Anxiety in Parkinson’s Disease: Correlation with Depression and Quality of Life

Introduction Anxiety is common in patients with Parkinson’s disease (PD). Its prevalence ranges from 20 to 40% but despite that, the high prevalence anxiety in PD is often undiagnosed and untreated. This research was aimed to study the pattern of anxiety with regard to its prevalence and risk factors and to establish the association of anxiety with depression and quality of life (QOL) in patients with PD. Methods A total of 105 patients with PD were prospectively observed. Demographic and clinical variables were recorded and patients were assessed for anxiety (the Parkinson anxiety scale [PAS]), depression (geriatric depression scale [GDS]), and QOL (Parkinson’s Disease Questionnaire-39 [PDQ-39]). Multiple forward logistic regression analysis was done for parameters showing association with anxiety. Pearson’s correlation was used to calculate the strength of association of depression and QOL with anxiety. Results Anxiety was present in 56 PD patients (53.3%). Episodic anxiety was noted in 50%, avoidance behavior in 35%, and persistent anxiety in 15% of these patients. There was significant association of anxiety with duration of disease (p = 0.001), severity (p < 0.005), levodopa equivalent dose (LED; p = 0.001), and tremor phenotype of PD (p = 0.004). Anxiety coexisted with depression in 50 patients (79.4%), which was statistically significant in our cohort (p = 0.001). There was significant linear relationship between the PAS and PDQ-39. Conclusion Anxiety exerts a negative impact on the QOL as revealed by proportionately worsening PDQ-39 and PAS scores. Screening for anxiety will allow efficient delivery of support and treatment to patients with PD and their families.

Keratoconus Diagnosis: Validation of a Novel Parameter Set Derived from IOP-Matched Scenario

Purpose. Considering that intraocular pressure (IOP) is an important confounding factor in corneal biomechanical evaluation, the notion of matching IOP should be introduced to eliminate any potential bias. This study aimed to assess the capability of a novel parameter set (NPS) derived from IOP-matched scenario to diagnose keratoconus. Methods. Seventy samples (training set; 35 keratoconus and 35 normal corneas; pairwise matching for IOP) were used to determine NPS by forward logistic regression. A large validation dataset comprising 62 matching samples (31 keratoconus and 31 normal corneas) and 203 unmatching samples (112 keratoconus and 91 normal corneas) was used to evaluate its clinical significance. To further assess its diagnosis capability, NPS was compared with the other two prior biomechanical indexes. Results. NPS was comprised of three biomechanical parameters, namely, DA Ratio Max 1 mm (DRM1), the first applanation time (AT1), and an energy loading parameter (Eload). NPS was successfully applied to the validation dataset, with a higher accuracy of 96.8% and 95.6% in the IOP-matched and -unmatched scenarios, respectively. More surprisingly, accuracy of NPS was 95.5% in the combined validation, an improvement compared to the two prior biomechanical indexes. Conclusions. This is the first study taking IOP bias into consideration to determine a biomechanical parameter set. Our study shows that NPS indeed offers comparable performance in keratoconus diagnosis. Translational Relevance. Determining a parameter set after eliminating the influence from IOP is useful in revealing the essential differences between keratoconus and normal corneas and possibly facilitating further progress in keratoconus diagnosis.

Comparing Forward Conditional Analysis and Forward Logistic Regression Methods in a Landslide Susceptibility Assessment: A Case Study in Sicily

Forward logistic regression and conditional analysis have been compared to assess landslide susceptibility across the whole territory of the Sicilian region (about 25,000 km2) using previously existing data and a nested tiered approach. These approaches were aimed at singling out a statistical correlation between the spatial distribution of landslides that have affected the Sicilian region in the past, and a set of controlling factors: outcropping lithology, rainfall, landform classification, soil use, and steepness. The landslide inventory used the proposal of building the models like the official one obtained in the PAI (hydro geologic asset plan) project, amounting to more than 33,000 events. The 11 types featured in PAI were grouped into 4 macro-typologies, depending on the inherent conditions believed to generate various kinds of failures and their kinematic evolution. The study has confirmed that it is possible to carry out a regional landslide susceptibility assessment based solely on existing data (i.e., factor maps and the landslide archive), saving a considerable amount of time and money. For scarp landslides, where the selected factors (steepness, landform classification, and lithology) are more discriminate, models show excellent performance: areas under receiver operating characteristic (ROC) (AUCs) average > 0.9, while hillslope landslide results are highly satisfactory (average AUCs of about 0.8). The stochastic approach makes it possible to classify the Sicilian territory depending on its propensity to landslides in order to identify those municipalities which are most susceptible at this level of study, and are potentially worthy of more specific studies, as required by European-level protocols.

