Interleukin-mediated therapies in liver diseases and comorbidity effects

Cytokines like interleukins(ILs)play important roles in inflammation and innate immune.Yang and Zhang carried out an interesting study related to ILs and hepatic diseases.They described the role of ILs in the pathogenesis and resolution of hepatic disorders.The authors summarized alcohol-related liver disease and virus-induced hepatitis,as far as clinical studies a fortiori carried out on ILmediated treatments pertaining to these dysfunctions.This editorial contributes to the review by Yang and Zhang titled,"Interleukins in liver disease treatment",and focuses on therapies mediated by ILs in comorbid liver diseases.The documentary search was conducted on recent pertinent literature,primarily using the Google Scholar and PubMed databases.

Impacts of Comorbidity and Mental Shock on Organic Micropollutants in Surface Water During and After the First Wave of COVID-19 Pandemic in Wuhan (2019–2021), China

The first pandemic wave of coronavirus disease 2019(COVID-19)induced a considerable increase in several antivirals and antibiotics in surface water.The common symptoms of COVID-19 are viral and bacterial infections,while comorbidities(e.g.,hypertension and diabetes)and mental shock(e.g.,insomnia and anxiety)are nonnegligible.Nevertheless,little is known about the long-term impacts of comorbidities and mental shock on organic micropollutants(OMPs)in surface waters.Herein,we monitored 114 OMPs in surface water and wastewater treatment plants(WWTPs)in Wuhan,China,between 2019 and 2021.The pandemic-induced OMP pollution in surface water was confirmed by significant increases in 26 OMP concentrations.Significant increases in four antihypertensives and one diabetic drug suggest that the treatment of comorbidities may induce OMP pollution.Notably,cotinine(a metabolite of nicotine)increased 155 times to 187 ngL1,which might be associated with increased smoking.Additionally,the increases in zolpidem and sulpiride might be the result of worsened insomnia and depression.Hence,it is reasonable to note that mental-health protecting drugs/behavior also contributed to OMP pollution.Among the observed OMPs,telmisartan,lopinavir,and ritonavir were associated with significantly higher ecological risks because of their limited WWTP-removal rate and high ecotoxicity.This study provides new insights into the effects of comorbidities and mental shock on OMPs in surface water during a pandemic and highlights the need to monitor the fate of related pharmaceuticals in the aquatic environment and to improve their removal efficiencies in WWTPs。

Development of a model based on the age-adjusted Charlson comorbidity index to predict survival for resected perihilar cholangiocarcinoma

BACKGROUND Perihilar cholangiocarcinoma(pCCA)has a poor prognosis and urgently needs a better predictive method.The predictive value of the age-adjusted Charlson comorbidity index(ACCI)for the long-term prognosis of patients with multiple malignancies was recently reported.However,pCCA is one of the most surgically difficult gastrointestinal tumors with the poorest prognosis,and the value of the ACCI for the prognosis of pCCA patients after curative resection is unclear.AIM To evaluate the prognostic value of the ACCI and to design an online clinical model for pCCA patients.METHODS Consecutive pCCA patients after curative resection between 2010 and 2019 were enrolled from a multicenter database.The patients were randomly assigned 3:1 to training and validation cohorts.In the training and validation cohorts,all patients were divided into low-,moderate-,and high-ACCI groups.Kaplan-Meier curves were used to determine the impact of the ACCI on overall survival(OS)for pCCA patients,and multivariate Cox regression analysis was used to determine the independent risk factors affecting OS.An online clinical model based on the ACCI was developed and validated.The concordance index(C-index),calibration curve,and receiver operating characteristic(ROC)curve were used to evaluate the predictive performance and fit of this model.RESULTS A total of 325 patients were included.There were 244 patients in the training cohort and 81 patients in the validation cohort.In the training cohort,116,91 and 37 patients were classified into the low-,moderate-and high-ACCI groups.The Kaplan-Meier curves showed that patients in the moderate-and high-ACCI groups had worse survival rates than those in the low-ACCI group.Multivariable analysis revealed that moderate and high ACCI scores were independently associated with OS in pCCA patients after curative resection.In addition,an online clinical model was developed that had ideal C-indexes of 0.725 and 0.675 for predicting OS in the training and validation cohorts.The calibration curve and ROC curve indicated that the model had a good fit and prediction performance.CONCLUSION A high ACCI score may predict poor long-term survival in pCCA patients after curative resection.High-risk patients screened by the ACCI-based model should be given more clinical attention in terms of the management of comorbidities and postoperative follow-up.

