The role of emotional factors in glaucoma has received wide recognition by investigators and clinicians from the very beginning. Prevalence of depression in glaucoma has been estimated to be 10 to 12 percent in previous studies. Insomnia is another psychiatric co-morbidity reported with glaucoma. Both depression and insomnia in glaucoma patients may significantly affect overall quality of life in these patients adversely. The present study explores the predictive factors of insomnia and depression in patients with Glaucoma. A case-series type of observational study was carried out on 100 glaucoma cases attended at ESIC Model Hospital, Jaipur (Rajasthan) India. The PHQ -9 and ISI were used to assess depression and insomnia respectively. Data in details were collected as per pre-designed Performa. Data collected were analyzed and inferred with chi-square test. Insomnia and depression was found in 37% and 36% respectively in glaucoma cases. Insomnia and depression both were found associated with Age, Visual acuity in both the eyes and severity of glaucoma. No other studied socio-demographic and disease variables had significant association with either insomnia or depression. It was concluded that insomnia and depression are commonly found with glaucoma. Both insomnia and depression were found significantly more in older agr group, less visual acuity and sever glaucoma than their counterparts.
Multisensory Environments and the Patient with Alzheimer’s Disease: An Eviden...CrimsonPublishersTNN
Multisensory Environments and the Patient with Alzheimer’s Disease: An Evidence-based Review by Hassan Izzeddin Sarsak in Techniques in Neurosurgery & Neurology
Chronic Tension-type headache is the most common type of headache encountered in clinical setup. This study aims to examine the clinical profile of patients suffering from chronic Tension-type headache.
Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
Association of Anxiety and Depression with Glaucoma-Glaucoma is the third largest cause of blindness worldwide after cataract and trachoma. Along with burden of blindness it also has psychological impact. So this study was designed to find out association of Insomnia, Anxiety and depression with Glaucoma. A case-series type of observational study was carried out on 100 glaucoma cases attended at ESIC Model Hospital, Jaipur (Raj). For assessment of anxiety and depression the Hospital Anxiety and Depression Scale (HADS) and for insomnia modified Diagnostic and Statistical Manual, Fourth edition (DSM-IV) criteria was used. Data collected were analysed and inferred with chi-square test. It was found in this study that Insomnia is associated with Age, Visual acuity in both the eyes and severity of glaucoma in glaucoma cases, with severity of glaucoma it was observed highly significant. Anxiety is associated with Age, Pupilary reaction, Visual acuity in both the eyes and severity of glaucoma in glaucoma cases, with age and severity of glaucoma it was observed highly significant. Depression is not associated with any of supra-said factors in glaucoma cases
Abstract—In the case of neurological disorders, patient autonomy is a fundamental principle which must be taken into consideration. In the case of this pathology, fluctuating mental deterioration is encountered most frequently in the case of mild forms of dementia. In the case of severe forms of dementia, the patient loses any autonomy and requires permanent medical care, as well as a permanent legal representative.
Aim of this study was to know autonomy of the patients with certain neurological disorders about ability of making decisions for their medical care.
Material and method: It is a quantitative retrospective observational study and data for which is gathered from the observation charts of 323 patients attended in either emergency or outpatient, between April to December 2006, in “Prof. Dr. Nicolae Oblu” Clinical Hospital of Emergency, Iasi, Romania. Study subjects were split into 2 groups: Group 1 (with a number of 215 cases) – a group of patients with the diagnostics of acute cerebrovascular accident, aphasia and dementia. Group 2 (with a number of 108 cases) – patients known or recently diagnosed with amyotrophic lateral sclerosis, multiple sclerosis and myasthenia gravis. Consent informed given by patient in the observation charts of above two groups was observed and number of patients who has given consent was compared in both the groups.
Results: On the cases under study, only for 13.6% of the patients of the first group there is consent informed in the observation chart, while for the patients in the second group this percentage was slightly smaller (9.3%).
Conclusions: As very few patients have given written informed consent and more sever the neurological disorder less the chances to have written informed consent by patients. So it can be concluded that medical performance brings indisputable benefits, however it should be done by a careful selection of the subjects and by following ethical principles.
Multisensory Environments and the Patient with Alzheimer’s Disease: An Eviden...CrimsonPublishersTNN
Multisensory Environments and the Patient with Alzheimer’s Disease: An Evidence-based Review by Hassan Izzeddin Sarsak in Techniques in Neurosurgery & Neurology
Chronic Tension-type headache is the most common type of headache encountered in clinical setup. This study aims to examine the clinical profile of patients suffering from chronic Tension-type headache.
Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
Association of Anxiety and Depression with Glaucoma-Glaucoma is the third largest cause of blindness worldwide after cataract and trachoma. Along with burden of blindness it also has psychological impact. So this study was designed to find out association of Insomnia, Anxiety and depression with Glaucoma. A case-series type of observational study was carried out on 100 glaucoma cases attended at ESIC Model Hospital, Jaipur (Raj). For assessment of anxiety and depression the Hospital Anxiety and Depression Scale (HADS) and for insomnia modified Diagnostic and Statistical Manual, Fourth edition (DSM-IV) criteria was used. Data collected were analysed and inferred with chi-square test. It was found in this study that Insomnia is associated with Age, Visual acuity in both the eyes and severity of glaucoma in glaucoma cases, with severity of glaucoma it was observed highly significant. Anxiety is associated with Age, Pupilary reaction, Visual acuity in both the eyes and severity of glaucoma in glaucoma cases, with age and severity of glaucoma it was observed highly significant. Depression is not associated with any of supra-said factors in glaucoma cases
Abstract—In the case of neurological disorders, patient autonomy is a fundamental principle which must be taken into consideration. In the case of this pathology, fluctuating mental deterioration is encountered most frequently in the case of mild forms of dementia. In the case of severe forms of dementia, the patient loses any autonomy and requires permanent medical care, as well as a permanent legal representative.
Aim of this study was to know autonomy of the patients with certain neurological disorders about ability of making decisions for their medical care.
Material and method: It is a quantitative retrospective observational study and data for which is gathered from the observation charts of 323 patients attended in either emergency or outpatient, between April to December 2006, in “Prof. Dr. Nicolae Oblu” Clinical Hospital of Emergency, Iasi, Romania. Study subjects were split into 2 groups: Group 1 (with a number of 215 cases) – a group of patients with the diagnostics of acute cerebrovascular accident, aphasia and dementia. Group 2 (with a number of 108 cases) – patients known or recently diagnosed with amyotrophic lateral sclerosis, multiple sclerosis and myasthenia gravis. Consent informed given by patient in the observation charts of above two groups was observed and number of patients who has given consent was compared in both the groups.
Results: On the cases under study, only for 13.6% of the patients of the first group there is consent informed in the observation chart, while for the patients in the second group this percentage was slightly smaller (9.3%).
Conclusions: As very few patients have given written informed consent and more sever the neurological disorder less the chances to have written informed consent by patients. So it can be concluded that medical performance brings indisputable benefits, however it should be done by a careful selection of the subjects and by following ethical principles.
Running head The Critique of Ethical Consideration of Patients wi.docxtodd521
Running head: The Critique of Ethical Consideration of Patients with Dementia 1
The critique of ethical consideration of patients with dementia
8
The Critique of Ethical Consideration of Patients with Dementia
Yeni Hernandez
GCU NRS-433V
August 19, 2018
The critique of ethical consideration of patients with dementia
Introduction
Based on Pan et al. (2013) study, the severities of the behavioural and psychological symptoms that are evident for vascular dementia are clearly presented. The research focuses on the application of quantitative measures to understand the severity of the symptoms using a sample of 51 patients with vascular dementia (Pan et al., 2013). The analysis considered the fluctuation of the behavioural symptoms based on diurnal, evening, and nocturnal activities. The ageing population has been outlined as being a risk factor for the continued prevalence and rise in the cases of dementia for decades. This paper will critique the PICOT statement on the grounds of those living with dementia in their daily lives.
PICOT statement for patients with dementia
P- (problem/patient/population): the research will focus on patients living with dementia (PWD)
I- Intervention will come in the form of integrating regular exercises to dementia patients to help improve memory loss and maintain a healthy fit.
C- Comparison: if a patient cannot engage in productive and useful forms of exercises, provide a supportive environment through informal caregiving to facilitate relaxation and safety.
O- Outcome: the outcome of the study is an improved overall safety of a patient living with dementia to reduce re-hospitalizations that result from injuries.
T- Time- this will show the time required in addressing the problem of dementia among home care patients.
Background information
Dementia generally is used to refer to the symptoms shown by individuals and mostly relate to memory. There have been complaining about the existence of rare signs amongst patients who visit clinical institutions. This included the loss of memory hence reducing their ability to carry out their daily tasks appropriately. However, it had been clearly proven that there was little that was done in realizing the desired the desired solutions to help out the patients. At higher stages patients showed problems in communication and language, focusing and paying attention, perceptions relating to visions, judgment and how the patients reasoned out. This, therefore, prompted the need to carry out a qualitative and quantitative study with a major aim of presenting ethical issues that relate to patients with dementia. The study was based on scholarly articles to present appropriate information that can help curb such instances in most or all medical and clinical institutions hence saving the patients. It is evident that the lack of patient care and safety acted as the major reason as to.
Correlation between Demographic, Socio-economic, and Cancer-Specific Factors with Quality of Life Scores among Newly-Diagnosed Cancer Patients of the Medical Oncology Clinics of the Philippine General Hospital Cancer Institute
https://www.actamedicaphilippina.org/issue/1102
Objective: To describe cognitive disorders in patients with epilepsy attending neurology consultations in the city of Ouagadougou. Methodology: This was a prospective cross-sectional multicenter study carried on patients with epilepsy during the period from 1erJanuary 2018 to 30 April 2019. All the patients were screened using mini-mental state examination (MMSE). Results: The study included 102 patients with a mean age of 33.28 ± 15.55 years. The sample was consisted of 54 (52.9%) men and 48 (47.1%) women. The majority of patients had secondary level (55.7 %). Generalized seizures were more common (74.5%). The most common causes of epilepsy was head trauma (24.5%). A great number of patients were treated by phenobarbital (49%). The overall mean MMSE score was 25.65 ± 5.07. The frequency of cognitive disorders was 61.8%, including cognitive impairment (25.5%), mild dementia (25.5%), moderate dementia (7.8%) and severe dementia (3%). The domains most affected were calculation and attention
deficit (48%) followed by memory disorders (27.5%) and copying (12.8%). Head trauma and phenobarbital were signifi cantly associated to cognitive. Cognitive disorders were less frequent in young adult aged of 26-35 years.
Name Professor Course Date Sexual Harassment .docxroushhsiu
Name
Professor
Course
Date
Sexual Harassment Essay Outline
I. Introduction
A. Background
1. Despite ongoing public campaigns designed to prevent sexual harassment,
this destructive behavior continues to be a widespread issue in the United
States. Sexual harassment is particularly rampant on college campuses,
where 62% of female students and 61% of male students report having
been victims of this form of mistreatment, according to the AAUW
Educational Foundation. Most of the harassment is noncontact, but about
one-third of students are victims of physical harassment.
B. Thesis Statement
1. Although mass media and news outlets alike tend to shy away from the
sexual harassment problem occuring across our campuses nationwide,
universities are failing to protect their students from sexual harassment
resulting in mental health damage of both males and females in all parts of
the nation
II. Body
A. Sexual Harassment Amongst Both Genders
1. Female Sexual Harassment In Comparison
a) Statistics Regarding Harassment Committed Against
b) General Concerns Over Safety Amongst Females
2. Male Sexual Harassment In Comparison
a) Statistics Regarding Harassment Committed Against
b) Lack of Awareness That Men Can Also Experience Harassment
On College Campuses
B. Sexual Harassment Being Neglected Nationwide
1. Lack of Media Coverage & Lack of Awareness
a) Disregard Of A Widespread Issue Going On In Our Nation
b) People Not Taking Sexual Harassment Seriously/Not Being Aware
of It
2. Lack of Knowledge Regarding Universities Legal Duty to Protect
Students
a) Title XI Law of 1972
b) Title VII of the Civil Rights Act of 1964
C. Sexual Harassment’s Effect on Students Experiencing It
1. Short Term Mental Effects
a) People Disregarding and Neglecting People Who Claim Sexual
Harassment Can Cause Them Insecurity and Hopelessness
b) People Tend To Blame Themselves For Being Harrassed
2. Long Term Mental Effects
a) Depression and Inability To Trust Others
b) Can Lead To Drastic Effects Like Turning To Drugs Or
Committing Suicide, It is Afterall A Form Of Bullying
III. Conclusion
A. The failure of our nations awarness and our universities inability to abide to the
law by protecting our students has resulted in many students being permanently
damaged from sexual harassment
B. We the people of the United States have gone through all the proper legal
measures in order to guarantee the youths safety when attending college
universities; yet these laws along with their $60,000 tuitions do not seem to be
enough motivation for these universities to abide to the law. Does a student need
to be found dead in the middle of the campus in order to get the message across?
Psychiatric Diagnostic Screening Questionnaire
Review of The Psychiatric Diagnostic Screening Questionnaire by MICHAEL G. KAVAN, Associate Dean for Student Affairs and Associate Professor of Family Medicine, Creighton University Sch ...
Annovis Bio (NYSE American: ANVS) is a clinical-stage, drug platform company addressing neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease (PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to be the only company developing a drug for AD, PD and AD-DS that inhibits more than one neurotoxic protein and improves the information highway of the nerve cell, known as axonal transport. When this information flow is impaired, the nerve cell gets sick and dies. The company expects its treatment to improve memory loss and dementia associated with AD and AD-DS, as well as body and brain function in PD. Annovis has an ongoing Phase 2a study in AD patients and plans to commence a second Phase 2a study in PD patients. Learn more at ANVSinfo.com.
Pain in the elderly. How to better understand and rate it.Ross Finesmith M.D.
It is often difficult to determine the amount of pain an elderly person is experiencing.This is complicated by dementia and verbal impairment. This presentation describes helpful methods to assess pain in the elderly.
Mental Stress Evaluation using an Adaptive ModelIDES Editor
Chronic stress can have serious physiological and
psychological impact on an individual’s health. Wearable
sensor systems can enable physicians to monitor physiological
variables and observe the impact of stress over long periods of
time. To correlate an individual’s physiological measures with
their perception of psychological stress, it is essential that
the stress monitoring system accounts for individual
differences in self-reporting. Self-reporting of stress is highly
subjective as it is dependent on an individual’s perception of
stress and thus prone to errors. In addition, subjects can tailor
their answers to present their behavior more favorably. In
this paper we present an adaptive model which allows recorded
stress scores and physiological variables to be tuned to remove
biases in self-reported scores. The model takes an individual’s
physiological and psychological responses into account and
adapts to the user’s variations. Using our adaptive model,
physiological data is mapped efficiently to perceived stress
levels with 90% accuracy.
Depresi dan bunuh diri sebagai masalah kesehatan mental yang lazim untuk pasien hemodialisis. Tujuan: Para penulis meneliti faktor-faktor demografi dan psikologis yang terkait dengan depresi pada pasien hemodialisis dan dijelaskan hubungan antara depresi, kecemasan, kelelahan, kualitas kesehatan yang berhubungan hidup yang buruk, dan meningkatkan risiko bunuh diri.
Similar to Associating factors of insomnia and depression in Glaucoma: A Descriptive analysis (20)
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Associating factors of insomnia and depression in Glaucoma: A Descriptive analysis
1. International Multispecialty Journal of Health (IMJH) ISSN: [2395-6291] [Vol-4, Issue-2, February- 2018]
Page | 41
Associating factors of insomnia and depression in Glaucoma: A
Descriptive analysis
Dr. Akhilesh Jain1
, Dr. Rekha Sharma2
, Dr. Ashok Goyal3§
, Dr. Neelam Yadav4
,
Dr. Garima Jain5
, Dr. Mukesh M6
1
Head of Psychiatry Department, Model ESIC Model Hospital, Jaipur (Rajasthan) India
2,3,4,5,6
Medical Officer, Model ESIC Model Hospital, Jaipur (Rajasthan) India
§
Corresponding author's Email: ashokgoyal_dr@yahoo.com
Abstract—The role of emotional factors in glaucoma has received wide recognition by investigators
and clinicians from the very beginning. Prevalence of depression in glaucoma has been estimated to be
10 to 12 percent in previous studies. Insomnia is another psychiatric co-morbidity reported with
glaucoma. Both depression and insomnia in glaucoma patients may significantly affect overall quality
of life in these patients adversely. The present study explores the predictive factors of insomnia and
depression in patients with Glaucoma. A case-series type of observational study was carried out on 100
glaucoma cases attended at ESIC Model Hospital, Jaipur (Rajasthan) India. The PHQ -9 and ISI were
used to assess depression and insomnia respectively. Data in details were collected as per pre-designed
Performa. Data collected were analyzed and inferred with chi-square test. Insomnia and depression was
found in 37% and 36% respectively in glaucoma cases. Insomnia and depression both were found
associated with Age, Visual acuity in both the eyes and severity of glaucoma. No other studied socio-
demographic and disease variables had significant association with either insomnia or depression. It
was concluded that insomnia and depression are commonly found with glaucoma. Both insomnia and
depression were found significantly more in older agr group, less visual acuity and sever glaucoma than
their counterparts.
Keywords: Insomnia, Depression, Glaucoma, PHQ -9, Insomnia Severity Index (ISI).
