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REVIEW ARTICLES
Yoga and brain wave coherence: A systematic review for brain function improvement
Anup De, Samiran Mondal
April-June 2020, 4(2):33-39
DOI:10.4103/hm.hm_78_19  
Background: The recent hype in yoga practice is concomitant with the fact that it helps the practitioner to achieve radiant health and serene mind. The science of yoga has also become a powerful stream of knowledge. It has increased the number of scientific studies on different yogic interventions, but has also been performed to evaluate its effects on brain wave activity, particularly in neural oscillations. Objectives: In this systematic analysis, we reviewed studies investigating the effect of integrated yoga, meditation, and pranayama on brain wave activity that affects overall cognitive functions. Methods: Broad search strategy was practiced using several online databases: PubMed, Google Scholar, Web of Science, Embase, Medline, PsycINFO, Europe PMC, Scopus, and IndMED. Studies were included in integrated yoga, meditation, and pranayama with brain wave activity, and the entire relevant articles were critically analyzed according to the nature of this study. Results: Several studies examined yogic interventions for restoring brain functions, nerve diseases, and cognitive impairment and suggested that integrated yoga, meditation, and pranayama practices improve verbal skills, reaction time, hand–eye coordination, speed accuracy, and neural activity. Yogic intervention increases overall brain wave (delta, theta, alpha, beta, and gamma) activity, which increases overall cognitive functions with greater perceived cognition, working memory, attention, better switching ability, focusing ability, positive mind, and perception. It has also been reported that yogic intervention activates dormant areas of brain while downgrading memories not of interest and upgrading useful ones.Conclusions: There is emerging evidence from randomized controlled trials to support yoga practice, which significantly improves brain wave activity resulting in better cognitive functions.
  40,107 4,505 5
ORIGINAL ARTICLES
Satisfaction with an exercise physiology consultation after treatment for childhood cancer: An opportunity for healthy lifestyle education
David Mizrahi, Claire E Wakefield, Lauren Ha, Richard J Cohn, David Simar, Joanna E Fardell
July-September 2019, 3(3):77-106
DOI:10.4103/hm.hm_47_19  
Purpose: Many childhood cancer survivors are not engaging in sufficient physical activity despite high chronic disease incidence. We assessed satisfaction and acceptability of attending an exercise physiology consultation. Methods: An 8–18-year-old cancer survivor >1-year posttherapy were assessed by an exercise physiologist (T0). We assessed parents' and survivors' satisfaction and acceptability with the consultation and information received 1-month later (T1). Parents and survivors were asked whether they would see an exercise physiologist again and whether other survivors should be assessed. Results: We recruited 102 participants, with 70 unique families retained. Parents were more satisfied with information received about exercise from T0to T1 (43.4 ± 33.2 vs. 81.5 ± 17.6/100,P < 0.001). Parents reported high satisfaction from the consultation (94.7 ± 10.2/100). Most parents (96.6%) and survivors (95.9%) recommended other survivors see an exercise physiologist. Some parents (37.0%) wanted their child to be more active, while 47.8% of survivors wanted to be more active. Conclusions: There was support for an exercise physiology consultation from parents and survivors. Guidance from an exercise physiologist may be important to alter lifestyle behaviors, which can be potentially beneficial to cardiovascular and psychological well-being.
  33,002 3,919 3
REVIEW ARTICLES
Novel comprehensive cardiac rehabilitation to combat the dose-dependent relationship between psychosocial stress and cardiovascular disease
Evan L OKeefe, Carl J Lavie, Sergey M Kachur
October-December 2020, 4(4):109-115
DOI:10.4103/hm.hm_32_20  
The association of cardiovascular disease (CVD) and psychosocial stress (PSS) is a bidirectional function, whereby the two conditions create a self-reinforcing feedback loop. Either can incite and/or magnify the other, prognosis consequently deteriorates and spontaneous remission is unlikely. Several studies show that even subclinical PSS increases mortality. Recent evidence suggests that stress exhibits a strong dose–response toxicity on cardiovascular health with increased levels of PSS directly correlating to additional morbidity and mortality. As such, it will be important that future research considers PSS as a continuous variable capable of causing a spectrum of disease. This article proposes targeted exercise routines as the most efficient therapy for both arms of the feedback loop. A consistent body of data indicates that regular physical activity eases the PSS burden while simultaneously lowering CVD risk. Exercise therapy, mindfulness training, and interventions targeting positive psychological well-being stress management are indispensable therapies, particularly for at-risk and already established cardiovascular patients. Indeed, comprehensive cardiac rehabilitation and exercise training programs inclusive of education, lifestyle, and psychological measures in addition to fitness training are a potent multifaceted therapy for improving quality of life and overall prognosis.
