Depression in patients receiving pharmacotherapy for epilepsy: An audit in a tertiary care centre

BackgroundThe association of depression and epilepsy is thought to be bidirectional. The present study aimed to evaluate the prevalence of depression in patients on antiepileptic drugs (AEDs) and factors affecting it.MethodsIn this preliminary cross sectional study, patients at epilepsy clinic of a tertiary care centre were studied for occurrence of depression, using Hospital Anxiety and Depression Scale (HADS-D) and Patient Health Questionnaire (PHQ-2) scales. Correlation analysis was carried out to determine the factors associated with presence of depression in these patients.ResultsA total of 12 AEDs (maximum 5 per patient including older and newer) were prescribed to 933 patients in different treatment regimens over a period of 3 years. The median age of the patients was 22 years (10–77) and among them 63.5% were men. Mild and clinically relevant depression occurred in 279 (29.9%) and 223 (23.9%) patients, respectively. Mean HADS-D and PHQ-2 score was significantly higher with polytherapy as compared to monotherapy (p < 0.001). Patients on levetiracetam exhibited significantly higher HADS-D score in comparison to phenytoin (p < 0.001), carbamazepine (p < 0.001) and sodium valproate (p < 0.05). However, there was no significant difference in PHQ score among patients on monotherapy of different AEDs. Multivariate regression analysis suggested correlation between depression and seizure frequency, total number of AEDs and their load (p < 0.001).ConclusionDepressive symptoms were found to be present in more than half of the patients with epilepsy which require detailed work up for depression. Levetiracetam was found to be associated with a higher incidence of subclinical depression which needs further investigation.     

Effect of catheter ablation on progression of paroxysmal atrial fibrillation

Ablation and Progression of Atrial Fibrillation. Objective: The objective was to determine the effect of radiofrequency catheter ablation (RFA) on progression of paroxysmal atrial fibrillation (AF). Background: Progression to persistent AF may occur in up to 50% of patients with paroxysmal AF receiving pharmacological therapy. Hypertension, age, prior transient ischemic event, chronic obstructive pulmonary disease, and heart failure (HATCH score) have been identified as independent risk factors for progression of AF. Methods: RFA was performed in 504 patients (mean age: 58 ± 10 years) to eliminate paroxysmal AF. A repeat RFA procedure was performed in 193 patients (38%). Clinical variables predictive of outcome and their relation to progression of AF after RFA were assessed using multivariate analysis. Results: At a mean follow‐up of 27 ± 12 months after RFA, 434/504 patients (86%) were in sinus rhythm; 49/504 patients (9.5%) continued to have paroxysmal AF; and 14 (3%) were in atrial flutter. Among the 504 patients, 7 (1.5%) progressed to persistent AF. In patients with recurrent AF after RFA, paroxysmal AF progressed to persistent AF in 7/56 (13%, P < 0.001). The progression rate of AF was 0.6% per year after RFA (P < 0.001 compared to 9% per year reported in pharmacologically treated patients). Age >75 years, duration of AF >10 years and diabetes were independent predictors of progression to persistent AF. The HATCH score was not significantly different between patients with paroxysmal AF who did and did not progress to persistent AF (0.7 ± 0.8 vs 1.0 ± 0.5, P = 0.3). Conclusions: Compared to a historical control group of pharmacologically treated patients with paroxysmal AF, RFA appears to reduce the rate of progression of paroxysmal AF to persistent AF. Age, duration of AF, and diabetes are independent risk factors for progression to persistent AF after RFA. (J Cardiovasc Electrophysiol, Vol. 23, pp. 9‐14, January 2012)     

Visual impairment and the prevalence of ocular pathology in homeless children and adults globally: a systematic review

BackgroundHomelessness is a global issue in developing and developed countries. This article is the first systematic review to explore its impact on visual health globally.MethodsA systematic literature search was conducted on OVID MEDLINE, EMBASE, and Cochrane CENTRAL. Peer-reviewed English-language studies with a focus on homeless children or adults that reported on ocular outcomes were included. Primary outcomes and secondary endpoints were reported via weighted averages. Primary outcomes between homeless children and homeless adults were compared using the Fisher exact test.ResultsThere were 5774 individuals across 23 full-text articles included in the review. For studies reporting primary outcomes, 36.8% of homeless individuals self-reported dissatisfaction with their vision, 26.8% self-reported a previous ocular pathology, 26.3% had uncorrected refractive error, 25.6% were functionally visually impaired, 9.2% had at least one previous eye surgery or procedure, and 4.0% had nonrefractive visual impairment. Upon screening, 25.1% of homeless individuals had some type of ocular pathology, which included cornea and external eye diseases (13.4%), glaucoma (7.4%), cataracts (6.3%), retinal diseases (5.3%), ocular motility disorders (4.7%), trauma (2.3%), neuro-ophthalmological conditions (1.7%), and oculoplastic conditions (0.7%). Homeless adults had significantly more visual impairment (p < 0.001), uncorrected refractive error (p < 0.001), ocular pathology (p < 0.001), cataracts (p < 0.001), retinal pathology (p < 0.001), and neuro-ophthalmological conditions (p < 0.001) relative to children.ConclusionsVisual impairment in homeless individuals is higher than the general population. Uncorrected refractive error is a leading cause of visual impairment in this population. Additionally, homeless adults have significantly more visual impairment and ocular pathology than homeless children. Future studies should also explore if these differences are consistent in developing countries and investigate ways to increase eye care access for homeless individuals.