ICD-11 'mixed depressive and anxiety disorder' is clinical rather than sub-clinical and more common than anxiety and depression in the general population.

BACKGROUND: The new International Classification of Diseases was published in 2018 (ICD-11; World Health Organization, 2018) and now includes 'Mixed depressive and anxiety disorder' (6A73: MDAD) designated as a mood disorder. This disorder is defined by symptoms of both anxiety and depression occurring more days than not, for a period of two weeks, and neither set of symptoms considered separately reaches a diagnostic threshold for either disorder. However, to date no study has examined the validity of these guidelines in a general population sample. METHODS: Using Goldberg et al.'s (2017) guidelines regarding measurement of depression and anxiety, this study used factor mixture modelling (FMM) to examine the validity of the ICD-11 criteria of MDAD. Symptom endorsement rates are provided as well as demographic predictors and somatization outcomes. RESULTS: Fit indices suggested the two-factor four-class solution was the best balance between model complexity and model fit. The results did not support a class that is subsyndromal to both anxiety and depression. On the contrary, we suggest that there exists a 'Comorbid' class that represents endorsement of both anxiety and depression symptoms at a higher level when compared to both 'anxiety' and 'depression' groups. Demographic predictors, as well as somatization and functional impairment outcomes, provided support for this FMM solution. CONCLUSIONS: The 'Comorbid' group was the largest symptomatic group and had the highest levels of both anxiety and depression symptoms. Importantly, this group was larger than either the 'anxiety' or 'depression' group and was associated with high levels of functional impairment and somatization.

Fish and human health: an umbrella review of observational studies.

Fish represents one of the most important dietary sources of omega-3 polyunsaturated fatty acids, which are known to be associated with various health benefits. This study aimed to systematically review existing meta-analyses of observational studies exploring the association between fish intake and various health outcomes. A systematic search of electronic databases was conducted to retrieve a total of 63 studies. Evidence was deemed as possible for the association between higher fish intake and decreased risk of the acute coronary syndrome, liver cancer, and depression, and limited for other outcomes (including age-related macular degeneration, Alzheimer's disease, heart failure, all-cause and coronary heart disease mortality, total and ischaemic stroke) due to heterogeneity between results and potential otherwise inexplicable confounding factors. In conclusion, results from epidemiological studies support the mechanistic effects associated with omega-3 fatty acids from high fish consumption, but evidence needs to be further corroborated with more reliable results.

How is loneliness related to anxiety and depression: A population-based network analysis in the early lockdown period.

High risk of mental health problems is associated with loneliness resulting from social distancing measures and "lockdowns" that have been imposed globally due to the COVID-19 pandemic. This study explores the interconnectedness of loneliness, anxiety and depression on a symptom level using network analysis. A representative sample of participants (N = 1041), who were of at least 18 years of age, was recruited from the Republic of Ireland (ROI). Loneliness, anxiety and depression were assessed using validated instruments. Network analysis was used to identify the network structure of loneliness, anxiety and depression. Loneliness was found to be largely isolated from anxiety and depression nodes in the network. Anxiety and depression were largely interconnected. "Trouble relaxing," "feeling bad about oneself" and "not being able to stop or control worrying" were suggested as the most influential nodes of the network. Despite the expectation that loneliness would be implicated more robustly in the anxiety and depression network of symptoms, the results suggest loneliness as a distinct construct that is not interwoven with anxiety and depression.

Polyphenol-Rich Beverages and Mental Health Outcomes.

Emerging evidence suggests that diets rich in plant-based foods and beverages may exert plausible effects on human health tackling the risk of chronic diseases. Although the data are promising for numerous outcomes, including cardiovascular diseases, the data on mental health are limited. The aim of this study was to investigate the association between individual polyphenol-rich beverages intake and mental health outcomes, such as perceived stress, depressive symptoms, and sleep quality, among adult individuals living in the Mediterranean area. The demographic and dietary characteristics of a sample of 1572 adults living in southern Italy were analysed. Multivariate logistic regression analyses, controlling for confounding factors, were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between individual polyphenol-rich and alcoholic beverages containing polyphenols and mental health outcomes. The multivariate model adjusted for background covariates and the Mediterranean diet showed that individuals with a moderate intake (up to 1 cup/glass per day) of coffee and tea were less likely to have high perceived stress (OR = 0.61, 95% CI: 0.45-0.84) and depressive symptoms (OR = 0.56, 95% CI: 0.39-0.80), respectively. Furthermore, regular coffee and moderate/regular red wine drinkers were less likely to have depressive symptoms (OR = 0.72, 95% CI: 0.54-0.95 and OR = 0.74, 95% CI: 0.54-0.99, respectively). No significant associations were retrieved for the intake of polyphenol-rich and alcoholic beverages and sleep quality. In conclusion, the results of the present study suggest that polyphenol-rich beverages may be associated with mental health, in terms of depressive symptoms and perceived stress. Nonetheless, further research exploring how the polyphenol-rich beverages impact brain health and what the optimal patterns of consumption are for different populations are warranted.

