Understanding the prevalence of mental distress in hospitalized patients and identifying associated factors can help reduce the burden of mental disorders on their medical management and improve their quality of life. This study aimed to examine the prevalence of mental distress among hospitalized patients in general hospitals and assess its associated factors. In this cross-sectional study, we evaluated the mental health status of inpatients in seven cities in Iran, using the General Health Questionnaire-12 (GHQ-12), with a total GHQ-12 score ≥ 4 or higher categorized as "mentally distressed." Statistical analyses were conducted using independent t-tests, one-way analysis of variance, and cross-tabulations. A total of 524 patients (347 females) were assessed, with 208 (38.7%) being classified as mentally distressed. The prevalence of mental distress was significantly higher among males (52.0%) compared to females (34.0%) (p = 0.002). There were no significant differences in GHQ-12 scores among different age groups (p > 0.05). Significant differences were observed in mental health status based on job status, with retired (64.7%) and laborer (22.8%) patients showing the highest and lowest rates of mental distress, respectively (p < 0.001). Additionally, mental distress prevalence varied significantly across hospital wards, with internal medicine (47.6%) and obstetrics and gynecology (28.3%) having the highest and lowest prevalence, respectively (p = 0.004). A considerable proportion of patients hospitalized for medical reasons also experience mental distress. Various demographic factors are associated with their mental health status. This highlights the need for integrated mental health assessments alongside medical treatment to alleviate the burden of mental disorders.
Amyotrophic lateral sclerosis (ALS) is a highly progressive and debilitating neurodegenerative disease, which usually leads to the death of affected individuals within a few years after the onset of symptoms. ALS is currently incurable and very little is known about its pathophysiology. Finding validated biomarkers will help us to advance our understanding of ALS etiology and find better strategies for early diagnosis and management of the disease. The main aim of the present systematic review is to evaluate the concentration of 11 frequently reported biomarkers for ALS in peripheral blood and CSF of patients diagnosed with ALS compared with controls. This systematic review protocol has been established according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 guideline. We will include all types of observational studies with human subjects that investigated the concentrations of intended biomarkers (amyloid beta (Aβ-42), tau and phosphorylated tau (p-Tau), neurofilaments, S100β, cystatin C, progranulin (PGRN), glial fibrillary acidic protein (GFAP), monocyte chemoattractant protein-1 (MCP-1), brain-derived neurotrophic factor (BDNF), TAR DNA-binding protein-43 (TDP43), YKL-40, and CHIT1 in CSF or peripheral blood of ALS patients for initial assessment. Also, we will include case series with a minimum of 10 cases and clinical trials which have measured baseline biomarker levels. Case studies, case reports, reviews, letters, and animal and in vitro studies will be excluded. Multiple electronic databases including Cochrane Library, MEDLINE (PubMed), ISI Web of Science, and EMBASE will be searched to find all eligible articles published since 1980. No language restriction will be applied. All titles and abstracts retrieved by searching information sources will be evaluated independently by two authors against the eligibility criteria. The following information will be extracted from each included study by two independent authors: bibliographic details (first author, study title, year of publication, country), demographics and clinical information (number of patients and controls, type of ALS and controls, study design, age, gender, specimen, biomarkers levels, ALS functional rating scale Revised (ALSFRS-R), duration of disease), and measurements (method, value type, biomarkers levels). We will use the extracted mean and standard deviation (SD) of biomarkers concentrations to calculate the standardized mean difference (SMD) and 95% confidence intervals (CI). The primary outcome measures are the mean difference of biomarker levels between ALS patients and controls, different types of ALS, and ALS patients with genetic mutations. We will systematically review the literature and analyze studies of biomarker level in CSF and peripheral blood of patients with ALS and controls. The results will help us to identify biomarkers with possible diagnostic and prognostic value. PROSPERO CRD42017078127
Tipepidine, a synthetic, non-opioid expectorant, has been shown to improve depressive-like behavior in animal models of depression. In this study, we assessed the efficacy and tolerability of tipepidine combination therapy with citalopram in treatment of major depressive disorder (MDD).In a randomized, double-blinded, placebo-controlled clinical trial, 62 patients with MDD were assigned into two parallel groups to receive citalopram (up to 40 mg/day) plus placebo or citalopram plus tipepidine (30 mg twice daily) for 6 weeks. Participants were assessed with the Hamilton Rating Scale for Depression (HAM-D) at baseline and Weeks 2, 4, and 6.Fifty-six patients completed the trial. The tipepidine group showed greater improvement in HAM-D scores from baseline to all three study time points (P = 0.048 for all). The remission and response-to-treatment rates were significantly higher in the tipepidine group (53.6% and 100%) compared to the placebo group (25.0% and 75%) at the study end-point (P = 0.029 and 0.005, respectively). The remission and response times in patients in the tipepidine group were also shorter compared with the placebo group (log-rank P = 0.020 and 0.004). There was no significant difference between the two groups in baseline parameters or frequency of side-effects.Tipepidine combination therapy with citalopram can effectively improve symptoms of patients with MDD in a shorter period of treatment. However, further studies with larger sample sizes and longer follow-up treatment are needed to confirm our findings.