  29,943 3,711 -
ORIGINAL ARTICLES
Prevalence rates of chronic fatigue complaints in a probability sample of Arab college students
Ahmed M Abdel-Khalek
January-March 2019, 3(1):15-20
DOI:10.4103/hm.hm_49_19  
Objectives: Fatigue is a common complaint in the community. The twofold aims of the present study were (a) to estimate the prevalence rate of reported chronic fatigue syndrome-like (CFS-like) complains, and (b) to explore the sex-related differences in it. Methods: A probability non-clinical sample of 3,465 Kuwaiti volunteer undergraduate men (n = 1,745) and women (n = 1,720) was recruited. Their ages ranged between 16 and 43 years. They responded to the Arabic Scale of Chronic Fatigue (ASCF). It has good internal consistency, temporal stability, criterion-related validity, and factorial validity (its loading on a CFS factor = 0.81). Principal component analysis disclosed 2 factors: Mental fatigue and Physical fatigue. The prevalence rate was computed based on 2 criteria, i.e., the percentage of persons which have total scores greater than (a) the M + 1 SD, and (b) greater than the M + 2 SD. Results: Based on criterion (a), prevalence rates were 13.47% for men and 20.98% for women. As to criterion (b), the rates were 2.35% for men and 5.76 % for women. These rates lie in the rage of the international studies on CFS-like complaints (from 1.2% to 30.5%). Women obtained significantly higher mean score and prevalence rates than did their male counterparts. Conclusion: It is highly probable that the participants obtained the higher scores than did their M + 2 SD are in need of therapeutic intervention. It was concluded that psychological scales may be useful in screening disorders to detect the cases.
  29,020 3,647 -
REVIEW ARTICLES
Cross-country comparison in the evaluation of evolocumab by health technology assessment agencies in England, Canada, and Australia
Swaroop Varghese, Marc-Alexander Ohlow, Narendra Kumar
October-December 2019, 3(4):140-146
DOI:10.4103/hm.hm_17_19  
Evolocumab is a proprotein convertase subtilisin/kexin type 9 inhibitor drug which has shown great treatment effects in the treatment of uncontrolled hypercholesterolemia, particularly elevated low-density lipoprotein cholesterol levels. Due to its significant costs, several health technology assessment agencies (HTA) worldwide have exercised caution in issuing its recommendation across different patient groups. This study attempts to review the processes and compare the approach adopted by the HTA agencies in England (National Institute for Care and Health Excellence [NICE]), Canada (Canadian Agency for Drugs and Technologies in Health [CADTH] Common Drug Review), and Australia (Pharmaceutical Benefits Advisory Committee [PBAC]) in the evaluation of evolocumab. Between July and August 2018, the websites of CADTH, the NICE in England, and the PBAC of the Pharmaceutical Benefits Scheme in Australia were searched for technology appraisal documents pertaining to evolocumab. The search included the initial appraisal, resubmissions, as well as the final recommendation made between 2015 and 2018. Significant variability exists between the recommendations and clinical and economic assessment processes in the evaluation of evolocumab across the three selected HTAs. More collaborative efforts may be required to align the interagency HTAs.
  28,712 3,738 1
Tobacco use topography and etiology: Similarities and differences among teens and emerging adults
Steve Sussman
October-December 2019, 3(4):133-139
DOI:10.4103/hm.hm_53_19  
Tobacco regulatory science seeks in part to reduce harm of new tobacco products. Part of this interest is to help chronic adult smokers switch to potentially less harmful products, while not facilitating use of these modified risk tobacco products by nonusers (particularly teens). Studies to discern a lack of interest in reduced harm products are conducted on emerging adults as a proxy for teens. The present empirical review explores the topography and etiology of tobacco use among emerging adults compared to teens to discern whether they might be a reasonable proxy for such reduced harm studies. Both teens and emerging adults view combustible and e-cigarette smoking as disapproved of by peers and are likely to process tobacco marketing information similarly. I conclude that while some differences do exist (e.g., emerging adults are in a period of escalating use and dependence, whereas teens are relatively likely to be initiating use), emerging adults may indeed be a reasonable proxy, at least for current reduced harm studies.
