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Ischemic stroke is the leading cause of disability and one of the leading causes of death. Ischemic stroke mimics (SMs) can account for a noteble number of diagnosed acute strokes and even can be thrombolyzed.The aim of our comprehensive review was to summarize the findings of different studies focusing on the prevalence, type, risk factors, presenting symptoms, and outcome of SMs in stroke/thrombolysis situations.Overall, 61 studies were selected with 62.664 participants. Ischemic stroke mimic rate was 24.8% (15044/60703). Most common types included peripheral vestibular dysfunction in 23.2%, toxic/metabolic in 13.2%, seizure in 13%, functional disorder in 9.7% and migraine in 7.76%. Ischemic stroke mimic have less vascular risk factors, younger age, female predominance, lower (nearly normal) blood pressure, no or less severe symptoms compared to ischemic stroke patients (p 0.05 in all cases). 61.7% of ischemic stroke patients were thrombolysed vs. 26.3% among SMs (p 0.001). (p 0.001). Overall intracranial hemorrhage was reported in 9.4% of stroke vs. 0.7% in SM patients (p 0.001). Death occurred in 11.3% of stroke vs 1.9% of SM patients (p 0.001). Excellent outcome was (mRS 0-1) was reported in 41.8% ischemic stroke patients vs. 68.9% SMs (p 0.001). Apart from HINTS manouvre or Hoover sign there is no specific method in the identification of mimics. MRI DWI or perfusion imaging have a role in the setup of differential diagnosis, but merit further investigation.Our article is among the first complex reviews focusing on ischemic stroke mimics. Although it underscores the safety of thrombolysis in this situation, but also draws attention to the need of patient evaluation by physicians experienced in the diagnosis of both ischemic stroke and SMs, especially in vertigo, headache, seizure and conversional disorders.

Aim. An evidence review on use of bismuth in irritable bowel syndrome.Key points. Irritable bowel syndrome (IBS) is a common functional disorder significantly impacting the quality of life and social status, i.a., through frequent manifestations of diarrhea. Postinfectious IBS emerges after a bacterial, pro-tozoan or viral intestinal disease. The new coronavirus pandemic supposedly affects most factors involved in functional disorder developments and may serve a fuelling cause of postinfectious IBS. Bismuth salts accumulate cytoprotective, anti-inflammatory and antibacterial properties. Therapeutic efficacy of bismuth compounds has been demonstrated in treatment of diarrhea-accompanied diseases of various etiology, including postinfectious IBS. The use of therapeutic-dosed bismuth preparations is safe and well tolerated by patients.Conclusion. Use of bismuth may be considered a treatment and prevention approach in diarrhea-predominant IBS, both in monotherapy and combined regimens.

Recently, there has been a significant growth in parasitic invasions among young children. At a younger age, parasitic infestations most often occur “under the mask” of gastroenterological pathology. At this age range, according to the domestic and world literature, functional diseases prevail. In May 2016, at the week of American gastroenterology, the Rome criteria IV were adopted. According to the the Rome criteria IV, as well as in the previous editions, it is suggested to prescribe therapy on the basis of the predominant symptom principle, giving preference to so-called complementary and alternative medicine, and, in particular, phytotherapy as additional therapy for the disease, but all also from the standpoint of evidence. The first such combined phytocomplex, which attracted interest from clinical researchers and patients, is Vormil Phyto — a mix of extracts of thirteen plants. The purpose of our research was the improvement of therapeutic approaches to the correction of the combined functional pathology of the biliary tract and parasitic invasion, as well as unassociated pathology of the biliary tract using phytocomplex Vormil Phyto in the main treatment regimens. Sixty children were divided into three groups: the first group with combined functional disorder of the biliary tract and parasitic infestation; the second group with a functional biliary tract disorder, received the phytocomplex Vormil Phyto; the third group with a functional biliary tract disorder, received traditional therapy. In the course of the research, data were obtained that indicate the effectiveness of the phytocomplex Vormil Phyto, which has not only an antihelmintic effect, but also normalizes the kinetics of the biliary tract that improves appetite rapidly and does not induce dyspeptic symptoms at earlier terms.

Актуальность. Как отмечают многие авторы, тяжесть течения и выраженность атопического дерматита (АД) во многом зависят от функционального состояния органов пищеварения. Цель: исследовать частоту и проанализировать особенности течения атопического дерматита у детей с нарушениями билиарной системы. Материалы и методы. Обследовано 168 детей в возрасте от 1 до 18 лет с АД. Диагноз АД у детей выставляли согласно диагностическим критериям J.M. Hanifin и G. Rajka (1980). Все пациенты и их родители были анкетированы с использованием карты обследования. Изучали общий и специфические IgE (педиатрическая панель). Состояние билиарной системы изучали с помощью ультрасонографии, биохимических показателей сыворотки крови. Статистическая обработка результатов исследований осуществлялась с помощью стандартных алгоритмов вариационной статистики. Результаты. По данным анкетирования выявлены следующие факторы риска развития АД у детей и подростков: наследственность (53,5 %), проявления аллергии на первом году жизни (62,5 %), высокие уровни IgЕ (52,3 %); факторы, способствующие обострению АД (триггеры): смешанные аллергены — 23,8 %, пищевые аллергены — 71,4 %, лекарственные аллергены — 17,8 %, бытовые аллергены — 5,9 %, пыльцевые аллергены — 3,4 %, температурный фактор — 1,7 %, психоэмоциональный фактор — 1,7 %, неустановленные — 24,6 %; искусственное вскармливание с рождения (13,1 %); общая продолжительность манифестации АД: до года — 11,3 %, от 1 до 5 лет — 44,9 %, от 5 до 10 лет — 23,8 %, более 10 лет — 20,3 %. Среднее значение по шкале SCORAD у пациентов с легкой степенью АД составило 14,01 ± 0,63 балла, со средней степенью АД — 31,04 ± 0,92 балла, у пациентов с тяжелой степенью — 56,17 ± 5,23 балла. Средний балл по шкале EASI у обследованных пациентов в возрасте от 5 до 7 лет составил 8,67 ± 0,46. Повышенный уровень IgE отмечался у 52,3 % детей. При активном опросе и осмотре признаки функционального расстройства билиарного тракта обнаружены у большинства пациентов — 109 (64,8 ± 3,2 %) детей. При УЗИ у 45 (42,8 %) из 109 детей, которые имели жалобы, установлена дисфункция желчного пузыря. Увеличение размеров печени (до 10 %) без изменения эхоструктуры и эхогенность наблюдалось у 26 (23,8 ± 0,8 %) детей с АД. Выводы. С учетом высокой частоты функциональных нарушений билиарного тракта детям с АД целесообразно проводить ультразвуковое исследование органов пищеварительной системы. На основе полученных данных важно проводить соответствующую коррекцию выявленных нарушений в комплексном лечении АД., Background. According to the data of numerous authors, the severity of atopic dermatitis (AD) strongly depends on the functional state of the digestive system. The purpose of the study is to analyze frequency and peculiarities of atopic dermatitis course in children with disorders in the biliary system. Materials and methods. A total of 168 children aged 1 to 18 years old with AD were studied. Diagnosis of AD in children was verified according to the diagnostic criteria of J.M. Hanifin and G. Rajka (1980). All patients and their parents were questioned using a survey record. General and specific IgE (pediatric panel) was determined. State of the biliary system was assessed using ultrasonography, biochemical parameters of blood serum. Statistical processing of research results was performed using standard algorithms of variation statistics. Results. According to the questionnaire results, the following risk factors for the development of AD in children and adolescents are found: burdened heredity (53.5 %), allergic manifestations during the 1st year of life (62.5 %), high IgE levels (52.3 %); factors causing exacerbation of AD (triggers): mixed allergens — 23.8 %, food allergens — 71.4 %, medicinal allergens — 17.8 %, household allergens — 5.9 %, pollen allergens — 3.4 %, temperature factor — 1.7 %, psychoemotional factor — 1.7 %, not specified — 24.6 %; artificial feeding from birth (13.1 %); the total duration of manifestation: up to a year — 11.3 %, from 1 to 5 years — 44.9 %, from 5 to 10 years — 23.8 %, more than 10 years — 20.3 %. The mean scoring value for SCORAD in patients with mild AD levels was 14.01 ± 0.63 points, with an average grade of AD of 31.04 ± 0.92 points, and in patients with severe degrees of 56.17 ± 5.23 points. The average score on the EASI scale in the examined patients aged 5 to 7 years was 8.67 ± 0.46 points. The elevated IgE level was registered in 52.3 %. The active survey and observation revealed the signs of functional disorder of the biliary tract in the majority of patients — 109 (64.8 ± 3.2 %) children. The ultrasound examination demonstrated gallbladder dysfunction in 45 (42.8 %) out of 109 children with complaints. Increase liver (up to 10 %) without changes in echostructure and echogenicity was observed in 26 (23.8 ± 0.8 %) children with AD. Conclusions. Given a high frequency of functional disorders of the biliary tract in children with AD, it is recommended to perform an ultrasound examination of the hepatobiliary system and to make the appropriate correction of the revealed violations in the complex treatment of AD on the basis of the obtained data., Актуальність. Як відзначають багато авторів, тяжкість перебігу та вираженість атопічного дерматиту (АД) багато в чому залежать від функціонального стану органів травлення. Мета: дослідити частоту та проаналізувати особливості перебігу атопічного дерматиту в дітей із порушеннями в біліарній системі. Матеріали та методи. Проведене дослідження 168 дітей віком від 1 до 18 років, хворих на АД. Діагноз АД у дітей встановлювали згідно з діагностичними критеріями J.M. Hanifin та G. Rajka (1980).Усі пацієнти і їх батьки були анкетовані з використанням карти обстеження. Визначали загальний та специфічні IgE (педіатрична панель). Стан біліарної системи вивчали за допомогою ультрасонографії, біохімічних показників сироватки крові. Статистична обробка результатів досліджень здійснювалась за допомогою стандартних алгоритмів варіаційної статистики. Результати. За даними анкетування виявлені такі фактори ризику розвитку АД у дітей і підлітків: обтяжена спадковість (53,5 %), прояви алергії на першому році життя (62,5 %), високі рівні IgЕ (52,3 %); чинники, що викликають загострення АД (тригери): змішані алергени — 23,8 %, харчові алергени — 71,4 %, лікарські алергени — 17,8 %, побутові алергени — 5,9 %, пилкові алергени — 3,4 %, температурний фактор — 1,7 %, психоемоційний фактор — 1,7 %, неуточнені — 24,6 %; штучне вигодовування з народження — 13,1 %. Загальна тривалість маніфестації: до року — 11,3 %, від 1 до 5 років — 44,9 %, від 5 до 10 років — 23,8 %, понад 10 років — 20,3 %. Cереднє значення за шкалою SCORAD у пацієнтів із легким ступенем АД становило 14,01 ± 0,63 бала, із середнім ступенем АД — 31,04 ± 0,92 бала, у пацієнтів із тяжким ступенем — 56,17 ± 5,23 бала. Середній бал за шкалою EASI в обстежених пацієнтів віком від 5 до 7 років становив 8,67 ± 0,46. Підвищений рівень IgE відзначався у 52,3 %. При активному опитуванні та огляді ознаки функціонального розладу біліарного тракту виявлені в більшості пацієнтів — 109 (64,8 ± 3,2 %) дітей. При УЗД у 45 (42,8 %) із 109 дітей, які мали скарги, встановлено дисфункцію жовчного міхура. Збільшення розмірів печінки (до 10 %) без зміни ехоструктури та ехогенності спостерігалося у 26 (23,8 ± 0,8 %) дітей із АД. Висновки. З огляду на високу частоту функціональних порушень біліарного тракту дітям з АД доцільно проводити ультразвукове дослідження органів гепатобіліарної системи. На основі отриманих даних важливо проводити відповідну корекцію виявлених порушень у комплексному лікуванні АД.

In Medical Science, Hoarseness is the term used to describe a change in normal quality of voice of a patient which is rough or harsh, lower in pitch and more or less discordant Depends on duration of illness, hoarseness can be divided into acute or chronic condition. The acute onset is more common and mainly caused by inflammation (acute laryngitis) chronic sinusitis acid reflux disease, excessive alcohol use, smoking and over use or misuse of voice whereas other cause may be, laryngeal trauma or thyroid surgery and systemic disease The aim of our study is to analyse clinical profile, assess different etiological factors and to find out common precipitating factors leading to hoarseness of voice.A total of 34500 patients visited OPD of Otolaryngology department from June 2017 to May2019. Out of these,253 cases presented with complaint of change in voice (Hoarseness). The incidence of hoarseness among total OPD patient was 0.73%. Among 253 cases ,165 (65.21%) were male and 88 (34.78%) were female. Male predominance was observed with Male: female ratio of 1.87:1 in this study. Majority of patients (22.13%) were reported in 51-60 years age group followed by 31-40 years age group (21.73%). Largest group of patients were housewives (19.76%), then farmer (19.36%%) and labour (18.57%). Rest was teacher (13.43%), singer (5.92%) politician (5.13%), policeman (1.97%) and sportsman (0.79%).Many predisposing factors were noted like tobacco chewing, smoking, alcohol drinking. Tobacco chewing (38.33%), smoking (33.99%) and alcohol consumption (15.81%) were most common predisposing factors in descending order. Functional disorder was reported in (5.13%) cases and vocal abuse in 2.37% cases. In present study most of the patients were referred for speech therapy and psychotherapy along with vocal conservation and maintenance of vocal hygiene.

Objective To study the value of the subjective visual vertical (SVV) in the diagnosis of vestibular migraine (VM). Methods This study recruited 128 VM patients and 64 age-matched normal subjects. We detected the SVV during the interval between attacks in both groups, in sitting upright, and the head tilted at 45° to the left or right. We then examined the correlation between the SVV results with the vestibular evoked myogenic potential (VEMP) and canal paresis (CP). Results It was found there was a significant difference in SVV at the upright position between VM patients and normal controls (P=0.006) and no significant difference was found at the tilts of 45° to the left or right between the two groups. The SVV results at the upright position were significantly correlated with cervical VEMP (P=0.042) whereas not significantly correlated with CP and VEMP. There existed no significant difference in the conformity to the Müller effect (M effect) between the two groups. ROC analysis exhibited that the sensitivity, specificity of SVVs at the upright were 67.200% and 62.500% respectively. The diagnostic value of SVV at the upright position was significantly higher than that at tilts of 45° to the left and right (P=0.006). Nonetheless the diagnostic accuracy was relatively low. Conclusion Abnormality in SVV possibly stems from the lasting functional disorder of cerebellar or high-level cortical centers in VM patients or is linked to the vestibular compensation. The SVV is of low diagnostic value for VM and the value of SVV in VM warrants further study.

Objective. To describe the basic predictors of developing dysfunction of temporomandibular joint (TMJ) in patients with maxillary dental anomalies. Materials and methods. An open, prospective, controlled clinical experimental study was carried out; 250 patients aged 18 to 35 (mean age 23.5 2.6 years) with maxillary dental anomalies including 134 persons with temporomandibular joint dysfunction and 116 with normal articular function were examined. Results. A multidimensional disperse analysis permitted to conclude that an extremely high (95100 %) probability of occurring temporomandibular joint dysfunction is determined with the presence of combination of two and more functional disorders with a complex of other (occlusive and cephalometric) preclinical markers of dysfunction; a high (7595 %) probability of development when one functional disorder is associated with a gnathic form of dentition occlusion anomaly; a medium degree (4575 %) of probability of occurring dysfunction with the presence of gnathic form of dentition occlusion anomaly with roentgenological changes in TMJ and the absence of functional signs; a low (1545 %) probability when detecting a dentoalveolar form of occlusion anomaly or dentition anomaly combined with roengenological changes in the joint and the absence of functional disorders; a very low (015 %) probability of dysfunction development with the presence of congested position of incisors, anomalies of separate teeth position in the sagittal plane in the frontal part and the absence of functional disorders. Conclusions. The knowledge of the above-mentioned predisposing factors (signs) of the disturbance of the joint function can be used as an instrument for prediction of the probability of developing the temporomandibular joint dysfunction in patients with maxillary dental anomalies.

Objective: to study the functional disorder, joint structural changes with acute phase parameters, and interleukin-1 beta (IL-1β) in patients with hand osteoarthritis (HOA). Materials and methods: the study included 52 women with HOA, the mean age was 63.4 (10.0) years old. The degree of functional impairment was evaluated according to the visual analogue scale (VAS) and the author’s questionnaire. The laboratory study included an assessment of ESR, C-reactive protein (CRP), and IL-1β levels in the blood. The instrumental diagnostic was performed by X-ray, ultrasonography (US), and magnetic resonance imaging (MRI) of the hand joints. Results: no significant data were obtained on the dependence of the severity of structural and functional disorders from ESR, CRP, and IL-1β levels (rConclusions: there was no correlation between HOA activity and CRP and IL-1β levels but some authors propose to use highly sensitive methods to detect CRP. The application of highly sensitive methods for CRP detection could reveal the association between this indicator and the HOA activity. The absence of dependence between IL-1β level and morpho-functional parameters agrees with the data obtained by other researchers. It is possible that the evaluation of the IL-1β level in dynamics can be useful for assessing the treatment response but this requires further studies.

