BackgroundAltered thyroid function and increased rates of N-terminal pro-B-Type natriuretic peptide (NT-pro-BNP) are highly prevalent in coronary artery disease (CAD) patients with heart failure, and are associated with unfavorable prognosis. This study was undertaken to examine the relationship and prognostic impact of thyroid hormones, inflammatory biomarkers, and NT-pro-BNP on long-term outcomes in patients after acute coronary syndrome (ACS).MethodsThe study comprised of 642 patients (age 58 ± 10 years, 77 % male) attending an in-patient cardiac rehabilitation program after experiencing ACS. Patients were evaluated for demographic, clinical and CAD risk factors as well as thyroid hormones (e.g., fT3, fT4 level, fT3/fT4 ratio), inflammatory biomarkers (hs-CRP, IL-6) and NT-pro-BNP levels. Data on fT3/fT4 ratio and NT-pro-BNP levels were not normally distributed and were natural-log transformed (ln). Both all-cause (cumulative) and cardiac-related mortality were considered the primary outcomes of interest.ResultsAccording to the Cox model, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.53, 95 % CI 1.13–2.07), fT4 level (HR 1.15, 95 % CI 1.04–1.27), and (ln)fT3/fT4 ratio (HR 0.08, 95 % CI 0.02–0.32) were the most important predictors of all-cause mortality among CAD patients after ACS. Similarly, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.62, 95 % CI 1.11–2.36), fT4 (HR 1.15, 95 % CI 1.02–1.29) and (ln)fT3/fT4 ratio (HR 0.10, 95 % CI 0.02–0.55) independently predicted cardiac-related mortality. Kaplan-Meier analyses provided significant prognostic information with the highest risk for all-cause mortality in the low cut off measures of fT3/fT4 ratio <0.206 and NT-pro-BNP ≥290.4 ng/L (HR 2.03, 95 % CI 1.39–2.96) and fT4 level >12.54 pg/ml (HR = 2.34, 95 % CI 1.05–5.18). There was no association between hs-CRP, IL-6 and mortality in CAD patients after ACS.ConclusionsThyroid hormones (i.e., fT4 level and fT3/fT4 ratio) together with NT-pro-BNP level may be valuable and simple predictors of long-term outcomes of CAD patients after experiencing ACS.

SUMMARYEvidence on the association between insomnia symptoms and mortality is limited and inconsistent. This study examined the association between insomnia symptoms and mortality in cohorts from three countries to show common and unique patterns. The Covariates were age, marital status, education, smoking, alcohol, physical inactivity, obesity, diabetes, cardiovascular diseases, depression, shift work, sleep duration, and self-rated health. Cox regression analysis was used. Frequent difficulties initiating sleep were associated with all-cause mortality among men after full adjustments in the Finnish (hazard ratio 2.51; 95% confidence interval 1.07-5.88) and Norwegian (hazard ratio 3.42; 95% confidence interval 1.03-11.35) cohorts. Among women and in Lithuania, insomnia symptoms were not statistically significantly associated with allcause mortality after adjustments. In conclusion, difficulties initiating sleep were associated with mortality among Norwegian and Finnish men. Variation and heterogeneity in the association between insomnia symptoms and mortality highlights that further research needs to distinguish between men and women, specific symptoms and national contexts, and focus on more chronic insomnia.

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BackgroundThe hypothesis that microbial infections may be linked to mental disorders has long been addressed for Borna disease virus (BDV), but clinical and epidemiological evidence remained inconsistent due to non-conformities in detection methods. BDV circulating immune complexes (CIC) were shown to exceed the prevalence of serum antibodies alone and to comparably screen for infection in Europe (DE, CZ, IT), the Middle East (IR) and Asia (CN), still seeking general acceptance.MethodsWe used CIC and antigen (Ag) tests to investigate BDV infection in Lithuania through a case-control study design comparing in-patients suffering of primary psychosis with blood donors. One hundred and six acutely psychotic in-patients with no physical illness, consecutively admitted to the regional mental hospital, and 98 blood donors from the Blood Donation Centre, Lithuania, were enrolled in the study. The severity of psychosis was assessed twice, prior and after acute antipsychotic therapy, by the Brief Psychiatric Rating Scale (BPRS). BDV-CIC and Ag markers were tested once after therapy was terminated.ResultsWhat we found was a significantly higher prevalence of CIC, indicating a chronic BDV infection, in patients with treated primary psychosis than in blood donor controls (39.6 % vs. 22.4 %, respectively). Free BDV Ag, indicating currently active infection, did not show significant differences among study groups. Higher severity of psychosis prior to treatment was inversely correlated to the presence of BDV Ag (42.6 vs. 34.1 BPRS, respectively; p = 0.022).ConclusionsThe study concluded significantly higher BDV infection rates in psychotic than in healthy Lithuanians, thus supporting similar global trends for other mental disorders. The study raised awareness to consider the integration of BDV infection surveillance in psychiatry research in the future.