Borderline Personality Disorder (BPD) and Complex Posttraumatic Stress Disorder (CPTSD): A Network Analysis in a Highly Traumatized Clinical Sample.

Whether complex posttraumatic stress disorder (CPTSD) and borderline personality disorder (BPD) diagnoses differ substantially enough to warrant separate diagnostic classifications has been a subject of controversy for years. To contribute to the nomological network of cumulative evidence, the main goal of the present study was to explore, using network analysis, how the symptoms of ICD-11 PTSD and disturbances in self-organization (DSO) are interconnected with BPD in a clinical sample of polytraumatized individuals (N = 330). Participants completed measures of life events, CPTSD, and BPD. Overall, our study suggests that BPD and CPTSD are largely separated. The bridges between BPD and CPTSD symptom clusters were scarce, with "Affective Dysregulation" items being the only items related to BPD. The present study contributes to the growing literature on discriminant validity of CPTSD and supports its distinctiveness from BPD. Implications for treatment are discussed.

Nutrient deficiency profiles and depression: A latent class analysis study of American population.

BACKGROUND: Research into the effects of nutrition on depression is often performed by examining the effects of singular nutrients and dietary styles (e.g.: vegan, Mediterranean). The present study is the first one to establish the effects of patterns of nutritional deficiency within the American population and examines their effects on depression. METHODS: Data was drawn from National Health and Nutrition Examination Survey (NHANES). Latent class analysis was performed to identify homogeneous groups of nutrient deficiency. A 3-step analysis was performed to establish class-dependant differences in depression severity. BCH analysis revealed unique predictors of depression dependant on most probable class. RESULTS: Analysis revealed 4 classes of nutrient deficiency. Magnesium and dietary fibre were the least endorsed. 'Nutrient deprived' individuals showed the highest depression severity (Mean = 4.137, SD = 0.337). Profiles were predicted by different socioeconomic and anthropogenic predictors with meeting minimum calories showing the strongest odds of not being nutrient deprived (OR between 5.44 and 11.11). Overall, age (ß = -0.115, p ≤ 0.01) and income (ß = -0.147, p ≤ 0.01) were the strongest protecting factors while being female (ß = 0.128, p ≤ 0.01) and arthritis (ß = 0.130, p ≤ 0.01) were the strongest risk factors. LIMITATIONS: The study involved binary variables based on minimum daily intakes and did not account for positive effects of exceeding minimum recommended doses. CONCLUSIONS: The study supports the notion of a negative relationship between good nutrition and depression. Finding unique risk factors for depression symptoms supports the utility of nutrient deficiency profiling.

Dietary Phytoestrogen Intake and Cognitive Status in Southern Italian Older Adults.

BACKGROUND: Aging society faces significant health challenges, among which cognitive-related disorders are emerging. Diet quality has been recognized among the major contributors to the rising prevalence of cognitive disorders, with increasing evidence of the putative role of plant-based foods and their bioactive components, including polyphenols. Dietary polyphenols, including phytoestrogens, have been hypothesized to exert beneficial effects toward brain health through various molecular mechanisms. However, the evidence on the association between dietary phytoestrogen intake and cognitive function is limited. The aim of this study was to investigate the association between phytoestrogen intake and cognitive status in a cohort of older adults living in Sicily, Southern Italy. METHODS: Dietary information from 883 individuals aged 50 years or older was collected through a validated food frequency questionnaire. Cognitive status was assessed through the Short Portable Mental Status Questionnaire. RESULTS: The highest total isoflavone (including daidzein and genistein) intake was inversely associated with cognitive impairment compared to the lowest (odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.20-0.92). Higher intake of total lignans and, consistently, all individual compounds (with the exception of secoisolariciresinol) were inversely associated with cognitive impairment only in the unadjusted model. CONCLUSIONS: A higher intake of phytoestrogens, especially isoflavones, was associated with a better cognitive status in a cohort of older Italian individuals living in Sicily. Taking into account the very low intake of isoflavones in Italian diets, it is noteworthy to further investigate selected populations with habitual consumption of such compounds to test whether these results may be generalized to the Italian population.

[Is suxamethonium still useful for paediatric anaesthesia?]. / Czy suksametonium ma ciagle miejsce we wspólczesnej amestezologii dzieciecej?

Suxamethonium is the only depolarising neuromuscular blocking agent, which is still being widely used during general anaesthesia. Some of its unique properties rank suxamethonium as an ideal neuromuscular blocking agent i.e. the fast onset of muscle paralysis and spontaneous neuromuscular block reversal. However, the agent may trigger malignant hyperthermia, hyperkaliaemia, severe bradycardia and other complications, which have to be considered. Due to differences in postsynaptic nicotine receptor structure and functional insufficiency of the neuromuscular junction, paediatric patients when compared to adults, are more sensitive to potential side effects when suxamethonium is administered. Malignant hyperthermia is an important risk factor. Ryanidine receptors located in the sarcoplasmic/endoplasmic reticulum membrane are responsible for the release of Ca2+ from intracellular stores and trigger this complication.The risk of hyprethermia increases in children when some neurologic and muscle diseases coexist. Nowadays, in rapid sequence induction of anaesthesia, suxamethonium may be replaced with rocuronium - a non-depolarising muscle relaxant which provides the intubating conditions similar to suxamethonium. The rocuronium-induced neuromuscular blockade, which lasts longer than blockade following suxamethonium, is reversed with sugammadex - a new selective relaxant binding agent. Despite new agents and methods, suxamethonium still remains the drug of choice for muscle relaxation for intubation in children.

Predictors of PTSD and CPTSD in UK firefighters.

Background: Globally, professional firefighters are often exposed to traumatic events and are at high risk of developing posttraumatic stress disorder (PTSD) symptoms. Objective: With the publication of the 11th edition of the International Classification of Diseases (ICD-11) there arose a need for research based on the new diagnostic criteria, and the associated disorder, Complex PTSD (CPTSD). Method: Participants were 1300 former or present firefighters from the UK. Prevalence rates of PTSD and CPTSD were estimated using International Trauma Questionnaire in accordance with ICD-11 criteria, and service related and personal trauma exposure were also assessed using an anonymous online questionnaire. Multinomial logistic regression was performed to assess how service and personal trauma exposure predicted PTSD and CPTSD. Results: CPTSD criteria were met by 18.23% (95% CI 16.13-20.33%) and PTSD criteria were met by 5.62% (95% CI 4.37-6.87%) of the sample. Experiencing higher levels of service-related trauma significantly increased the risk for both PTSD and CPTSD, and nonwork related trauma uniquely predicted CPTSD but not PTSD. Conclusions: This study provided the first examination of the new ICD-11 criteria for PTSD and CPTSD in a large sample of firefighters, and CPTSD was more common than PTSD. Exposure to multiple different types of trauma increased the odds of PTSD and CPTSD.

Antecedentes: A nivel mundial, los bomberos profesionales están con frecuencia expuestos a eventos traumáticos y están en alto riesgo de desarrollar síntomas del trastorno de estrés postraumático (TEPT).Objetivo: Con la publicación de la 11° edición de la Clasificación Internacional de Enfermedades (CIE-11) surgió la necesidad de realizar una investigación basada en los nuevos criterios diagnósticos y el trastorno asociado, el TEPT complejo (TEPT-C).Método: Los participantes fueron 1 300 bomberos, tanto en retiro como en servicio, del Reino Unido. Se estimaron las tasas de prevalencia del TEPT y del TEPT-C usando el Cuestionario Internacional de Trauma de acuerdo con los criterios de la CIE-11. También fueron evaluados la exposición a trauma personal y al relacionado con el servicio mediante un cuestionario anónimo en línea. Se realizó una regresión logística multinomial para evaluar cómo la exposición al trauma personal y del servicio predijeron el TEPT y el TEPT-C.Resultados: Los criterios del TEPT-C fueron cumplidos por el 18,23% (95% IC 16,13% - 20,33%) y los criterios del TEPT fueron cumplidos por el 5,62% (95% IC 4,37% −6,87%) de la muestra. Experimentar niveles más altos de trauma relacionado con el servicio aumentó significativamente tanto el riesgo del TEPT como del TEPT-C. El trauma no relacionado con el trabajo predijo de manera única el TEPT-C pero no el TEPT.Conclusiones: Este estudio proporcionó la primera evaluación de los nuevos criterios de la CIE-11 para el TEPT y el TEPT-C en una muestra grande de bomberos. Asimismo, el TEPT-C fue más común que el TEPT. La exposición a múltiples traumas de distintos tipos aumentó la probabilidad de desarrollar el TEPT y el TEPT-C.