  27,897 3,906 -
ORIGINAL ARTICLES
To investigate the role of Withania somnifera in a mouse model of posttraumatic stress disorder
Ravjot Kaur, Amteshwar Singh Jaggi, Anjana Bali
October-December 2019, 3(4):153-160
DOI:10.4103/hm.hm_14_19  
The present study was conducted to explore the role of Withania somnifera in posttraumatic stress disorder (PTSD) in mice. Swiss albino mice were subjected to a 2-day electric foot-shock stress of 5 min, which included 15 alternating inescapable foot shocks of 0.8 mA intensity with 10-s duration and 10-s intershock interval on the electrified grid floor. It was followed by 3 week re-exposures (on day 3, 7, and 14) in the same context (as situational reminders) for 5 min without delivering any foot-shocks. Trauma and situational reminders results a significant development of behavioral deficits and reduced serum corticosterone levels, as assessed on the 21st day. A significant development of freezing behavior was also observed in response to situational reminders on 3rd, 7th and 14th days. Repeated administration (for 21 days) of W. somnifera (50 mg/kg and 100 mg/kg) considerably restored the behavioral changes and normalized the corticosterone levels. W. somnifera led to significant reduction in the freezing behavior in response to situational reminders suggesting the inhibition of formation of aversive fear memory. It may be concluded that W. somnifera may be beneficial in preventing the PTSD symptoms in response to a traumatic event.
  27,059 3,656 -
Inflammatory and vascular correlates of mood change over 8 weeks
Jonathan W Birdsall, Samantha L Schmitz, Oluchi J Abosi, Lyndsey E DuBose, Gary L Pierce, Jess G Fiedorowicz
April-June 2019, 3(2):47-54
DOI:10.4103/hm.hm_24_19  
Background: Mood disorders have been associated with a variety of cardiovascular disease (CVD) risk factors, including inflammation and large arterial stiffness, particularly while depressed, although longitudinal studies have been limited. Materials and Methods: With measurements at baseline and 8 weeks, the researchers prospectively assessed mood, levels of inflammatory markers (high-sensitivity C-reactive protein and tumor necrosis factor-alpha [TNF-α]), serum lipids, and large arterial stiffness in a cohort of 26 participants with a diagnosis of a mood disorder, enriched for current depression. Depressive symptoms were measured using the Montgomery–Šsberg Depression Rating Scale (MADRS) at baseline and 8 weeks. Associations between depressive symptoms and other measures were assessed using linear mixed models, unadjusted and adjusted for age and body mass index. Results: The mean age of the participants (n = 26) was 41.6 (standard deviation [SD] 12.8) years, and 81% were female. During the study, there was a mean (SD) MADRS score improvement of 9.5 (9.4) from baseline to 8 weeks. Reductions in the primary outcome of tumor necrosis factor-α with improvement in depression fell short of statistical significance (P = 0.076). In secondary analyses, there was a statistically significant association between improved cholesterol ratio (P = 0.038) and triglycerides (P = 0.042) with improvement in depression. There was no statistically significant change in large arterial stiffness during the study. Conclusion: Improved depressive symptoms were associated with improved cholesterol ratios even after adjustment, suggesting a possible mechanism by which acute mood states may influence CVD risk. Future longitudinal studies with extended and intensive follow-up investigating CVD risk related to acute changes and persistence of mood symptoms are warranted.
  25,877 3,717 1
CASE REPORT
Concomitant acute aortic thrombosis and pulmonary embolism complicating COVID-19 pneumonia
Hassan H Allam, Abdulhalim Jamal Kinsara, Amt Alkhaliq A Alrajawi, Tareq Tuiama
October-December 2020, 4(4):123-125
DOI:10.4103/hm.hm_34_20  
There is rapidly accumulating literature regarding the hypercoagulable state associated with patients diagnosed with COVID-19 infection. Pulmonary, cardiac, and visceral involvement has been described. We describe a middle-aged male, with a background of diabetes and hypertension, diagnosed with severe COVID-19, who passed away despite maximum support. He had concomitant aortic and pulmonary thrombus. This is a devastating, poorly understood complication of severe COVID-19, adding to the body of medical literature related to severe COVID-19. COVID-19 is a hypercoagulable disease, and multi-organ involvement should be considered. Aortic imaging during a computed tomography pulmonary angiography can add additional information to the risk stratification and clinical implications in a patient diagnosed with COVID-19, with a suspected hypercoagulable state and possible multi-organ involvement.