I. INTRODUCTION
Glaucoma is a chronic, progressive, and irreversible disease which can result in severe visual disability.1
The role of emotional factors in glaucoma has received wide recognition by investigators and clinicians
from the very beginning. Glaucoma probably more than any other eye disease has been considered to be
a psychosomatic disorder. Physical illnesses also create psychological squeal that precipitate psychiatric
disorders severe enough to require independent attention. It has been postulated that mental health may
impact clinical factors such as glaucoma medication adherence and persistence.2,3
Prevalence of depression in glaucoma has been estimated to be 10 to 12 percent in previous studies.4,5
However, in severe glaucomatous disease, the prevalence of depression has been reported to be as high
as 32.1%.6
Furthermore, depression has been correlated with patient’s perception of vision.7
However, in contrast
to subjective measures of visual perception, objective measures of function such as visual acuity or
visual field results have not been linked to glaucoma diagnosis or depression severity.6,7
Insomnia is
another psychiatric co-morbidity reported with glaucoma.8
Both depression and insomnia in glaucoma patients may significantly affect overall quality of life in
these patients adversely.
2. International Multispecialty Journal of Health (IMJH) ISSN: [2395-6291] [Vol-4, Issue-2, February- 2018]
Page | 42
In order to prevent and treat these psychiatric co-morbidity that develop with glaucoma, it is also
important to find out the associating factors of these psychiatric co-morbidity. Hence this present study
was planned to identify these determinants of these psychiatric co-morbidity in glaucoma.
II. METHODOLOGY
A hospital based case series type of observational study was carried out as joint venture of Department
of Psychiatry and Department of Ophthalmology in ESIC Model Hospital, Jaipur, India which is a
multi-specialty referral centre in capital of Rajasthan. This hospital caters larger population from each
corner of the state.
Among glucoma cases attended either at outpatient department or ward during 1st
Jan. 2013 to 30th
June
2013 was recruited for this study. Hindi speaking adult patients (18 -88 years) with glaucoma from more
than 6 months prior to enrollment was included in the study. Glaucoma was diagnosed based on
glaucomatous disc cupping and reproducible visual field damage in one or both eyes. Patients with
primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), primary -closure glaucoma
(PACG) and secondary glaucoma (SG) were included in the study. Out of these identified cases, cases
with present or past history of major psychiatric illness, current use of any medication which may result
in psychiatric manifestations (systemic use of beta blockers), incisional eye surgery within the previous
three months or laser treatment within the previous one month, disability in visual field testing due to
causes other than glaucoma (e.g., cognitive impairment) and other severe vision-impaired eye diseases
(e.g., cataracts (Lens Opacities Classification System III grade 2 or more and age-related macular
degeneration) were excluded.
Finally Hundred patients with glaucoma i.e. 50 males and 50 females were recruited. After tacking
written informed consent 100 eligible subjects were enterogated as per pre-designed performa to
incorporate socio-demographic details and disease characteristics. All participants underwent
comprehensive ophthalmic examinations and evaluated for glaucoma symptoms like pain, congestion
etc. Anterior chamber depth was examined by slit lamp, and visual aquity by refraction unit. Detailed
fundus examination was also done and cup disc ratio was calculated. Automated static perimerty
(Humphrey visual field analyzer 30-2) was used to detect peripheral visual field defects and gonioscopy
was done to find status of angle (open or closed). Patients were categorized as mild, moderate and
severe depending on the results of status of cup and fields. Insomnia Severity Index (ISI) and PHQ-9
were applied to detect Insomnia and depression respectively.
Depression was assessed by administering the nine-item PHQ-9, a self-report version of PRIME-MD11
which assesses the presence of major depressive disorder using modified Diagnostic and Statistical
Manual, Fourth edition (DSM-IV) criteria. 9,10
There is good agreement reported between the PHQ
diagnosis and those of independent psychiatry health professionals (for the diagnosis of any one or more
PHQ disorder, kappa = 0.65; overall accuracy, 85%; sensitivity, 75%; specificity, 90%). In this study
Hindi version of PHQ-9 was used. It has been validated in Indian population and is considered to be
reliable tool for diagnosis of depression. The PHQ-9 is a dual instrument that is used to establish a
provisional depressive disorder as well as it provides a symptoms severity score. For the diagnosis of
depression, clinical significant depression was defined as: a PHQ-9 score of 8–9 as minor depression, a
PHQ-9 score of 10-14 as moderate depression; a score of 15 or more and one of the two cardinal
3. International Multispecialty Journal of Health (IMJH) ISSN: [2395-6291] [Vol-4, Issue-2, February- 2018]
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symptoms (either depressed mood or anhedonia) as definite major depression. In this study, PHQ 9
score of 10 or more was accepted as depression.
Insomnia was assessed on Insomnia Severity Index (ISI).11
ISI is one of the most commonly used
disease-specific measures for self-perceived insomnia severity. The ISI has 7 items describing insomnia-
related health impairments.