Acoustic radiation force impulse predicts long-term outcomes in a large-scale cohort:High liver cancer,low comorbidity in hepatitis B virus

BACKGROUND Acoustic radiation force impulse(ARFI)is used to measure liver fibrosis and predict outcomes.The performance of elastography in assessment of fibrosis is poorer in hepatitis B virus(HBV)than in other etiologies of chronic liver disease.AIM To evaluate the performance of ARFI in long-term outcome prediction among different etiologies of chronic liver disease.METHODS Consecutive patients who received an ARFI study between 2011 and 2018 were enrolled.After excluding dual infection,alcoholism,autoimmune hepatitis,and others with incomplete data,this retrospective cohort were divided into hepatitis B(HBV,n=1064),hepatitis C(HCV,n=507),and non-HBV,non-HCV(NBNC,n=391)groups.The indexed cases were linked to cancer registration(1987-2020)and national mortality databases.The differences in morbidity and mortality among the groups were analyzed.RESULTS At the enrollment,the HBV group showed more males(77.5%),a higher prevalence of prediagnosed hepatocellular carcinoma(HCC),and a lower prevalence of comorbidities than the other groups(P<0.001).The HCV group was older and had a lower platelet count and higher ARFI score than the other groups(P<0.001).The NBNC group showed a higher body mass index and platelet count,a higher prevalence of pre-diagnosed non-HCC cancers(P<0.001),especially breast cancer,and a lower prevalence of cirrhosis.Male gender,ARFI score,and HBV were independent predictors of HCC.The 5-year risk of HCC was 5.9%and 9.8%for those ARFI-graded with severe fibrosis and cirrhosis.ARFI alone had an area under the receiver operating characteristic curve(AUROC)of 0.742 for prediction of HCC in 5 years.AUROC increased to 0.828 after adding etiology,gender,age,and platelet score.No difference was found in mortality rate among the groups.CONCLUSION The HBV group showed a higher prevalence of HCC but lower comorbidity that made mortality similar among the groups.Those patients with ARFI-graded severe fibrosis or cirrhosis should receive regular surveillance.

Integrated analysis of comorbidity, pregnant outcomes, and amniotic fluid cytogenetics of fetuses with persistent left superior vena cava

BACKGROUND Persistent left superior vena cava(PLSVC)is the most common venous system variant.The clinical characteristics and amniotic fluid cytogenetics of fetuses with PLSVC remain to be further explored.AIM To develop reliable prenatal diagnostic recommendations through integrated analysis of the clinical characteristics of fetuses with PLSVC.METHODS Cases of PLSVC diagnosed using prenatal ultrasonography between September 2019 and November 2022 were retrospectively studied.The clinical characteristics of the pregnant women,ultrasonic imaging information,gestational age at diagnosis,pregnancy outcomes,and amniocentesis results were summarized and analyzed using categorical statistics and the chi-square test or Fisher’s exact test.RESULTS Of the 97 cases diagnosed by prenatal ultrasound,49(50.5%)had isolated PLSVC and 48(49.5%)had other structural abnormalities.The differences in pregnancy outcomes and amniocentesis conditions between the two groups were statistically significant(P<0.05).No significant differences were identified between the two groups in terms of advanced maternal age and gestational age(P>0.05).According to the results of the classification statistics,the most common intrac-ardiac abnormality was a ventricular septal defect and the most common extrac-ardiac abnormality was a single umbilical artery.In the subgroup analysis,the concurrent combination of intra-and extracardiac structural abnormalities was a risk factor for adverse pregnancy outcomes(odds ratio>1,P<0.05).Additional-ly,all abnormal cytogenetic findings on amniocentesis were observed in the comorbidity group.One case was diagnosed with 21-trisomy and six cases was diagnosed with chromosome segment duplication.CONCLUSION Examination for other structural abnormalities is strongly recommended when PLSVC is diagnosed.Poorer pregnancy outcomes and increased amniocentesis were observed in PLSVC cases with other structural abnor-malities.Amniotic fluid cytogenetics of fetuses is recommended for PLSVC with other structural abnormalities.

焦虑与抑郁的合病(Comorbidity)

抑郁与焦虑两组症状群之间的关系很早就已为人所注意。早在1934年,Lewis就提出过两组症状之间的连续性,认为焦虑症状从整体上或部分上是抑郁的一部分。英国Newcastle学派的领袖Roth(1981)也把两组症状群之间的联系看做是情感障碍的核心组成部分。但是,后来Newcastle学派的Mountjoy与Roth(1982)一系列研究结果表明,抑郁与焦虑应清楚地区分开来。

Disease Risk Comorbidity Index for Patients Receiving Haploidentical Allogeneic Hematopoietic Transplantation

We aimed to develop a disease risk comorbidity index(DRCI)based on disease risk index(DRI)and Hematopoietic Cell Transplantation-Specific Comorbidity Index(HCT-CI)in patients receiving haploidentical hematopoietic stem cell transplantation(haplo-HSCT).We identified the prognostic factors of disease-free survival(DFS)in a training subset(n=593),then assigned a weighted score using these factors to the remaining patients(validation subset;n=296).The multivariable model identified two independent predictors of DFS:DRI and HCT-CI before transplantation.In this scoring system,we assigned a weighted score of 2 to very high-risk DRI,and assigned a weighted score of 1 to high-risk DRI and intermediate-and high-risk HCT-CI(i.e.,haplo-DRCI).In the validation cohort,the three-year DFS rate was 65.2%(95%confidence interval(CI),58.2%–72.2%),55.8%(95%CI,44.9%–66.7%),and 32.0%(95%CI,5.8%–58.2%)for the low-,intermediate-,and high-risk group,respectively(P=0.005).Haplo-DRCI can also predict DFS in disease-specific subgroups,particularly in acute leukemia patients.Increasing score was also significantly predictive of increased relapse,increased non-relapse mortality(NRM),decreased DFS,and decreased overall survival(OS)in an independent historical cohort(n=526).These data confirmed that haplo-DRCI could effectively risk stratify haplo-HSCT recipients and provide a tool to better predict who will best benefit from haplo-HSCT.

Attention deficit hyperactivity disorder and comorbidity: A review of literature

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood.It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents.This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders,learning disorders,externalising and internalising disorders.Challenges in screening for,diagnosing and managing comorbidity with ADHD are summarised.Also,methodological challenges and future directions in research in this interesting field are highlighted.

Review of Neuromyelitis Optica Spectrum Disorder with Pain-Depression Comorbidity

Neuromyelitis optica spectrum disorder(NMOSD)is an inflammatory disorder of the central nervous system predominantly targeting optic nerves and the spinal cord.The prevalence of the disease is much higher in Asia than in other parts of the world.Pain can be detected in more than 80%of NMOSD patients,with evoked pain mostly being caused by painful tonic muscle spasms and neuropathic pain as the most characteristic types.Depression is often comorbid with pain,and their comorbidity can severely influence quality of life.In recent years,studies have found considerable overlaps between the mechanisms of pain and depression;however,their association remains unclear.This article reviews the epidemiology,mechanism,evaluation and treatment of paindepression comorbidity in NMOSD patients.

Comorbidity in inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) can be affected by other unrelated diseases. These are called comorbid conditions, and can include any secondary health problem that affects a person suffering from a primary or main disease, and which is neither linked physiopathologically to the primary condition, nor is it due to the treatments used for the primary condition or to its long-term anatomical or physiological consequences. Different comorbid conditions, as well as their influence on IBD, are discussed.

Comorbidity negatively influences prognosis in patients with extrahepatic cholangiocarcinoma

