No End in Sight; Assessing the Impact of Internet Gaming Disorder on Digital Eye Strain Symptoms and Academic Success.

BACKGROUND: Internet Gaming Disorder (IGD) has been associated with symptoms of Digital Eye Strain (DES) and poor academic performance among adolescent students. The purpose of this study is to assess whether a student's achievement of a specific academic goal within a short period of time can be directly predicted by symptoms of IGD and DES. METHODS: This is a cross-sectional survey of 140 high school graduates who received an examination of visual acuity as a pre-requisite for entering the written admission examinations of law enforcement and military academies. The students completed the Digital Eye Strain Questionnaire (DESQ) and the Ten-Item Internet Gaming Disorder Test (IGDT-10) and stated their own evaluation of their chances for success. They were contacted following their admission examinations, and their success or failure to be admitted was recorded. RESULTS: The students with IGD symptomatology were more likely to present with symptoms of DES. They were also more pessimistic about their chances of success in the subsequent written admission examinations; none succeeded, while the rest of the students recorded an expected rate of success. A combination of IGD and complaints related to the prolonged fixation of the upper body in a specific viewing position was the best predictor variable set for future success in admission examinations. CONCLUSIONS: IGD is associated with a failure to achieve academic success. Combining a factor for physical discomfort during prolonged sessions of gaming with the typical criteria for IGD may expand the predictive validity of the construct of gaming disorder.

Bipolar Disorder and Gaming Disorder-Compatible or Incompatible Diagnoses?

Gaming Disorder (GD) is one of the latest additions in the psychiatric taxonomy, following its official inclusion in the latest revision of the International Classification of Diseases (ICD-11). This narrative review examines the rationale of an exclusion criterion for the diagnosis of GD, that of disordered gaming being limited exclusively during an episode of elevated mood in bipolar disorder. The history of the formulation of diagnostic criteria for the disorder and all relevant published studies are examined critically, and conclusions are drawn as to the potential validity and usability of the exclusion criterion. Suggestions are offered for future research to elucidate not only the relevance of the exclusion criterion but also the differential diagnosis of GD with pathological gambling (PG).

A Psychoanalytic Approach to Internet Gaming Disorder.

BACKGROUND: Internet Gaming Disorder (IGD) is now an official diagnosis and significant public health challenges have been already identified regarding the provision of appropriate care to patients of all ages and the preparedness of mental health professionals to manage the disorder. Despite the existence of psychotherapeutic treatment modalities available for some time now, there is a paucity of any psychoanalytically driven treatments and the disorder is widely regarded and classified as being 'behavioral'. This has profound implications for patients with long-standing character pathology and psychiatric comorbidities, who are underserved by the provision of health services that could efficiently address their issues. METHODS: This study presents a psychoanalytic perspective on IGD, based on Kohut's Self Psychology as applied in the treatment of other addictions. An outline of the theory, assessment and treatment modalities is presented with two case reports that illustrate its application. RESULTS: The presentation outlines the challenges in treating IGD, expanding on the concept of guided imagery, resistance to treatment, selfobject transference and comorbidity with marijuana use and bipolar disorder. CONCLUSIONS: A psychoanalytically driven protocol can be effective in treating IGD, especially in cases with marked character pathology and low motive to engage in other treatment modalities.

Spotlight on Digital Eye Strain.

Digital Eye Strain (DES) is a clinical syndrome manifested with visual disturbances and/or ophthalmic dysfunction related to the usage of screen-enabled digital equipment. This term is gradually replacing the older term computer vision syndrome (CVS) that focused on the same symptoms found on personal computer users. DES is encountered more frequently during the past years due to the explosive increase in the usage of digital devices and subsequent increase in time in front of any screens. It presents with a series of atypical symptoms and signs stemming from asthenopia, dry eye syndrome, preexisting untreated vision issues and poor screen ergonomics. This review summarizes research data to date to determine whether the concept of DES has been conclusively defined and demarcated as a separate entity and if sufficient guidance is offered on professionals and the lay public. The maturity of the field, grouping of symptoms, examination techniques, treatment and prevention modalities are summarily presented.

Correction of Presbyopia Alone Does Not Adequately Protect against Digital Eye Strain from Handheld Devices.

SIGNIFICANCE: The use of screen-enabled handheld devices has increased exponentially during the last few years among the older adults. Up until now, a general suggestion for preventing symptoms of digital eye strain with large screen use was to address any existing refractive error, including presbyopia. It is unclear whether this advice is of consequence in the case of smaller handheld devices. PURPOSE: The aim of this study was to examine whether correcting presbyopia ameliorates the negative effect on digital screen use, examining handheld devices where these issues are expected to be more acute with presbyopic individuals. METHODS: This is a cross-sectional study of 120 consecutive participants who had received correction for presbyopia during the past month and returned for a routine follow-up examination. The participants filled in a demographics questionnaire, questions on time spent online and using devices with digital screens, data on their eye complaints, and the validated Digital Eye Strain Questionnaire (DESQ). RESULTS: The DESQ factor scores and total score correlated with the near addition ( P < .001). Higher DESQ scores were associated (by order of magnitude) with higher near addition and a lower amount of time spent using a handheld screen-enabled device ( P < .001) while controlling for age and type of corrective lenses. CONCLUSIONS: Results indicate that older adults are at an additional disadvantage while using handheld screen-enabled devices compared with younger adults: they are more likely to be presbyopes and need higher near addition, yet increasing near addition does not guarantee greater comfort in the use of smartphones but rather increase the likelihood of experiencing digital eye strain symptoms.

Association of Cyberbullying and Internet Use Disorder.

Purpose of Review: The purpose of this review is to critically assess the published studies on the relationship between cyberbullying and internet use disorder (IUD), and propose directions for further study. Recent Findings: There were only four prospective studies out of thirty-two reviewed studies conducted since 2004, with only one prospective study conducted during the past 5 years. The field of study has been stagnant during the past 5 years with the vast majority of studies conducted on primary or secondary education and failing to address cyberbullying and IUD in social media and online gaming. Summary: Cyberbullying and IUD have been described since the nineties, yet there are still significant issues with their definition and research. Lately, both these problematic behaviors are sharing the same environments in social media and online gaming. This critical appraisal of published research examined thirty-two published peer-reviewed studies carried out since 2004. Findings indicate a number of significant issues including an overreliance on cross-sectional study design, near-exclusive focus on primary and secondary education students, widespread employment of unstandardized measures for cyberbullying and IUD, and lack of assessment for objective measures of psychological distress. Directions for future research are offered.

An Extremely Rare Case of a Primary Pancreatic Yolk Sac Tumor.

Yolk sac tumor (YST) is a rare malignant type of germ cell tumor (GCT). Extragonadal yolk sac tumor is a very rare entity. We report the case of a 33-year-old male with a pancreatic mass, which proved to be a primary yolk sac tumor, arising in the pancreas.

A Rare Case of an Adrenal Mass Proved to Be a Benign Cellular Schwannoma.

Adrenal schwannomas are extremely uncommon tumors. We report the case of a 39-year-old male with a right adrenal mass. Laboratory tests were normal and radiological exams revealed the adrenal tumor. Open surgical adrenalectomy was performed. The postoperative course was uneventful. Microscopy and immunohistochemistry revealed a cellular schwannoma. Adrenal schwannomas are rare tumors, very difficult to diagnose in preoperative evaluation. Surgical excision of the tumor, histological and immunohistochemical examination of the specimen provide a definitive diagnosis. Prognosis is generally very good. Recurrence rates are related to positive surgical margins.

Drop in well-being of ARMD patients under treatment with anti-VEGF injections during the COVID-19 pandemic.

PURPOSE: Patients with age-related macular degeneration (ARMD) are required to follow a treatment protocol that requires regular follow-ups. The COVID-19 pandemic has created an additional burden for patients with ARMD under treatment with anti-vascular endothelial growth factor (anti-VEGF) injections, since patients face a congestion of the health system and closing of the outpatient services. This study examines the impact of the uncertainty regarding patients' treatment on their sense of well-being. METHODS: This is a longitudinal cohort study of eighty patients who were followed during the year following the outbreak of the COVID pandemic. Patients reported their sense of well-being with the WHO-5 questionnaire and their perception and fears for the impact of the pandemic on their ongoing ARMD treatment. RESULTS: There was a significant drop in mental well-being during the pandemic that paralleled the self-reported impact of the pandemic on ARMD treatment. Patients who reported a higher impact of COVID-19 on their treatment had experienced a higher drop in mental wellbeing compared to those who hadn't, with female gender being an additional risk factor. Objective measurements of visual acuity did not factor in the drop of sense of well-being. CONCLUSIONS: The high initial level of uncertainty regarding ARMD patients' long-term course was further exacerbated when exposed to additional uncertainties during the pandemic regarding their standard of care. Planning ahead for continuation of services and close contact with patients during similar health emergencies is of paramount importance.

Blue Light Blocking Treatment for the Treatment of Bipolar Disorder: Directions for Research and Practice.

Recent results from a small number of clinical studies have resulted in the suggestion that the process of blocking the transmission of shorter-wavelength light ('blue light' with a wave length of 450 nm to 470 nm) may have a beneficial role in the treatment of bipolar disorder. This critical review will appraise the quality of evidence so far as to these claims, assess the neurobiology that could be implicated in the underlying processes while introducing a common set of research criteria for the field.

Large-Cell Esophageal Neuroendocrine Carcinoma: Report of a Rare Case.

Neuroendocrine tumors (NETs) are neoplasms with neuroendocrine characteristics such as secretion of neuropeptides, large secretory vesicles, and a lack of neural structures. Neuroendocrine carcinoma (NEC) of the esophagus is a very rare malignancy. We present the case of a 58-year-old male with a pure large cell NEC of the esophagus.

Validation of the Digital Eye Strain Questionnaire and pilot application to online gaming addicts.

INTRODUCTION: 'Digital eye strain' (DES) is a clinical syndrome with eyesight symptoms related to continuous engagement in front of a screen-enabled digital device. With use of these devices constantly on the rise, the related symptoms have become prominent, even in younger ages. This study describes the process of validating the Digital Eye Strain Questionnaire (DESQ), a thirteen-item self-report scale in a yes-no format designed to offer a measure of complaints related to digital eye strain syndrome (DES). METHODS: The validation process included 150 outpatients with no long-standing eye disease who were examined for various eye complaints and 50 outpatients who were diagnosed with gaming addiction according to WHO ICD-11 clinical criteria. All participants filled in a demographics questionnaire, the DESQ, the Computer Vision Syndrome Questionnaire (CVS-Q) and the Problematic Internet Use Questionnaire-9 (PIUQ-9). RESULTS: Principal component analysis of categorical variables confirmed the proposed three-factor DES structure with a total of 61.02% of explained variance and Cronbach's alpha equal to.94. Concurrent validity was assessed by comparing the results of the DESQ to the CVS-Q while convergent validity was assessed by examining correlations of the DESQ with results from the PIUQ-9 questionnaire. In all cases the DESQ demonstrated excellent reliability and validity. CONCLUSIONS: Results indicate that the DESQ questionnaire can be employed to reliably measure the symptomatology of digital eye strain in clinical populations who present either with eye issues or with excessive use of the gaming and screen-enabled devices in general.

Myocardial infarction with non obstructive coronary arteries complicated with ventricular septal rupture: A case report and literature review.

Ventricular septal rupture represents one of the most serious complications after an acute coronary syndrome. Nowadays this condition is rare due to early revascularization, but is still associated with high mortality rate. In this case report, we present an unusual case of a woman suffering an acute myocardial infarction with normal coronary arteries complicated with a ventricular septal rupture, which required surgical correction.

Personality of patients with central serous chorioretinopathy.

INTRODUCTION: Central serous chorioretinopathy (CSC) is a disease of the retina that is a frequent cause of mild to moderate visual impairment. The disease can be precipitated by psychosocial stress and hypercortisolism while full remission will often be spontaneous within a few months. Risk factors have included male gender, increased plasma cortisol due to other conditions or steroid use and Type A behavior. METHODS: This is a cross-sectional study comparing three research groups that included 100 CSC patients, 200 healthy volunteers, and 200 patients with other ophthalmic disease on their results in the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). RESULTS: CSC patients differed from the other subjects on increased high Neuroticism-Anxiety, low Sociability, and high Aggression-Hostility. CONCLUSIONS: Since high Neuroticism is related to increased cortisol levels only in males, and high Aggression-Hostility is related to increased cortisol response, these findings point to the possibility of a robust neurobiological background to the etiopathogenesis of CSC that merits further research. The association of Type A behavior with CSC may be a spurious one and its widespread reference in ophthalmology texts should be re-examined.

Effectiveness of Available Treatments for Gaming Disorders in Children and Adolescents: A Systematic Review.

