnoses were three times more likely to have high DA and nearly two times more likely to have avoided dental treatment >2 yr.;25.9% reported extreme DA, compared to 9.3% of controls. Models of high general fear levels, predisposing anxiety sensitivity and vulnerability all demonstrated significant and strong association with intensity of dental anxiety in bivariate analyses. Feelings of vulnerability were the strongest predictor of DAS high anxiety, according to logistic regression analyses. Conclusion: Co-morbidity explanatory models as represented in present trait measures appear not to be competitive, but rather explain different aspects of a vulnerability model in high dental anxiety. Higher incidence of DA and treatment avoidance in psychiatric patients requires special attention.

Preliminary Investigation of Sex Differences in Procedural Skill Learning in Veterans with Co-Morbidities

Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for returning Veterans that have a range of co-morbid conditions (traumatic brain injury, posttraumatic stress disorder, and depression) and possess impairments in multiple domains. Sixty-five (55 males, 10 females) Veterans completed two procedural learning tasks and answered self-report questionnaires. Participants’ performance and total learning slope were analyzed to determine sex differences in learning. Our results revealed sex differences in both tasks demonstrating females tend to perform better than males with a large effect size for these mean differences. While females performed better on the procedural learning tasks compared to males, their rate of learning was equivalent. Skill learning is an important requisite for rehabilitation, as skill learning is necessary to perform daily activities in new settings. Ultimately, these results provide insight into skill learning in Veterans with a range of co-morbid conditions and provide support for further investigation of sex differences in procedural learning.

Treatment of psychological co-morbidities in common gastrointestinal and hepatologic disorders

Anxiety and depressive disorders frequently coexist with gastrointestinal and hepatologic conditions.Despite their high prevalence,approach to treating these co-morbidities is not always straightforward.This paper aims to review the current literature into etiology of psychological comorbidities and their treatment in three conditions commonly encountered at gastroenterology outpatient clinics,namely inflammatory bowel disease(IBD),irritable bowel syndrome(IBS) and chronic hepatitis C(HepC).The paper demonstrates that although psychotherapy(and cognitive-behavioural therapy in particular) has been established as an effective treatment in IBS,more studies are needed in HepC and IBD.Antidepressants have been recognized as an effective treatment for psychological and somatic symptoms in IBS and for depression in HepC,but good quality studies in IBD are lacking despite the promising preliminary findings from animal models and case studies.Further studies in this area are needed.

A Physician Suffering from COVID-19 with Multiple Co-Morbidities Have Delayed Viral Clearance: A Case Report from Bangladesh

Background: Novel corona virus (SARS-Coronavirus-2 SARS-CoV-2) which emerged in China has spread to multiple countries rapidly. Little information is known about delayed viral clearance in mild to moderate COVID-19 pa-tients. As it is highly contagious, health care workers including physicians are high risk of being infected in hospital care. Case Report: A 37 years old Bangladeshi physician working in a paediatric unit of a medical college hos-pital with multiple co-morbidities, hypertension, diagnosed axial spondy-loarthropathy (ankylosing spondylitis) taking disease modifying anti rheu-matic drugs— DMARDs (Salfasalazine) from 2016 till now, chronic persis-tent bronchial asthma on medication developed sore throat, increasing breathlessness and cough admitted to his own hospital on 22 April, 2020. He had a history of contact with a relapse nephrotic syndrome (glomerulone-phritis) patient admitted with severe respiratory distress later confirmed as COVID-19 following RT PCR test on 14 April, 2020. After 3 days of contact with the patient, the physician also developed the symptoms mentioned above. The RT PCR test result of the physician came positive on 18 April, 2020. The physician primarily taken only azithromycin 500 mg once daily along with other regular drugs. On 5, 12 and 18 May, 2020, his sample was taken for re-test and came positive subsequently. After that he started Iver-mectin (0.15 mg/kg) once daily for 3 days and doxycycline 100 mg BD for 7 days. He gave samples again on 27 and 29 May, 2020 which were came nega-tive after 39 days. On full recovery he was discharged from hospital on day 40. We choose the patient because presence of co-morbidities may be asso-ciated with delayed viral clearance and physicians with co-morbidities working in a hospital have high risk of being infected.

Metabolic co-morbidities and psoriasis: The chicken or the egg?