Coagulation changes in a siamese twin in SIRS after death of the other twin: a case study.

BACKGROUND: Conjoined twins represent a rare case of embryonic failure. Siamese twins' final outcome is usually associated with poor prognosis due to complications, among which the inflammatory and septic disturbances are often present. CASE REPORT: The article describes Siamese twins of craniopagus type. One of the twins died of heart and aortic failure after 48 hours of life. The decision regarding surgical separation then became an emergency. At the same time laboratory results for the surviving twin I indicated steadily worsening coagulation functions and processes, which we believed were caused by the death of twin II, as well as by systemic inflammatory response syndrome (SIRS). CONCLUSIONS: Due to vascular conjunction between the twins' brains' circulatory systems the sequenced progress of coagulopathy was noticed in the surviving twin.

[Regional cerebral oximetry]. / Regionalna oksymetria mózgowa.

Regional cerebral oximetry (RCO), introduced to clinical practice 15 years ago, is a non-invasive method of measuring regional cerebral venous oxygen saturation using optical spectroscopy. Monitoring during anaesthesia is mainly directed at providing optimal oxygenation and avoiding desaturation incidents. RCO offers new and broader possibilities for measurement of cerebral and regional tissue oxygenation.This method has proven useful both in anaesthesia and in intensive care; The article shows the indications for which this method of monitoring may be useful during anaesthesia and in intensive care units, allowing the avoidance of more invasive methods, e.g., mixed venous saturation and venous bulbar saturation. It is also extremely useful in small children in whom cannulation of large vessels may be difficult or impossible. In the review, possible applications of the method are presented and discussed.

[Multiple organ failure in a severely malnourished patient with chromosome aberration]. / Skrajne niedoiywienie jako przyczyna niewydolnosci wielonarzadowej u chorej z aberracja chromosomalna.

BACKGROUND: Pneumonia and malnutrition are two of the biggest killers in childhood, as defined by the World Health Organisation. Although common in the developing world, these conditions can also be observed in more advanced countries, as a result of negligence and lack of proper care in disabled children. We describe a case in which severe malnutrition resulted in multiple organ failure. CASE REPORT: A 16-yr-old retarded girl with +14q chromosome aberration, was admitted to hospital because of severe anaemia and dyspnea. She was extremely malnourished. Her body weight was 32 kg with a height of 152 cm (BMI 13.9). Her Hb concentration was 1.12 mmol L(-1), Ht 7%, and RBC 0.93 T L(-1). RBC transfusion resulted in transfusion-related acute lung injury (TRALI) and multiple organ failure. She was treated with mechanical ventilation, inotropic support and parenteral nutrition, complicated by the refeeding syndrome and gastrointestinal haemorrhage. After recovery, a gastrostomy was performed, but due to gastric retention she required a laparotomy for adhesiolysis.The girl recovered and remains under home care. DISCUSSION: In a case of a girl with retardation, multiple organ failure resulting from ten years of malnutrition was observed. She was especially difficult to treat because of a prolonged dysfunction of homeostasis, hypoproteinemia, hypophosphatemia and SIRS. Such patients require careful treatment in ICU settings.

COVID-19-related anxiety predicts somatic symptoms in the UK population.

This study aimed to estimate the association between anxiety associated with COVID-19 and somatic symptoms, using data from a large, representative sample (N = 2,025) of the UK adult population. Results showed that moderate to high levels of anxiety associated with COVID-19 were significantly associated with general somatic symptoms and in particular with gastrointestinal and fatigue symptoms. This pattern of associations remained significant after controlling for generalized anxiety disorder (GAD), pre-existing health problems, age, gender, and income. This is the first evidence that anxiety associated with COVID-19 makes a unique contribution to somatization, above and beyond the effect of GAD.

