Insomnia as a Symptom or a Disease

Insomnia is an important public health problem because it has a significant negative impact on individuals’ physical, psychological, and social performance, and quality of life. It may arise directly from a sleep-wake regulatory dysfunction and/or indirectly result from comorbid psychiatric or medical conditions. It is also known that insomnia as a symptom has a negative impact on clinical structure, response to therapeutic intervention, and prognosis of co-morbid pathology. However, it has generally been viewed and treated as a symptom rather than disease. It is not always clear which insomnia cases are primary and which are secondary. But the distinction between insomnia as a disease (primary) and as a symptom (secondary) is essential for better conceptualization of the condition for etiopathogenesis, and it is also important for choosing the most appropriate and effective therapy. For these reasons, a systematic evaluation of insomnia cases is needed

Neuropsychological profiles in levels of obstructive sleep apnea-hypopnea syndrome

The aim of this study was to determine the cognitive deficits that accompany different levels of severity of obstructive sleep apnea-hypopnea syndrome (OSAHS). The sample originally consisted of 71 adult male volunteers with at least 11 years of education. Participants were assigned to groups based on their apnea-hypopnea index (AHI). There were 20 participants in the mild-to-moderate OSAHS group (AHI 6-28; mean age 41.8 +/- 8.96 years), 16 in the severe OSAHS group (AHI 38-86; mean age 44.5 +/- 7.96 years), and 35 in the non-OSAHS group (AHI 0-3; mean age 41.8 +/- 8.96 years). Neuropsychological functions were measured using Stroop Test TBAG version, Cancellation Test, Auditory Verbal Learning Test, Serial Digit Learning Test, and Raven Standard Progressive Matrices. Analyses were conducted on z-transformed scores. Multivariate analysis of variance (education as covariate) showed decrease in various functions such as processing speed, disturbance in selective and sustained attention, deficit in visual perception, search and scan, deficit in recognition memory, increase in susceptibility to interference, and decrease in visuospatial reasoning and general ability. Correctness of estimation increased as severity of OSAHS increased. However, principal component analysis showed that OSAHS severity represents impairment in the basic processes of processing speed and vigilance/sustained attention. Untreated OSAHS patients are potential risks to themselves and to others. Controlled studies are necessary for unraveling the functional correlates of OSAHS

Sleep spindles detection using short time Fourier transform and neural networks

Sleep spindles are a hallmark of the stage 2 sleep. Their distribution over the non-REM sleep is clinically important. In this paper, a method that detects the sleep spindles in sleep EEG is proposed. Short time Fourier Transform is used for feature extraction. Both multilayer perceptron and Support Vector Machine are utilized in detection of the spindles in sleep EEG for comparison. The classification performance of MLP is found to be 88.7% and that of SVM as 95.4%. It should be noted that there might be differences also in visual scoring by experts, so the results obtained are quite satisfactory

Sleep spindles detection using autoregressive modeling

Being one of the well-defined and functional rhythmic activities observed in sleep EEG, sleep spindles are significant for brain research. Visual detection of sleep spindles is very time consuming and subjective. In this study, automated spindle detection by using AR modeling for feature extraction is proposed. Multilayer Perceptron (MLP) and Support Vector Machine (SVM) are used as classifiers for comparison. Performances were found as 93.6% for the MLP and 94.4% for the SVM classifiers

Predictors of high-grade residual disease after repeat conization in patients with positive surgical margins

