Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

The measurement of meaning

Mini Mental State

Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

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Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

M ILD COGNITIVE i m p a i r m e n t (MCI) has been actively investigated for the past decade. , 2 The term was coined in the late 1980s by the New York University group to identify individuals who were not cognitively normal for age and yet did not have overt dementia, and their outcomes were described in an article examining predictors of dementia by Flicker et al in the early 1990s. Flicker et al characterized MCI as equivalent to a Global Deterioration Scale rating of 3 and found that a diagnostic approach combining a careful, structured interview and the appropriate neuropsychological tests can discriminate those individuals with MCI likely to experience cognitive deterioration from those with a benign prognosis. Recently MCI has been given more specific criteria involving the features outlined in Figure 1 of the comments by Gauthier and Touchon abstracted from Petersen et al. In conjunction with increased attention to the early stages of development of Alzheimer disease (AD), these criteria served to catalyze intense interest in MCI as a possible prodromal stage of AD. Several studies on longitudinal populations were conducted, some retrofitting criteria to longitudinal studies of aging, and several others are either underway or completed and have demonstrated a progression from MCI to AD at an elevated rate over the base rate in the population. Most of these studies examined the amnestic subtype of MCI, in which memory impairment is a key feature. However, other studies, often encompassing a broader definition of MCI, have demonstrated a reversion to normal in some subjects, implying a lack of stability for the construct over time. This has led to a closer inspection of the underlying premises of MCI and a refinement of criteria to recognize that MCI is a heterogeneous condition. Several factors have emerged as contributing to the variability in the outcomes of several of these studies. Among these are the following factors: (1) criteria for MCI, (2) implementation of the criteria, (3) source of subjects, and (4) reference standards for normal performance. Each of these points deserves discussion as it pertains to the comments raised by Gauthier and Touchon.

http://lib.ajaums.ac.ir/booklist/archives%20of%20neurology_July-7_17.pdf

Mild Cognitive Impairment as a Clinical Entity and Treatment Target

The functioning of the thyroid gland is of great importance for the formation, maturation and activity of the central nervous system. The association of clinical thyroid dysfunction with mental disorders, including cognitive impairment, seems to be well documented. Abnormal concentrations of thyroid hormones can lead to deterioration of cognitive processes through changes in neurotransmission, intensification of oxidative stress, or impact on β-amyloid transformation and glucose metabolism in the central nervous system. Doubts concern mainly subclinical forms of thyroid dysfunction. According to some data, they are supposed to be related to the state of cognitive functions and to be one of the factors accelerating the mechanisms leading to degeneration of the brain tissue and, consequently, development of dementia. The results of studies on the correlation of thyroid activity with cognitive functions and the possible beneficial effects of hormonal supplementation on cognitive processes, however, bring contradictory results, which may be at least partly due to large methodological problems. One should also not exclude a reverse correlation, where the ongoing neurodegenerative process would affect thyroid function, e.g., by the changed production and secretion of thyroliberin. Despite several decades of intensive research, the explanation of this relationship is still far from conclusive.

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Cognitive functions and thyroid hormones secretion disorders.

Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.

Use of Sertraline in Hemodialysis Patients

BACKGROUND Stress urinary incontinence often leads to major physical, psychological and social problems, and many patients struggle to cope with this illness. The issue of urinary leakage during sex is particularly troublesome. CASE REPORT In order to show the relationship between psychosexual biography and the strategies applied to cope with urinary leakage during sexual intercourse, we analyzed the psychosexual biographies of 2 patients with stress urinary incontinence. CONCLUSIONS Psychosexual biography influences the choice of strategies used by incontinent women to cope with urinary leakage during sexual intercourse. Normal psychosexual development in all developmental stages conditions proper sexual functioning in women with urinary leakage during sexual intercourse and the choice of less restrictive coping strategies.

Psychosexual biography and the strategies used by women afflicted with stress urinary incontinence during intercourse: two case studies

AIM: The aim of the study was to assess the prevalence of sleep disorders in the preclinical period of the Alzheimer's disease (AD). METHOD: The initial population consisted of care centers residents, who had had the presence of dementia excluded. The enrolled patients (n = 2910) underwent the assessment of cognitive functions by means of the ADAS-cog scale, as well as of the severity of sleep disorders on the basis of the NPI-NH scale and the AMDP scale. The diagnosis of dementia was verified at the end of the observation period, after seven years, and annually during the follow-up tests. Dementia in the Alzheimer's disease was diagnosed based on the NINCDS-ADRDA criteria. RESULTS: After seven years of observation, 150 patients were qualified to the final analysis. 25 of them were diagnosed to suffer from the AD, while 111 people (forming the control group) did not meet the criteria of dementia. The control group was compared with the AD group in terms of incidence and severity of sleep disorders assessed based on the elements of the NPI-NH scale and the AMDP scale. Disturbances in the assessed categories were more pronounced in the AD group, reaching statistical significance in the qualitative assessment and with regard to the depth of the ascertained disorders. CONCLUSION: The patients in the preclinical period of dementia experienced sleep disturbances more frequently and with greater intensity, which in combination with other factors may have some prognostic value. Language: pl

[Sleep disorders in the preclinical period of the Alzheimer's disease].

Aim The aim of the study was the evaluation of cognitive functions of town and village inhabitants. Method One thousand people who were more than 60 years old were randomized from the list of inhabitants of Pruszcz Gdanski city and another thousand from the communes: Pruszcz Gdanski, Tratbki Wielkie i Pszczolki. The cognitive functions were assessed according to the MMSE (Mini Mental State Examination) which were next calculated according to an algorithm proposed by Mungas et al. Results Village inhabitants presented more severe cognitive impairment. The possible influence of education, sex and age are discussed.

Leszek Bidzan

Papers

Cognitive functions and thyroid hormones secretion disorders.

Use of Sertraline in Hemodialysis Patients

Psychosexual biography and the strategies used by women afflicted with stress urinary incontinence during intercourse: two case studies

[Sleep disorders in the preclinical period of the Alzheimer's disease].

Environment and cognitive functions in a population 60 years and older