Made available in DSpace on 2022-04-29T08:45:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-07-01 OBJECTIVE: To report the outcomes and complications of colored soft contact lenses (SCLs) to improve esthetic or eye function in visually impaired (VI) or blind patients. METHODS: This retrospective study enrolled consecutive patients with unilateral or bilateral VI or blindness who had received colored SCLs to improve appearance or ocular function. Data were collected on demographics, complaints, complete ophthalmological examinations, types of SCL, follow-ups, and complications. RESULTS: The study sample was comprised of 109 patients (ages 4-80 years). Eighty-six patients (78.89%) had unilateral blindness, and 14 patients (12.84%) had functional disorder. Most of the patients presenting for improved esthetic had anterior segment pathology (74/67.88%), mainly secondary to trauma (55/50.5%) resulting in leukoma (73/66.97%). Patients with functional VI (19/17.43%) received filtered SCLs for color blindness (7/6.42%), diplopia (7/6.42%), or photophobia (5/4.58%). No serious complications were observed in any cases, and 94.49% of patients were satisfied with the SCLs. CONCLUSION: Colored SCLs can cover ocular surface imperfections in VI or blind eyes of patients who are seeking better cosmesis or improvement functional VI. Soft contact lenses with only one filter can cover imperfections of the ocular surface and improve vision in functional VI. Appropriate follow-up of these patients can reduce complication rates, resulting in good cosmesis and patient satisfaction with a positive impact on the lives of patients suffering from functional VI or blindness. Eye Department of Contat lenses (P.P.Y. and V.F.S.), Hospital Sadalla Amin Ghanem, Joinville, SC, Brazil; Department of Ophthalmology (S.A.S.), Medical School, State University of Sao Paulo-UNESP, Botucatu, SP, Brazil; and Department of Biostatistic (C.R.P.), Biosciences Institute, State University of Sao Paulo-UNESP, Botucatu, SP, Brazil

Introdução: O bruxismo infantil é um ato inconsciente que pode estar atrelado a fatores hereditários e psicológicos, uma desordem funcional, que é caracterizada pelo típico ranger de dentes, com forças oclusais extremamente elevadas quando comparadas ao normal que são capazes de gerar, a médio e longo prazo, grandes consequências. Objetivo: Relatar um caso clínico de confecção e instalação de pistas diretas planas em paciente infantil, realizado na Clínica Escola de Odontologia da Universidade Federal de Campina Grande (UFCG), com intuito de considerar a eficácia do tratamento. Relato do caso: Este estudo apresenta o caso de um paciente infantil, 10 anos, que procurou atendimento odontológico com queixa de bruxismo. Através de anamnese e exame clínico, foi possível observar a presença dessa disfunção. O tratamento proposto foi instalação de pistas diretas planas em molares inferiores. O procedimento foi iniciado a partir da moldagem anatômica com moldeiras infantis 2 e alginato tipo ll, seguido de vazamento do molde em gesso. Com modelos vazados, utilizou-se resina composta e espátula de resina para confecção das pistas, foi realizado polimento das mesmas adaptadas no modelo com pedra pomes. A instalação, foi precedida por profilaxia, ataque ácido e enxague, inserção de adesivo e fotopolimerização. As pistas foram adaptadas individualmente com auxílio de resina flow e fotoativação nos elementos 74, 75, 84, 85. Conclusão: O tratamento escolhido baseou-se em técnica bastante prática e reversível, que demonstrou grande êxito e proporcionou relaxamento muscular com consequente ausência de sintomatologia.

Background Cognitive dysfunction is a functional disorder that occurs after brain tissue damage, which can be classified as mild, moderate, or severe according to the degree of illness, especially in the elderly. Mild cognitive impairment (MCI) has many causes and is difficult to treat. It has been reported that biopsychosocial holistic care models can achieve good results in treating MCI. This study aimed to explore the application effect of biopsychosocial holistic care models on elderly patients with MCI. Methods A total of 140 patients with MCI diagnosed in Nantong People's Hospital (Nantong, China) from March 2019 to March 2020 were selected as the research cohort. Using a computer-generated randomization list, the participants were randomly allocated to either the observation group or control group, with 70 cases in each group. We compared the cognitive function and quality of life scores of the 2 groups before treatment, 1 month after treatment, and 3 months after treatment. Results In the first and third months after the intervention, the mini mental state examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score of the observation group were higher than those of the control group, and activities of daily living (ADL) score was lower than that of the control group. The difference between MMSE and MoCA scores between the 2 groups of participants at the third month of treatment was statistically significant (P=0.000). Conclusions Biopsychosocial holistic care models can improve the cognitive function and quality of life of elderly MCI patients. Trial registration Chinese Clinical Trial Registry ChiCTR2100046021.

Each year many patients are admitted to the emergency department with a suspicion of acute ischaemic stroke (AIS). There are several conditions that can present with acute stroke-like symptoms, of which the most common are seizures, migraine and functional disorder. The latter are called functional stroke mimics (FSM). While the outcome of patients with AIS has extensively been studied, little is known about the outcome of FSM. Short-term follow-up studies in acute FSM have shown that about 80% of patients with FSM still reported symptoms after 2 months,1 but long-term follow-up studies are lacking. We therefore compared the long-term outcome in patients with FSM with patients diagnosed with mild AIS. ### Patient selection This single centre retrospective cohort study was performed in the University Medical Centre Groningen. Patients with FSM and AIS who presented between January 2016 and December 2018 were identified from a local patient registry. Inclusion criteria were: (1) suspicion of AIS by the ambulance; (2) age between 18 and 80 years; (3) mild–moderate symptoms (National Institutes of Health Stroke Scale (NIHSS) ≤10); (4) patients with AIS treated with intravenous thrombolysis; and (5) functionally independent at 3 months after admission (Modified Ranking Scale [mRS] 0–2). Final diagnosis was made by a vascular neurologist based on clinical information and imaging. Participants were approached 13–42 months after admission by mail to complete the questionnaires. Patients were also given the option to only rate their change in …

The primary treatment of tophaceous gout is to control the disease by pharmacological therapy. Additional surgical intervention is used to correct cosmetic deformation in joints or disabling functional disorder; however, one of its reported complications is hyperuricemia and recurrent attacks of pain. Objectives: to access the effectiveness of Low Intensity Laser therapy as addition to urate lowering treatment in patients with tophaceous gout, who underwent joints surgery in the Chengdu Rheumatism Hospital, in comparison to those patients who received only nonsurgical treatment. Subjects and methods. The effectiveness of Low Intensity Laser therapy (LILT) and urate lowering treatment in patients with tophaceous gout was investigated in 63 male patients of Chengdu Rheumatism hospital with tophaceous gout who underwent joints surgery. Control group was formed of 63 gout patients comparable in age and pre-treatment uric acid, who received non-surgical treatment.Results. Patients underwent surgery in one or two sessions, the most common lesion site being foot joints: toes (49.41%), ankle (39.68%) and knee (34.92%), with restricted mobility in the mentioned joints. Levels of CRP before the treatment were elevated in almost all patients (median 3.74 (0.2, 48.75) mg/L), regardless of the other comorbidities. Urate lowering therapy notably reduced the levels of CRP to 2.44 (0, 33.27) mg/L in study group and to 1.3 (0.13, 31.72) mg/L in controls. After surgery and following urate lowering therapy all patients noted functional improvement and reduction of pain. Decrease in serum urate levels were reported in 96.83% of patients in study group and in 93.65% of controls. There was no significant difference in serum UA between patients who underwent joint surgery and who didn’t. Patients, who in addition to surgery received Low-Level Laser Therapy therapy, had a lowest mean serum UA after treatment (280.93 ± 97.05 μmol/L), but due to wide range of variation, difference to other groups wasn’t statistically significant. Addition of laser therapy also helped to reduce the pain almost twice (0.56±0.56 compared to 1.04 ± 0.91). However, we haven’t registered notable anti-inflammatory influence of LILT. There was a weak direct link established between levels of serum UA and CRP after treatment, but in patients receiving laser therapy, CRP was elevated more often, compared to those who weren’t prescribed with LILT or controls. Conclusion. Arthroscopic shaving and other surgical approaches focused on joints often doesn’t affect system hyperuricemia in any way and can’t be viewed as a substitute to urate lowering therapy. However, our experience confirms that timely performed surgery contribute to functional improvement and reduction of pain in gout patients. Low Intensity Laser therapy doesn’t affect hyperuricemia or guarantee long-term systemic anti-inflammatory effect, but help to additionally relieve pain in joints and thus enhance treatment effect and quality of patients’ life.

Background and Summary: Chronic abdominal pain is a challenging complaint for both primary care providers and gastroenterologists alike, due to a broad differential diagnosis and sometimes extensive and negative workup. In the absence of red flag features that herald more acute conditions, the majority of patients with chronic abdominal pain have a benign cause or a functional disorder (e.g., irritable bowel syndrome). The costs associated with a diagnostic workup are an expensive burden to health care. A systematic approach for evaluating patients and initiating a management plan are recommended in the primary care setting. Undiagnosed abdominal pain should be investigated starting with a detailed history and physical examination. Diagnostic investigations should be limited and adapted according to the clinical features, the alarm symptoms, and the symptom severity. This review will focus on the diagnostic tools which general practitioners utilize in the evaluation of chronic abdominal pain. Key Messages: The primary role of the general practitioner is to differentiate an organic disease from a functional one, to refer to a specialist, or to provide treatment for the underlying cause of pain. The functional disorders should be considered after the organic pathology has been confidently excluded. Once a diagnosis of functional pain is established, repetitive testing is not recommended and the patient should be referred to receive psychological support (e.g., cognitive therapy) associated with available pharmacological therapeutic options.

Chronic constipation is a functional disorder that decreases a patient's quality of life (QOL). Because dysbiosis has been associated with constipation, we aimed to investigate the efficacy of Bifidobacterium bifidum G9-1 (BBG9-1) in improving QOL in patients with constipation. This was a prospective, single-center, non-blinded, single-arm feasibility trial. A total of 31 patients with constipation and decreased QOL received BBG9-1 treatment for 8 weeks, followed by a 2-week washout period. The primary endpoint was change in the overall Japanese version of the patient assessment of constipation of QOL (JPAC-QOL) score after probiotic administration relative to that at baseline. Secondary endpoints included changes in gut microbiota, stool consistency, frequency of bowel movement, degree of straining, sensation of incomplete evacuation, and frequency of rescue drug use. The overall JPAC-QOL scores and frequency of bowel movement significantly improved after BBG9-1 administration from those at baseline (p

Aim: To evaluate the relationship between the neurological outcome, neonatal epileptic seizures, and signal-intensity visibility of the frontal and parietal periventricular crossroads of pathways on brain magnetic resonance imaging (MRI) in preterm infants at term-equivalent age. ----- Methods: The study enrolled 48 preterm infants born between 2012 and 2016. The signal-intensity characteristics of the frontal and parietal periventricular crossroads were evaluated and classified into four grades. A non-favorable outcome was defined as a motor and functional disorder with developmental delay and/or cerebral palsy. ----- Results: Neonatal seizures, epilepsy, pathological EEG and brain ultrasound finding, and brain MRI abnormalities were mostly found in neonates with non-favorable outcomes. Visible frontal and parietal periventricular crossroads were associated with a normal neurologic outcome (P=0.0004; P=0.0009, respectively). Not-visible or slightly visible periventricular crossroads were associated with non-favorable outcomes in the case of frontal crossroads (P=0.036) and not-visible periventricular crossroads in the case of both frontal and parietal crossroads (P=0.001, P=0.015, respectively). The visibility of the frontal and parietal periventricular crossroads was associated with a lack of neonatal epileptic seizures (P=0.03; P=0.02, respectively). The frontal crossroads were more frequently slightly visible, while the parietal periventricular crossroads were more frequently visible. ----- Conclusion: Poor visibility of the frontal and parietal crossroads of pathways on MRI is associated with neonatal epileptic seizures and poor neurological outcomes in preterm infants at term-equivalent age.

Normal baseline investigation results in a patient with common symptoms is often labelled as being due to a functional disorder, with all the pejorative connotations that go along with that term. When given the opportunity to see a patient for a second opinion, it is important to retain an open mind rather than assuming previous assessments are correct. Such an attitude helps with both attaining the definitive diagnosis but is also crucial to helping give hope to the patient. Understanding the patient's concerns about the meaning of their symptoms is critical in finding the balance between advanced investigation to identify a putative cause versus a decision to proceed with symptomatic control.

Background: Irritable bowel syndrome is a functional disorder with recurrent abdominal discomfort associated with abnormalities in gut motility. One of the risk factors for IBS is anxiety and depression. This study aims to find out the relationship between medical student’s psychosocial conditions, measured by depression and anxiety with incidence of IBS. Gastrointestinal-specific anxiety (GSA), a subset of general anxiety, is measured and its relationship with incidence of IBS is also evaluated.Method: This research is a cross sectional study. Sample consists of 168 medical students from UPH batch 2016-2018 that fits into inclusion and exclusion criteria. Data is collected with demographics questionnaire, Rome IV IBS Criteria, Depression, Anxiety and Stress Scale 21, and Visceral Sensitivity Index. Categorical data between depression and anxiety and IBS is analyzed with Chi Square. GSA is a numerical data and its relationship with IBS is analyzed with t-test. Because GSA All statistical data is analyzed using SPSS version 22.0.Results: Results showed that from 168 samples that are acquired for this research, 65 (38,7%) are IBS and 103 (61,3%) are non-IBS. Significant associations are found between depression (p=0,03), anxiety (p=0,039), gastrointestinal-specific anxiety (p0,001), and obesity (p=0,026) with incidence of IBS.Conclusion: There is a significant association between depression and anxiety with incidence of IBS.

Rory C Monahan,1 Hannelore JL Beaart,1 Rolf Fronczek,2,3 Gisela M Terwindt,2 Liesbeth JJ Beaart-van de Voorde,1 Jeroen de Bresser,4 Margreet Kloppenburg,1,5 Nic JA van der Wee,6 Tom WJ Huizinga,1 Gerda M Steup-Beekman1,7 1Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; 2Department of Neurology, LUMC, Leiden, the Netherlands; 3Sleep-Wake Center SEIN, Heemstede, the Netherlands; 4Department of Radiology, LUMC, Leiden, the Netherlands; 5Department of Clinical Epidemiology, LUMC, Leiden, the Netherlands; 6Department of Psychiatry, LUMC, Leiden, the Netherlands; 7Department of Rheumatology, Haaglanden Medical Center, The Hague, the NetherlandsCorrespondence: Rory C MonahanDepartment of Rheumatology, Leiden University Medical Center (LUMC), Leiden 2333 ZA, the NetherlandsTel +3171-5265762Fax +3171-5266752Email r.c.monahan@lumc.nlPurpose: To evaluate the use of immunosuppressive treatment, clinical outcome and diagnostic strategy in patients with systemic lupus erythematosus (SLE) presenting with clinical features of transverse myelitis (TM), but normal MRI of the spinal cord (sMRI) and normal cerebrospinal fluid (CSF) assessment, and to suggest a clinical guideline.Patients and Methods: All patients with SLE and clinical features compatible with (sub)acute TM visiting the NPSLE clinic of the LUMC between 2007 and 2020 were included. Information on baseline characteristics, investigations, treatment and outcomes was collected from electronic medical records. In addition, a systematic review of individual participant data was performed up to April 2020 in PubMed, Embase and Web of Science, identifying all patients with TM, SLE and sMRI assessment. Data regarding sMRI, CSF analysis, treatment and outcome were extracted, and outcome was compared between patients with normal sMRI and CSF (sMRI-/CSF-) and patients with abnormalities.Results: Twelve SLE patients with a clinical diagnosis of TM were identified: four sMRI-/CSF- and one sMRI- with CSF not available. All patients received immunosuppressive treatment, but outcome in sMRI-/CSF- patients was worse: no recovery (n=1) or partial recovery (n=3) compared to partial recovery (n=4) and (nearly) complete recovery (n=3) in MRI+ patients. The systematic literature review yielded 146 articles eligible for inclusion, 90% case reports. A total of 427 SLE patients with TM were identified, of which only four cases were sMRI-/CSF- (1%), showing no improvement (n=1), partial improvement (n=2) and complete recovery (n=1) after immunosuppressive treatment.Conclusion: Outcome in SLE patients presenting with clinically suspected TM with normal sMRI and CSF is less favorable, despite treatment with immunosuppressive therapy. Taking a functional neurological disorder into consideration may be helpful in order to start other therapeutic strategies. We suggest prescribing immunosuppressive treatment for a restricted period of time to evaluate its effect in cases where a functional disorder initially is considered unlikely.Keywords: lupus, neuropsychiatric, transverse myelitis, MRI, CSF

ObjectiveTo describe clinical features relevant to diagnosis, mechanism, and etiology in patients with “scan-negative” cauda equina syndrome (CES).MethodsWe carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery center comprising semi-structured interview and questionnaires investigating presenting symptoms, neurologic examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress, and disability.ResultsA total of 198 patients presented consecutively over 28 months. A total of 47 were diagnosed with scan-positive CES (mean age 48 years, 43% female). A total of 76 mixed category patients had nerve root compression/displacement without CES compression (mean age 46 years, 71% female) and 61 patients had scan-negative CES (mean age 40 years, 77% female). An alternative neurologic cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow-up. Patients with scan-negative CES had more positive clinical signs of a functional neurologic disorder (11% scan-positive CES vs 34% mixed and 68% scan-negative,p< 0.0001), were more likely to describe their current back pain as worst ever (41% vs 46% and 70%,p= 0.005), and were more likely to have symptoms of a panic attack at onset (37% vs 57% and 70%,p= 0.001). Patients with scan-positive CES were more likely to have reduced/absent bilateral ankle jerks (78% vs 30% and 12%,p< 0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention.ConclusionThe first well-phenotyped, prospective study of scan-negative CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurologic disorders may be relevant.