  25,293 3,594 2
LETTER TO THE EDITOR
Stress-induced cardiomyopathy related to SARS-CoV-2
A Cereda, M Toselli, A Laricchia, A Mangieri, R Ruggiero, F Gallo, A Sticchi, A Khokhar, F Giannini, A Colombo
April-June 2020, 4(2):57-58
DOI:10.4103/hm.hm_10_20  
  24,429 3,567 2
REVIEW ARTICLE
The depressed heart
Seth W Perry, Julio Licinio, Ma-Li Wong
April-June 2019, 3(2):35-46
DOI:10.4103/hm.hm_13_19  
Our appreciation and understanding of the interrelationships between disrupted metabolic function and depression have increased significantly over the last few decades. This review focuses still more specifically on the intersections between cardiovascular disease (CVD) and major depressive disorder (MDD). General pathophysiological mechanisms implicated in both diseases include inflammation, cytokine and hypothalamic–pituitary–adrenal axis dysregulation, oxidative stress, neurotransmitter disruptions, neuroplasticity, and the microbiome. Here, we explore these mechanistic overlaps of depression and CVD, including some discussion of related and frequently comorbid disorders, such as obesity and diabetes, and the closely related “metabolic syndrome.” Finally, we discuss integrated therapeutic strategies for treating MDD comorbid with CVD.
  21,571 2,180 4
ORIGINAL ARTICLES
Cardiac pauses in critically ill Coronavirus Disease-2019 patients
Hajra Awwab, Juan I Solorzano, Keerthish C Jaisingh, Sampath Singireddy, Steven Bailey, Paari Dominic
January-March 2021, 5(1):4-8
DOI:10.4103/hm.hm_35_20  
Importance: Coronavirus disease 2019 is associated with a variety of arrhythmias. However, there are limited data regarding bradyarrhythmias and cardiac pauses in COVID-19. Objective: The objective was to characterize significant cardiac pauses in critically ill COVID-19 patients. Design: This was a case series of 26 consecutive patients with confirmed COVID-19 at an academic medical center in Shreveport, Louisiana. Setting: The study was conducted in the intensive care unit (ICU) and step-down ICU. Participants: Patients were either on mechanical ventilation or high-flow oxygen by nasal cannula. Main Outcomes and Measures: Demographic, clinical, laboratory, and medication data were analyzed. Continuous telemetry monitoring was utilized to record number, type, and duration of bradyarrhythmic events as well as their risk determinants. Results: The median age of the 26 patients was 49.5 years (range 33–78). Fifteen (57.7%) were men. Incidence of significant bradycardia and cardiac pauses, defined as an event, occurred in 11 (42.3%) patients. The median age of patients with an event was 57 years (range 33–66) and 5 (45.5%) were men. The average pause duration was 6.77 s with a range of 1.6–30 s. Five of 11 (45.5%) patients had high-grade atrioventricular (AV) nodal block. One patient required temporary pacemaker insertion for complete heart block and recurrent asystole arrests. A trend toward higher troponin I level in bradyarrhythmia patients was noted (mean troponin I was 2.72 ng/mL, [standard deviation] 4.48) compared to patients without event(s) (mean 0.42 ng/mL 0.52, P = 0.07). Conclusions and Relevance: Significant bradycardic events in critically ill patients with COVID-19 occurred in 42.3% of patients. This is the first case series of such events in COVID-19 patients. Increased awareness of these findings could affect management techniques and call for enhanced monitoring of such patients.
  20,741 2,853 -
Patient perspective on telehealth during the COVID-19 pandemic at the cardiology outpatient clinic: Data from a qualitative study
Mirela Habibovic, Channa M Kraaij, Steffen Pauws, Jos W. M G. Widdershoven
October-December 2021, 5(4):132-137
DOI:10.4103/hm.hm_39_21  
Background: Within the field of cardiology, telehealth has been advocated by many as important benefits have been demonstrated regarding disease management and survival. Both patient- and physician-related barriers have hampered the uptake of telehealth in the clinical practice. The COVID-19 pandemic has pushed the upscaling of telehealth modalities. Objective: The current study will examine patients' preferences, needs, and recommendations regarding the use of telehealth at the cardiology outpatient clinic during the pandemic. Methods: Semi-structured focus groups were organized covering two themes: (1) patients' experiences with telehealth and (2) patients' needs and recommendations regarding the use of telehealth. Focus groups were held online using Microsoft Teams, and audio recordings were made. After transcribing the recordings, thematic analysis was applied to code the answers that were given. Results: A total of n = 19 patients were recruited; the mean age was 62.4 (7.7) and 10 (52.6%) were female. The majority of the patients (15/19) indicated to be positive regarding telehealth use mainly due to its time-saving character. Four patients were negative toward telehealth as they did not receive appropriate care in their perception due to telehealth use. Patients recommend using blended care where teleconsultation, and face-to-face appointments are provided in accordance with patients' preferences. Conclusions: This is the first study to examine, in-depth, cardiac patients' experiences, needs, and recommendations regarding telehealth use in the clinical practice. Learning from current experiences with the COVID-19 pandemic where upscaling of telehealth emerged will give us a foundation to further increase the uptake of telehealth in the clinical practice.