Impact of Cardiac Risk Factors in the Postsurgical Outcomes of Patients With Cleft Palate: Analysis of the 2012-2014 NSQIP Database

Objective: To assess the risk of complication in patients undergoing cleft palate repair with congenital cardiac comorbidities in a large, national cohort. Design: Retrospective review. Patients/Setting: Using the 2012-2014 National Surgical Quality Improvement Program (NSQIP) Pediatric database, patients undergoing cleft palate repair were selected for analysis. Patients with cleft palate repairs were stratified based on the presence or absence congenital cardiac comorbidities. Univariate and stepwise forward logistic regression were conducted. Main Outcome Measures: It is hypothesized that risk of postoperative adverse events in patients with congenital cardiac comorbidities is higher than in patients without cardiac disease. Results: Nationally, between 2012 and 2014, 3240 patients underwent cleft palate repair, 422 (13.0%) with cardiac disease, and 2818 (87.0%) without cardiac disease. Patients with cardiac disease were smaller (10.5 [6.6] kg vs 11.6 [8.6] kg, P < .01) and more likely to be premature (4.6% vs 13.0%, P < .01) compared to those without cardiac disease. Postoperatively, patients with cardiac conditions were more likely to experience an adverse event (8.8% vs 4.2%, P < .01). Specifically, they were more likely to experience reintubation (1.7% vs 0.4%, P < .01), reoperation (2.1% vs 0.6%, P < .01), and longer length of stay (2.7 [7.0] vs 1.6 [2.8] days, P < .01). Rates of surgical site infection and dehiscence were not different. Conclusions: Cleft palate repair in patients with concurrent congenital cardiac defects is a safe procedure but carries elevated risk in the postoperative period as demonstrated in this analysis of the NSQIP-Pediatric database. Technical risks are equivalent. Additional anesthesia and surgical awareness of these potential complications is essential to minimize perianesthesia risks.

Increased Age Predicts Failure to Rescue

Failure to rescue (FTR), defined as any death after the development of in-hospital complications, is an important quality measure, but the relationship with age after a traumatic injury, has not been well defined. We sought to examine whether older trauma patients are at higher risk for FTR. The National Trauma Databank (NTDB) research datasets 2007 to 2011 were queried for patients ≥16 years who had any reported complication. Those who survived (non-FTR) were compared with those who did not (FTR) using a forward logistic regression model. Overall, 218,986 subjects met inclusion criteria of those, 201,358 (91.2%) survived their complication (non-FTR) and 17,628 (8.8%) died (FTR). A forward logistic regression identified age 65 to 89 years as the strongest predictor of FTR [adjusted odds ratio (AOR) 95% confidence interval (CI): 6.58 (6.11, 7.08), P < 0.001]. Using age group 16 to 45 years as the reference group, the adjusted risk for FTR increased with increasing age in a stepwise fashion [AOR (95 % CI): 1.94 (1.80, 2.09) for age 46 to 65 years, 6.78 (6.19, 7.42) for age 66 to 89 years and 27.58 [21.81, 34.87] for age ≥90 years]. The adjusted risk of FTR also increased in a stepwise fashion with increasing number of complications, reaching AOR (95 per cent CI) of 2.25 (2.07, 2.45), P < 0.001 for ≥4 complications. The risk of failure to rescue increases with age and number of complications. Strategies which track this quality measure to encourage early recognition and treatment of complications in the elderly are necessary.

Aspirin Increases the Risk of Venous Thromboembolism in Surgical Patients

The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE.

Can the Need for Colectomy after Computed Tomography-guided Percutaneous Drainage for Diverticular Abscess be Predicted?

The primary aim of this study was to define predictors of computed tomography (CT)-guided percutaneous abscess drainage treatment failure in complicated diverticulitis. A 10-year retrospective analysis of inpatients seen in surgical consultation for diverticular abscess management subsequently referred for CT-guided percutaneous drainage (PD) was conducted. The clinical courses of patients undergoing a technically successful PD were categorized into three groups: 1) no colectomy; 2) elective colectomy; and 3) nonelective colectomy. Forty study patients were identified. Thirteen (33%) of the 40 patients required a nonelective colectomy, 20 patients (50%) underwent elective resection, and seven patients (18%) have been managed nonoperatively with no recurrent diverticulitis for a median of 46.8 months (range, 3.2 to 84.3 months). Forward logistic regression identified the presence of immunosuppression or renal insufficiency (creatinine 1.5 mg/dL or greater) as factors independently associated with failure of PD and need for non-elective colectomy. No clinical, laboratory, or radiologic variables were predictive of long-term nonoperative success. Although PD allows for the resolution of intra-abdominal sepsis for most cases of diverticulitis complicated by an abscess, a substantial proportion progress to nonelective colectomy, emphasizing the need for clinical vigilance in follow-up.

Familial aggregation of depression, but no familial aggregation of individual depressive symptoms

BackgroundFamilial aggregation of major depression might indicate a genetic liability for the disorder. The complete disorder or, alternatively, only some individual symptoms might be inherited. Under the latter condition, an increased frequency of inherited symptoms might consecutively increase the likelihood to reach the threshold for depression in relatives and, thus, might cause the familial aggregation of depression. Up to now, no study investigated the possibility of a relationship between individual depressive symptoms and the familial aggregation of depression.MethodsThe familial aggregation of early-onset depression (age-at-onset < 60 years, EOD) but less so of late-onset depression (LOD) has been shown in this sample. To assess the hypothesis of an inheritance of individual depressive symptoms as a possible cause of the familial aggregation of depression, frequencies of symptoms were compared in relatives of depressed patients and of controls using forward logistic regression analyses.ResultsSome individual depressive symptoms showed clustering in relatives of patients with depression, but the pattern of inheritance was inconsistent, i.e. the clustering of symptoms was different between non-depressed and depressed relatives of patients with EOD and LOD, respectively. No intra-familial clustering of specific depressive symptoms within families of depressed subjects could be observed.ConclusionsDue to the inconsistencies in the clustering of individual symptoms in non-depressed and depressed relatives and the lack of intra-familial clustering, the familial aggregation of depression is unlikely to be caused by the aggregation of individual depressive symptoms. An inheritance of the vulnerability for complete depressive disorders influenced by environmental factors is more likely.