Irritable bowel syndrome (IBS) – a recurrent functional disorder of the gastrointestinal tract (GIT), the main symptom of which is abdominal pain necessarily associated with a change in intestinal function. IBS is a functional intestinal disorder in which recurrent abdominal pain is associated with a defecation act and a change in the frequency or shape of the stool. The diagnosis of IBS remains exclusively clinical. The difficulty in studying IBS, especially from the perspective of its epidemiology, is that there is still no universal and specific biological marker. Very often patients complain about symptoms typical for several functional disorders, in particular, biliary tract pathology and IBS. The article discusses the multi-component causes and mechanisms of IBS formation, which are also present in other functional gastrointestinal tract diseases. Patients with IBS often have functional disorders of the biliary tract (FDBT) that are not associated with organic pathology. There are no reliable differences in the frequency and nature of FDBT in patients with IBS, depending on its current variant - with constipation or diarrhea prevalence. As a result, the treatment of patients with IBS remains a challenge, and the recurrence of the disease depends on the state of psycho-emotional health, the presence of overlap syndrome in most cases. The article presents the main international criteria for diagnostics of IBS. The main approaches to the treatment of IBS are considered. Good results in the treatment of IBS are observed when using drugs that affect the complex of pathophysiological mechanisms of the disease. This is confirmed in the article by a clinical case study. The prescription of the Sparex drug for pain relief in a patient with IBS and FDBT is justified by the fact that it not only eliminates pain, but also improves the rheological properties of bile, typical for overlap “IBS-FDBT” syndrome.

Intrinsic disorder can be found in all proteomes of all kingdoms of life and in viruses, being particularly prevalent in the eukaryotes. We conduct a comprehensive analysis of the intrinsic disorder in the human proteins while mapping them into 24 compartments of the human cell. In agreement with previous studies, we show that human proteins are significantly enriched in disorder relative to a generic protein set that represents the protein universe. In fact, the fraction of proteins with long disordered regions and the average protein-level disorder content in the human proteome are about 3 times higher than in the protein universe. Furthermore, levels of intrinsic disorder in the majority of human subcellular compartments significantly exceed the average disorder content in the protein universe. Relative to the overall amount of disorder in the human proteome, proteins localized in the nucleus and cytoskeleton have significantly increased amounts of disorder, measured by both high disorder content and presence of multiple long intrinsically disordered regions. We empirically demonstrate that, on average, human proteins are assigned to 2.3 subcellular compartments, with proteins localized to few subcellular compartments being more disordered than the proteins that are localized to many compartments. Functionally, the disordered proteins localized in the most disorder-enriched subcellular compartments are primarily responsible for interactions with nucleic acids and protein partners. This is the first-time disorder is comprehensively mapped into the human cell. Our observations add a missing piece to the puzzle of functional disorder and its organization inside the cell.

Facial palsy (FP) is a functional disorder of the facial nerve involving paralysis of the mimic muscles. According to the principle “time is muscle,” early surgical treatment is tremendously important for preserving the mimic musculature if there are no signs of nerve function recovery. In a 49-year-old female patient, even 19 months after onset of FP, successful neurotization was still possible by a V-to-VII nerve transfer and cross-face nerve grafting. Our patient suffered from complete FP after vestibular schwannoma surgery. With continuous application of electrostimulation (ES) therapy, the patient was able to bridge the period between the first onset of FP and neurotization surgery. The significance of ES for mimic musculature preservation in FP patients has not yet been fully clarified. More attention should be paid to this form of therapy in order to preserve the facial musculature, and its benefits should be evaluated in further prospective clinical studies.

This case report describes a 60-year-old female patient diagnosed with intercostal neuropathy and vertebral compression fractures which occurred following an electric shock injury. The patient received acupuncture, pharmacopuncture, and herbal medicine administration between February 10th, 2020 and April 25th, 2020. The pain level in the thoracic and left intercostal areas was assessed using the Numerical Rating Scale. The Self-report of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale were used to diagnose neuropathic pain. The Neuropathic-Pain -Scale was used to evaluate the degree of neuropathic symptoms. The Oswestry Disability Index and the European Quality of Life-5 Dimensions were used to assess quality of life scales and functional disorder. Following combined Korean medicine treatment, the patient exhibited reduced levels of pain and significant improvement in functional disorder symptoms and quality of life.

Background. Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. Laparoscopic ISR and robotic ISR have been widely used with the proposal of 2 cm or even 1 cm rule of distal free margin and the development of minimally invasive technology. The aim of this review was to describe the newest advancements of ISR. Methods. A comprehensive literature review was performed to identify studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, oncological outcomes, and functional outcomes and thereby to summarize relevant information and controversies involved in ISR. Results. Although PCRT is employed to avoid positive circumferential resection margin (CRM) and decrease local recurrence, it tends to engender damage of anorectal function and patients’ quality of life (QoL). Common complications after ISR include anastomotic leakage (AL), anastomotic stricture (AS), urinary retention, fistula, pelvic sepsis, and prolapse. CRM involvement is the most important predictor for local recurrence. Preoperative assessment and particularly rectal endosonography are essential for selecting suitable patients. Anal dysfunction is associated with age, PCRT, location and growth of anastomotic stoma, tumour stage, and resection of internal sphincter. Conclusions. The ISR technique seems feasible for selected patients with low rectal cancer. However, the postoperative QoL as a result of functional disorder should be fully discussed with patients before surgery.

Irritable bowel syndrome is a chronic functional disorder of the intestine, manifested by altered intestinal habits and recurrent abdominal pain in combination with two or more criteria: association with defecation, association with a change in the frequency of defecation, association with a change in the appearance of the stool. To date, IBS remains a diagnosis of exclusion that needs to be differentiated from a wide range of organic diseases. In recent years, a large number of publications have appeared on the research of etiopathogenesis, diagnosis and treatment of IBS. This literary review highlights the problems of searching for biomarkers of IBS as a way to solve the problem of diagnosis of this pathology and understanding the causes of its occurrence.

