A survey of depression and anxiety disorders in urban and rural Suriname

Background Suriname is a Low-middle income country consisting of diverse population groups. Epidemiological studies concerning mental disorders like depression and anxiety had not been conducted until 2015. The treatment gap for mental disorders in Low and middle-income countries (LMICs) may reach 76-80% as treatment is not always readily available. In this study, we estimate and compare the prevalence of potential cases of depression and anxiety, as well as the size of the treatment gap in a rural (Nickerie) and urban (Paramaribo) region of Suriname, a lower middle-income country. Methods Subjects were selected by a specific sampling method of the national census bureau. The Center for Epidemiological Studies-Depression (CES-D) was used to assess depression. Generalized anxiety disorder was assessed with the Generalized Anxiety Disorder 7 (GAD-7) and The Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ) were used to assess Panic disorder. The treatment gap was calculated by estimating the percentage of subjects with depression or anxiety that did not seek out professional help. Results About 18% of the respondents from Nickerie and 16% from Paramaribo were at risk of depression and the established cut-off values of the instruments used indicate that about 3-4% in both regions may suffer from Generalized Anxiety Disorder. Women in both samples were most at risk of high anxiety about body sensations and maladaptive thoughts about panic. The treatment gap varies between 78 and 100% for the two disorders. Conclusions A high depression rate has been found in both areas, especially among young females. In addition, a high treatment gap is noted which insinuates that more therapeutic strategies are required to tackle depression and anxiety in Suriname.

Prevalence of osteoporosis and osteopenia in elderly patients scheduled for total knee arthroplasty

Introduction Osteoporosis is a common comorbidity in elderly patients with osteoarthritis (OA) and may increase perioperative complications in orthopedic surgery (e.g., component migration, periprosthetic fractures). As there is no investigation of bone mineral density (BMD) in elderly patients prior to total knee arthroplasty (TKA) in Europe, we investigated this issue with a particular focus on a potential treatment gap. Materials and methods We assessed the BMD by dual-energy X-ray absorptiometry (DXA) in 109 consecutive elderly patients (age ≥ 70 years) scheduled for TKA. In addition to a detailed assessment of osteoporosis and osteopenia, the influence of clinical risk factors and radiological OA severity on BMD was evaluated using group comparisons and linear regression models. In addition, we analyzed differences in BMD between patients scheduled for TKA vs. total hip arthroplasty (THA). Results Of the included 109 patients, 19 patients (17.4%) were diagnosed with osteoporosis and 50 (45.9%) with osteopenia. In the osteoporotic patients, a clinically relevant underdiagnosis concomitant with a serious treatment gap was observed in 95.0% of the patients. Body mass index, OA grade, and glucocorticoid use were identified as independent factors associated with BMD. No differences in BMD were found between the patients scheduled for TKA vs. THA. Conclusions Considering the high prevalence of osteoporosis and osteopenia in elderly patients, DXA screening should be recommended for patients ≥ 70 years indicated for TKA.

New Access Routes to Undertreated Populations; How Do Problem Substance Users Recruited from an Unemployment Office Differ from Detoxification Treatment Inpatients?

Background: Only a minority of subjects with substance use disorders (SUDs) are in addiction-specific treatment (treatment gap). Co-operation between an unemployment office and a psychiatric hospital was established for the assessment and counseling of long-term unemployed clients with SUD. We aim at validating whether such a treatment gap exists in that group, and whether clients from an unemployment office differed from a matched group of inpatient detoxification patients with regard to socio-economic characteristics, substance use and treatment history, and the prevalence of mental disorders Methods: Unemployment office clients (n = 166) with an SUD were assessed using a standardized sociodemographic and clinical interview. They were compared with 83 inpatients from a local detoxification ward, matched for age, sex, and primary addictive disorder (matching ratio 2:1). Results: Most (75.9%) subjects were males, with an average age of 36.7 years. The SUDs mostly related to alcohol (63.9%) and cannabis (27.7%). Although most unemployment office clients had a long SUD history, only half of them had ever been in addiction-specific treatment during their lifetime, and only one in four during the last year. There were no statistically significant differences between the groups regarding age at onset of problematic substance use, the proportion of migrants, and prevalence of comorbid mental disorders. The unemployment office sample showed lower levels of education (p < 0.001), job experience (p = 0.009), and current employment rates (p < 0.001). Conversely, inpatients showed lower rates of imprisonment (p < 0.001), more inpatient detoxification episodes (p < 0.03); and longer abstinence periods (p < 0.005). Conclusions: There was a lifetime and recent treatment gap in the group of long-term unemployed subjects with alcohol and cannabis dependence. The markedly lower educational attainment, chronic employment problems and higher degree of legal conflicts in the client group, as compared with patients in detoxification treatment, might require specific access and treatment options. The co-operation between the psychiatric unit and the unemployment office facilitated access to that group.

