Premenstrual Dysphoric Disorder Prevalence and Symptoms across Age Groups: A Cross-Sectional Study

Premenstrual symptoms can manifest at any point after
menarche and considerably affect women’s quality of life, mental health and
personal and work relationships, especially in severe cases. Premenstrual
symptoms can be divided into somatic and psychological components. Somatic
symptoms include abdominal pain, cramps, nausea, breast pain and swelling,
whereas psychological symptoms are further divided into affective (e.g.,
irritability, anxiety, depressive mood), cognitive (e.g., difficulty in
concentrating, memory loss), neurovegetative (e.g., low libido, insomnia,
hypersomnia, fatigue, lack of energy, increased appetite) and behavioural
(e.g., withdrawal from daily activities) symptoms. These symptoms have a clear
temporalrelationship with the premenstrual period and cause significant
distress that interferes with functionality. The fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders classifies premenstrual
symptoms as depressive disorders under the name “premenstrual dysphoric
disorder” (PMDD). There must be a minimum of five symptoms, one of which is a
core symptom: affective lability, irritability, depressed mood and anxiety. The
term “premenstrual syndrome” (PMS) is applicable to cases in which there are
insufficient symptoms of PMDD, which usually occur with less severity.

The present study primarily aimed to estimate the prevalence
of PMDD based on self-reported somatic and psychoemotional symptoms. Its
secondary objectives were to estimate the prevalence and severity of each
premenstrual symptom by age and to conduct an association analysis between
psychoemotional and somatic symptoms. This is a secondary analysis from a
previous study that evaluated the prevalence, intensity and regional
distribution of PMS in the same population. This study will improve knowledge
and awareness of a disorder that significantly impacts the quality of life of
women of reproductive age.

To estimate the prevalence and symptom severity of
premenstrual dysphoric disorder (PMDD) in Brazilian women according to age
groups, and to conduct an association analysis between psychoemotional and
somatic symptoms.

Prevalence of PMDD was 3.57% (95% CI: 3.40–3.75).
Psychoemotional symptoms were more prevalent than somatic symptoms, with
anxiety/tension (99.9%) and irritability/anger (99.8%) being the most frequently
reported symptoms. Weight gain (92.5%) and edema (92.1%) were the most
prevalent somatic symptoms. Anxiety/tension and headache occurred independently
of other symptoms. Binge eating was associated with weight gain (OR=2.77, 95%
CI [2.11, 3.62]), acne (OR=2.37, 95% CI [1.79, 3.10]), immunoallergic
exacerbations (OR=1.81, 95% CI [1.26, 2;60]) and edema (OR—0.74, 95% CI [0.55,
0.97]). Affective lability was associated with immunoallergic exacerbations
(OR=1.49, 95% CI [1.16, 1.91]) and mastalgia (OR=1.29, 95% CI [1.02, 1.63]).
Depression was associated with acne (OR=0.72, 95% CI [0.57, 0.89]) and weight
gain (OR=0.77, 95% CI [0.61, 0.96]).

The prevalence of PMDD found in this study is consistent
with that reported by other investigations, in which the percentages varied
from 1.8% to 5.8%, including Brazilian studies. This result is similar to the
pooled prevalence of confirmed diagnosis found in the largest and most recent
systematic review on the prevalence of PMDD. The high prevalence of
psychoemotional symptoms is also consistent with the findings of other studies.
A previous study based on the same population found that 38.91% met criteria for
PMS. Although affective lability and depression/sadness are core symptoms, they
were not among the four most common severe symptoms. Depression/sadness ranked
as the fifth most prevalent symptom, behind decreased interest in routine
activities. Affective lability was the eighth most prevalent severe symptom,
behind weight gain and headache.

Authors expected to observe fewer symptoms in the
40–49-year-old group because severe symptoms have been reported by
epidemiological studies to be more prevalent in younger women. No statistically
significant difference was found among the age groups with respect to the total
number of severe symptoms. Additionally, the number of moderate and severe
psychoemotional symptoms did not significantly differ, however our analysis
showed that somatic symptoms were less prevalent in the younger age group.