Accumulating evidence supports that psoriasis may be a potential multisystem inflammatory disease associated with a range of co-morbidities showing an overlapping pathology and an important health impact such as metabolic diseases.Psoriasis is associated with an increased risk of obesity,metabolic syndrome(Mets)and diabetes mellitus type 2,following a"dose-response"relationship from mild to severe psoriasis.Conversely,recent evidence from large prospective studies suggests that obesity constitutes a risk factor for psoriasis and psoriatic arthritis.Also,a dyslipidemic profile may precede psoriasis onset.Both obesity,Mets and psoriasis,characterized as chronic inflammatory states,stem from a shared underlying pathophysiology exhibiting common genetic predisposition and risk factors such as high caloric intake,physical inactivity and psychological stress.Excess weight may potentiate the inflammation of psoriasis through the deregulation of adipocytokines while,at the same time,it may help the development of Mets.Interestingly,recent translational data has shown that psoriasis,through increased T-helper inflammatory cytokines in skin and sera,may exert a plethora of effects on insulin regulation and lipid metabolism.Largerpopulation-based prospective cohort and longitudinal studies are needed to unravel the association between psoriasis and metabolic co-morbidities.The recognition of the intricate complex interplay between psoriasis and metabolic co-morbidities may help dermatologists to be aware of associated metabolic co-morbidities in order to screen for metabolic diseases and manage holistically and effectively the psoriatic patient.

Viruses and autism: A Bi-mutual cause and effect

Autism spectrum disorder(ASD)is a group of heterogeneous,multi-factorial,neurodevelopmental disorders resulting from genetic and environmental factors interplay.Infection is a significant trigger of autism,especially during the critical developmental period.There is a strong interplay between the viral infection as a trigger and a result of ASD.We aim to highlight the mutual relationship between autism and viruses.We performed a thorough literature review and included 158 research in this review.Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism,especially for specific viral infections such as Rubella,Cytomegalovirus,Herpes Simplex virus,Varicella Zoster Virus,Influenza virus,Zika virus,and severe acute respiratory syndrome coronavirus 2.Viral infection directly infects the brain,triggers immune activation,induces epigenetic changes,and raises the risks of having a child with autism.At the same time,there is some evidence of increased risk of infection,including viral infections in children with autism,due to lots of factors.There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism.In addition,children with autism are at increased risk of infection,including viruses.Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism.Immune modulation of children with autism should be considered to reduce the risk of infection.

Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding

AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective databases.RESULTS:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after RYGB.There were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound infection.LAGB had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.CONCLUSION:RYGB produces substantially greater weight loss than LAGB.Whilst peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.

Anti-Hypertensive Prescription and Cost Patterns in an Outpatient Department of a Teaching Hospital in Lagos State Nigeria

Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study was aimed at identifying associated co-morbid conditions, the prescribing patterns and cost of prescription for the treatment of hypertension in an outpatient clinic at Lagos University Teaching Hospital. Materials and Methods: A cross sectional study was carried out. A total of 147 prescriptions were obtained from the case notes of patients treated at the LUTH outpatient department between February 2012 and August 2012. For each prescription, the number of drugs, the class and combinations of antihypertensives were recorded. The monthly cost of a 30-day anti-hypertensive supply based on the recommended daily dose was calculated. Results: The mean age of the patients was 54(+/-14) years and of the 147 prescriptions, 77(52.4%) was for females and 70(47.6%) was for males. The mean systolic blood pressure was 141.6 mmHg (+/-20.5SD) and mean diastolic blood pressure was 86.5 mmHg (+/-13.3SD). Of the 147 prescriptions, 112(76.2%) were for patients with co-morbidities. The frequency of prescription of the various classes of anti hypertensives are;diuretics 117(79.6%), angiotensin receptor blockers 78(53.1%), angiotensin converting enzyme inhibitors 65(44.2%), calcium channel blockers 65 (44.2%) beta blockers 54(36.7%) and centrally acting agents 12(8.2%). Average cost per month was =N=6611.47 (US$44). There was a statistically significant association between co morbid conditions and high cost of prescriptions with 73.7% of those with diabetes and 63.2% of those with renal disease having cost of prescriptions within the high cost group (p < 0.05). Conclusion: The cost per month is high and it is recommended that hypertension should be addressed as part of an integrated care program. Ingenious ways of health care financing also have to be promoted.

Alpha-Stim Cranial Electrotherapy Stimulation (CES) for Anxiety Treatment: Outcomes in a United Kingdom (UK) Primary Care Practice

Background: Anxiety disorders are the most common mental disorders, typically treated with psychotherapy and medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a Cranial Electrotherapy Stimulation (CES) treatment with evidence of effectiveness in treating anxiety disorders. Objective: The aim of this paper is to present outcomes on anxiety, depression, and quality of life of Alpha-Stim use in primary care patients in the United Kingdom’s (UK) National Health Service (NHS) who reported symptoms of anxiety. Methods: Open label patient cohort design. Self-report measures: PHQ-9 (depression), GAD-7 (anxiety) and EQ-5D-5L (health related quality of life). Twenty-three patients with symptoms of anxiety completed a six-week course of Alpha-Stim intervention. Results: Reliable improvement and remission rates respectively were 60.9% and 17.4% for the GAD-7;42.9% and 22.7% for the PHQ-9. Significant improvement and medium/large effect sizes (n2 = 0.59 and 0.56 respectively). EQ-5D-5L results showed significant improvements in quality of life. Perceived quality of life doubled with an improvement of 0.36 on the health index score, this intervention adds 3.64 Quality Adjusted Life Years (QALYs). Limitations: The study was not an RCT, there was no control group. Conclusions: Alpha-Stim AID CES can be delivered through a UK primary care practice, and can have a significant impact on symptoms of anxiety and depression, and improve quality of life in primary care patients with anxiety symptoms. Further feasibility studies in primary care and sufficiently powered RCT are required.

From bariatric to metabolic surgery:Looking for a"diseasemodifier"surgery for type 2 diabetes

In this review the recent evolution of the comprehension of clinical and metabolic consequences of bariatric surgery is depicted. At the beginning bariatric surgery aim was a significant and durable weight loss. Later on, it became evident that bariatric surgery was associated with metabolic changes, activated by unknown pathways, partially or totally independent of weight loss. Paradigm of this "metabolic" surgery is its effects on type 2 diabetes mellitus(T2DM). In morbid obese subjects it was observed a dramatic metabolic response leading to decrease blood glucose, till diabetes remission, before the achievement of clinically significant weight loss, opening the avenue to search for putative antidiabetic "intestinal" factors. Both proximal duodenal(still unknown) and distal(GLP1) signals have been suggested as hormonal effectors of surgery on blood glucose decrease. Despite these findings T2 DM remission was never considered a primary indication for bariatric surgery but only a secondary one. Recently T2 DM remission in obese subjects with body mass index(BMI) greater than 35 has become a primary aim for surgery. This change supports the idea that "metabolic surgery" definition could more appropriate than bariatric, allowing to explore the possibility that metabolic surgery could represent a "disease modifier" for T2 DM. Therefore, several patients have undergone surgery with a primary aim of a definitive cure of T2 DM and today this surgery can be proposed as an alternative therapy. How much surgery can be considered truly metabolic is still unknown. To be truly "metabolic" it should be demonstrated that surgery could cause T2 DM remission not only in subjects with BMI > 35 but also with BMI < 35 or even < 30. Available evidence on this topic is discussed in this mini-review.

Assessment of visual outcomes of cataract surgery in Tujia nationality in Xianfeng County, China

AIM: To evaluate the visual outcome and factors influencing visual outcome of manual small incision cataract surgery(MSICS) in the rural area in the Xianfeng County.METHODS: Eighty-two eyes of 82 patients who underwent cataract surgery performed by using MSICS technique were identified. Data collected included each patient's age, gender, the level of education. Uncorrected and corrected distance visual acuity(UDVA and CDVA) at presentation and at 1, 6, 8wk postoperatively, pre-existing eye disease, operative findings and complications, the risk factors were evaluated.RESULTS: In 82 patients, the average age was 69.6±0.6y, illiterate were 52(63.4%). Of 82 eyes, pseudophakia was present in 77 eyes(93.9%). At 1wk postoperatively,47 eyes(57.3%) had the UDVA of ≥6/18, and 52 eyes(63.4%) had the CDVA of ≥6/18. At 6 to 8wk postoperatively, 50 eyes(61.0%) had UDVA of ≥6/18, and57 eyes(69.5%) had the CDVA of ≥6/18. Postoperative visual status was significantly related to the co-morbidities, such as corneal pathology, glaucoma(P <0.001).Operative complications, such as posterior capsule opacity and cystoid macular edema were main operative cause for the poor visual outcome.CONCLUSION: MSICS provides a good visual recovery in our study but the vision outcome did not fulfill the standards proposed by WHO, which highlights the need for an improvement in local socioeconomic understanding, population education and surgery quality.