AIM:To study the outcome and prognostic factors in a series of patients with extrahepatic cholangiocarcinoma and determine the impact of comorbidity on survival.METHODS:A retrospective analysis of 68 patients with extrahepatic cholangiocarcinoma(perihilar,n = 37;distal,n = 31) seen at a single tertiary-care institution during the period 1999-2003 was performed.Data on presentation,management,and outcome were assessed by chart review.Pathologic confirmation was obtained in 37 cases(54.4%) .Comorbidity was evaluated by using the Charlson comorbidity index(CCI) .RESULTS:Mean age at diagnosis was 73.4 ± 11.5 years.Jaundice was the most common symptom presented(86.8%) .Median CCI score was 1(range,0 to 4) .Nineteen patients(27.9%) underwent tumor resection.Palliative biliary drainage was performed in 39 patients(57.4%) ,and 6 patients(8.8%) received only best supportive care.Tumor-free margin status(R0) was achieved in 15 cases(78.9% of resection group) .Baseline serum carbohydrate antigen 19-9(CA 19-9) level was revealed to be an independent predictor of surgical treatment(P = 0.026) .Overall median survival was 3.1 ± 0.9 mo,with 1-and 2-year survival rates of 21% and 7%,respectively.In the univariate analysis,tumor resection,CCI score,and serum CA 19-9 levels correlated significantly with outcome.In the multivariate analysis,only resection(HR 0.10;95% CI,0.02-0.51,P = 0.005) and a CCI score ≥ 2(HR 3.36;95% CI,1.0-10.9,P = 0.045) were found to independently predict survival.CONCLUSION:Tumor resection and comorbidity emerged as significant prognostic variables in extrahepatic cholangiocarcinoma.Comorbidity evaluation instruments should be applied in the clinical management of such patients.

Comorbidity of bipolar and anxiety disorders:An overview of trends in research

Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder(BD),but it also adversely impacts the course,outcome,and treatment of BD.The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses(n=103),epidemiological surveys,and large-scale clinical studies.The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time.All types of anxiety disorders were equally common in BD.However,there was a wide variation in rates across different sources,with most of this discrepancy being accounted for by methodological differences between reports.Comorbid anxiety disorders negatively impacted the presentation and course of BD.This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD.Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD.Nevertheless,the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.

Significance of age and comorbidity as prognostic indicators for patients with bladder cancer

The aim of this study was to determine the impact that age and comorbidity status have on both overall and bladder cancer-specific survival of bladder cancer patients. We obtained medical information pertaining to a population of 528 patients with newly diagnosed bladder cancer from Chung-Ang University Hospital cancer registry. The Adult Comorbidity Evaluation-27 （ACE-27） test, which has been previously validated in adult cancer patients, was used to assess comorbidity. We evaluated differences in the demographic and clinical characteristics of included patients, as well as differences in the treatments they received after categorizing them by age. The median age at the time of bladder cancer diagnosis of the entire cohort was 63 years, and the median follow-up time was 97 months. Of the 528 patients who were included in our study, 303 had at least one comorbid condition and 249 died during the follow-up period. When patients were stratified by age, we found that older patients had a higher proportion of severe comorbidities （P 〈 0.01） than younger patients, and that a lower proportion of them underwent radical cystec- tomy for invasive bladder cancer （IBC） （P 〈 0.01）. By multivariate analysis, we found that older age was predictive of lower overall survival （OS） and bladder cancer-specific survival （BCSS） rates among patients with superficial bladder cancer （SBC） and of lower OS rates among patients with IBC. We also found that moderate-severe comorbidity status and treatment through a bladder-conserving approach were predictive of lower OS and cancer-specific survival rates among patients with IBC. The disparity between overall deaths and bladder cancer deaths was shown in SBC and increased along with age and higher comorbidity. Age and comorbidity were found to be independent predictive factors of OS and BCSS among bladder cancer patients, and explained the disparity that we observed between overall bladder cancer-specific mortality rates.

Cancer and comorbidity:The role of leptin in breast cancer and associated pathologies

Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistance/type-2 diabetes mellitus, hypertension, and other cardiovascular diseases. Frequently, these health disorders exhibit as components/complications of the metabolic syndrome. Nevertheless, obesity-related diseases may coexist with postmenopausal breast cancer; and these comorbid conditions could be substantial. Therefore, it may be assumed that different diseases including breast cancer could originate from a common pathological background in excessive adipose tissue. Adipocyte-released hormone-like cytokine(or adipokine) leptin behaves differently in a normal healthy state and obesity. A growing body of evidence suggests an important role of leptin in our major obesity-related health issues such as insulin resistance, hypertension, and neoplasia. In this context, this review describes the relationships of the abovementioned pathologies with leptin.