Clinical profile of seizure disorder in hospitalized patients in tertiary care center - A prospective cross-sectional study

Background: Knowledge regarding people affected with epilepsy is essential for accurate planning and management of patients. This study was conducted to study clinical profile of seizure disorder in the patients hospitalized in a tertiary care hospital of Tamil Nadu. Aims and Objectives: To study clinical profile of seizure disorder in patients hospitalized in Coimbatore government medical college hospital. Materials and Methods: This study was a single center hospital based cross-sectional study of the clinical profile of seizure disorder in hospitalized patients at tertiary care center of Tamil Nadu, Neurology department the 2 years from 2018 to 2020. All the patients presenting with complaints of seizures were included in this study. Results: This study included a total of 321 patients with epilepsy. Their ages ranged between 10 and 100 years. 180 of the study population were males and 141 were female patients. 30% of patients had new onset seizures. Fever precipitated seizure in 16% of the subjects. Excitation, sleep deprivation, fever, watching television, and head trauma showed a strong association with generalized epilepsy. The majority of the patients had generalized tonic-clonic seizure, followed by focal neurological deficit. 98% of patients responded to treatment and they did not had recurrent episodes of seizure. Conclusion: The sample size of our cohorts is relatively small. It is possible that some prognosis factors may be missed due to the small sample size. Further studies with a larger sample cohort are required. Uneducated and low socioeconomic make people vulnerable to seizures because of lack of awareness, poor compliance to medicines, not detection of seizure provoking factor, repeated exposure to seizure provoking factor, prevalence of alcoholism, and thus lowering seizure threshold. There is a treatment gap still because of epilepsy and appropriate usage of resources will help to reduce this treatment gap and decreases epilepsy associated morbidity and mortality.

Community awareness of which seizure type should present to healthcare providers; a potential risk factor of the epilepsy treatment gap

Objective: the objective of this study was to assess the awareness of the community in Sudan of which seizure type(s) should present to health care providers.Methods: This is a cross-sectional descriptive internet-based survey that was conducted in Sudan during the period from January to April 2018, using google forms. The survey consisted of demographic data (age, gender, educational level), a statement evaluating participants’ sources of obtaining information regarding epilepsy, a statement assessing awareness about the primary care provider for people with epilepsy (PWE), and a statement describing the symptomatology of different seizure types in simple Arabic, asking what description(s) participants thought should present to health care providers. We included participants residing in Sudan, and those with a college degree or higher education. Four hundred sixty-seven participants completed the survey.Results: 467 participants were included, of whom, 279 (60%) were females. The mean age of participants was 28 years. Two-thirds of participants obtained their information from non-scientific sources. 84% of the participants were aware that doctors are the primary health care providers for people with epilepsy.The majority (92.%) of participants were aware that patients with symptoms corresponding to the generalized tonic-clonic seizure description should present to doctors, compared with two-thirds of participants for focal seizure symptom description, and only 30.6 % of participants for absence seizure symptom description.Conclusion: This study demonstrated poor awareness about the necessity of presentation for focal and absence seizures. We hypothesize that this lack of awareness may contribute to the epilepsy treatment gap, and we recommend further studies to examine this hypothesis.

Digital Semiology: A Prototype for Standardized, Computer-Based Semiologic Encoding of Seizures

Video-EEG monitoring (VEM) is imperative in seizure classification and presurgical assessment of epilepsy patients. Analysis of VEM is currently performed in most institutions using a freeform report, a time-consuming process resulting in a non-standardized report, limiting the use of this essential diagnostic tool. Herein we present a pilot feasibility study of our experience with “Digital Semiology” (DS), a novel seizure encoding software. It allows semiautomated annotation of the videos of suspected events from a predetermined, hierarchal set of options, with highly detailed semiologic descriptions, somatic localization, and timing. In addition, the software's semiologic extrapolation functions identify characteristics of focal seizures and PNES, sequences compatible with a Jacksonian march, and risk factors for SUDEP. Sixty episodes from a mixed adult and pediatric cohort from one level 4 epilepsy center VEM archives were analyzed using DS and the reports were compared with the standard freeform ones, written by the same epileptologists. The behavioral characteristics appearing in the DS and freeform reports overlapped by 78–80%. Encoding of one episode using DS required an average of 18 min 13 s (standard deviation: 14 min and 16 s). The focality function identified 19 out of 43 focal episodes, with a sensitivity of 45.45% (CI 30.39–61.15%) and specificity of 87.50% (CI 61.65–98.45%). The PNES function identified 6 of 12 PNES episodes, with a sensitivity of 50% (95% CI 21.09–78.91%) and specificity of 97.2 (95% CI 88.93–99.95%). Eleven events of GTCS triggered the SUDEP risk alert. Overall, these results show that video recordings of suspected seizures can be encoded using the DS software in a precise manner, offering the added benefit of semiologic alerts. The present study represents an important step toward the formation of an annotated video archive, to be used for machine learning purposes. This will further the goal of automated VEM analysis, ultimately contributing to wider utilization of VEM and therefore to the reduction of the treatment gap in epilepsy.