Search

The non-enzymatic interaction of sugar and protein resulting in the formation of advanced glycation end products responsible for cell signaling alterations ultimately leads to the human chronic disorders such as diabetes mellitus, cardiovascular diseases, cancer, etc. Studies suggest that AGEs upon interaction with receptors for advanced glycation end products (RAGE) result in the production of pro-inflammatory molecules and free radicals that exert altered gene expression effect. To date, many studies unveiled the potent role of synthetic and natural agents in inhibiting the glycation reaction at a lesser or greater extent. This review focuses on the hazards of glycation reaction and its inhibition by natural antioxidants, including polyphenols.

Background Aging is the irreversible change in the human physiology which occurs with the passage of time and it becomes very much critical to recommend drugs among the geriatrics patients because their body response is quite different. Objectives The purpose of the current study is to assess and evaluate the potentially inappropriate medications among the geriatric patients at the tertiary care Hospital of Larkana Sindh which is the biggest Hospital in the Northern Part of Sindh. Methods The descriptive cross-sectional study was conducted which included the 500 patients aged more than 60 years. The data was collected from the patients' case charts and the questionnaire distributed among the patients. BEERS′ criteria was used to detect the frequency of chronic disorders in geriatric patients and appraise the polypharmacy. Results The male patients were 42.6% and the female patients were 57.4%. The inappropriate medication use (IMU) was observed among 22.6% patients. Inappropriate antibiotics were seen in 35.39%, Benzodiazepine 28.32%, non-steroidal anti-inflammatory drugs (NSAIDs) 15.04%, cardiovascular system (CVS) drugs 12.39% of patients. Parenteral route of administration was observed in 70.04% of patients. Conclusion Polypharmacy is highly prevalent in the prescriptions of geriatrics patients, due to certain reasons like a chronic disease. Clinical Pharmacist can be better placed to provide his professional activities in this context.

INTRODUCTION: Elderly people have multiple diagnoses with similar patterns that can be analyzed by the theory of complex networks. Chronic disorders with repercussions on functional capacity tend to increase in number and severity in these individuals, requiring an integrated analysis to understand the relationship between aging and multimorbidities. OBJECTIVE: To analyze patterns of interaction between diseases that affect elderly people in a reference center. MATERIALS AND METHODS: Clinical data and diagnosed diseases were collected from 2973 medical records of elderly people registered at a reference center for elderly health care. Diseases were considered nodes in the network and the elderly were considered to be rough edges. The weight of the edges corresponded to the number of elderly people with two diseases simultaneously. Through the Gephi software (version 0.9.2), the degree of connectivity between diseases (degree of entry), the interaction of diseases in subgroups (Community), most influential diseases (Hubs), and diseases that act as bridges between two or more communities were analyzed. RESULTS: 30 nodes (diseases) and 433 edges with different weights were identified according to the number of elderly people, and 3 communities where the degree of connectivity is greater among themselves. Systemic Arterial Hypertension (SAH) was the most influential hub in the network. CONCLUSION: The construction of the complex network mapped diseases and the influence on care for the elderly. Relevant information for local managers, in search of effective interventions in the service that aims to contribute to the prevention of the main comorbidities and assist in the functional independence of patients.

The conditions used to describe the presence of an immune disease are often represented by interaction graphs. These informative, but intricate structures are susceptible to perturbations at different levels. The mode in which that perturbation occurs is still of utmost importance in areas such as cell reprogramming and therapeutics models. In this sense, module identification can be useful to well characterise the global graph architecture. To help us with this identification, we perform topological overlap-related measures. Thanks to these measures, the location of highly disease-specific module regulators is possible. Such regulators can perturb other nodes, potentially causing the entire system to change behaviour or collapse. We provide a geometric framework explaining such situations in the context of inflammatory bowel diseases (IBD). IBD are severe chronic disorders of the gastrointestinal tract whose incidence is dramatically increasing worldwide. Our approach models different IBD status as Riemannian manifolds defined by the graph Laplacian of two high throughput proteome screenings. It also identifies module regulators as singularities within the manifolds (the so-called singular manifolds). Furthermore, it reinterprets the characteristic nonlinear dynamics of IBD as compensatory responses to perturbations on those singularities. Then, particular reconfigurations of the immune system could make the disease status move towards an innocuous target state.

Diabetes self-management is a complex process and central to well-being of patients with this chronic disorder. A patient-centered telehealth program may potentially meet needs of those in underserved populations to reduce socioeconomic disparities. Achieving this goal requires a focused concentration on health behaviors and practices of individuals in underserved populations.

OBJECTIVE: Drug utilization habits of the pregnant are a critical aspect of rational use of the medicine (RUM). This study aimed to analyze the RUM related attitudes and the behaviors of women during their pregnancies. METHODS: The data were collected between May 2016–October 2016 by conducting surveys to 71 pregnant women admitted to the private and governmental hospitals in five districts of Northern Cyprus. The sociodemographic characteristics of the pregnant as well as their attitudes and behaviors concerning drug use were evaluated. RESULTS: The mean age and the gestational week of the patients was 29.7±4.3 years and 25.7±11.2 weeks, respectively. Planned pregnancies constituted 71.8% of all. The percentage of patients with an unplanned pregnancies who were using drugs at the time of the survey (25.0%) was lower than that in those with planned pregnancies (49.0%, p

Migraine is a common, chronic disorder that often manifests in childhood. This article discusses the prevalence, diagnosis, and clinical management of uncommon subtypes of migraine with aura, including hemiplegic migraine, retinal migraine, and abdominal migraine.

PurposeThe use and abuse of alcohol is problematic for a person’s social and individual development. Maintenance of abstinence after detoxification programs is difficult for patients who experience a craving, and relapses during the course of the disorder are common. The purpose of this paper is to describe the socio-demographic and clinical features of alcohol-dependent patients by sex and alcohol use status and to analyze the percentage of patients who remained abstinent after 10 months of psychological treatment.Design/methodology/approachIn total, 50 alcohol-dependent patients were enrolled (34 men and 16 women). The patients attended a psychological treatment program at a therapeutic community, Projecte Home Balears, Spain. This paper used the European Addiction Severity Index to collect socio-demographic data and data on alcohol and other drugs and the Trait Meta-Mood Scale-24 to measure emotional management.FindingsSignificant differences were observed in occupation (χ²= 9.9; p = 0.007) and duration of alcohol use (U = 137.000; p = 0.005) by sex and hospitalizations during the previous months (χ²= 15.477; p = 0.009) and type of chronic disorder (χ²= 7.6; p = 0.022) and duration (in months) of the longest period of abstinence after treatment in facilities (U = 219.500; p = 0.097) by alcohol use status. The survival analysis showed that 25% of relapses happened after 4.5 months of treatment; at 7.3 months, 50% of the sample remained abstinent.Originality/valueWomen had used alcohol for longer since age at onset than men. Furthermore, after 7.3 months of intensive therapy, 50% of alcohol-dependent patients were abstinent.