Objectives: To date, there is no reliable instrument which could be used to assess problematic Internet use (PIU) in Lithuania. The nine-item Problematic Internet Use Questionnaire (PIUQ-9) previously validated in multiple countries, could be a potential tool for measuring PIU severity. The main objective of the present study was to explore the psychometric properties of the Lithuanian version of the questionnaire. Methods: A total of 272 students (17% men, mean age 27 ± 9 years) completed the PIUQ-9, the Patient Health Questionnaire (PHQ) and answered questions about the impairment of daily functioning caused by PIU in an online survey. Results: A confirmatory factor analysis indicated that a bi-factor model with one general factor “general problem” and two-specific factors “obsession” and “neglect + control disorder” fitted the data well. The presence of a strong global factor was supported by the common variance index in the bi-factor model indicating that the “general problem” factor explained 67.7% of common variance. The multiple indicators multiple causes (MIMIC) model showed that psychiatric symptoms (β = 0.25) had a moderate, while impairment due to PIU (β = 0.41) had a moderate-to-strong direct effect on the factor “general problem” supporting the construct validity of the scale. Conclusion: The Lithuanian version of the PIUQ-9 has appropriate psychometric properties to be used in measuring PIU severity in student samples.

In CAD patients, type D personality and NA are associated with worse subjective sleep quality and this association is mediated by depression and anxiety symptoms irrespective of OSA presence.

The aim of the study was to investigate depressive mood in association with sociodemographic, behavioral, self-perceived health, and coronary artery disease (CAD) risk factors and sleep complaints among 35–74-year-old citizens of Palanga. Material and Methods. A representative sample of randomly selected 1602 persons, 600 men and 1002 women, was studied. Depressive mood was assessed by the WHO-5 Well-being Index. Sleep complaints, self-perceived health, and behavioral factors were evaluated by the Basic Nordic Sleep Quality questionnaire and questionnaires on self-perceived health and health behavior. Risk factors for CAD were assessed according to WHO recommendations. Results. The highest prevalence of depressive mood (34.7%) was identified in the age group of 45–54 years in the men and in the age group of 55–64 years in the women (30.0%). The highest odds ratios demonstrating a strong association between depressive mood and health behavior were established for the use of antidepressants (OR=26.0) in the men and for the use of sedatives (OR=3.09) in the women. The highest odds ratios demonstrating an association between depressive mood and self-perceived health were established for chronic pyelonephritis (OR=3.13) in the men and diabetic foot pain (OR=4.46) in the women. The highest odds ratios reflecting an association between depressive mood and sleep quality were established for the inability to work due to disturbed sleep (OR=1.93) in the men and self-perceived sleep quality (OR=1.55) in the women. Conclusions. Depressive mood, which was significantly associated with risky health behavior, poor self-perceived health, and disturbed sleep, was observed more often in the women than the men; however, significant associations between depressive mood and risk factors for CAD were not established.

Background Results of studies on associations between triiodothyronine serum levels and mortality after acute ischemic stroke (AIS) are inconsistent. Therefore, the aim of this prospective study was to evaluate links between serum levels of thyroid axis associated hormones and all-cause mortality during 1 year after AIS. Methods and results This study involved 255 patients with AIS. Patients were divided into two groups: those who survived 1 year after their index stroke and those who not, and by quartiles of free triiodothyronine (FT3) and ΔFT3 (difference between basal FT3 and repeated FT3 on discharge) hormone serum concentrations. To assess serum levels of thyroid stimulating hormone (TSH), FT3 and free tetraiodothyronine (FT4), venous blood was taken from all included patients on admission to hospital. On discharge, blood tests were repeated for 178 (69.8%) patients. Study endpoints were overall mortality within 30, 90 and 365 days after AIS. Results Compared with the survivals, those who died had significantly lower mean FT3, FT3/FT4 ratio in all periods and lower median TSH within 30 days. Higher FT3 serum levels versus lower, even after adjustment for included important variables, remained significant for lower odds of death within 365 days after AIS (OR=0.57; 95% CI: 0.33–0.97, p=0.04), but added insignificant additional predictive value to the NIHSS score or age. Kaplan–Meier survival curves demonstrated that the first FT3 quartile was significantly associated with increased mortality compared with all other quartiles within 365 days after AIS. With ΔFT3 quartiles no such association was found. Conclusions. Higher FT3 levels on admission versus lower are significantly associated with lower mortality within 365 days after AIS. FT3 serum levels changes over time didn’t show any association with mortality within first year.