  20,760 2,768 -
Somatic versus cognitive depressive symptoms as predictors of coronary artery disease among women with suspected ischemia: The women's ischemia syndrome evaluation
Ashley S Emami, C Noel Bairey Merz, Jo-Ann Eastwood, Carl J Pepine, Eileen M Handberg, Vera Bittner, Puja K Mehta, David S Krantz, Viola Vaccarino, Wafia Eteiba, Carol E Cornell, Thomas Rutledge
October-December 2021, 5(4):112-118
DOI:10.4103/hm.hm_34_21  
Background: Depression is an established predictor of coronary artery disease (CAD) progression and mortality. “Somatic” symptoms of depression such as fatigue and sleep impairment overlap with symptoms of CAD and independently predict CAD events. Differentiating between “somatic” and “cognitive” depressive symptoms in at-risk patients may improve our understanding of the relationship between depression and CAD. Methods: The study utilized data from the Women's Ischemia Syndrome Evaluation. Participants (N = 641; mean age = 58.0 [11.4] years) were enrolled to evaluate chest pain or suspected myocardial ischemia. They completed a battery of symptom and psychological questionnaires (including the Beck Depression Inventory [BDI]) at baseline, along with quantitative coronary angiography and other CAD diagnostic procedures. The BDI provided scores for total depression and for cognitive and somatic depressive symptom subscales. Results: Two hundred and fourteen (33.4%) women met criteria for obstructive CAD. Logistic regression models were used to examine relationships between depression symptoms and obstructive CAD. Neither BDI total scores (odds ratio [OR] =1.02, 95% confidence interval [CI], 0.99–1.05, P = 0.053) nor BDI cognitive scores (OR = 1.02, 95% CI, 1.00–1.04, P = 0.15) predicted CAD status. BDI somatic symptom scores, however, significantly predicted CAD status and remained statistically significant after controlling for age, race, and education (OR = 1.06, 95% CI, 1.01–1.12, P = 0.02). Conclusion: Among women with suspected myocardial ischemia, somatic but not cognitive depressive symptoms predicted an increased risk of obstructive CAD determined by coronary angiography. Consistent with prior reports, these results suggest a focus on somatic rather than cognitive depressive symptoms could offer additional diagnostic information.
  20,244 2,633 1
Escalation: Raising the college students' awareness regarding early signs of abusive relationships
Abir K Bekhet, Courtney A Kailunas, Alina T Atayan
January-March 2020, 4(1):1-6
DOI:10.4103/hm.hm_23_19  
Background: Abusive relationships are highly prevalent in our society, but often go unnoticed. Research showed that dating violence continues to escalate in college student populations. Purpose: The purpose of this study is to determine the effectiveness of the video as a chosen method of education in raising the college students' awareness regarding warning signs of an abusive relationship. Design: This study used a descriptive qualitative design. Sample/Data Collection: Five focus groups of college students' participants (freshmen to seniors) were recruited to participate in the “Escalation” workshop. To facilitate discussion, each focus group originally had 15 college students for a total of 75 college students' participants. Five participants dropped of the study the last minute due to conflicting schedules and personal situations. Each focus group lasted for 90 min and consisted of watching a 38 min “Escalation” video that depicts scenarios of abusive relationships and a pre- and a post-qualitative discussion. Results: The results of the study and the identified themes illustrate the broadened perspectives participants gained through participating in the workshop. Insights from participants became less focused on physical abuse and began to include more mental and emotional effects of abuse in their responses. This study showed that most participants were not previously aware of the progression and scope of violent relationships. Discussion/Conclusion: By recognizing the early signs of an abusive relationship, it is more likely for victims and/or peers to intervene in a safe manner rather than continuing to allow an abusive relationship to escalate to its full potential of violence and physical harm.
