Prevalence of Psychiatric Comorbidities in Patients With Neurofibromatosis.

Objective: To assess the prevalence of psychiatric comorbidities in patients with neurofibromatosis.Methods: In this cross-sectional study, we used the 2010-2014 National Inpatient Sample database. Patients ≥ 18 years of age with a primary or secondary diagnosis of neurofibromatosis and psychiatric comorbidities were queried.Results: A total of 43,270 patients with a mean age of 48.7 years (female: 55.7%, White: 70.1%) were included in the study. Overall, psychiatric comorbidities were present in 46.5% of patients; mood disorders (22.1%) and anxiety disorders (12.2%) were the most prevalent comorbidities. Although previous studies report prevalence rates of attention-deficit/hyperactivity disorder in up to 50% of patients with neurofibromatosis, our study found that the rate was much lower at 1.10%. Female sex and non-White race were less associated with psychiatric comorbidities (odds ratio = 0.868 [P = .003] and 0.689 [P < .001], respectively). The moderate-to-extreme loss of function illness severity category was associated with 1.35-times higher odds of having psychiatric comorbidities compared to mild-to-moderate or no loss of function (P < .001). The total length of stay was similar in patients with and without psychiatric comorbidities (mean = 4.98 [95% CI, 4.72-5.24] vs mean = 4.83 [95% CI, 4.60-5.07], respectively; P = .34).Conclusions: In adult patients with neurofibromatosis, 46.5% were found to have at least one psychiatric comorbid diagnosis. The most frequent psychiatric comorbid disorders were mood disorders and anxiety disorders. Female sex and non-White race predicted a lower likelihood of having a psychiatric disorder.Prim Care Companion CNS Disord 2023;25(5):23m03514. Author affiliations are listed at the end of this article.

Effectiveness of Gabapentin in Reducing Cravings and Withdrawal in Alcohol Use Disorder: A Meta-Analytic Review.

OBJECTIVE: The current meta-analysis synthesizes previous findings on the effect of gabapentin on alcohol withdrawal and craving. DATA SOURCES: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, a search for relevant English-language literature published between January 1999 and February 2019 was conducted using PubMed and Google Scholar with the keywords alcohol use disorder, alcohol dependence, alcohol withdrawals, alcohol craving, "gabapentin in alcohol use, consumption," and "gabapentin in alcohol withdrawals." STUDY SELECTION AND DATA EXTRACTION: Studies were included wherein gabapentin was used as an adjunctive or primary treatment of alcohol dependence/withdrawal. Studies included participants diagnosed with alcohol use disorder using DSM-IV, DSM-IV-TR, DSM-5, or the International Classification of Diseases, Tenth Revision (ICD-10). The search, as well as data extraction, was carried out by 3 blinded authors to preserve precision, using a template in Microsoft Excel to extract the needed data. Following the review of the initial 65 returns, 2 authors independently judged each trial by applying the inclusionary and exclusionary criteria, and any remaining disagreements were resolved by involving a third independent author. A total of 10 studies met the inclusion criteria and were selected for analysis. Subjects in these 10 studies were pooled using standard techniques of meta-analysis. DATA SYNTHESIS: Three sets of meta-analyses examined outcomes from (1) single-group pretest-posttest changes, (2) posttest differences between independent groups, and (3) differences in pretest-posttest change scores between independent groups. Statistically significant effect sizes were found for craving (P < .01) and withdrawal (P < .01, P < .001) in the meta-analysis of single-group pretest-posttest outcome changes and were associated with a high level of heterogeneity. In contrast, the meta-analyses of posttest differences between independent groups-that of differences in pretest-posttest change scores between independent groups-did not yield significant effect sizes. CONCLUSIONS: Our analysis of pooled data provides evidence that the use of gabapentin to manage alcohol withdrawal symptomatology and related cravings is at least moderately effective. However, given the limited number of available well-designed studies, these findings require further support through more rigorously designed studies.

Cognitive Behavioral Therapy (CBT) in Psychogenic Non-Epileptic Seizures (PNES): A Case Report and Literature Review.