Introduction: The major chronic disorders such as cancer, cardiac ailments and diabetes are global health burden and the dietary habits playing a significant role in setting these among other factors. There is an assumption that non-vegetarian diet produces more free radicals (FR) when compared to vegetarian food. However recent studies showed an equal contribution of FR injury in vegetarians too. The assessment of the FR markers may provide an analytical report in correlation with different dietary pattern. Materials and Methods: In this comparative study, the individuals (age group of 15 to 50 years) with their dietary habits of vegetarian (n=60) and of non-vegetarian diet (n=60), were included. The serum was analysed for the parameters, fasting blood sugar (FBS), Lipid Profile, MDA, IMA and oxidised LDL (oxLDL). The quantitative variables were analysed by appropriate statistical methods and the p value is considered statistically significant. Results: The comparative values are expressed as mean SD for vegetarians and non-vegetarian groups and it is evident that the FBS and lipid profile and oxLDL were statistically non-significant. Malondialdehyde (MDA) and Ischemia modified albumin (IMA) are significantly raised in non-vegetarian group in comparison to the vegetarian group (p Conclusion: Based upon the dietary patterns in the healthy individuals, the oxidative stress markers i.e. MDA, IMA are showed conspicuous difference and oxLDL is not significant. The ratio of IMA/MDA in non vegetarians has been considered for the intensity of the oxidative stress beyond the specified ratio (18.44). Keywords: Oxidative stress, Dietary patterns, Vegetarians, Non vegetarians, Oxidised LDL, Malondialdehyde, Ischemia modified albumin

With the change of life style, glucolipid metabolic disorders (GLMD) has become one of the major chronic disorders causing public health and clinical problems worldwide. Previous studies on GLMD pay more attention to peripheral tissues. In fact, the central nervous system (CNS) plays an important role in controlling the overall metabolic balance. With the development of technology and the in-depth understanding of the CNS, the relationship between neuro-endocrine-immunoregulatory (NEI) network and metabolism had been gradually illustrated. As the hub of NEI network, hypothalamus-pituitary-adrenal (HPA) axis is important for maintaining the balance of internal environment in the body. The relationship between HPA axis and GLMD needs to be further studied. This review focuses on the role of HPA axis in GLMD and reviews the research progress on drugs for GLMD, with the hope to provide the direction for exploring new drugs to treat GLMD by taking the HPA axis as the target and improve the level of prevention and control of GLMD.

Introduction Allergic fungal rhinosinusitis (AFRS) is a chronic disorder with significant morbidity and a high recurrence rate needing long-term follow-up. Even after its first description many decades ago, there is still considerable uncertainty about the management of this condition. Description In this chapter, we breakdown the topic "Optimal management of allergic fungal rhinosinusitis" into sub-headings in order to discuss the latest research and available literature under each topic in great detail. Every attempt has been made to incorporate the highest level of evidence that was available at the time of writing. Summary Pre-operative diagnosis and further management prior to surgery is important. Steroids help in reducing inflammation and help improve the surgical field. Surgery remains the mainstay in the management of this condition along with long-term medical management. Oral steroids are reserved for acute flare-ups in the background of associated lung concerns. Oral and topical antifungal agents have no role in the control of the disease. Biological agents are being prescribed predominantly by respiratory physician colleagues, mainly for the control of the chest-related issues rather than for sinus disease. Immunotherapy as an adjunct with surgery is promising. Conclusion AFRS is a disease with many variables and a wide range of symptomatic presentation. It takes a keen clinician to identify the disease and subsequently manage the condition. Treatment involves long-term follow-up with early detection of recurrence or flare-ups. Any of the mentioned modalities of management may be employed to effectively control the condition, and treatment protocols will have to be tailor-made to suit each individual patient. Various medications and drugs such as Manuka honey, antimicrobial photodynamic therapy, hydrogen peroxide and betadine rinses appear to be promising. More robust studies need to be undertaken to ascertain their routine use in clinical practice.

Background Epilepsy is the commonest serious neurological condition of childhood. It is a group of chronic disorders in which the indispensable feature is recurrence of seizure. Parents play the most significant role in caring for their children and helping them adapt to their conditions ,especially mothers. The aim of the present study was to assess parents` knowledge, practice and attitude toward care for their epileptic children at Helwan General Hospital, and Helwan fever Hospital. A descriptive design was conducted on a sample of 100 parents of children with epilepsy at the pediatric neurology outpatient clinic and in-patient units at Helwan General Hospital, Helwan Fever Hospital in Elkahera Governorate, Egypt .Three tools were used in this study, the first was a questionnaire interview sheet to collect data about studied parents and their children, and to assess parents` knowledge about epilepsy .The Second was seizure severity scale. The Third tool was a questionnaire sheet about parents`s knowledge regarding practices in caring for their epileptic children. Results indicated that the majority of the studied parents` (mothers) had a poor knowledge score about epilepsy while ,75/ had moderate knowledge score (Satisfactory level). Most of the studied parents` total care practices score was incompetent. More over there was a positive correlation between parents` total knowledge score and their total knowledge about care practices score with person`s correlation coefficient (r= 0.43, p= 0.001). Based n the result of the present study.it could be recommended that the educational programs for parents of epileptic children about epilepsy and its care should be conducted and establishing a standard of care for children with epilepsy in hospital and clinics is essential.

International audience; Background: Crohn's disease (CD) is a chronic disorder requiring long-term treatment. However, up to 20% of patients interrupt temporarily or permanently anti-TNFα. Primary aim was to identify internal and external factors influencing patient's motivation to pursue anti-TNFα in active CD.Methods: This was a French, multicentre, prospective study enrolling CD patients on anti-TNFα therapy since more than 3 months. Patients completed the Satisfaction of Patients with Crohn's Disease questionnaire (SPACE-Q) and other patient-reported-outcome tools at inclusion visit, and after 6 and 12 months.Results: A total of 274 patients were included: 146 (53.3%) received adalimumab, while 128 (46.7%) infliximab. Most patients (78%) were still treated with anti-TNFα 12 months after enrolment. Patients' perception of necessity (p = 0.01) and concerns (p

Narcolepsy type 1 is a debilitating chronic neurological disorder, whose main symptoms of excessive daytime sleepiness and cataplexy may partially improve with time, but typically do not fully resolve. The irreversible loss of orexin neurons is considered to be the pivotal mechanistic link underlying the development of cataplectic attacks in narcolepsy type 1. Here we describe a case of untreated narcolepsy type 1with low cerebrospinal orexin levels (< 50 pg/mL), where cataplexy fully resolved in the first 5–6 years after disease onset, whereas excessive daytime sleepiness persisted. CITATION: Wasserman D, Bassetti CLA, Rosenzweig I. Narcolepsy with resolution of cataplexy and persisting orexin deficiency. J Clin Sleep Med. 2020;16(8):1383–1386.

Wound healing is affected by several factors. Preexisting diagnoses may significantly alter, delay, or inhibit normal wound healing. This is most commonly seen with chronic disorders, such as diabetes and renal failure, but also occurs secondary to aging and substance abuse. Less commonly, genetic or inflammatory disorders are the cause of delayed wound healing. In some cases, it is not the illness, but the treatment that can inhibit wound healing. This is seen in patients getting chemotherapy, radiation, steroids, methotrexate, and a host of other medications. Understanding these processes may help treat or avoid wound healing problems.

BACKGROUND AND AIMS: Physical activity is beneficial in several chronic disorders including Crohn′s disease, but the preferred type of exercise is unknown. Our study aimed to examine and compare the safety, feasibility and potential beneficial effects of individual moderate endurance and moderate muscle training in patients with Crohn’s disease. METHODS: Quiescent or mildly active (Crohn’s disease activity index

AIM A chronic disorder of consciousness (DOC) is a devastating condition for the patients and their families. Achieving improved communication with patients in this state is of utmost importance. Over recent years we have seen some progress in the development of rehabilitation protocols for patients with DOC by which the patient's limited actions impact the environment (e.g. activate music) based on the principle of contingent stimulation. However, one of the major factors, which hinders further progress, is the limited overt responsiveness of the patient, which poses a severe limitation on the ability of the therapists to evaluate whether specific interventions have an impact. In this work, we harness a novel electrophysiological marker the Brain Engagement Index (BEI), which enables simple monitoring of patient's engagement during interventions, intending to overcome this limitation. METHODS We combine the BEI marker with the contingent stimulation principle, to propose a 4-levels protocol for advancing communication with DOC patients. RESULTS The potential of the evolving protocol is demonstrated with 4 representative case reports. Each case report demonstrates one level of the protocol. CONCLUSIONS The protocol seems to be both feasible and effective for better clarification of the communication abilities of DOC patients. We recommend its continued evaluation employing a more structured study.IMPLICATIONS FOR REHABILITATIONWe suggest a systematic method for rehabilitation of patients with disorders of consciousnessIt is based upon monitoring patient engagement in real-time and selecting interventions accordingly.

Mitochondrial dysfunction underlies a vast array of chronic disorders across the life span. The asymptotic limit theorems of information and control theories, supplemented by symmetry-breaking phase transition arguments adapted from physical theory, give deep insight into canonical mechanisms of cognition and regulation associated with such dysfunction. The probability models studied here can provide a foundation for the development of statistical tools useful in clinical and public health address of those disorders.

Background Skin alterations are usually related to chronic diseases that demand sustained and long-term dosages; hence, it is pivotal that the stability of treatments is preserved. A novel storable and endogenous topical serum (ES) based on the patient's own blood has been recently developed. Aims To investigate the long-term stability of the formulation and to provide preliminary data of its biologic potential. Methods Samples from six donors were obtained and either used as fresh samples or cold-stored for 6 months. Physicochemical, rheological, and biological stability of the formulation was determined. Results Endogenous topical serum maintained unaltered its organoleptic properties, viscosity, pH, spreadability index, and sterility. The growth factor content including TGFβ-I, EGF, PDGF-AB, HGF, and Ang-I showed no decrease. In contrast, ES showed lower levels of IGF-I once stored. Dermal fibroblasts showed no change in their proliferative activity. Conclusion Endogenous topical serum showed to maintain its physicochemical and biological properties after six months of storage. ES might reduce the frequency of blood extractions and would enable patients with chronic disorders to maintain a daily use of the product in a minimally invasive way.

Introduction: Physical inactivity is reported among 41% of Nigerians and 73.8% of adults in Calabar have been reported to be either overweight or obese. Obesity is a chronic disorder marked by excessive generalized deposition and storage of fat in human body. It is indicated by a Body Mass Index of 30kg/m2 and above. The objective of this study was to determine the prevalence of overweight and obesity among the staff of the University of Calabar, Calabar, Nigeria.Methods: A total of 321 staff in University of Calabar participated in this cross sectional study. A multi-stage sampling technique was employed to select faculties, departments, offices and respondents. Data was collected using a semi-structured and self administered questionnaire, a well calibrated weighing scale, a calculator and a checklist. Data analysis was done using IBM Statistical Package for Social Sciences version 20.0.Results: Of the 321 respondents, 55.1% were males and 60.0% were non-teaching. One hundred and twenty nine (40.0%) of the staff were 31-40 years. A total of 43.6% had normal weight, 35.5% were overweight while 19.6% were obese. A total of 45.1% were estimated to be physically inactive and 24.0% did not intend to begin exercises within the next six months. Majority, 91.3% of respondents were knowledgeable about overweight/obesity and 60.4% correctly mentioned at least one possible health implication of overweight/obesity but only 24.3% could define overweight and obesity based on Body Mass Index and most staff (72.0%) believed they had normal weight. Conclusion: The percentage of those found to be either overweight or obese is remarkable and the need to educate staff of the implication and ways to avoid over-nutrition. To avoid the increased risk of developing diabetes and cardiovascular diseases including communicable diseases, preventive health education and regular health checks for staff are recommended.

Fibromyalgia (FM) is a chronic disorder characterised by chronic widespread pain, fatigue and sleep disturbances with higher prevalence in females. Psychological factors contribute largely to FM. Although women war refugees represent a fragile population that is prone to psychological distress, FM was not studied in this population.The current study had three objectives: (1) to screen FM and insomnia prevalence and severity, (2) to study the correlation between FM severity and insomnia and (3) to study FM treatment trends and their concordance with the guidelines among female Syrian refugees residing in Jordan.A cross-sectional study design was performed. Data from 384 Syrian female were analysed from four medical centres in Jordan. The Fibromyalgia Impact Questionnaire (FIQ) was used to study FM prevalence. Structured questions were designed to explore FM pharmacotherapeutic trend, and the Insomnia Severity Index (ISI) was used to screen insomnia.The prevalence of severe FM was about (30%), with a significant correlation with insomnia. Acetaminophen was used for FM relief in 60% of the study sample.Fibromyalgia prevalence is high among female refugees and is associated with insomnia. The treatment is suboptimal. The early screening and raising awareness of FM diagnosis and treatments are highly recommended. Key Points Fibromyalgia is an overlooked disorder especially among female war refugees The prevalence of severe fibromyalgia was about (30%), with a significant correlation with insomnia Fibromyalgia among the Syrian female refugees is mistreated perhaps due to lack of the proper diagnosis.

Background and objectives Conversion disorder/functional neurological disorder (CD/FND) can be a chronic disorder and has an unknown pathology. This review explored the current level of research and understanding the origin of CD/FND pathology. Methods This narrative review collated relevant papers and articles identified by a search in both Scopus and PubMed. Systematic reviews and observational articles focusing on inflammation and childhood trauma were included. Articles that were not in English, case reports, or that included participants from military background, were excluded. Results Overall 54 papers were included from an initial search number of 5264. 34 of these articles were identifying and discussing new trends and theories related to the pathophysiology while the remaining 20 were defining the current knowledge of CD/FND. There is no definitively known pathophysiology of FND, with several noted categories of involved being immune system, inflammation and neural changes. Each system and mechanism could either be seen as a direct mechanism of action or an indirect effect from a further unknown mechanism of action. Additionally, there seems to be a lack of coherency between these different proposed theories, with little information bringing them together. Further research may explore whether or not inflammation plays a direct role in the pathophysiology of the disorder, and if a difference in the symptoms is dictated by different inflammatory markers. Conclusion Overall this narrative review identified and postulated different mechanisms for the pathology of CD/FND while also discovering where new research should focus.

Siblings of children with chronic disorders are at increased risk of experiencing family communication problems and poorer mental health. We assessed initial feasibility, acceptability, and outcomes of SIBS; a manual-based group intervention for siblings and parents of children with chronic disorders, aiming to improve parent-sibling communication and sibling mental health. Ninety-nine siblings aged 8–16 years (M = 11.5 years, SD = 2.0; 54.5% girls) and parents (63.6% mothers) of children with chronic disorders participated in three separate group sessions for siblings and parents and two joint sessions with integrated sibling-parent dialogues. We assessed participant satisfaction post-intervention and checked for group leader manual adherence. We measured the following outcomes at baseline, three, and six months post-intervention in an open trial: (1) parent-sibling communication quality; (2) sibling emotional and behavioral problems; (3) sibling adaptation to the disorder; and (4) sibling disorder knowledge. Using growth curve modeling, we found significant improvement in parent-sibling communication quality (p = 0.001), emotional and behavioral problems (p = 0.009), adaptation to the disorder (p = 0.003), and disorder knowledge (p = 0.000) from baseline to follow-up (effect sizes d = 0.22 to 0.64). Improvement in sibling-reported emotional and behavioral problems and adaptation to the disorder was partly explained by communication quality. User satisfaction was high and manual adherence was good. Our evaluation yields support for the SIBS intervention, with initial evidence of acceptability, feasibility, and beneficial outcomes. Our study suggests targeting parent-sibling communication may be a beneficial way of improving siblings’ mental health.

Neurodegenerative diseases are a heterogeneous group of chronic disorders linked by the progressive degeneration of neurons in discrete regions of the central nervous system. Knowledge about the etiology of neurodegenerative diseases remains a major goal in modern medicinal research. In this review, we analyze and summarize the evidence for fungal and bacterial infections in the nervous tissue of patients with chronic neurodegenerative diseases. There is a growing body of evidence supporting the concept that polymicrobial infection could be the etiological agent for several neurodegenerative diseases. A variety of fungi and bacteria can be directly visualized in brain tissue from patients by immunohistochemistry using specific antibodies, and next-generation sequencing has recently revealed the identification of potentially causative microorganisms. Notably, the brain microbiota can vary from patient to patient, but importantly, some microbial genera are more relevant in a given disease. Multiple experimental approaches have identified a diversity of fungal and prokaryotic populations in the central nervous system of patients with different neurodegenerative disorders. This diversity present in each patient could account for the differences in the severity and evolution of clinical symptoms.

Histamine is one of the factors that cause acute and chronic disorders, so it is necessary to investigate further the mechanism of antihistamines in the treatment of allergic diseases. Antihistamines are substances that can reduce or block the effects of histamine on the body by blocking histamine receptors. Antihistamines are one of the drugs that are often prescribed to children to the elderly. Thus the application of therapy in medicine is needed to ensure the use of appropriate drugs to prevent the occurrence of medication errors so that the goal of therapeutic effectiveness can be achieved. The purpose of this study was to determine the prescribing pattern of antihistamine drugs and assess the accuracy of the administration of antihistamines based on dose accuracy and potential drug interactions. Prescribing studies of this drug are descriptive quantitative and qualitative by using data sources in the form of patient prescription sheets taken retrospectively. The results of quantitative research data show that patients 57.23% were female, the highest age was 55-59 years old 12.26%, the most widely used drug was setirizine 72.48%, dose accuracy 89.60% and more doses 10.40%, the potential for drug interactions occurred in 27.83%, The drug that has the most potential for interaction is setirizine with theophylline.

Inflammatory bowel disease (IBD) has a rising prevalence in children and an increasing number of adults living with IBD were diagnosed in childhood. This chronic disorder requires frequent cross-sectional imaging for evaluating disease progression. Radiologists must be vigilant to detect and understand imaging manifestations of acute and chronic, alimentary, and extraintestinal findings of IBD. This article discusses the role of imaging in evaluation of IBD transitioning from pediatric to adult patients. Imaging modalities and techniques used for evaluating IBD are reviewed. Characteristic acute and chronic imaging findings of IBD are discussed with emphasis on what radiologists need to clearly understand.

El síndrome de intestino irritable (SII) es un trastorno crónico muy frecuente que requiere ser estudiado más allá del campo biomédico. El interés criminológico y antropológico criminal del SII radica en su alta prevalencia entre mujeres víctimas de violencia doméstica; víctimas de abuso físico, sexual y emocional en la edad adulta; víctimas de abuso sexual infantil; mujeres veteranas de guerra; y adultos expuestos durante la infancia a condiciones severas en tiempos de guerra. Además, las víctimas de violencia afectadas de SII pueden sufrir una revictimización por parte del sistema médico. Dado que el SII es un fenómeno universal con particularidades regionales y culturales, la investigación reciente señala la importancia que tienen en el desarrollo del SII aspectos como la socialización diferencial de género. Los mitos y creencias que poseen las personas afectadas de SII se han investigado abundantemente; no así aquéllos presentes entre el personal médico.

Background Sarcopenia (SP) is a syndrome described as generalized and progressive loss of muscle mass and strength that may cause fall, fractures, disability and death. Oxidative stress might be a probable etiologic factor in SP as well. SP is a comorbid syndrome that is seen in chronic illnesses. If these two considerations are taken together, one may also think that SP could be also seen in bipolar disorder (BD), because it is a chronic disorder and oxidative stress was related to both illnesses. In our study, we proposed to investigate the prevalence of SP in BD patients. Methods We recruited 111 consecutive BD patients who registered in Mood Disorders Unit of Cukurova University. Blood tests were taken from patients to exclude the possible confounding factor related to SP. Socio-demographic variable forms were filled out. Every patient underwent physical mass, strength, and performance tests for the diagnosis of SP, which was determined by the criteria of European consensus. Results The mean age of the patients was 38.00 ±11.44 years (18-68). Among the participants 69 (62.2%) were female, and 42 (37.8%) were male. Pre-SP was 6.3% (n=7), SP was 9.0% (n=10), and severe SP was 1.8% (n=2) in BD patients. The prevalence of pre-SP, SP and severe SP in BD patients was 7.1%, 16.7% and 2.4% in men and 5.8%, 4.3% and 1.4% in women, respectively. Although it was not marginally significant, a difference was observed in SP patients as they had more median psychotic features and median number of episodes per year for BD. Conclusion This is the first study that investigated SP in BD patients. Sarcopenia was found more frequently in BD patients than in the general population.

Background: Substance use is a chronic disorder that requires lifelong multimodal management. This study utilized the Multi-Theory Model (MTM) of Health Behavior Change to identify correlates of ch...

Generalized anxiety disorder (GAD), a chronic disorder characterized by excessive and difficult-to-control worry, has been shown to be associated with heightened risk for depression. However, despite the high rate of co-occurrence between GAD and depression, few studies have examined factors that might account for this comorbidity. Contemporary models of GAD suggest that the avoidance of positive- and negative-valenced emotions may be particularly worthwhile to investigate in this regard. Therefore, this study examined the extent with which positive and negative emotional avoidance explain the relationship between GAD and depression symptom severity. Participants were adults (N = 114) seeking treatment at an anxiety disorders clinic. Upon intake into the clinic, participants completed a variety of self-report measures assessing the constructs of interest in this study. Results revealed that GAD severity was associated with depression symptom severity through the avoidance of positive emotion, but not via negative emotional avoidance. Specifically, greater GAD severity was associated with greater positive emotional avoidance which, in turn, was associated with greater depression symptom severity. Consistent with the contrast avoidance model of GAD, findings suggest positive emotions may be avoided in an effort to maintain homeostasis and prevent negative emotional contrasts, which may increase the likelihood of depressive symptoms.

Diabetes is a chronic disorder caused by the inability of the pancreas to provide adequate insulin or to insure the body is not consumable. The height of the headingexperses of diabetes, which is caused by serious complications. After a certain time, there are serious complications such as eye diseases, cardiovascular diseases, kidney diseases, diabetes, the height of remediation experses and the person who is uncomfortable with the cause of loss of labour, socioeconomic is an important health problem forthecreation of boredom. Diabetes is often manifested by the average age in our ages and in adults. And because of these conditions, early diagnosis is important in diabetes as well as in many diseases. Different chemical tests are performed in blood and urine for diagnosis. In this study, the clinical data of individuals were examined and the data mining techniques were determined to determine whether individuals were diabetic.

Irritable bowel syndrome (IBS) is a chronic disorder characterised by recurrent abdominal pain or discomfort and transit disturbances with heterogeneous pathophysiological mechanisms. The link between food and gastrointestinal (GI) symptoms is often reported by patients with IBS and the role of fructose has recently been highlighted. Fructose malabsorption can easily be assessed by hydrogen and/or methane breath test in response to 25 g fructose; and its prevalence is about 22 % in patients with IBS. The mechanism of fructose-related symptoms is incompletely understood. Osmotic load, fermentation and visceral hypersensitivity are likely to participate in GI symptoms in the IBS population and may be triggered or worsened by fructose. A low-fructose diet could be integrated in the overall treatment strategy, but its role and implication in the improvement of IBS symptoms should be evaluated. In the present review, we discuss fructose malabsorption in adult patients with IBS and the interest of a low-fructose diet in order to underline the important role of fructose in IBS.

Vitiligo is a chronic disorder of the skin, characterized by progressive loss of melanocytes from the epidermis manifested as white macules or patches. This study aims to: Assess the effect of Nursing Guidelines on the life style pattern of patients with vitiligo. Research design: pre-post-test research design was utilized. Sample: this study included 40 adult patients with vitiligo their age between 18 to 60 years old and from both sexes. Setting: the study sample was recruited from the Dermatology Department, Assuit University Hospitals. Tools: three tools were used in this study: pre-post patient knowledge questionnaire sheet for healthy life style, and Pre-Post Patient Life Style Pattern Assessment Sheet for patients with vitiligo. Based on the result of the assessment phase nursing guidelines developed and implemented. Results: There was statistical significant difference between life style patterns pre-post the implementation of the nursing guidelines for patients with vitiligo. Conclusion: The study findings revealed that developing and implementing nursing guidelines based on the needs of patients with vitiligo were effective in improving their lifestyle.

Background The role of free radical reactions in disease pathology is well known to be involved in many acute and chronic disorders in human beings, such as diabetes, atherosclerosis, aging, immunosuppression and neurodegeneration. The search for new drugs of plant origin becomes increasingly urgent due to drug resistance. Aloe schelpei is an endemic Aloe species traditionally used for the treatment of infectious and chronic diseases. Aim This study was conducted to evaluate free radical scavenging activities of leaf latex of Aloe schelpei and its isolated compounds. Methods The leaf latex of A. schelpei was subjected to preparative thin-layer chromatography to afford three compounds. Free radical scavenging activities of the leaf latex and its constituents was carried out using a 2, 2-diphenyl-1-picrylhydrazyl method. Results Phytochemical investigation of the leaf latex Aloe schelpei by prepartive thin layer chromatography led to the isolation of three compounds, identified as microdontin A/B (1), aloin A/B (2) and aloinoside A/B (3). The results showed that the leaf latex had a strong free radical scavenging activity reaching a maximum of 84.3% at a concentration of 100 μg/mL, and with an IC50 value of 25.3 ± 2.45 μg/mL (p < 0.05). Among the isolated compounds, microdontin A/B (1) was found to have the strongest free radical scavenging activity with an IC50 value of 0.07 ± 0.005 mμ, followed by aloinoside A/B (IC50 = 0.13 ± 0.01 mM) and aloin A/B (IC50 = 0.15 ± 0.02 mM). Conclusion The traditional medicinal practice of the leaf latex may be due to the antioxidant activities of the leaf latex of A. schelpei and the isolated compounds.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic disorder that begins in childhood and endures into adulthood. Therefore it can affects children, teenagers and adults./nIt has a complicated diagnosis and there are several causes taking part into the onset of this disorder such as: sex, age, stage of development and social environment. /nADHD has different clinical presentation and according to this, patient are indicated a non-pharmacological treatment, drug therapy or the combination of both. /nThe main objective of this study is to analyse in the “Área de Gestión Sanitaria Sur de Sevilla” (AGSSS) patients currently treated for ADHD with Methylphenidate, Lisdexamfetamine, Atomoxetine and Guanfacine.?It has been compiled all the information about clinical histories of patients who are prescribed these four drugs in our Area, assessing the degree of adequacy of treatments. Therefore we need the algorithm for ADHD proposed by CADIME 2017. /nIn view of results we conclude that there is a lack of monitoring of patients and drugs are taken for a long period of time. La enfermedad del trastorno de déficit de atención e hiperactividad (TADH) es un trastorno crónico que se inicia en la infancia y perdura hasta la edad adulta pudiendo por tanto afectar tanto a niños como adolescentes y adultos./nPosee un diagnóstico complejo y son varias las causas que puedan intervenir en la aparición de este trastorno tales como el sexo, la edad, la etapa del desarrollo y el entorno social y cultural. /nEl TADH tiene diferentes manifestaciones clínicas y según esto, al paciente se le indicará un tratamiento no farmacológico, tratamiento farmacológico o la combinación de ambos. /nEl objetivo principal de nuestro trabajo es analizar en el Área de Gestión Sanitaria Sur de Sevilla (AGSSS) a los pacientes actualmente tratados para el TADH con metilfenidato, lisdexanfetamina, guanfacina y atomoxetina.?Ha sido recopilada toda la información del historial clínico de los pacientes que tienen recetados estos cuatro fármacos en nuestra Área, valorando el grado de adecuación de los tratamientos. Para ello se va a seguir el algoritmo de tratamiento para el TADH propuesto por el CADIME 2017. /nA la vista de los resultados obtenidos concluimos que hay una falta de seguimiento de los pacientes y una prolongación de tratamiento en el tiempo.

International audience; The transfer of adolescents from paediatric care to adult health facilities is often difficult for the patients and their families and can lead to a breakdown in medical follow-up and therefore serious complications. Existing recommendations for the successful transition of patients with chronic disorders do not specifically address patients with handicap. Preparations for the transfer must be made well in advance. They must aim to achieve the autonomisation of adolescents by making them responsible and providing them with the knowledge that will enable them to manage their care themselves, the know-how to react appropriately if there is any change in their condition, and to move comfortably within the adult health system. This requires the active participation of the patient, his or her family and the paediatric and adult care teams. It involves multidisciplinary management plus the production and maintenance of an educational therapy programme. Finally, the identification of doctors trained in handicap, relevant sub-specialists and even expert patients could enable improvements in the continuum of complete and appropriate care for these patients within adult medicine.

BACKGROUND: Migraine is a chronic disorder that negatively affects a patient's quality of life (QOL). As little is known about the QOL of migraine sufferers in Saudi Arabia, our aim was to investigate the QOL and the level of migraine-associated disability of migraine patients. MATERIALS AND METHODS: This cross-sectional study was conducted in neurology clinics at King Abdulaziz Medical City for National Guard and Prince Sultan Military Medical City in Riyadh, Saudi Arabia, from August to December 2018. The migraine-specific QOL questionnaire (MSQ), version 2.1, was used to measure restrictive, preventive, and emotional domains. The sum of the item responses ranged between 0 and 100, with higher scores indicating better QOL. A descriptive analysis of numerical variables was reported in terms of means and standard deviation, while categorical variables were described using frequencies and percentages. RESULTS: A total of 300 migraine patients completed the questionnaire; 67% were females. Age of participants ranged from 20 to 53 years, with mean age of 34.21 (SD=7.26). The mean score in the QOL restrictive domain was 51.8 ± 19, whereas the mean scores for preventive and emotional domains were 54 ± 18 and 46.3 ± 23.4, respectively. Low QOL scores were associated with young ages, long disease duration, frequent migraine attacks, and presence of chronic diseases. CONCLUSION: Chronic migraine has a negative impact on QOL, predominantly in young patients, patients with frequent attacks, those not using preventive medications, and those suffering from chronic diseases.

Introduction Abnormal rapid eye movement (REM) sleep is often symptomatic of chronic disorders, however polysomnography, the gold standard method to measure REM sleep, is expensive and often impractical. Attempts to develop cost-effective ambulatory systems to measure REM sleep have had limited success. As elevated twitching is often observed during REM sleep in some distal muscles, the aim of this study was to assess the potential for a finger-mounted device to measure finger twitches, and thereby differentiate periods of REM and non-REM (NREM) sleep. Methods One night of sleep data was collected by polysomnography from each of 18 (3f, 15m) healthy adults aged 23.2 ± 3.3 (mean ± SD) years. Finger movement was detected using a piezo-electric limb sensor taped to the index finger of each participant. Finger twitch densities were calculated for each stage of sleep. Results Finger twitch density was greater in REM than in NREM sleep (p < 0.001). Each sleep stage had a unique finger twitch density, except for REM and stage N1 sleep which were similar. Finger twitch density was greater in late REM than in early REM sleep (p = 0.005), and there was a time-state interaction: the difference between finger twitch densities in REM and NREM sleep was greater in late sleep than in early sleep (p = 0.007). Conclusion Finger twitching is more frequent in REM sleep than in NREM sleep and becomes more distinguishable as sleep progresses. Finger twitches appear to be too infrequent to make definitive 30-second epoch determinations of sleep stage. However, an algorithm informed by measures of finger twitch density has the potential to detect periods of REM sleep and provide estimates of total REM sleep time and percentage.