Objectives: No consensus exists on the subsequent management strategy of patients who exhibit positive surgical margin (PSM) after re-excision of high-grade cervical intraepithelial neoplasia (CIN). The aim of the study is to examine the predictors related to the persistence of high-grade CIN lesions after re-excision, where PSM was left behind. Material and methods: The present retrospective study included patients with PSM who underwent repeated conization due to residual high-grade CIN lesions between January 2005 and December 2019. The SPSS software v20.0 was used for data interpretation and statistical analysis. P values less than 0.05 were accepted as statistically significant. Results: Repeat conization was performed in 91 patients, 43 (47.3%) presented with PSM with high-grade CIN, 6 (6.5%) presented with micro-invasive carcinoma, and 42 (46.2%) presented with clear surgical margin or CIN 1 at the surgical margin. At the time of conization, patients who presented with lesions > 5 mm in repeat cone specimens, exhibited a significantly higher rate of residual disease (p < 0.001). Besides, the involvement of the endocervical margin with high-grade CIN was the predictor of residual disease in repeat cone specimens (p = 0.006). Conclusions: In the cone specimen, the presence of lesion size greater than 5 mm and involvement of the endocervical margin were the predictors of high-grade residual disease after re-excision. Whether it is the first or second procedure, great care must be given to excise the lesion entirely at the time of the conization, preferably in one piece

The effect of adenomyosis on endometrial cancer: a university hospital-based cohort study

Endometrial cancer (EC) can coexist with gynaecological diseases including adenomyosis which can be defined as the location of endometrial cells within the myometrium. Our aim was to clarify the impact of adenomyosis on the clinical and survival outcomes of EC. We included the patients who underwent an operation for EC and had concurrent adenomyosis in this retrospective cohort study. All clinicodemographical and tumour characteristics with survival outcomes of the patients were analysed comparatively. A total of 763 patients who met the eligibility criteria were included. Of those, 591 patients in the non-adenomyosis group and 172 patients in the adenomyosis group were examined. Disease-specific survival (DSS) was significantly prolonged while progression-free survival (PFS) was not affected by the presence of adenomyosis (p = .004 vs. p = .161). However, adenomyosis did not remain as an independent prognostic factor for EC in multivariate analysis (p = .341). These patients with coexistent adenomyosis and EC have better clinicopathological characteristics and less advanced tumour. Although adenomyosis is associated with prolonged DSS, it has no prognostic importance for survival outcomes of the patients with EC.IMPACT STATEMENT What is already known on this subject? Endometrial cancer (EC) can coexist with other gynaecological diseases including uterine adenomyosis. Adenomyosis is typically diagnosed by the pathological evaluation of the uterus following hysterectomy, although diagnosis is possible with imaging methods However, the coexistence of adenomyosis and EC is controversial in the literature. What do the results of this study add? To the best of our knowledge, our study is the largest study performed at a single university hospital. All potential confounding factors including clinicodemographical characteristics of the patients, examination of histopathology slides by the experienced gynaecological pathologists, evaluation of all included factors that may affect the survival outcomes of EC by multivariate analysis were examined. Although adenomyosis is associated with prolonged disease-specific survival (DSS), it has no prognostic importance for survival outcomes of the patients with EC. What are the implications of these findings for clinical practice and/or further research? Women having coexistent adenomyosis and EC should be informed about the impact of adenomyosis on the survival outcomes of EC

Evaluation of Prognostic and Predictive Values of Hemogram Parameters in Patients with Advanced Stage Ovarian Carcinoma

OBJECTIV

Patient adherence and efficacy of quetiapine treatment in schizophrenia: results of a multicentre, naturalistic 6-month follow-up study

The aim of the study was to evaluate the adherence and efficacy of quetiapine treatment in a 6-month, multicentre, noninterventional naturalistic design. Overall, 710 schizophrenia patients using quetiapine or who had switched to quetiapine were included. The continuation rate for quetiapine treatment during 6-month follow-up period was 69%. Adherence improved with each subsequent visit for continued patients, 92.9% at the second visit to 96.1% at the last. Treatment adherence was correlated to improvement of symptoms, though not significantly. Patients having lower clinical global impression severity scores at the beginning were twice as likely to improve compared with patients with higher clinical global impression scores. Schizophrenia patients with antisocial behaviour problems had two and a half times higher drop-out rates. In conclusion, this naturalistic study showed that adherence to quetiapine treatment was high, and treatment was effective in schizophrenia patients during long-term treatment. Remission of symptoms in schizophrenia is much related to severity of symptoms at baseline, treatment adherence and characteristics of patients such as antisocial behavioural patterns. Int Clin Psychopharmacol 25:342-348 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins