Suicide and Suicidal Tendency in Primary Care Setting; Review Article

Suicide is critical public health problem that primary care physicians potentially can help address given that concerned patients frequently visit them in the weeks and months preceding the successful suicide. This article contemplates issues placing the patient at high risk for successful suicide and clinical valuation techniques available to the primary care physician. Patients identified as being at risk of attractive suicidal or those who have a equal of suicidal ideation or behavior judged apposite for management in the primary care setting should be monitored for risk at regular intervals. It is extremely significant to learn about and try to contextualize the patients' emotions that triggered the present crisis. Nurses can make sure that they have a thorough understanding of the present acuity, and all of the precipitating factors, and can exactly and collaboratively communicate with the caregivers and other involved medical teams.

A CONCISE PICTURE OF HERNIA

A hernia is a disease wherein organs or tissues, like the bowel, bulge through the abdominal wall. The etiological, as well as precipitating factors for hernia include abdominal pressure, pre-existing weakness of abdominal muscles, gender, obesity, age, diet, lack of regular exercise, and smoking. Swelling, stiffness, and discomfort seem to be the most prevalent hernia symptoms, particularly while straining, moving, or bending down. Open and laparoscopic techniques are mainly used for hernia repair, both use mesh to counterbalance the abdominal wall flaws and provide a tension-free restoration.

Early Outcomes of Emergency Surgery for Left-Sided Mechanical Valve Thrombosis

Background: Valve thrombosis is a potentially lethal complication of mechanical cardiac valves. We examined the clinical characteristics as well as the early outcomes of patients undergoing emergency surgery for left-sided mechanical valve thrombosis. Methods: Between January 2012 and May 2020, 104 consecutive patients were offered an emergency redo surgery for acute mechanical valve thrombosis. Ninety-seven of these patients were included in the current study. Results: The mean age was 34.2 ± 10.3 years. Most of the patients were females (61 patients), and 27 patients (27.8%) were pregnant. The mitral valve was the site of thrombosis in 81 patients. Inadequate anticoagulation was found in 60.8% of patients. The overall early mortality was 32.9% (32 patients) with an operative mortality of 25.7%. Outcomes in the pregnant subgroup tended to be worst with a maternal mortality in the range of 37%, and with fetal and neonatal survival as low as 33.3%. Conclusion: The overall mortality in cases of mechanical valve thrombosis warranting surgery remains high. Since inadequate anticoagulation seems to be one of the major precipitating factors, the current study highlights the need for improvements in anticoagulation practices. The use of tissue valves should also be contemplated more seriously in some younger patients, especially females expressing the desire for future pregnancies.

To search for targets of therapy that changes the course of Parkinson’s disease

Background. Parkinson’s disease (PD) is a multisystem disease that requires a more comprehensive approach to its study and treatment. The purpose was to give clinical and laboratory characteristics of PD patients, in whom the onset of motor symptoms of the disease is associated with the action of precipitating factors and provide a theoretical justification for the underlying and/or associated electrophysiological phenomena. Materials and me-thods. Two hundred and seven patients with PD were examined. Questionnaire analysis and laboratory research were performed. Results. Among patients with a rapidly progressive type of PD, pain during the survey was registered in 49 (42.2 %) cases, and stress in 73 (62.3 %). In cases of a slowly progressive course, 14 (15.4 %) individuals experienced pain syndromes, and 53 (58.2 %) patients — stress. Statistically significant differences between patients with rapidly and slowly progressive PD courses were noted in the number of cases of herpetic diseases, inflammatory diseases of the oral cavity. The results of laboratory tests also showed statistically significant differences between these groups in the blood serum level of IL1β and cortisol, the level of IL1β in the cerebrospinal fluid, and the albumin coefficient. The patients with a rapidly progressive type of disease presented with a greater number of precipitating factors for PD development. In patients with rapidly progressive PD, the number of precipitating factors and the serum level of antibodies to α-synuclein (r = –0.18), IL10 (r = 0.31), and cortisol (r = 0.18) correlated. Some objective characteristics of non-motor PD symptoms statistically significantly correlated with a level of laboratory biomarkers in blood serum (Montreal Cognitive Assessment value with cortisol level (r = –0.4); Pittsburgh Sleep Quality Index value with antibodies to α-synuclein (r = 0.31); Epworth Sleepiness Scale value with IL10 level (r = –0.21)). Significant acute psychological stresses and pain syndromes may change the pattern of propagation of depolarization waves in the nervous system with the formation of “autowave penumbra”. Possible clinical criteria for the effectiveness of therapy that change the course of PD are presented. Conclusions. Pain syndromes and acute significant psychological stresses not only contribute to the onset of motor symptoms of PD but also lead to the rapid progression of the disease. The effect of precipitating factors may manifest itself not only in clinical, morphological, and laboratory changes but also in changes in the excitability of nerve cells. The electrophysiological penumbra (“autowave penumbra”) can be considered a possible target for the action of a therapy method that modifies the course of PD.

Assessment of Depression in Patients with Acute Stroke

Objectives: To assess degree and severity of depression To describe the symptomatic profile of depression Analyse the relation between depression and demographic, predisposing and precipitating factors. Materials and Methods: A cross-sectional study was done on 160 subjects chosen by random sampling technique from the Department of General Medicine of Saveetha Medical College and Hospital using Montgomery-Asberg Depression Rating Scale. Results: 68% of the cases with acute stroke was assessed and found to have depression according to Montgomery-Asberg Depression Rating Scale. Conclusion: Post-Stroke Depression is expected in patients diagnosed with acute stroke.

Hypertensive Heart Failure in Asia

Hypertension (HT) is an important risk factor for heart failure (HF). The prevalence of HT among the HF population is higher in Asia than in other regions around the world. In Asia, HT is the most common cause of HF after ischemic heart disease. Hypertensive HF (HHF) results from structural and functional adaptations of the heart, which lead to left ventricular (LV) hypertrophy (LVH). Hypertensive LVH can cause ventricular diastolic dysfunction and becomes a risk factor for myocardial infarction, which is a well-known cause of LV systolic dysfunction. Asymptomatic systolic and diastolic LV dysfunction easily progress to clinically overt HF with other precipitating factors. Although the precise pathophysiology of HHF is still unclear, we have known that HHF can be reversed by effective control of blood pressure (BP). Thus, HT control is essential not only for primary prevention but also for the secondary prevention of HF. Here, we reviewed the epidemiology, pathophysiology, outcome, and implication of BP management in HHF patients, especially in the Asian population.