Influence of comorbidity on outcomes of older patients with acute pancreatitis based on a national administrative database

Little information is available on the influ- ence of comorbidities on outcomes of older patients with acute pancreatitis. This study aimed to investigate the influence of co- morbidities on outcomes of older patients with acute pancreati- tis using data from a national Iapanese administrative database. METHODS： A total of 14 322 older patients （〉70 years） with acute pancreatitis were referred to 1090 hospitals between 2010 and 2012 in Japan. We collected patients＇ data from the administrative database to compare the in-hospital mortal- ity and length of stay of older patients with acute pancreatitis. The patients were categorized into four groups according to comorbidity level using the Charlson Comorbidity Index （CCI）： none （CCI score=0; n=6890）; mild （1; n=3874）; moder- ate （2; n=2192） and severe （〉3; n=1366）. RESULTS： Multiple logistic and linear regression analyses revealed that severe comorbidity was significantly associated with higher in-hospital mortality and longer length of stay [odds ratio （OR）=2.26; 95% confidence interval （CI）： 1.75-2.92, P〈0.001 and coefficient 4.37 days; 95% CI： 2.89-5.85, P〈0.001, respectively]. In addition, cardiovascular and renal diseases were the most significant comorbidities affecting outcomes of the older patients. ORs of cardiovascular and renal diseases for mortality were 1.44 （95% CI： 1.13-1.85, P=0.003） and 2.69 （95% CI： 1.88-3.85, P〈0.001）, respectively, and coefficients forlength of stay were 3.01 days （95% CI： 1.34-4.67, P〈0.001） and 3.72 days （95% CI： 1.01-6.42, P=0.007）, respectively. CONCLUSION： This study demonstrated that comorbidities significantly influenced outcomes of older patients with acute pancreatitis and cardiovascular and renal comorbidities were significant factors affecting outcomes.

Mindfulness intervention in the management of chronic pain and psychological comorbidity: A meta-analysis

Objective:To review trials on mindfulness intervention for chronic pain in primary care to clarify the evidence base and establish whether mindfulness is an important intervention for relieving pain and improving psychological comorbidity.Methods:We performed a literature search using PubMed,the Cochrane Database,EBSCOhost,Elsevier,Wiley,Springer,and the references of retrieved articles.We included articles written in English and that were published up to January 2012.We found 428 empirical studies,but only eight were included as randomized controlled trials of mindfulness intervention for chronic pain in our meta-analysis.After extracting and synthesizing data from these eight trials,we analyzed the data extracted and synthesized from these eight trials.Results:Compared with control intervention,mindfulness intervention had no specific effect on reducing pain intensity(weighted mean difference 3.24,95%confidence interval[CI]:
8.92 to 2.45).Mindfulness intervention led to greater improvement in psychological comorbidity with chronic pain,such as depression(weighted mean difference
3.91,95%CI
5.94 to
2.32)and trait anxiety(weighted mean difference
4.07,95%CI
4.48 to
3.65).Conclusion:There is insufficient evidence that mindfulness intervention relieves pain intensity.However,it improves depression and trait anxiety in patients with chronic pain.Further research in larger,properly powered,and better-designed studies is warranted.

Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis

BACKGROUND Differential diagnosis,comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder(ASD),but clinical assessments often omit screening for personality disorders(PD),which are especially common in individuals with high-functioning ASD where there is less need for support.AIM To summarize the research findings on PD in adults with ASD and without intellectual disability,focusing on comorbidity and differential diagnosis.METHODS PubMed searches were performed using the key words“Asperger’s Syndrome”,“Autism”,“Personality”,“Personality disorder”and“comorbidity”in order to identify relevant articles published in English.Grey literature was identified through searching Google Scholar.The literature reviews and reference sections of selected papers were also examined for additional potential studies.The search was restricted to studies published up to April 2020.This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.RESULTS The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria:16 evaluated personality profiles or PD in ASD(comorbidity),five compared ASD and PD(differential diagnosis)and one performed both tasks.There were significant differences in the methodological Cluster A and cluster C PD are the most frequent co-occurring PD,but overlapping features should be considered.Data on differential diagnosis were only found with cluster A and cluster B PD.CONCLUSION ASD in high-functioning adults is associated with a distinct personality profile even if variability exists.Further studies are needed to explore the complex relationship between ASD and PD.

Simultaneous nephrectomy during kidney transplantation for polycystic kidney disease does not detrimentally impact comorbidity and graft survival

BACKGROUND The lack of space,as an indication for a native unilateral nephrectomy for positioning a future kidney graft in the absence of other autosomal dominant polycystic kidney disease-related symptoms,remains controversial.AIM To evaluate the surgical comorbidity and the impact on graft survival of an associated ipsilateral native nephrectomy during isolated kidney transplantation in patients with autosomal dominant polycystic kidney disease.METHODS One hundred and fifty-four kidney transplantations performed between January 2007 and January 2019 of which 77 without(kidney transplant alone(KTA)group)and 77 with associated ipsilateral nephrectomy(KTIN group),were retrospectively reviewed.Demographics and surgical variables were analyzed and their respective impact on surgical comorbidity and graft survival.RESULTS Creation of space for future graft positioning was the main reason(n=74,96.1%)for associated ipsilateral nephrectomy.No significant difference in surgical comorbidity(lymphocele,wound infection,incisional hernia,wound hematoma,urinary infection,need for blood transfusion,hospitalization stay,Dindo Clavien classification and readmission rate)was observed between the two study groups.The incidence of primary nonfunction and delayed graft function was comparable in both groups[0%and 2.6%(P=0.497)and 9.1%and 16.9%(P=0.230),respectively,in the KTA and KTIN group].The 1-and 5-year graft survival were 94.8%and 90.3%,and 100%and 93.8%,respectively,in the KTA and KTIN group(P=0.774).The 1-and 5-year patient survival were 96.1%and 92.9%,and 100%and 100%,respectively,in the KTA and KTIN group(P=0.168).CONCLUSION Simultaneous ipsilateral native nephrectomy to create space for graft positioning during kidney transplantation in patients with autosomal dominant polycystic kidney disease does not negatively impact surgical comorbidity and short-and long-term graft survival.

Psychiatric Comorbidity in Patients with Psoriasis, Vitiligo, Acne, Eczema and Group of Patients with Miscellaneous Dermatological Diagnoses

Background: Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety particularly for specific dermatological disorders such as psoriasis and acne. Aim: The aim of this study was to compare the rates of psychiatric symptoms in patients with psoriasis, acne, vitiligo, and eczema versus patients who had other dermatological conditions;and to compare each dermatological group versus healthy control subjects. Methods: This prospective cross-sectional study was conducted in dermatology outpatient clinics in Khartoum. Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety (HADS-A) and depression (HADS-D). ICD-10 criteria were used for clinical psychiatric diagnosis. Tabulated results were analyzed using Chi-square test. Significance was set at P < 0.05. Results: HADS-D scores above the cut off points were significantly higher in patients with psoriasis (P = 0.0062), vitiligo (P = 0.0054), acne (P = 0.0103) and eczema (P = 0.0359) compared with healthy subjects. Similarly, HADS-A scores above the cut off points were significantly higher in patients with psoriasis (P < 0. 0.0001), vitiligo (P = 0.0001), acne (P = 0.0143) and eczema (P = 0.0281) compared with healthy subjects. No significant difference between the control group and patients with other dermatologic conditions regarding both HADS-D and HADS-A scores. Using ICD-10 criteria for clinical psychiatric diagnoses indicated that 52.3% of dermatology patients had an associated ICD-10 diagnosis;most commonly anxiety disorders (28.6%), and depression (21.9%). ICD-10 diagnoses of anxiety disorders included: OCD (13.3%) generalized anxiety disorder (5.7%), panic disorder (4.8%), phobic anxiety disorder (3.8%) and post-traumatic stress disorder (0.95%). Conclusion: Dermatological conditions are associated with high rates of psychiatric comorbidity. Screening for anxiety and depressive symptoms may be helpful for early diagnosis and management of associated psychiatric symptoms.

Comorbidity of Attention-Deficit/Hyperactivity Disorder (ADHD) in Children with Epilepsy, Egyptian Study

Background: Epilepsy is one of the most common neurological conditions with about 65 million people affected worldwide. It is also a common condition in children, where its prevalence is approximately 3.2 - 5.5/1000 in the developed world. Children with epilepsy (CWE) experience not only seizures but also multiple cognitive, behavioral, and emotional problems. ADHD is one of the more common comorbidities of childhood epilepsy. Objectives: To discuss the relationship between childhood epilepsy and comorbidities especially ADHD. Study Design: This is a prospective observational analytical cross-sectional study carried out on one hundred and fifteen patients at Ain Shams University and Nasr-city Health Insurance out-patient clinics, Cairo, Egypt fulfilling the inclusion criteria. Patients were selected by simple random sample. Results: ADHD is very common epilepsy comorbidity in Egyptian epileptic children with under-diagnosis and treatment. Conclusion: Frequent assessment for ADHD in epileptic children is mandatory for better quality of life.