Background Low anterior resection syndrome (LARS) is a common functional disorder after low anterior resection impacting the quality of life. Data on LARS derives nearly exclusively from rectal cancer studies. Therefore, the study was designed to assess LARS in advanced epithelial ovarian cancer (EOC) patients, who underwent rectal resection and to compare it with a female rectal cancer cohort. Material and methods A cross-sectional multi-centre analysis was performed on female patients suffering from either rectal or EOC who received a low anterior resection as part of their therapy regimen. None of the patients received pre- or postoperative radiotherapy. LARS was defined by using the validated LARS score and its severity was divided into “no”, “minor” and “major LARS”. Results In total, 125 female patients (44.8% (n = 56) EOC vs. 55.2% (n = 69) rectal cancer patients) met the final inclusion criteria and were retrospectively analyzed. Baseline characteristics were comparable between the groups. Median follow-up was 22 (IQR 12–56) months. In total, 30.4% (n = 38) of the patient group reported bowel dysfunction after surgery. Rates of LARS were not significantly different between EOC and rectal cancer patients (major LARS 16.1% (n = 9) vs. 15.9% (n = 11); minor LARS 17.9% (n = 10) vs. 11.6% (n = 8); p = 0.984). The time interval between surgery and final assessment had no impact on the postoperative bowel function (p = 0.820). Conclusion LARS is a frequent and highly underreported postoperative disorder in EOC patients who require cytoreductive surgery with rectal resection. The functional outcome is comparable to female patients with rectal cancer who underwent low anterior resection without receiving radiotherapy.

Background A recent investigation reported that 92.7% Japanese family physicians have prescribed Kampo medicine (KM). KM can treat a wide variety of conditions from mental disorders to physical weaknesses. However, the characteristics and course of patients treated with KM at the Department of General Medicine remain unclear. Aims To investigate the characteristics and course of patients treated with KM in our hospital. Methods Data on medical history, complaints, course after Kampo treatment, and Hamilton Depression Rating Scale (HAM‐D) scores were retrogradely collected. The background of patients who received Kampo treatment was compared to that of patients who did not. Result Of 362 patients, 51 were treated with KM. Symptoms for which KM was prescribed included pain, general malaise, or sensory disturbance of extremities. All patients treated with KM were screened and initially diagnosed with a functional disorder or noncritical condition. KM including a crude drug of saiko such as hochuekkito, shigyakusan, shosaikoto, and yokukansan, was frequently prescribed for patients. Subjective symptoms showed improvement (53%) and no change (47%), while worsening was not observed in any patient. HAM‐D scores showed that patients treated with KM had higher anxiety levels and related symptoms as well as a higher frequency of mental disorders prior to presenting at the hospital. Conclusion Most complaints of the patients treated with KM were pain, general malaise, and sensory disturbance. KM is more likely to be prescribed in patients with health‐related anxiety or a history of mental disorders., Kampo medicine is more likely to be prescribed in patients with health‐related anxiety or a history of mental disorders who visit the Department of General Medicine.

ObjectiveIrritable Bowel Syndrome (IBS) is among the most unknown psychosomatic disorders in the field of gastroenterology. IBS is a chronic, disabling, and functional disorder of the gastrointestinal tract. Moreover, it is characterized by recurrent abdominal pain, bloating, and changes in bowel habits in the absence of identifiable structural diseases. The present study aimed to evaluate the effects of group logotherapy on the IBS symptoms and Quality of Life in patients with IBS.MethodsIn a randomized clinical trial study, 30 IBS patients were selected; of them, 15 took part in 10×1 group therapy, and 15 were the controls. The data gathering tools included the IBS Severity Scoring System (IBS-SSS) for assessing the severity of IBS and the Irritable Bowel Syndrome Quality of Life (IBS-QOL) questionnaire. These inventories were completed in 3 stages of pre-test, Post-test, and follow-up. The collected data were analyzed using descriptive statistics and Multivariate Analysis of Covariance (MANCOVA) in SPSS. ResultsThe mean scores of the experimental group, including pre-test (50.97), Post-test (30.50), and follow-up (25.83) phases, revealed significant changes in the studied patients’ Quality of Life and decreased IBS severity scores. Moreover, these results remained consistent in the follow-up study that indicated a significant decrease in the IBS severity and Quality of Life of the patients (P

Objective The aim: To summarize the literature data on abnormal uterine bleeding in adolescents. Patients and methods Materials and methods: This article presents an assessment of 32 literary sources from 2003 to 2018, which raise the issues of etiology and pathogenesis of abnormal uterine bleeding in adolescents. Abnormal uterine bleeding in adolescents (AUBA) is a risk factor for disorders of menstrual and generative function, hormone-related abnormalities in the reproductive age. Despite the progress made in the development of methods for the diagnosis and treatment of AUBA, the criteria for selecting a particular method of diagnosis and therapy have not yet been made sufficiently clear. Conclusion Conclusions: AUBA is a complex polyetiological disease affecting all parts of the hypothalamic-pituitary-adrenal-ovarian system. It has a negative impact on the girl's health and quality of life. Abnormal uterine bleeding is a "signal" to the body of an organic or functional disorder. If this feature is ignored, the pathology can progress and lead to severe consequences. The urgency of the problem of AUBA is further explained by the fact that this disease indicates the presence of serious disorder of the reproductive system, which in the future may be transformed into impaired reproductive function.

Whereas functional symptoms are common in Parkinson's disease (PD), a parkinsonian syndrome may occasionally reflect a pure functional disorder (also named functional parkinsonism [FP]). This review aimed to decipher these entities to clarify the link between functional manifestations and PD.Following the PRISMA guidelines, the authors performed a systematic literature search of the PubMed and Science Direct databases for the period 1988 to December 2018 to identify studies of patients with either FP or PD associated with functional neurological symptoms.From the 844 articles screened, 22 were retained, including 12 studies of functional neurological symptoms in PD and 16 studies of FP. The studies of functional symptoms in PD included 121 patients-57% were women, and the mean age was 61.3 years. Psychiatric history (mostly depression) and exposure to triggering stressors were frequent: 60% and 82.5%, respectively. The most common symptom was tremor (33.8%), most often located on the side most affected by PD (50%). Studies of FP included a total of 120 patients-62% were women, and the mean age was 50.7 years. The first FP symptoms appeared on average 5 years before diagnosis, with an abrupt onset in half the cases; 67.6% had a psychiatric history, and 46.8% were exposed to triggering stressors, such as physical injury, stress at work, or loss of family or friends.Findings suggest a possible relationship between PD and FP. Clinicians should keep in mind the possibility of functional symptoms in PD patients.