  20,029 1,860 1
COMMUNICATION
Strategy for discharges from the stress test laboratory for ambulatory patients with chest pain/dyspnea in COVID-19 times
Jesus Peteiro, Alberto Bouzas-Mosquera, Cayetana Barbeito-Caamaño, Jose Manuel Vazquez-Rodriguez
July-September 2021, 5(3):95-97
DOI:10.4103/hm.hm_7_21  
Introduction: To reduce contacts during the COVID-19 pandemic, we elaborated a protocol for ambulatory referrals for exercise testing that included discharges from the stress test laboratory (STL). Methods and Results: From 403 patients referred for chest pain (68%) or dyspnea (32%), 219 were straight discharged from the STL (54%), without findings of coronary artery disease in 192 (88%), whereas in 120 (29.5%), further visits were recommended. Medical treatment was modified after the tests in 116 patients (29%). Conclusions: A strategy consisting of discharge from the STL for patients with negative/spurious stress test results, making therapeutic recommendations, seems feasible, effective, and overall opportune in the current situation.
  19,329 2,521 2
ORIGINAL ARTICLES
Unpredictable chronic mild stress-induced depressive-like behaviors in spontaneously hypertensive rats
Lijun Zhang, Meiyan Liu
October-December 2021, 5(4):119-131
DOI:10.4103/hm.hm_49_21  
Objective: The objective is to explore whether hypertension influences unpredictable chronic mild stress (UCMS)-induced depressive-like behaviors and the potential therapeutic effect of Guan-Xin-Shu-Tong capsules (GXST) in controlling hypertension and depressive-like behaviors. Materials and Methods: Fifteen spontaneously hypertensive rats (SHR) and 15 wistar rats were divided into three groups respectively (n = 5, in each group), including control, UCMS, and UCMS + GXST groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at the end of the experiment. Rats were subjected to seven kinds of UCMS over 4 weeks. GXST treatments were administrated (2.8 g/kg) by intragastric gavage once a day over 4 consecutive weeks during UCMS treatment. Sucrose-preference and open-field tests were used to detect depressive-like behaviors. Results: SHR exposed to 4-week UCMS treatment had lower HR when compared with control and UCMS + GXST groups (P < 0.05); Wister rats receiving UCMS or UCMS + GXST had lower SBP (P < 0.05), lower DBP (P < 0.05) and lower MAP (P < 0.05) than controls. Compared with the controls, UCMS reduced the sucrose preference of Wistar rats, UCMS and UCMS + GXST decreased both grid-crossings and the number of upright postures measured in Wistar rats (P < 0.05). SHR showed lower sucrose consumption, less sucrose preference, and fewer grid-crossings after UCMS than control SHR. However, the lower incidence of upright postures in SHR was prevented by GXST treatment (P < 0.05). Linear correlation showed that grid-crossings or upright postures were negatively related to the values of SBP, DBP, or MAP, presenting the positive relationship between depressive-like behaviors and SBP, DBP, or MAP reduction in Wistar rats; there was a negative correlation between grid-crossings and DBP responses, and MAP responses in SHR, and a positive correlation between depressive-like behaviors and DBP and MAP response elevation in SHR. Conclusions: UCMS-induced depressive-like behaviors in Wistar and SHR, accompanied by a blood pressure decrease in Wistar rats but not in SHR. While GXST exhibited effective relief of depressive-like behaviors in SHR without influencing their blood pressure.
  19,328 2,451 -
Adverse childhood experiences and the structure of personality in patients with takotsubo syndrome versus myocardial infarction
Lutz Goetzmann, Elisabeth Olliges, Barbara Ruettner, Karin Meissner, Karl-Heinz Ladwig, Christian Möller, Daniela Deftu-Kloes, Stefan Pohl, Gert Richardt, Christoph Burgdorf, Alexander Steger, Joram Ronel
January-March 2020, 4(1):12-20
DOI:10.4103/hm.hm_76_19  
Context and Aims: Psychosocial risk factors are known to result in either takotsubo syndrome (TTS) or myocardial infarction (MI). In this article, the results of a cross-sectional study are presented within the framework of “progressive somatization” by comparing the psychosocial traits of TTS and MI patients. Design/Subjects and Methods: 136 patients were administered a battery of questionnaires comprising the Childhood Trauma Questionnaire (CTQ), the Toronto Alexithymia Scale (TAS-20), the Experiences in Close Relationships-Revised Questionnaire, and the Operationalised Psychodynamic Diagnosis Structural Questionnaire (OPD-SQ). Life events prior to the onset of cardiac disease were recorded. Statistical Analysis: Descriptive statistics data were expressed in absolute numbers, percent, and mean and standard deviation. To identify differences between groups, T-tests for independent samples, Chi-square-tests and Mann-Whitney-Tests were used. Pearson correlations were computed to assess the relationship between the patient samples as well as between the patient samples and norms. Results: Few differences were found between TTS and MI patients, with both groups reporting moderate-to-severe “emotional neglect” in their childhood (CTQ). Compared to the norm group, TTS and MI patients showed higher values of “alexithymia” (TAS-20), and MI patients reported higher “attachment avoidance”. There are more “structural limitations of the personality” in TTS and MI patients than in a psychosomatic sample (OPD-SQ). Conclusions: TTS as well as MI patients suffer from “adverse childhood experiences” and “structural limitations of personality.” The results sustain the psychosomatic theory of progressive somatization that leads to severe bodily diseases. Patients might benefit from a specific psychotherapeutical support.