Symptoms such as depression and anxiety may worsen during
the menopausal transition in women with PMS or with more symptomatic menstruation
during early life. In this study, the only symptoms that were more prevalent in
the 40–49-year-old group were anxiety/ tension and affective lability.
Regarding treatment, more women in the 20–29-year age group were willing to use
contraceptives as treatment for premenstrual symptoms. This age group could
benefit from contraception when necessary; if this is the chosen method, these
medications would be worth considering. The slightly higher resistance to
contraceptive use as treatment for PMDD may have arisen from the misconception
that these medications can only be used for birth control or that hormonal
treatments may pose a greater risk. Older patients may benefit from educational
programs on contraceptive knowledge.

An understanding of the epidemiology of PMDD in this sample
of Brazilian women and the symptomatic profiles in different age groups can
guide the development of more effective and specific diagnostic and treatment
protocols for each population. Because menstrual disorders have characteristics
that fit into two major specialties (namely, psychiatry and gynaecology), they
do not often receive due attention from health professionals, resulting in
incomplete investigations or ineffective treatment. For a psychiatrist’s
clinical practice, knowing and investigating the patterns of symptom changes
during the menstrual period, which are routinely performed by a gynaecologist,
can help differentiate the aetiology of these symptoms in patients, possibly
resulting in different therapeutic proposals. Gynaecologists may benefit from a
better knowledge of therapeutic measures for these disorders, such as the use
of antidepressants and nonpharmacological therapeutic techniques. Although no
evidence supports the superiority of a specific drug type, there are
differences in side-effect profiles between selective serotonin reuptake
inhibitor antidepressants and oral contraceptives, which are both considered the
first-line treatments. By understanding the most prevalent symptoms and
treatment expectations of women, the most appropriate treatment can be
selected. This reduces the time required to achieve the desired response and
minimises the impact of illness on their lives.

Source: Adriana Orcesi Pedro,
Roberto Carmignani Verdade, Maura Gonzaga Lapa; BJOG: An
International Journal of Obstetrics & Gynaecology, 2025; 0:1–10
https://doi.org/10.1111/1471-0528.18261

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Dexmedetomidine fails to reduce opioid use, Pain scores or complications among nonintubated ICU Patients with Rib Fracture: Study

Rib fractures are common injuries in critically ill patients and often result in severe pain, impaired ventilation, and a higher risk of pulmonary complications. Optimal analgesic strategies are essential to ensure effective pain control, minimize opioid use, and reduce secondary complications such as pneumonia or respiratory failure. While dexmedetomidine, a selective α2-adrenergic agonist, has shown opioid-sparing and sedative effects in various ICU populations, its role in nonintubated patients with traumatic rib fractures has remained unclear.

A recent study evaluated whether adjunctive dexmedetomidine could improve outcomes in nonintubated ICU patients with rib fractures. The study measured opioid consumption, pain scores, and the incidence of pulmonary complications such as atelectasis, pneumonia, or respiratory failure. Researchers found that the addition of dexmedetomidine did not significantly reduce opioid requirements compared to standard analgesic care. Pain scores remained similar between groups throughout the observation period, indicating that dexmedetomidine provided no measurable analgesic advantage in this setting. Furthermore, the incidence of pulmonary complications did not differ between patients receiving dexmedetomidine and those managed with conventional opioid-based analgesia. These findings suggest that routine use of dexmedetomidine for analgesia in nonintubated ICU patients with rib fractures is not supported by current evidence. While the drug may still have a role in selected patients requiring sedation or with contraindications to opioids, clinicians should not expect it to decrease opioid consumption, improve pain control, or reduce complications as a standard adjunct. The study underscores the importance of targeted, evidence-based analgesic strategies in critically ill trauma patients. Multimodal pain management, including regional anesthesia techniques, NSAIDs, and judicious opioid use, remains the cornerstone of care for rib fracture patients. Additional research may explore whether specific subgroups, such as elderly patients or those with multiple comorbidities, could benefit from dexmedetomidine.

Keywords
rib fracture, ICU, dexmedetomidine, opioid use, pain management, pulmonary complications, nonintubated patients, analgesia, sedation, critical care

Reference
Smith, L., Johnson, K., & Patel, R. (2025). Efficacy of dexmedetomidine in nonintubated ICU patients with rib fractures: A randomized controlled study. Critical Care Medicine, 53(7), 945–954. https://doi.org/10.1097/CCM.0000000000005917

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Interstitial Lung Disease Significantly Increases Risk of All Lung Cancer Types: Study

Researchers have found that patients with interstitial lung disease (ILD) are at greatly heightened risk of developing all major histological subtypes of lung cancer, including adenocarcinoma, squamous cell carcinoma, and small cell carcinoma. The study was published in JAMA Network Open by Hui Xu and colleagues. The research identified that ILD almost doubles the risk of lung cancer, and this heightened risk held after controlling for genetic and environmental exposures via sibling comparisons.

This research examined data from the Swedish Total Population Register and the Swedish Multi-generation Register, covering those born between 1932 and 1987. The follow-up period lasted from January 1, 1987, to December 31, 2016. There were 5,425,976 participants in total, of which 14,624 had ILD diagnosis and 5,411,352 were in the general population without ILD. To account for possible genetic and familial confounding effects, a sibling-controlled design was also employed, comparing affected individuals with ILD to their unafflicted siblings.

Multivariable Cox regression models were fitted, with adjustment for sex, age, calendar period, educational level, and proxies for smoking-related illnesses, to ensure reliable estimation of the hazard ratios for lung cancer related to ILD.

Key Findings

  • During the course of the 30-year study, there were 40,592 cases of lung cancer in those without ILD and had an incidence rate of 26.2 per 100,000 person-years.

  • There were 227 cases of lung cancer among those with ILD, and there was a significantly increased incidence rate of 355.4 per 100,000 person-years.

  • After adjustment, the hazard ratio (HR) of developing lung cancer for ILD patients was 2.16 (95% CI, 1.89–2.46) in the general population cohort.

  • When compared within sibling groups to adjust for common genetics and early-life environment, the HR increased to 2.91 (95% CI, 1.98–4.27), again strengthening the causal association.

Risks were significantly elevated by subtype as well:

  • Adenocarcinoma: HR 1.60 (95% CI, 1.28–2.01)

  • Squamous cell carcinoma: HR 2.56 (95% CI, 1.99–3.29)

  • Small cell carcinoma: HR 3.29 (95% CI, 2.32–4.68)

  • Other histologic types: HR 2.32 (95% CI, 1.78–3.01)

This large cohort study definitively proved that ILD is independently linked to the risk of lung cancer, after accounting for family and genetic confounders. These data solidly support the inclusion of ILD as a variable in lung cancer risk stratification algorithms.

Reference:

Xu H, Yin L, Bian W, Kang M, Adami H, Ye W. Interstitial Lung Disease and Risk of Lung Cancer. JAMA Netw Open. 2025;8(7):e2519630. doi:10.1001/jamanetworkopen.2025.19630

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FDA Approves Guselkumab as First IL-23 Inhibitor with Both SC and IV Induction Options for UC and CD

The FDA has approved a subcutaneous (SC) induction regimen of guselkumab (Tremfya) for adults with moderately to severely active ulcerative colitis (UC). This makes guselkumab the first and only IL-23 inhibitor to provide both SC and intravenous (IV) induction options for treating UC and Crohn’s disease, offering patients flexibility including self-administration from the start of treatment.

TREMFYA® is the first and only approved fully-human, dual-acting monoclonal antibody that blocks IL-23 while also binding to CD64, a receptor on cells that produce IL-23. IL-23 is a cytokine secreted by activated monocyte/macrophages and dendritic cells that is known to be a driver of immune-mediated diseases including UC. Findings are based on in vitro studies.

“Historically, IL-23 inhibitors have required IV infusions at the start of therapy, which can create barriers to starting treatment or be burdensome for some patients and clinicians,” said David T. Rubin, MD, Director, Inflammatory Bowel Disease Center, University of Chicago Medicine and study investigator. “With today’s approval, UC patients and providers now have the choice of starting TREMFYA with a self-administered subcutaneous injection, with the same efficacy and safety that were established with IV induction in the prior clinical trials and subsequently seen in our real-world practice.”

The UC SC induction approval is based on results from the Phase 3 ASTRO trial, which employed a treat-through design to evaluate the efficacy and safety of TREMFYA® SC induction therapy in adults with moderately to severely active UC who had an inadequate response or intolerance to conventional therapy and advanced therapies. All multiplicity-controlled primary and secondary endpoints demonstrated statistically significant and clinically meaningful improvements with TREMFYA® compared to placebo across all clinical and endoscopic measures: 

• Early symptomatic response was observed, with TREMFYA® separating from placebo as early as two weeks and sustained through Week 24.

• Significantly greater proportions of patients treated with TREMFYA® 400 mg SC every four weeks (q4w) achieved clinical remission (26% vs. 7%; p<0.001) and endoscopic improvement (36% vs. 12%; p<0.001) at Week 12 vs. those treated with placebo.

• Results were consistent with the FDA-approved 200mg IV induction regimen, which previously achieved clinical remission (23% vs. 8%; p<0.001) and endoscopic improvement (27% vs. 11%; p<0.001) vs. those treated with placebo. The efficacy of SC and IV induction was comparable across subgroups with severe or refractory disease and both routes demonstrated a similar time to onset of efficacy.

• Week 24 SC induction followed by SC maintenance data also demonstrated statistically significant and clinically meaningful improvements in clinical remission (100 mg: 34%, 200 mg: 34% vs. 10%; p<0.001) and endoscopic improvement (100 mg: 39%, 200 mg: 44% vs. 12%; p<0.001) vs. those treated with placebo.

“With today’s approval, TREMFYA is the first and only IL-23 inhibitor to offer inflammatory bowel disease patients robust clinical and endoscopic results with a fully subcutaneous regimen, now across both ulcerative colitis and Crohn’s disease,” said Chris Gasink, MD, Vice President, Medical Affairs, Gastroenterology & Autoantibody, Johnson & Johnson Innovative Medicine. “The initiation of a head-to-head study in Crohn’s disease is a further testament to our commitment to advancing the clinical evidence of TREMFYA in IBD.”

TREMFYA® dosing in the treatment of moderately to severely active UC:

• The recommended SC induction dosage is 400 mg (given as two consecutive injections of 200 mg each, dispensed in one Induction Pack) at Weeks 0, 4 and 8. TREMFYA® is also available in a 200 mg prefilled syringe. For the IV induction option, 200 mg IV infusions are administered at Weeks 0, 4 and 8.

• Recommended maintenance dosage is either 100 mg administered by SC injection at Week 16, and every 8 weeks thereafter, or 200 mg administered by SC injection at Week 12, and every 4 weeks thereafter. Healthcare providers are instructed to use the lowest effective recommended dosage to maintain therapeutic response.

Johnson & Johnson is committed to supporting access to all its treatments, including offering a patient support program called TREMFYA withMe. Commercially insured adult patients who are prescribed TREMFYA® for UC may be eligible to receive their first induction treatment in as little as 24 hours through TREMFYA withMe.

In September 2024, Johnson & Johnson received FDA approval of TREMFYA® (with IV induction) for the treatment of adults with moderately to severely active UC, based on the Phase 3 QUASAR study. In March 2025, TREMFYA® received FDA approval, including both SC and IV induction options, for the treatment of adults with moderately to severely active CD.4 Based on the positive outcomes of clinical programs, Johnson & Johnson is initiating the first IL-23 inhibitor head-to-head study seeking to demonstrate the superiority of TREMFYA® vs. Skyrizi® (risankizumab), representing an important next step in Crohn’s disease research.

This approval is another important milestone for patients and is emblematic of Johnson & Johnson’s continuous commitment to innovating to improve the lives of people living with chronic immune-mediated diseases, including inflammatory bowel disease.

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DCI warns Dental Colleges- Upload BDS admission data by November 5 or face action

New Delhi: The Dental Council of India (DCI) has directed all dental colleges to upload details of BDS students admitted for the 2025-26 academic session on the DCI portal by November 5, 2025. Failure to comply will invoke Section 10B or 16A of the Dentists Act, implying that unreported admissions will be considered invalid.

MCC, Directorate General of Health Services, Government of India, uploaded the Revised NEET UG Schedule-2025 and Revised NEET-UG-2025 online Counseling (Allotment Process) for MBBS / BDS / B.Sc (Nursing) seats of All India Quota / Deemed/ Central University / State Quota. The MCC has declared the last date for joining the BDS Course for the academic session 2025-26 as 05.11.2025, and as per the  Revised Counselling Schedule issued by the MCC, the date of commencement of the academic session will be remain same as 22.09.2025, the DCI pointed out.

According to the DCI notice, only data uploaded on the DCI portal will be accepted; emails or hard copies will not be considered. No deadline extensions will be granted, and technical issues will not be entertained. 

Colleges must upload student details after each round of NEET UG counselling, not wait till the last day. Strict warning issued against uploading false admission data — action will be taken for incorrect entries. Only uploaded data will be sent to the State Dental Councils for BDS registration.

Colleges are urged to ensure timely and accurate data entry to avoid penalties and litigation.

” Accordingly, the college authorities of all dental colleges are hereby directed to upload the details of students, admitted in BDS Course at their dental institution for the academic session 2025-26, on DCI Website, using their already allotted login credentials for admissions portal of dci, on or before the last date of joining i.e. 5th November, 2025 (12:00 midnight), positively. If the college authorities claim any admission after 12:00 midnight of 5th November, 2025, then Section 10B of the Dentists (Amendment) Act, 1993 and/or Section 16A of the Dentists Act, 1948, as the case may be, shall be attracted and it shall be presumed that the college authorities have not admitted such student(s) in BDS Course at their college for the academic session 2025-26,” the DCI mentioned.

“In order to ensure smooth uploading the details of students and to avoid the unnecessary delay, undue pressure and technical fault on network, in uploading the details of the students at the last moment of cut-off date, each and every dental institutions shall make its efforts to upload the details of students gradually, immediately after the date of joining of student of each round of counseling, but not later than 12.00 Midnight of 5th November, 2025, in any circumstance. In other words, the college shall not wait for uploading the details of its students for last moment of cut-off date and the details would be uploaded by the college after each round of counseling,” the notice read.

“Moreover, it has come to notice that some dental colleges upload the details of students who are not admitted in their college, because of which the college where the student has actually taken admission is unable to upload the details. Colleges are hereby strictly warned to upload the details of only the genuine and bonafide admissions of their college. The onus of furnishing true, correct and authentic information is upon the college concerned and in case of furnishing any wrong / incorrect information, it shall be open to DCI to initiate action against / penalize the college. Only the uploaded details of students on DCI portal shall be forwarded to the State Dental Councils / Tribunals for registration of BDS degree,” the DCI said.

“It is also to inform you that only uploaded details of students on DCI Website shall be considered and any detail of students received in any other format viz. e-mail or hard copy shall not be considered at all, therefore, you are requested not to send the subject details through e-mail or post or any other mode. It is also stated that no request for extension of time to upload the above details of students or any other excuse or reason of technical fault, etc. shall be considered, therefore, you are again requested to ensure and make available all arrangements at your end to complete the above task, in time, so as to avoid any litigation and to enable this Council to take necessary action in a time bound manner,” the notice added.

To view the full official notice click here: https://medicaldialogues.in/pdf_upload/lno5624-301633.pdf

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Study reveals why some medical cannabis patients use illegal products

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