Each item is rated on a 5-point Like rt scale with scores ranging from 0 to 4, indicting ‘‘none’’, ‘‘mild’’,
‘‘moderate’’, ‘‘severe’’ and ‘‘very severe’’ sleep problems, respectively. The total ISI score is
calculated by summing the scores from the 7 items, and range from a minimum of 0 to a maximum of
28, with higher scores reflecting more severe sleep problems. In clinical assessments, the ISI total
summary score falls into 1 of 4 ISI categories; with scores 0–7, 8–14, 15–21, and 22–28 indicating no
clinically significant insomnia, sub-threshold insomnia, moderate insomnia and, clinically severe
insomnia, respectively. The psychometric properties of the ISI have been evaluated in earlier studies and
have been reported to have sound measurement quality for measuring perceived insomnia severity and
the impact of insomnia in different populations.12
Hindi version of the Insomnia Severity Index13
was used in this study, which has a reliability of 0.91
and a corrected item correlation range of 0.56–0.87. Hindi version of the Insomnia Severity Index is a
valid and reliable tool for the measurement of severity of insomnia.
Statistical analysis: All data collected were entered into Microsoft excel 2007 worksheet in the form of
master chart. These data were classified and analysed. Both descriptive and inferential statistics were
inferred with the help of MS Excel 2007 and Primer (version 6) statistical software. The data on sample
characteristics described in terms of percentage and proportions in the form of tables and graphs
whenever it was applicable. To find out difference in proportion 'Chi square test' was used. For
significance ‘p’ value 0.05 or less was considered significant.
III. RESULTS
Out of total 100 eligible glaucoma cases studied with assigned scales to identify psychiatric co-
morbidity, it was observed that insomnia and depression was found in 37%, and 36% of glaucoma cases
respectively. (Figure 1&2)
Figure 1 Figure 2
Yes
37%
No
63%
Presence of Insomnia wise distribution of
Glaucoma Cases (N=100)
Yes
36%
No
64%
Presence of Depression wise
distribution of Glaucoma Cases
(N=100)
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Various Socio-demographic variables studied in this study were age, sex, marital status and Income.
Male and Female ratio was kept 1:1 in this study. Maximum participants were from the age group 50 to
70 years ( 58%) and 95 % were married. 34% participants were having their monthly income between
5000 to 10000 rupees while only 4% had more than 15000 rupees per month. (Table 1)
Table 1
Socio-demographic characteristics of study population (N=100)
S. No. Socio-demographic Variables Number Percent (%)
1
Age
(in Years)
<30 6 6
30-50 29 29
51-70 58 58
>70 7 7
2 Sex
Males 50 50
Females 50 50
3 Marital Status
Married 95 95
Unmarried 5 5
4
Income
Rs/month
<5000 59 59
5000-10000 34 34
10,001-15,000 3 3
>15000 4 4
It was found that none of the socio-demographic variable was associated significantly with Insomnia
except age. Insomnia was found to be statistically significant with growing age (p =0.013). (Table 2)
Table 2
Association of Socio-demographic variables with Insomnia in Glaucoma cases (N=100)
S. No. Socio-demographic Variables
Total No. of
cases
Insomnia Status (N=37) Chi square Test
P Value LSPresent Absent
1
Age
(in Years)
<30 6 0 6
11.252 at 3 DF
0.013 S
30-50 29 6 23
51-70 58 29 29
>70 7 2 5
2 Sex
Males 50 17 33 0.172 1 DF
0.679 NSFemales 50 20 30
3
Marital
Status
Married 95 36 59 0.111 1 DF
0.739 NSUnmarried 5 1 4
4
Income
Rs/month
<5000 59 27 32
6.895 3 DF
0.099 NS
5000-10000 34 10 24
10,001-15,000 3 0 3
>15000 4 0 4
Similarly, Depression was also not found to have significant association with socio-demographic
variables except with age. Depression was found significantly more with increasing age was significant
(p =0.014.) (Table 3)
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Table 3
Association of Socio-demographic variables with depression in Glaucoma cases (N=100)
S. No. Socio-demographic Variables
Total No. of
cases
Depression Status (N=36) Chi square Test
P Value LSPresent Absent
1
Age
(in Years)
<30 6 1 5
11.117 at 3 DF
0.014 S
30-50 29 4 25
51-70 58 28 30
>70 7 3 4
2 Sex
Males 50 15 35 1.085 1 DF
0.285 NSFemales 50 21 29
3
Marital
Status
Married 95 34 61 0.082 1 DF
0.774 NSUnmarried 5 2 3
4
Income
Rs/month
<5000 59 23 36
2.446 3 DF
0.649 NS
5000-10000 34 12 22
10,001-15,000 3 1 2
>15000 4 0 4
Regarding symptomatology of glaucoma cases, pain was found in 66% of cases, congestion in 23%,
pupilary reaction in 53%, anterior chamber depth shallow in 28%, visual acuity 6/60 or less in right eye
in 37% and in left eye 28%. When association of psychiatric co-morbidity with symptomatology of
glaucoma cases was observed it was found that insomnia was found significantly more in participants
having visual acuity 6/60 or less in right eye (54.1% v/s 26.9%, P=0.018) as well as in left eye (57.1%
v/s 29.1%, P= 0.018). (Table 4).
Table 4
Association of Socio-demographic variables with Insomnia in Glaucoma cases (N=100)
S. No. Socio-demographic Variables
Total No. of
cases
Insomnia Status (N=37) Chi square Test
P Value LSPresent Absent
1 Pain
Yes 34 15 19 0.705 1 DF
0.401 NSNo 66 22 44
2
Congestion Yes 23 9 14 0.009 1 DF
0.996 NSNo 77 28 49
3
Pupilary
Reaction
Yes 53 24 29 2.606 1 DF
0.106 NSNo 47 13 34
4
Anterior
Chamber Depth
Normal 72 27 45 2.004 1 DF
0.949 NSShallow 28 10 18
5
Visual Acuity
(RE)
6/60 or less 37 20 17 5.622 1 DF
0.018 S6/30 or more 63 17 46
6
Visual Acuity
(LE)
6/60 or less 28 16 12 5.622 1 DF
0.018 S6/30 or more 72 21 51
7
Type of
Glaucoma
Open 75 26 49 0.358 1 DF
0.550 NSClosed 25 11 14
8
Duration of
Glaucoma
(In Months)
6-9 19 3 16
5.279 4 DF
0.260 NS
9-12 7 3 4
12-18 7 2 5
18-24 13 5 8
>24 54 24 30
9
Severity of
Glaucoma
Mild 34 4 30
16.602 2 DF
<0.001 S
Moderate 42 18 24
Sever 24 15 9
Likewise, depression was found to be significantly associated with visual aquity 6/60 or less in both
eyess (P<0.05). Depression was found significantly more with lesser vision. (Table 5)
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It was also revealed that more the severity of glaucoma significantly more the probability of depression
(p<0.001). (Table 5)
Among all glaucoma cases of present study, 75% were open angle and 25% were closed angle
glaucoma. Majority of cases (54%) had more than 24 month’s duration. Further, 34% cases were mild,
42% moderate and 24% severe cases of glaucoma. (Table 4 & 5)
On application of Chi Square test, depression and insomnia were significantly associated with severity
of Glaucoma (p <0.05), however association of insomnia and depression with type of glaucoma and
duration of glaucoma were not found significant. (Table 4 & 5)
Table 5
Association of Socio-demographic variables with Depression in Glaucoma cases (N=100)
S. No. Socio-demographic Variables
Total No. of
cases
Depression Status (N=36) Chi square Test
P Value LSPresent Absent
1 Pain
Yes 34 16 18 2.050 1 DF
0.152 NSNo 66 20 46
2
Congestion Yes 23 8 15 0.012 1 DF
0.913 NSNo 77 28 49
3
Pupilary
Reaction
Yes 53 22 31 1.020 1 DF
0.312 NSNo 47 14 33
4
Anterior
Chamber Depth
Normal 72 25 47 0.038 1 DF
0.084 NSShallow 28 11 17
5
Visual Acuity
(RE)
6/60 or less 37 21 16 4.420 1 DF
0.036 S6/30 or more 63 15 48
6
Visual Acuity
(LE)
6/60 or less 28 15 13 4.206 1 DF
0.040 S6/30 or more 72 21 51
7
Type of
Glaucoma
Open 75 15 60 0.521 1 DF
0.470 NSClosed 25 11 14
8
Duration of
Glaucoma
(In Months)
6-9 19 4 15
3.693 4 DF
0.448 NS
9-12 7 3 4
12-18 7 4 3
18-24 13 4 9
>24 54 21 33
9
Severity of
Glaucoma
Mild 34 5 29
23.000 2 DF
<0.001 S
Moderate 42 13 29
Sever 24 18 6
IV. DISCUSSION
The prevalence of insomnia and depression in this study was found 37% and 36% respectively. Almost
similar observations were made by other authors. Mabuchi F et. al and Wang SY et. al reported that
glaucoma is a significant predictor of depression.4,14
Another study conducted in Greece showed that the
anxiety and depression levels were significantly higher in patients of primary open angle
glaucoma(POAG)than those in healthy controls.15
Reduced participation in activities of daily living, less
social and recreational activities, impaired performance at work may be implicated as some of the
plausible explanation for high prevalence of depression in glaucoma patients. Seixas, Azizi, et al.16
observed a significant association between visual impairment and insomnia symptoms in their study
sample of 307 patients with almost 62 percent of patients reporting insomnia symptoms. Furthermore, a
high prevalence of sleep disorders, such as insomnia, daytime sleep, sleep apnea can be found in
patients with glaucoma.17
7. International Multispecialty Journal of Health (IMJH) ISSN: [2395-6291] [Vol-4, Issue-2, February- 2018]
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Waller EA et. al (2008) observed that individuals with visual impairment are at risk for sleep
disturbances and sleep-disordered breathing.18
Other authors also found that patients with glaucoma are
at risk for obstructive sleep apnea (OSA).19,20
Dhillon S et. al (2007) reported that Glaucoma is
associated with sleep-disordered breathing and circadian rhythm disruptions.21
Recent studies have shown that sleep problems, due to visual impairment can lead to more debilitating
conditions (e.g., delayed or advanced sleep-phase syndrome and irregular sleep-wake cycles), which can
lead to insomnia and circadian rhythm disorders.22
Amongst the socio demographic variables, age was found to associate with insomnia and depression in
this study population. Insomnia and depression both were found significantly more in older age group in
this study population.
Mabuchi et. al4
in his study also have found significant association between depression and older age.
Skalicky and Goldberg6
used Geriatric Depression Scale-15 questionnaire and reported that older age
was a risk factor for depression in glaucoma patients. Chronicity of the illness, risk of blindness and
various treatment challenges faced by elderly age group who are otherwise also compromised in terms
of general debility and other physical problems may have been responsible for this association between
old age and depression.23
Wang H et. al 24
in his study have found that global sleep quality decreased with age in both healthy
controls and POAG patients. With increasing age, the density of the lens increases thereby reducing
light transmission, particularly for the short wavelength (blue) light to which the circadian system has
been shown to be most sensitive.25
On the other hand, the occurrence of circadian timing disturbances with age may also be due to
neurodegenerative changes in the SCN which may cause decreased regulation function of the non-
image-forming system.26
While analyzing clinical in this study, variables insomnia and depression were found associated with
visual acuity in either of the eyes and severity of glaucoma regardless of the type of glaucoma.
Association between severity of visual field defect with depression has been reported earlier by
Mabuchi,27
Skalicky and Goldberg6
also reported that depression was more prevalent with increasing
glaucoma severity. Erb et. al28
observed that POAG inpatients had higher score for depression with BDI
than outpatients, citing the reason that the severity of glaucoma had been more in inpatients than the
outpatients. With progressive increase in vision loss and consequent worsening of glaucoma, the
impairment in ability to function optimally escalates and social restrictions get imposed which may
perpetuate emotional and sleep problems in these patients.
Chuandi Zhou et al29
have attributed self reported visual functions being consistently correlated with
anxiety and depression in glaucoma patients and has emphasized self reported visual function as
predictor of anxiety in glaucoma patients. Lundmark et. al30
also reported a disproportionate relationship
between depression and visual field loss. They suggested that patient related outcomes are more
reflective of their psychological status than objective clinical measures, such as MD of visual field,
visual acuity and IOP.
Nevertheless, contrary to the above observations, observations of this study suggest that objective
measures are equally important in predicting psychological status. In our study visual acuity and
8. International Multispecialty Journal of Health (IMJH) ISSN: [2395-6291] [Vol-4, Issue-2, February- 2018]
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severity of glaucoma were strongly correlated with insomnia and depression. These objective clinical
measures are the principal component in determining the severity of glaucoma which in turn has been
correlated with psychological symptoms in many studies.6,27
Hence it is imperative to understand and
vindicate the correlation between objective clinical measures and psychological symptoms, instead of
merely relying much on clinical symptoms as risk factor for anxiety and depression in glaucoma
patients.
V. CONCLUSION
This study concludes that insomnia and depression were in 37% and 36% of glaucoma patients.
Significantly more insomnia and depression were found in these patients in older age group. Objective
clinical parameters exhibit great potential in evaluating psychological factors. Consequently the
psychological factors should equally be considered of paramount importance to deliver a comprehensive
treatment. Hence clinician should be made acquainted to identify and address the concomitant sleep
problems and depression and a proper psychiatric referral if needed to provide comprehensive care.
CONFLICT OF INTEREST
None declared till now.
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