In 2020, the prevalence of gaming disorder (GD) was comparable with the prevalence of obsessive-compulsive disorder, thus demonstrating the necessity of addressing Internet gaming disorder (IGD) and GD in general. GD has been introduced as a psychiatric disorder by International Classification of Diseases and paving the way for treatment and prevention interventions. In this review, we researched available treatment interventions in children and adolescents. Τhe initial search resulted in 972 studies and we ended up with 16 by excluding inappropriate studies according to six inclusion criteria. The studies confirmed that cognitive-behavioral therapy (CBT) or CBT-based interventions are the most used, and in cases of comorbidity, such as depression or attention-deficit/hyperactivity disorder, the appropriate pharmaceutical intervention also was an effective option. Other interventions combined CBT with family therapy or CBT-based therapies that took place in specialized camps. Family as a supportive expedient or even treatment expedient seemed to play a major role. It is remarkable that only little knowledge exists regarding treatment interventions for children aged 8-12 years old. Therefore, more studies need to be carried out for this age range especially, with comparable efficacy to this of other interventions.

Colouterine and Jejunouterine Fistula Secondary to Chronic Diverticulitis.

Fistulae between the colon or the small intestine and the uterus are extremely rare as the uterus is a thick, muscular organ. Here, we present the case of a 74-year-old female presenting to our surgical department because of fecal vaginal discharge for the past few months, which proved to be caused by a combined colouterine and jejunouterine fistula due to chronic diverticulitis. Total abdominal hysterectomy with bilateral oophorectomy with en bloc resection of part of the jejunum and the sigmoid colon and primary anastomoses were performed. This case represents an unusual type of diverticulitis complication and aims to point out the diagnostic and therapeutic issues of such a rare medical condition.

Mixed Large Cell Neuroendocrine Carcinoma of the Ovary: Report of a Rare Case.

LCNC (large cell neuroendocrine carcinomas) of the ovary is a rare aggressive tumor entity of the genital tract. Its pathogenesis, origin, and prognosis have not been fully elucidated, since there are a limited number of cases reported in literature. We report a case of an 80-year-old patient, who presented with a growing abdominal mass, which turned out to be a mixed LCNC/epithelial neoplasm. Although this type of tumor is rare, the continuous development of pathologoanatomy and immunohistochemistry contributes to our better knowledge and comprehension of these neoplasms.

Cross-Cultural Adaptation of the Greek Versions of the Lysholm Knee Scoring Scale and Tegner Activity Scale.

Purpose The Lysholm Knee Scoring Scale (LKSS) and the Tegner Activity Scale (TAS) are widely used instruments for assessing knee function and activity level in various knee pathologies, especially knee ligament injuries. The purpose of this study was to translate and cross-culturally adapt the Greek versions of the Lysholm Knee Scoring Scale (Gr-LKSS) and Tegner Activity Scale (Gr-TAS) and assess their reliability and validity in Greek patients suffering from various knee problems. Materials and methods Translation of the LKSS and TAS questionnaires was done according to established international guidelines. Fifty-five patients (32 males and 23 females; mean age: 24 ±7 years; range: 17-54 years) with various knee pathologies completed the Gr-LKSS and Gr-TAS along with the Greek versions of International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) and the Oxford Knee Score (OKS). Test-retest reliability was evaluated with the intraclass correlation coefficient (ICC) in 53 (96%) individuals, who completed the questionnaires again after 48-72 hours while abstaining from all forms of treatment. Internal consistency for the Gr-LKSS was measured using Cronbach's alpha and criterion-related validity was evaluated with the Pearson's correlation coefficient (r) in relation to control questionnaires (IKDC, KOS-ADLS, OKS). The distribution of floor and ceiling effects were also determined. Results There were no problems during the forward-backward translation and cultural adaptation of the Gr-LKSS and Gr-TAS. Criterion-related validity was confirmed with moderate to high associations of Gr-LKSS and Gr-TAS (after injury) with the IKDC and KOS-ADLS (Pearson's r ranging between 0.61-0.71 and 0.64-0.73, respectively). However, weak correlations were yielded between both questionnaires with the OKS (r=0.14-0.19). The internal consistency for Gr-LKSS was high (Cronbach's alpha: 0.779) and the test-retest reliability was high for both questionnaires (Gr-LKSS: ICC=0.950; Gr-TAS before and after injury: ICCs of 0.877 and 0.876, respectively). Conclusion The cultural adaptation and validity of Gr-LKSS and Gr-TAS were successfully accomplished. These questionnaires are recommended for use in the evaluation of soft tissue knee disorders in both clinical practice and research.