Obesity is a chronic disorder that is associated with body mass index (BMI) of greater or equal to 30 kg/m2. The prevalence of obesity in the Kingdom of Saudi Arabia (KSA) is increasing at an alarming rate and is expected to reach 41% in men and up to 78% in women by 2022. Since chemokines are associated with involuntary weight loss, the objective of this study was to elucidate their association with BMI among Saudis. A questionnaire was used to collect information about diet, health conditions, and demographics from 15 men and 16 women who participated in the study. BMI was calculated based on clinical measurements and participants were classified according to their BMI category as: normal, underweight, overweight, or obese. Serum samples were collected for a multiplex assay using the Human Chemokine Magnetic 30-plex panel. The serum concentration of either the monokine induced by gamma interferon (MIG) or the CXC-motif chemokine ligand 9 (CXCL-9) was significantly increased in obese men (P = 0.0194) and women (P = 0.043) as compared to underweight men and women, respectively. However, the serum levels of other chemokines were not significantly different among the groups. We found that MIG levels are differentially regulated in serum, based on individuals’ BMI. Keywords: Chemokines, Body mass index, Obesity, Saudi Arabia, Multiplex assay

Swarna Malini Vasantha is a herbomineral rasashastriya formulation which is commonly prescribed in day to day practice. Especially chronic disorders like chronic fever, rickets, chronic non healing ulcer , mental retardation in children, ADHD, delayed mile stone development in children etc. It contains Swarna bhasma, shuddha hingula, Naga bhasma, Vanga bhasma, shuddha kharpara and pippali choorna and swetamaricha These ingredients are nadi balya, mastishka balavardhaka, rasayana and dhatwagni vardhaka in action.The present paper highlights about the clinical indications of swarna Malini Vasantha in a Experiential and scientific view.

BACKGROUND: Tracheostomy is a frequent surgical procedure in subjects with chronic disorders of consciousness (DOC). There is no consensus about safety of tracheostomy decannulation in this population.The aim of our study was to estimate if DOC improvement is a predictor for tracheostomy decannulation. Secondary outcomes include mortality rate and discharge destination. METHODS: We conducted an observational, retrospective, case-control study at a weaning and rehabilitation center (WRC). We included tracheostomized subjects with DOC admitted between August 2015 and December 2017. We matched groups based on the consciousness level at admission assessed withthe coma recovery scale revised (CRS-R). Subjects who were later decannulated formed the cases, while those that remained tracheostomized at the end of follow-up formed the controls. Improvement of DOC was defined as a progress in the categories of the CRS-R. RESULTS: 22 subjects were included in each group. No significant differences were found in clinical and demographic variables, except that controls had longer neurologic injury evolution (65.5 vs 51 days, P = .047), more tracheostomy days at admission to ourinstitution (53 vs 33.5, P = .02), and higher prevalence of neurological comorbidities (12 vs 4, P = .03). Subjects who improved their DOC had more chances of being decannulated (OR 11.28, 95% CI 1.96–123.08). Tracheostomy decannulation could not be achieved in most subjects who did not improve from vegetative state (VS) (OR 0.13, 95% CI 0.02–0.60). 8 subjects, however, could be decannulated in VS, with only one decannulation failure and no deaths. Mortality was higher in controls (0 vs 6, P = .02), especially among VS (0 vs 5, P = .049). No significant differences were found in discharge destination between groups. CONCLUSIONS: Subjects who improve their DOC are more likely to achieve tracheostomy decannulation. Some subjects in VS were decannulated, with lower mortality than those who remained tracheostomized.

Lactation is a two-person system, and breastfeeding both affects and is affected by the mother’s physiology. Both acute maternal health conditions and chronic disorders may have an impact on the mother–baby dyad. Often, the mother’s acute health condition itself does not affect breastfeeding physiology, but the process of navigating the health care system disrupts lactation. Any clinician who cares for women of childbearing age and cares for women who are lactating must consider both the effects of lactation on maternal health conditions and the effects of maternal health conditions on lactation. Such care requires consideration of the whole mother–baby dyad, centered on the values and preferences of the lactating woman. The distinct individual health conditions affecting mothers must be examined along with any proposed medical management to optimize the initiation and maintenance of lactation. Medication use in the mother should be guided by the medication’s safety profile during lactation. Consultation of regularly updated databases of the newest information on the medication’s use in lactation is essential to optimal use safely for the mother and infant.

When Gee described coeliac disease in 1888 and Dicke introduced the gluten-free diet in 1950, neither could have known the implications of what they had launched. Coeliac disease has moved from being an uncommon illness confined to children of European descent to one of the most common chronic disorders encountered in the western world that can occur at any age and in many other countries. Gluten-related disorders now include not only coeliac disease and dermatitis herpetiformis but also non-coeliac gluten sensitivity, wheat allergy and gluten ataxia (neuropathy). This chapter traces the early recognition of gluten-related disorders to the present time, highlighting some of the more important developments.

Cognitive Behavioral Therapy for Insomnia (CBT-I) has been repeatedly shown to be efficacious and is now considered the first-line treatment for insomnia for both uncomplicated insomnia (primary insomnia) and insomnia that occurs comorbidly with other chronic disorders (secondary insomnia). CBT-I is a multicomponent treatment that consists of Sleep Restriction Therapy (SRT), Stimulus Control Therapy (SCT), Cognitive Therapy (CT), and Sleep Hygiene (SH). When combined these interventions produce large treatment effects. The purpose of this chapter is to review and discuss the efficacy and effectiveness of CBT-I, its components, and, finally, discuss when it is appropriate to adapt CBT-I for certain medical/psychiatric conditions and/or demographic groups.

International audience; Obstructive sleep apnea is a common chronic disorder that leads to chronic intermittent hypoxia described as an important factor contributing to the pathogenesis of OSA-related comorbidities. Besides, recent data suggest that intermittent hypoxia can induce adaptative cardiovascular pathways inducing a relative resistance to ischemic insults. Adaptative pathways induced by hypoxia could implicate autophagic processes and Beclin-1, one of the first mammalian autophagy effectors. Thus, activation of autophagy could protect against cardiovascular events in patients with OSA and could be considered as biomarker of a better prognosis.

Hoarding disorder is a chronic disorder defined as the persistent difficulty in parting with possessions and the need to save items, regardless of their actual value. Severe hoarding has largely been a hidden clinical problem, and awareness has mostly been limited to voyeuristic depictions of the plight of hoarders in popular media. Approximately 28% to 32% of individuals with attention deficit hyperactivity disorder (ADHD), especially the inattentive subtype, have been reported to have clinically significant hoarding. It has been hypothesized that patients with ADHD initially acquire objects impulsively and later develop emotional attachments or intrinsic meaning, resulting in a perpetuating cycle of reliance on hoarding as a coping mechanism. Treatment focused on impaired attention has shown improved prognosis, which further signifies the relationship between inattentive ADHD and hoarding. We discuss the case of a patient with ADHD (inattentive type), major depressive disorder, and hoarding traits.

Introduction: Oral status has a clear impact on systemic health, a key component of successful aging. Awareness of oral disorders permits early diagnoses and treatments. This study investigates oral disorders awareness among community-dwelling elders. Methods: Community-based survey through face-to-face interviews undertaken in four cities at busy commercial and administrative areas. Results: A total of 789 people were recruited, mostly nonsmoker (60.3%) males (56.9%) with basic education (65.6%). The most frequently recalled disorder was bruxism, followed by periodontal diseases and ulcerations/aphthae. Caries was mentioned by 3.91%. Dentate participants were more aware of dental-related disorders, such as bruxism ( p = .001) and periodontitis ( p = .010), except for caries ( p = .100). Caries awareness was related to educational level ( p = .018) and smoking ( p = .020), as was oral cancer ( p = .019) with former smokers more aware of this neoplasm. Education was strongly related with periodontal awareness ( p = .001). Conclusion: Awareness of the main oral disorders is worryingly poor among the elderly population and immediate action is required by taking advantage of the position of family nurses in the treatment of systemic chronic disorders and through educational interventions on this population subgroup to ease preventive behaviors, favor early diagnoses, and promote simpler, more effective treatments with a lower financial burden.

Diabetes mellitus is a significant public health problem worldwide. It encompasses a group of chronic disorders characterized by hyperglycemia, resulting from pancreatic islet dysfunction or as a consequence of insulin-producing β-cell death. Organ-on-a-chip platforms have emerged as technological systems combining cell biology, engineering, and biomaterial technological advances with microfluidics to recapitulate a specific organ’s physiological or pathophysiological environment. These devices offer a novel model for the screening of pharmaceutical agents and to study a particular disease. In the field of diabetes, a variety of microfluidic devices have been introduced to recreate native islet microenvironments and to understand pancreatic β-cell kinetics in vitro. This kind of platforms has been shown fundamental for the study of the islet function and to assess the quality of these islets for subsequent in vivo transplantation. However, islet physiological systems are still limited compared to other organs and tissues, evidencing the difficulty to study this “organ” and the need for further technological advances. In this review, we summarize the current state of islet-on-a-chip platforms that have been developed so far. We recapitulate the most relevant studies involving pancreatic islets and microfluidics, focusing on the molecular and cellular-scale activities that underlie pancreatic β-cell function., This review received financial support from the European Research Council program under grants ERC-StG-DAMOC (714317), the Spanish Ministry of Economy and Competitiveness, through the “Severo Ochoa” Program for Centres of Excellence in R&D (SEV-2016-2019) and “Retos de investigación: Proyectos I+D+i” (TEC2017-83716-C2-2-R), the CERCA Programme/Generalitat de Catalunya (2017-SGR-1079), and Fundación Bancaria “la Caixa”- Obra Social “la Caixa” (project IBEC-La Caixa Healthy Ageing).

Chronic obstructive pulmonary disease (COPD) represented as inflammatory complication of chronic bronchitis which is characterized by oxidative stress driven phenotypic changes likely enlarged alveoli and increased mucus along with tightened smooth muscle which exaggerate pathological consequences such as breathing problems. The association between COPD and obesity as a metabolic disorder following a variety of environmental stressors include lifestyle change (e.g., diet and e-smoking or marijuana) and air pollution are less likely to be evaluated. People who are suffering with COPD developed extensive suffocation and difficulty breathing, which ultimately leads to fatal conditions in severe cases, for example lung cancer, heart attack, and stroke. Previous studies showed metabolic disorder like obesity appeared as a risk determinant to COPD like breathing problem or deep vein thrombosis and its genetic modification resulted from abnormality of molecular dynamics turned out key trigger in case of immune alteration and inflammation following exposure of several environmental factors which could be linked with comorbidity in secondary chronic diseases pairing with other metabolic disorders (e.g., diabetes, heart disease, cancer or fatty liver disease). Lifestyle changes along with physical activities and management of the diet is worth to reduce COPD symptomatic firing. However, environmental factors like air pollution or particle matter owing to industrialization and urbanization include a variety of dust within indoor life, certain type of e-smoke also triggers the establishment of emphysema and enhances the progression of COPD aligned with molecular alteration in the lung tissue or interaction between different organs. Prediction and prevention skills as key tools of health management and evaluation in case of COPD remains unclear. Integrative care includes clinic assessment (e.g., the body mass index, diets, and metabolic profile using survey following physician guidance) could be coupled cellular and topological interaction between obesity and COPD supplemented with advanced functional and genetic variation utilize human genomics study like single nucleotide polymorphism (SNP). To understand the impact of environmental risk better (e.g., air pollution or particle matter) on pathogenesis of disease or onset of the disease underlying the pulmonary system stratified lifestyle, age, metabolic disorders, diets, and medications, we envision exploring risks such as disease barrier and social determinants along with detection tools which may assess molecular dynamics and their alteration following stress might be associated with COPD in the pathogenesis. Environmental stressors (e.g., air pollution, particle matter, food addictive chemicals, and stress) as epigenetic modifiers could attribute to early phase of COPD onset and pathogenesis which reflect the molecular dynamics and redirection of networking pathways depending on gut immunity. Profiling of secondary metabolites is worth to explicate intervention of metabolism cascade owing to alter molecular sensitivity and connectivity. Utilized multi-dimensional omics such as metabolomics, genomics with exome sequencing, and epigenomics, prevention and prediction skills could visualize a new angle of disease diagnostic under the platform of integrative health care and surveillance supporting to patient’s quality of life.

Autoimmune blistering diseases (AIBDs) are rare, chronic disorders of the skin and mucous membranes, with a broad spectrum of clinical manifestations and morphological lesions. Considering that 1) diagnosis of AIBDs is a challenging task, owing to their rarity and heterogeneous clinical features, and 2) misdiagnoses are common, and the resulting diagnostic delay is a major factor in their high mortality rate, patient prognosis stands to benefit greatly from the development of a computer-aided diagnostic (CAD) tool for AIBDs. Artificial intelligence (AI) research into rare skin diseases like AIBDs is severely underrepresented, due to a variety of factors, foremost a lack of large-scale, uniformly curated imaging data. A study by Julia S. et al. finds that, as of 2020, there exists no machine learning studies on rare skin diseases [1], despite the demonstrated success of AI in the field of dermatology. Whereas previous research has primarily looked to improve performance through extensive data collection and preprocessing, this approach remains tedious and impractical for rarer, under-documented skin diseases. This study proposes a novel approach in the development of a deep learning based diagnostic aid for AIBDs. Leveraging the visual similarities between our imaging data with pre-existing repositories, we demonstrate automated classification of AIBDs using techniques such as transfer learning and data augmentation over a convolutional neural network (CNN). A three-loop process for training is used, combining feature extraction and fine-tuning to improve performance on our classification task. Our final model retains an accuracy nearly on par with dermatologists’ diagnostic accuracy on more common skin cancers. Given the efficacy of our predictive model despite low amounts of training data, this approach holds the potential to benefit clinical diagnoses of AIBDs. Furthermore, our approach can be extrapolated to the diagnosis of other clinically similar rare diseases.