Psychogenic non-epileptic seizures (PNES) are classified as a somatoform conversion disorder. We present a case of a 24-year-old male with a past psychiatric history of posttraumatic stress disorder (PTSD) and anxiety disorder, admitted to our inpatient psychiatric unit. The patient experienced multiple episodes of seizures during hospitalization. Work up was unremarkable, and PNES were suspected and later confirmed with video-electroencephalography (video-EEG). He underwent supervised withdrawal of antiepileptic medications with the initiation of cognitive behavioral therapy (CBT), which reduced the frequency of seizures. Diagnosis of PNES can present as a challenge and failure to diagnose its psychological nature can lead to a delay in the psychological intervention. CBT leads to a decrease in seizure frequency, and improvement in psychiatric symptoms, psychosocial functioning, and quality of life. It is important to consider PNES in the differential diagnosis of seizures presented by psychiatric patients, as CBT is necessary for better patient outcomes.

Quantification of Degree of Liver Fibrosis Using Fibrosis Area Fraction Based on Statistical Chi-Square Analysis of Heterogeneity of Liver Tissue Texture on Routine Ultrasound Images.

RATIONALE AND OBJECTIVES: We present a novel method to quantify the degree of liver fibrosis using fibrosis area fraction based on statistical chi-square analysis of heterogeneity of echo texture within liver on routine ultrasound images. We demonstrate, in a clinical study, that fibrosis area fraction derived this way has the potential to become a noninvasive, quantitative radiometric discriminator of normal or low-grade liver fibrosis (Ishak fibrosis score range = F0-3) and advanced liver fibrosis or cirrhosis (Ishak fibrosis score range = F4-6) on routine ultrasound images. MATERIALS AND METHODS: This retrospective patient study was institutional review board approved. Ultrasound images of 100 patients (61 males, 39 females; 18-81 years) who underwent nontargeted ultrasound-guided biopsy were randomly divided into two groups: a training group consisted of 31 cases, and a validation group that contained the rest cases. An investigator manually selected a primary region of interest (ROI; approximately 4-6 cm2) in the liver tissue while avoiding nonhepatic parenchyma. The primary ROI contained a large number of secondary ROIs (25 × 25 pixels) to maintain the precision of statistical analysis. Sample variance σ2 of image gradient (a texture feature related to the amount of edge structures) was calculated in secondary ROIs in a roster scan fashion. A theoretical derivation was presented to estimate population variance [Formula: see text] of image gradient across the primary ROI from mean gradient µ of secondary ROIs. The χ2 (χ2 = σ2/ [Formula: see text] ) was computed at each secondary ROI, forming a χ2 map of liver tissue heterogeneity. A cut-off value was optimized from datasets in the training group by comparing to the fibrosis grades determined by biopsy. This cut-off value was then applied to the datasets in the validation group to convert the χ2 maps into binary images, from which fibrosis area fractions (fraction of fibrosis area to the total area of the primary ROI) were calculated and entered in a statistical analysis. RESULTS: In the training group, the optimal setting was found to be [Formula: see text] = 6.0, which resulted a maximum discrimination of F0-3 vs F4-6: p < 0.0001, area under curve = 0.985, sensitivity = 93.7%, specificity = 93.3%. When this setting was applied to the datasets in the validation group, a distinct separation was seen between the two classes (p < 0.0001). F0-3 class had an average fibrosis area fraction of 4.7% (1.7%-11.4%), whereas the F4-6 class had an average fibrosis area fraction of 17.3% (9.8%-29.6%). A strong correlation was demonstrated between the fibrosis area fraction and histological fibrosis grade determined by biopsy (area under curve = 0.89, sensitivity = 87.9%, specificity = 90.3%). CONCLUSION: The presented method is a promising noninvasive tool for distinguishing normal or low-grade liver fibrosis (F0-3) and advanced liver fibrosis or cirrhosis (F4-6) from routine ultrasound images. These findings support the further development of texture heterogeneity analysis, particularly fibrosis area fraction, as a quantitative biomarker for distinguishing various liver fibrosis grades.

Efficacy and Safety of Varenicline for Smoking Cessation in Schizophrenia: A Meta-Analysis.