Background: Preterm birth (PB) is associated with significant morbidities in surviving infants. Accurate prediction of PB is essential for effective prevention and management. Continuous monitoring of cervical parameters has shown utility in several studies. Objectives: This study aimed to investigate the role of the anterior uterocervical angle (UCA) in predicting the incidence of PB. Methods: A prospective, descriptive-analytic study was conducted with 165 pregnant women referred to the prenatal care clinic at Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, in 2021 - 2022. Participants were selected through convenience sampling. Cervical parameters, including UCA, length, and width, were measured via vaginal ultrasound during each trimester. All women were followed until delivery to determine PB incidence. Data were analyzed using descriptive and analytical statistical tests, including the chi-square or Fisher’s exact test and the independent samples t-test or Mann-Whitney U test. Results: Among the participants, 12 (7.3%) experienced preterm delivery. Cervical length was significantly shorter in women with PB during the second trimester (32.58 ± 4.77 mm vs. 34.68 ± 3.80 mm, P = 0.042) and third trimester (30.00 ± 4.74 mm vs. 32.77 ± 3.88 mm, P = 0.022). The mean UCA in women with preterm delivery was higher than in those with term delivery during both the second (90.58 ± 17.21° vs. 88.66 ± 16.76°) and third (100.25 ± 14.56° vs. 98.89 ± 17.78°) trimesters (P > 0.05). A UCA greater than 105° in the second trimester had a sensitivity of 16.7% and specificity of 81.5% for predicting PB. In the third trimester, a UCA greater than 105° showed a sensitivity of 58.3% and specificity of 60.7% for predicting PB. Conclusions: This study emphasizes the importance of regular cervical parameter measurements throughout pregnancy. A UCA greater than 105° in the third trimester appears to be a potential predictor of PB.
Transcranial magnetic stimulation (TMS) has become a promising strategy for bipolar disorder (BD). This study reviews neuroimaging findings, indicating functional, structural, and metabolic brain changes associated with TMS in BD. Web of Science, Embase, Medline, and Google Scholar were searched without any restrictions for studies investigating neuroimaging biomarkers, through structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and single photon emission computed tomography (SPECT), in association with response to TMS in patients with BD. Eleven studies were included (fMRI = 4, MRI = 1, PET = 3, SPECT = 2, and MRS = 1). Important fMRI predictors of response to repetitive TMS (rTMS) included higher connectivity of emotion regulation and executive control regions. Prominent MRI predictors included lower ventromedial prefrontal cortex connectivity and lower superior frontal and caudal middle frontal volumes. SPECT studies found hypoconnectivity of the uncus/parahippocampal cortex and right thalamus in non-responders. The post-rTMS changes using fMRI mostly showed increased connectivity among the areas neighboring the coil. Increased blood perfusion was reported post-rTMS in PET and SPECT studies. Treatment response comparison between unipolar depression and BD revealed almost equal responses. Neuroimaging evidence suggests various correlates of response to rTMS in BD, which needs to be further replicated in future studies.
The interplay between peripheral and central inflammation has a significant role in dopaminergic neural death in nigrostriatal pathway, although no direct assessment of inflammation has been performed in relation to dopaminergic neuronal loss in striatal nuclei. In this study, the correlation of neutrophil to lymphocyte ratio (NLR) as a marker of peripheral inflammation to striatal binding ratios (SBRs) of DAT SPECT images in bilateral caudate and putamen nuclei was calculated in 388 drug-naïve early PD patients [288 tremor dominant (TD), 73 postural instability and gait difficulty (PIGD), and 27 indeterminate] and 148 controls. NLR was significantly higher in PD patients than in age- and sex-matched healthy controls, and showed a negative correlation to SBR in bilateral putamen and ipsilateral caudate in all PD subjects. Among our three subgroups, only TD patients showed remarkable results. A positive association between NLR and motor severity was observed in TD subgroup. Besides, NLR could negatively predict the SBR in ipsilateral and contralateral putamen and caudate nuclei in tremulous phenotype. Nonetheless, we found no significant association between NLR and other clinical and imaging findings in PIGD and indeterminate subgroups, supporting the presence of distinct underlying pathologic mechanisms between tremor and non-tremor predominant PD at early stages of the disease.
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