[Difficult airways--why do we need algorithms]. / Trudne drogi oddechowe--o potrzebie algorytmów.

The difficult airway and/or intubation are still one of the most important challenges for anaesthesiologists. Recent clinical trials reported a decrease in the number of fatal cases associated with a difficult airway; however, these complications are still among the major causes of severe morbidity and mortality in anaesthesiology. Severe anaesthesiological complications including serious hypoxia, brain damage and death occur mostly during induction of anaesthesia, and are often related to a difficult airway. The term is often misinterpreted, and relates to failed intubation, difficult tracheal intubation, difficult laryngoscopy, and/or difficult mask ventilation. Difficult intubation is not easy to anticipate. The majority of prognostic methods, i.e. assessment scales accepted in clinical practice, are not satissfactory. Up to 40% of tracheal intubations preoperatively anticipated as difficult are performed without problems. In some cases, however, the procedure proves difficult only on direct laryngoscopy. This review presents current reports and statistical analysis of serious airway-related incidents in medical practice, and indicates the need for the introduction of mandatory guidelines for difficult airway assessment and management in clinical practice.

[Iatrogenic tracheal rupture, tension pneumotorax and cardiac arrest]. / Jatrogenny uraz tchawicy powiklany obustronna odma prezna i zatrzymaniem krazenia.

BACKGROUND: Tracheobronchial rupture is a life-threatening complication that may occur during and/or after intubation and tracheostomy. In the majority of described cases, the posterior membranous part of the trachea was affected. CASE REPORT: A 35-year-old woman was admitted to the ICU because of viral meningo-encephalitis with subsequenttetraplegia and respiratory failure. Five days after admission she underwent surgical tracheotomy.The immediate postoperative period was complicated by accidental misplacement of the tracheal tube with hypoxia and bradycardia. The patient was intubated with difficulty and an endotracheal tube was inserted over a bougie guidewire. An ENT surgeon re-inserted the tracheal tube, but two hours later bilateral pneumothorax with subcutaneous emphysema occurred, and the patient was re-intubated. This was followed by a cardiac arrest. CPR was commenced and thoracic drains were inserted, resulting in a return of spontaneous circulation. Bronchoscopy revealed a 1 cm laceration of the anterior tracheal wall. The patient was ventilated for another 50 days and eventually recovered without neurologic deficit. CONCLUSIONS: Tracheal rupture is a rare complication of tracheostomy, and it is difficult to determine the exact mechanism of injury in the case described. In any case of sudden deterioration of a newly tracheotomized patient, pneumothorax should be suspected. Immediate intubation and bronchoscopy are recommended.

Pharmacokinetics and pharmacodynamics of propofol in children undergoing different types of surgeries.

BACKGROUND: Propofol is a commonly used agent in total intravenous anesthesia (TIVA). However, the link between its pharmacokinetics and pharmacodynamics has not been fully characterized in children yet. Our aim was to determine the quantitative relationship between the venous plasma concentration and bispectral index (BIS) effect in a heterogeneous group of pediatric patients undergoing various surgical procedures (ASA status I-III). METHODS: Nine male and nine female patients were anesthetized with propofol-fentanyl TIVA. Sparse venous samples for propofol concentrations assay and dense BIS measurements were collected during and after the end of infusion. Nonlinear mixed-effect modeling in NONMEM was used for data analysis. RESULTS: A three-compartment model was linked with a classical Emax model through a biophase compartment to describe the available data. All clearance and volume terms were allometrically scaled to account for the body mass difference among the patients under study. A typical patient had their PK parameters observed within the range of literature values for children. The pharmacodynamic parameters were highly variable. The EC50 of 2.80 mg/L and the biophase distribution rate constant of 3.33 min(-1) were found for a typical patient. CONCLUSIONS: The BIS values in children are highly correlated with the propofol effect compartment concentrations according to the classical Emax concentration-response relationship. Children had slightly lower sensitivity to propofol and slightly higher clearance, as compared with the adult data available in literature. The intra-patient variations in the BIS require the anesthesiologist's attention in using BIS values alone to evaluate the depth of anesthesia in children.