Objective: Smoking represents a major public health problem among patients with schizophrenia. To this end, some studies have investigated the efficacy of varenicline for facilitating smoking cessation in schizophrenia patients. The present review seeks to synthesize the results of these studies as well as document the reported side effects of using this medication. Methods: An electronic search was performed using five major databases: PubMed, Scopus, EMBASE, Web of Science, and Cochrane Library. Included in the current analysis were randomized clinical trials (RCTs) that have investigated the effect of varenicline in promoting smoking cessation in patients with schizophrenia. Risk of bias among included RCTs was assessed using the Cochrane Collaboration's quality assessment tool. Results: Among the 828 screened articles, only four RCTs, which involved 239 participants, were eligible for meta-analysis. In patients with schizophrenia, varenicline treatment when compared to placebo significantly reduced the number of cigarettes consumed per day [SMD (95% CI) = 0.89(0.57-1.22)] and expired carbon monoxide levels [SMD (95% CI) = 0.50 (0.06-0.94)] respectively. Conclusion: Despite a limited number of studies included in the meta-analysis, our results suggest that varenicline is an effective and safe drug to assist smoking cessation in patients with schizophrenia. Future large-scale well-designed RCTs are required to validate these findings.

Combined use of electroconvulsive therapy and antipsychotics (both clozapine and non-clozapine) in treatment resistant schizophrenia: A comparative meta-analysis.

AIM: To assess the relative efficacies of clozapine plus Electroconvulsive Therapy (ECT) compared against non-clozapine typical and atypical antipsychotics plus ECT for the treatment of "Treatment Resistant Schizophrenia" (TRS). Primarily to assess if clozapine delivers a significant improvement over other antipsychotics when combined with ECT. DESIGN: Major electronic databases were searched between 1990 and March 2017 for trials measuring the effects of either clozapine augmented ECT, other antipsychotic-augmented ECT, or both. After the systematic review of the data, a random-effects meta-analysis was conducted measuring the relative effect sizes of the different treatment regimens. SUBJECTS: 1179 patients in 23 studies reporting the usage of ECT augmentation with antipsychotics. A total of 95 patients were tested with clozapine, and ECT (9 studies) and 1084 patients were tested with non-clozapine antipsychotics (14 studies) such as flupenthixol, chlorpromazine, risperidone, sulpiride, olanzapine, and loxapine with concurrent ECT treatment considered for systematic review. Of these, 13 studies reported pre and post-treatment scores were included in the meta-analysis. MAIN OUTCOME MEASURES: The main outcome measure was the presence and degree of both positive and negative psychotic symptoms, as measured by either of two standardized clinician administered tests, the Brief Psychiatric Rating Scale (BPRS), and the Positive and Negative Symptom Scale (PANSS). RESULTS: The comparison of the different antipsychotics established the supremacy of ECT-augmented clozapine treatment against other typical and atypical antipsychotics. The Forest Plot revealed that the overall standard mean difference was 0.891 for non-clozapine studies and 1.504 for clozapine studies, at a 95% interval. Furthermore, the heterogeneity plots showed that while clozapine studies showed no significant heterogeneity, non-clozapine studies showed an I2 statistic value at 42.19%, suggesting moderate heterogeneity. Lastly, publication bias showed asymmetrical plots and significant values of Kendal's tau and Egger's rank test. CONCLUSION: ECT augmentation technique was found to be effective in the reduction of psychometric scale scores, and the resulting improvement was significant. Clozapine maintained its stance as the most effective treatment for Treatment-Resistant Schizophrenia, followed by flupenthixol.

Clinical Presentation of Ulcerative Colitis in Pakistani Adults.

OBJECTIVE: The aim of this study was to determine the clinical presentation and severity of ulcerative colitis (UC) in Pakistani adult patients. MATERIALS AND METHODS: An observational study. Data were obtained by reviewing the medical records of patients who visited a gastroenterology clinic between 2008 and 2012. RESULTS: There were 54 patients diagnosed as UC. The male to female ratio was 1:1. Mean age at diagnosis of UC was 38.7 ± 11.8 years (median 36.5, range 18-64). The predominant presenting symptoms were mucus diarrhea in 49 (90.7%), gross blood in stools in 42 (77.8%), abdominal pain or cramps in 40 (74.1%) and weight loss in 15 (27.7%). Left-sided colitis was present in 23 (42.6%), pancolitis in 15 (27.8%), extensive colitis in 11 (20.4%), and proctitis in five (9.2%). The severity of UC as judged by the Mayo scoring system showed that 68.5% were suffering from moderate to severe disease while 31.5% had mild disease. The extra-intestinal manifestation were found only in seven patients; arthritis in five patients and anterior uveitis in two patients. The arthritis was unilateral and the sites were knee joint in three patients and sacroiliac joint in two patients. CONCLUSION: Ulcerative colitis presents in our adult patients may present at any age with no gender preponderance. The disease severity is moderate to severe in the majority of patients and more than half of them have left-sided colitis or pancolitis at the time of presentation. Extraintestinal manifestations were not common. HOW TO CITE THIS ARTICLE: Qureshi M, Abbas Z. Clinical Presentation of Ulcerative Colitis in Pakistani Adults. Euroasian J Hepato-Gastroenterol 2015;5(2):127-130.