  19,510 1,859 1
CASE REPORT
A case report: Steroid-induced mania in the context of COVID-19: The compounding impact of treatment on mental health
John Michael Perez, Spencer Murdock, Sarah Singh, Wanhong Zheng
October-December 2021, 5(4):157-160
DOI:10.4103/hm.hm_17_21  
The coronavirus disease 19 (COVID-19) pandemic has negatively affected people's day-to-day lives, especially those with mental illness. We present a case of a manic episode with psychotic features induced by dexamethasone administered as part of COVID-19 treatment. The patient had underlying depression, anxiety, and posttraumatic stress disorder, but was stable before contracting COVID-19. The implications of quarantine and social stress on mood stability are also discussed. We call for better patient education on the risks of steroid-induced mania and psychosis as well as increased attention to mental illness screening and treatment during this unprecedented pandemic time.
  18,362 2,455 -
EDITORIAL
Spotlight on the relationship between heart disease and mental stress
Meiyan Liu
January-March 2021, 5(1):1-3
DOI:10.4103/hm.hm_12_21  
  17,697 3,024 6
ORIGINAL ARTICLES
Low-carbohydrate diet improves the cardiopsychiatry profile of patients with schizophrenia: A pilot study
Noor J Altooq, Safa Abduljalil Aburowais, Ahmed N Alajaimi, Isa Y Albanna, Omar A Alhaj, Haitham A Jahrami
July-September 2021, 5(3):80-85
DOI:10.4103/hm.hm_25_21  
Background and Objective: Patients with schizophrenia are more prone to develop metabolic syndrome (MetS) with its related complications, including cardiovascular diseases and diabetes mellitus compared to the general population. In this study, we aim to evaluate the effect of low-carbohydrate diet on MetS Z score, weight status, and symptomatology of patients with schizophrenia in Bahrain. Materials and Methods: This single-group pretest–posttest study was executed while considering an ethical approach of volunteer participants, a sample size of 35 patients with schizophrenia. The participants were instructed to follow a low-carbohydrate moderate-fat diet for 8 weeks. Anthropometric measurements, mean arterial pressure, basal metabolic index, body fat percentage (BFP), body surface area (BSA), and MetS Z score and Clinical Global Impression (CGI) Scale were collected before and after the diet intervention. Descriptive statistics, including the mean and standard deviations, were used for continuous variables and percentages for the categorical variables. Paired t-tests and effect size were used to analyze the mean difference of the values before and after the diet intervention. Results: A statistical significance in the mean difference was observed among the following variables: MetS Z score, weight, body mass index (BMI), high-density lipoproteins (HDL), low-density lipoprotein (LDL), thrombin generation test, waist circumference (WC), BFP, BSA, and CGI-improvement (CGI-I). Weight, BMI, TG, BFP, BSA, and CGI-I had a large effect size of the mean difference, whereas LDL, HDL, and WC had a moderate effect size. There was no statistically significant difference in the MetS Z score between male and female after the diet intervention (P = 0.274). Conclusion: Dietary modification with low-carbohydrates restriction is a workable approach in the management of schizophrenia and its related metabolic complications. Clinical trials need to be conducted to corroborate the implementation of dietary intervention as a co-treatment of schizophrenia.
