Bouveret Syndrome in a Cirrhotic Patient.

Here, we present a case of Bouveret syndrome, a rare etiology of gallstone impaction in the setting of chole-enteric fistula, in a cirrhotic patient. This syndrome is most often seen in elderly patients with multiple comorbidities and as such has high morbidity and mortality rates. Because of its prevalence in this patient population and its rarity, there are no established guidelines for the workup and management of this disease. We discuss currently available options for management and thoughts on our comorbid patient and her clinical course.

It is a painful somatic symptom, not the history of cancer/malignancy that is associated with depression: findings from multiple national surveys.

Medical case management has improved in the past few decades, changing the dynamic interaction between depression and prevalent medical diseases. It is relevant to describe the comorbidity between depression and medical diseases to further improve the effectiveness of case management. We analyzed the data of adults aged 20 years and older, who completed depression screening as a part of the National Health and Nutrition Examination Survey, 2005 to 2012. Depression was ascertained using the Patient Health Questionnaire, a 9-item screening instrument asking about the frequency of depression symptoms over the past 2 weeks. Comorbid diseases were assessed in a self-reported personal interview on doctor-diagnosed health conditions. The associations between depression and medical diseases were limited to the diseases with painful somatic symptoms. Reported from 19.78% of men and 27.84% of women, arthritis was the most prevalent chronic disease, and was the only one consistently associated with depression. The odds ratio of moderate to severe depression was 1.65 (95% confidence interval = 1.12-2.44) for men and 2.11 (1.63-2.99) for women with arthritis compared with their counterparts free of arthritis. Moderate/severe depression was associated with a history of heart disease among men (2.45 [1.19-5.06]) and angina/angina pectoris among women (2.13 [1.07-4.26]). No associations were found between depression and cancer/malignancy, either among men or women. The potential impact of pain management on depression prevention among general population is substantial; more efforts are needed to assess chronic pain to facilitate timely prevention and treatment of depression and comorbid medical conditions.

The association between arthritis and depression is intensified by excessive body weight: Findings from a US national survey, 2005-2012.

OBJECTIVE: Obesity and arthritis are leading chronic conditions, but comorbidity of these conditions and their interaction leading to depression have not been fully investigated. The purpose of this study is to determine the degree to which excess body weight effect-modifies the relationship between arthritis and depressive symptoms. METHODS: We used the data of 8677 men and 8820 women aged 20 or older, who completed a depression screening and general medical condition interview as a part of the National Health and Nutrition Examination Survey, 2005-2012. Depression was ascertained using the Patient Health Questionnaire-9 (PHQ-9); a PHQ-9 score of 15 or higher was defined as indicative of depression. RESULTS: Arthritis was reported in 26.5% (SE=0.9) of men and 36.9% (SE=1.4) of women. The association between depression and arthritis was not significant among healthy weight women, but significant among overweight and obese women. The prevalence ratios (PRs) of depression among arthritis-free women were 1.00 (reference) for healthy weight, 1.43 (0.85-2.42) for overweight, and 1.99 (1.23-3.23) for obese women. For women with arthritis, the PRs were 1.16 (0.63-2.12) for healthy weight, 3.80 (2.24-6.45) for overweight and 3.73 (2.30-6.05) for obese women. The intensifying effect from excessive body weight on the association between arthritis and depression was less salient among men than women. CONCLUSIONS: The association between arthritis and depression is intensified significantly by increased body weight, in particular, among women.

Relationships Among Meeting Physical-Activity Guidelines and Health Risk Behaviors.

BACKGROUND: Young adults have the highest participation in physical activity but also have the highest incidence rates of binge drinking, cigarette smoking, and smokeless tobacco use. We examined these factors to determine whether there are relationships among physical activity and health risk behaviors. METHODS: We conducted correlation and χ² analyses using the American College Health Association-National College Health Assessment fall 2009 data set (N = 34,208) to examine the relationship among meeting physical-activity guidelines, binge drinking, and tobacco use among survey participants. RESULTS: The data suggest a positive relationship between meeting physical-activity guidelines and binge drinking, with the strongest relationship between those reporting binge drinking 4 times in a 2-week period. Meeting physical-activity guidelines was negatively associated with cigarette use but positively associated with all other types of tobacco use. CONCLUSIONS: Associations between physical activity and binge-drinking episodes indicate a need to address the relationship between heavy drinking and alcohol dependence and physical-activity behavior patterns. Further studies should examine relationships between physical activity and binge drinking in other age groups. Results also suggest the need to examine differing associations between physical activity and types of tobacco use.