Consensus interferon plus ribavirin for hepatitis C genotype 3 patients previously treated with pegylated interferon plus ribavirin.

BACKGROUND: Not enough data are available about the effectiveness of consensus interferon (CIFN) among HCV genotype 3 patients who failed to respond to pegylated interferon and ribavirin. OBJECTIVES: We aimed to assess the efficacy and safety of CIFN and ribavirin in non-responders and relapsers to pegylated interferon with ribavirin therapy. PATIENTS AND METHODS: This open-label investigator-initiated study included 44 patients who received CIFN 15 µg /day plus ribavirin 800-1200 mg daily. In patients with an early virological response (EVR), the dose of CIFN was reduced to 15 µg thrice a week for further 36 weeks. Patients with delayed virological response continued to receive daily CIFN plus ribavirin to complete 48 weeks. The patients were considered "non-responders" if there were less than 2 log reduction in HCV RNA at 12 weeks and detectable HCV RNA at 24 weeks. RESULTS: Twenty-four patients (55%) were non-responders and 20 patients were relapsers to the previous treatment with pegylated interferon plus ribavirin (mean age 43.6 ± 9.4 years, males 25 (57%)). Nine patients were clinically cirrhotic (Child A). End of treatment virological response was achieved in 19 (43.1%) patients and sustained virological response (SVR) occurred in 12 (27.3%). Out of these 12 patients, eight were non-responders and four were relapsers to the previous treatment. Advanced fibrosis or clinical cirrhosis was associated with low SVR. Adverse events were fever, myalgia, anorexia, depression, and weight loss. Two patients received granulocyte colony stimulating factor for transient neutropenia. Seven patients were given erythropoietin to improve hemoglobin, and six were treated for mild depression. Two patients developed portosystemic encephalopathy. CONCLUSIONS: More than one-quarter of treatment-experienced patients with HCV genotype 3 achieved SVR after re-treatment with consensus interferon plus ribavirin.

Hepatocellular carcinoma in hepatitis D: does it differ from hepatitis B monoinfection?

BACKGROUND/AIM: Hepatitis D virus (HDV) superinfection in patients with chronic hepatitis B leads to accelerated liver injury, early cirrhosis, and decompensation. It may be speculated that hepatocellular carcinoma (HCC) may differ in these patients from hepatitis B virus (HBV) monoinfection. The aim of this study was to compare clinical aspects of hepatocellular carcinoma in patients of hepatitis D with HBV monoinfection. PATIENTS AND METHODS: A total of 92 consecutive HCC cases seropositive for antibody against HDV antigen (HDV group) were compared with 92 HBsAg-positive and anti-HDV-negative cases (HBV group). RESULTS: The features including sex, body mass index, presence of ascites, serum biochemistry, gross tumor appearance, child class, barcelona cancer liver clinic and okuda stages were not significantly different between the 2 groups. Decreased liver size was noticed more in cases of HDV compared with HBV group where the liver size was normal or increased (P=0.000). HDV patients had lower platelets (P=0.053) and larger varices on endoscopy (P=0.004). Multifocal tumors and elevated alpha-fetoprotein level >1000 IU/mL were more common in HBV group (P=0.040 and P= 0.061). TNM classification showed more stage III-IV disease in HBV group (P=0.000). CONCLUSION: Decreased liver size and indirect evidence of more severe portal hypertension and earlier TNM stage compared with HBV monoinfection indicate that HDV infection causes HCC in a different way, possibly indirectly by inducing inflammation and cirrhosis.