  17,813 2,471 -
REVIEW ARTICLES
Cardiovascular complications of COVID-19
Joana Brito, Beatriz Valente Silva, Pedro Alves da Silva, Nuno Cortez-Dias, Doroteia Silva, João R Agostinho, Tatiana Guimar, Dulce Brito, Fausto J Pinto
July-September 2020, 4(3):67-74
DOI:10.4103/hm.hm_28_20  
Coronavirus disease 19 (COVID-19) has rapidly expanded to a global pandemic, resulting in significant morbidity and mortality. Even though predictors of infection remain unclear, age and preexisting cardiovascular conditions have been clearly identified as predictors of adverse outcomes and higher fatality rates. Since the virus infects host cells through angiotensin-converting enzyme 2 receptors, a key player in the renin-angiotensin-aldosterone system, the interaction between the cardiovascular system and the progression of COVID-19 is nowadays a focus of huge interest. In this review, the authors analyze the available and very recent evidence on the risk factors and mechanisms of the most relevant cardiovascular complications associated with COVID-19, including acute cardiac injury, myocarditis, stress-cardiomyopathy, ischemic myocardial injury, cytokine release syndrome, thrombotic disease, cardiac arrhythmias, heart failure, and cardiogenic shock. Finally, we discuss the cardiovascular impact of the therapies under investigation for COVID-19 treatment.
  18,528 1,691 3
CASE SERIES
Cardiac rhythm management devices and ablation procedures in psychiatric patients: A case series and review of the literature
Konstantinos A Gatzoulis, Dimitrios Tsiachris, Georgia Balta, Christos-Konstantinos Antoniou, Petros Arsenos, Polychronis Dilaveris, Dimitrios Tousoulis
January-March 2020, 4(1):21-25
DOI:10.4103/hm.hm_74_19  
Psychiatric patients often present with symptoms similar to those indicating the need for a cardiac rhythm management device or even cardiac arrhythmia ablation. However, due to the unreliability of symptom self-reporting, the ability of the underlying neuropsychiatric condition to elicit similar phenomena, and the perceived reduced compliance and increased complication rates among this population, both of the above approaches remain underutilized with often detrimental effects. In the present case series, it is attempted to describe an alternative, electrophysiology study-guided approach to these patients, aiming to both firmly establish the need for invasive intervention (including implantation of pacemakers – three cases, implantable cardioverter-defibrillators – three cases, and electrophysiological ablations – two cases), as well as dispel preconceptions, bordering on stigma, regarding their outcomes.
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ORIGINAL ARTICLES
A comparative epidemiology model for understanding mental morbidity and planning health system response to the COVID-19 pandemic
David Cawthorpe
October-December 2021, 5(4):103-111
DOI:10.4103/hm.hm_60_21  
Introduction: This particular coronavirus disease is a pandemic giving rise to great global affliction and uncertainty, even among those who have dedicated their lives to health care or the study of disease, or both. Notwithstanding those directly affected, the lives of all people have been turned upside down. Each person has to cope with her or his personal situation and a story is taking shape for everyone on earth. Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 virus, the source of the 2020 pandemic. This paper contains brief highlights from a duplicable PubMed search of the COVID-19 literature published from January 1 to March 31, 2020, as well as a duplicable search of past influenza-related publications. Excerpts from select papers are highlighted. The main focus of this paper is a descriptive analysis of influenza and other respiratory viruses based on a 16-year population-based dataset. In addition, the paper includes analyses based on the presence or absence of mental disorder (MD) in relation to influenza and all other respiratory viruses. Methods: The investigation is descriptive and exploratory in nature. Employing a case-comparison design, a 16-year population-based dataset was analyzed to both understand the present and plan for the future. While not all viral infections are equal, this paper focuses on system responses by describing the epidemiology of respiratory viruses, such as influenza. Influenza is established in the global population and has caused epidemics in the past. Where possible direct comparisons are made between COVID-19, influenza, and other respiratory viruses. Results: Those with MD had a higher rate of viral infection per 100,000 capita compared to those with the viral infection and no MD. Further, the postviral infection MD rate was not higher compared to the MD per capita rate before viral infection. The postinfluenza rate of MD among those who were without mental disorder before influenza represents an estimate of postinfection mental health burden. Conclusions: In summary, those with preinfluenza MD are at greater risk for viral infection. Further, while the postviral infection MD rate was not higher compared to the MD per capita rate before viral infection, this independent estimate may inform the degree to which services may need to undergo a sustained increase to address the bio psychosocial needs of each served population were COVID-19 to persist and become established in the global population.
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CASE REPORTS
Acute heart failure due to invasive pneumococcal disease and purulent pericarditis: A case report
Gregorio Tersalvi, Manuela Averaimo, Dario Winterton, Francesca Scopigni
April-June 2021, 5(2):58-60
DOI:10.4103/hm.hm_26_21  
This report describes a 61-year-old female with no previous cardiovascular history presented with acute heart failure. Clinical, laboratory, and imaging findings suggested the diagnosis of pneumococcal invasive disease with concomitant purulent pericarditis. Prompt pharmacological and operatory treatment with both pericardiocentesis and further fenestration brought to a complete recovery.
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