Traumatic Subdural Effusion Evolving into Chronic Subdural Hematoma

Background: Chronic subdural hematoma (CSDH) is a common complication in head injuries. The objective of this study is to establish the evolution of traumatic subdural effusion (TSDE) into CSDH using clinical signs and symptoms as well as radiology. Our aim is to effectively manage such cases without postoperative recurrence (PR). Methodology: The study was a retrospective cohort carried out in the No. 1 People’s Hospital of Jingzhou from August 2007 to November 2013. The hospital is affiliated to the Yangtze University. All the patients included in this study were involved in road traffic accidents and sustained various degree of head injury. Serial CT scans were done to establish the development TSDE and the evolution of the TSDE into CSDH and treatment options. Results: In all 159 patients developed TSDE and out of these 34 which constitute 21.38% had their TSDE evolving into CSDH. Most of the patients were elderly. Twelve patients were treated conservatively while the remaining patients were treated surgically by drilling and drainage of hematoma. All the patients survived with marked improvement in their sign and symptoms with no recurrence. Conclusion: TSDE is one of the etiological factors for the development of CSDH in the elderly although in most cases the etiology of CSDH is usual multifactory. It must be stated clearly that, the evolution of TSDE into CSDH is initially a hidden process and presents with nonspecific signs and symptoms which can easily be missed. CT scan is usually the initial radiology of choice in making diagnosis of TSDE but MRI could be used to make early diagnosis of the transgression of TSDE into CSDH, and hence early surgical intervention before the formation of a neomembrane could reduce PR rate.

Infantile onset diabetes mellitus in developing countries-India

Infantile onset diabetes mellitus(IODM) is an uncommon metabolic disorder in children. Infants with onset of diabetes mellitus(DM) at age less than one year are likely to have transient or permanent neonatal DM or rarely type 1 diabetes. Diabetes with onset below 6 mo is a heterogeneous disease caused by single gene mutations. Literature on IODM is scanty in India. Nearly 83% of IODM cases present with diabetic keto acidosis at the onset. Missed diagnosis was common in infants with diabetes(67%). Potassium channel mutation with sulphonylurea responsiveness is the common type in the non-syndromic IODM and Wolcott Rallison syndrome is the common type in syndromic diabetes. Developmental delay and seizures were the associated co-morbid states. Genetic diagnosis has made a phenomenal change in the management of IODM. Switching from subcutaneous insulin to oral hypoglycemic drugs is a major clinical breakthrough in the management of certain types of monogenic diabetes. Mortality in neonatal diabetes is 32.5% during follow-up from Indian studies. This article is a review of neonatal diabetes and available literature on IODM from India.

The influence of obesity duration on left ventricular mass, volume and function: A pilot study

Introduction: Despite the bulk of evidence between obesity and cardiovascular complications, the effect of the duration of obesity (DOO) on cardiac function has so far received limited attention. The aim of the study is to study the relationship between a new, American Heart Association (AHA) and World Health Organization (WHO)-adapted formula for reporting DOO with echocardiographic findings and comorbidities in a large cohort of individuals whose BMI ranged from normal (·m﹣2) to morbid obesity (>40 Kg·m﹣2) and had been obese for varying lengths of time. Methods: 198 (M60/F138) asymptomatic patients were recruited. Patients were classified according to their reported DOO. The normal weight group (N = 92 (40/F52) was formed by those patients who did not recall maintaining a BMI > 30 Kg·m﹣2 from age 18 while those recalling maintenance of a BMI > 30 Kg·m﹣2 since age 18 and thereafter formed the obese group (N = 106 (M20/F86)). A detailed clinical, echo-cardiographic and analytical study was performed. Results: DOO in our series disclosed a significant correlation with left ventricular architecture and hemodynamics, left ventricular mass, cardiac output as well as the prevalence of diabetes mellitus, hypertension and insulin resistance. Stepwise multiple regression analysis revealed that almost 54% of the interventricular septum thickness’s variance can be independently predicted by a model including DOO, gender, hypertension and logtransformed HOMA. Conclusions: Our formula for estimating the duration of obesity provides a simple, user-friendly tool whose utilization in bariatric preoperative assessments and in advanced nursing practice deserves prospective studies.