Psychiatric morbidity in asymptomatic human immunodeficiency virus patients

Background: Psychiatric morbidity in human immunodeficiency virus (HIV) patients is being studied all over the world. There is paucity of Indian literature particularly in asymptomatic HIV individuals. Aim: The aim of the following study is to establish the prevalence and the determinants of psychiatric morbidity in asymptomatic HIV patients. Materials and Methods: A cross-sectional study was undertaken to assess psychiatric morbidity as per ICD-10 dacryocystorhinostomy criteria in 100 consecutive asymptomatic seropositive HIV patients and an equal number of age, sex, education, economic and marital status matched HIV seronegative control. All subjects were assessed with the general health questionnaire (GHQ), mini mental status examination, hospital anxiety and depression scale (HADS) and sensation seeking scale (SSS) and the scores were analyzed statistically. Results: Asymptomatic HIV positive patients had significantly higher GHQ caseness and depression but not anxiety on HADS as compared to HIV seronegative controls. On SSS asymptomatic HIV seropositive subjects showed significant higher scores in thrill and adventure seeking, experience seeking and boredom susceptibility as compared to controls. HIV seropositive patients had significantly higher incidence of total psychiatric morbidity. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls. Conclusion: Psychiatric morbidity is higher in asymptomatic HIV patients when compared to HIV seronegative controls. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls. High sensation seeking and substance abuse found in HIV seropositive patients may play a vital role in engaging in high-risk behavior resulting in this dreaded illness

The role of fiberoptic endoscopic evaluation of swallowing in the assessment of pediatric dysphagia

En Abstract Background Swallowing is a basic, life-sustaining function that involves interplay between two distinct but related phenomena, airway protection and bolus transport. Pediatric dysphagia is one of the most important symptoms to be assessed and managed. The standard fiberoptic endoscopic evaluation of swallowing (FEES) protocol of Langmore (2001) was designed to assess dysphagia on all populations. Aim The aim of this work was to clarify the role of FEES in the diagnosis of pediatric dysphagia and the signs related to it. Study design This was a retrospective study that was conducted to assess pediatric dysphagia using FEES as a clinical diagnostic tool. Participants and methods The study included 64 children (38 male, 26 female). Of them, 32 patients were suffering from difficulty in swallowing of different degrees and 32 were controls (they were not suffering from any difficulty in swallowing). The mean age in months for symptomatic children was 41.47 ± 36.25 and the mean age in months for control cases was 42.08 ± 35.61. The examination was carried out using FEES applying the standard FEES protocol of Langmore (2001). Results Application of the standard FEES protocol of Langmore (2001) showed highly related signs of pediatric dysphagia, such as handling of secretions, pharyngeal function in part I and timing of the bolus flow/initiation of the swallow, structural movements during the swallow, and residue after the swallow and between swallows in part II. Conclusion and recommendation There are more common signs related to pediatric dysphagia than others and should be considered in any therapeutic program for overcoming dysphagia in children. Laryngomalacia is a structural disorder causing pediatric dysphagia in a considerable number of children. The standard FEES protocol should be applied on a larger number of pediatric populations with different disorders

Psychometric Characteristics of Non-instrumental Swallowing and Feeding Assessments in Pediatrics: A Systematic Review Using COSMIN

As early diagnosis of swallowing and feeding difficulties in infants and children is of utmost importance, there is a need to evaluate the quality of the psychometric properties of pediatric assessments of swallowing and feeding. A systematic review was performed summarizing the psychometric properties of non-instrumental assessments for swallowing and feeding difficulties in pediatrics; no data were identified for the remaining twelve assessments. The COSMIN taxonomy and checklist were used to evaluate the methodological quality of 23 publications on psychometric properties. For each assessment, an overall quality score for each measurement property was determined. As psychometric data proved incomplete, conflicting or indeterminate for all assessments, only preliminary conclusions could be drawn; the most robust assessment based on current data is the dysphagia disorder survey (DDS). However, further research is needed to provide additional information on all psychometric properties for all assessments