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Objective: To conduct a translation and validation study of the Chronic Orchialgia Symptom Index (COSI), which has 12 questions in three domains pain (P), sexual symptoms (SS), and quality of life (QoL), in the Turkish language. Material and methods: The study included a total of 175 patients diagnosed with chronic scrotal content pain (CSCP) between January 2023 and January 2024. In addition to demographic data, the scores obtained on the COSI questionnaire and Visual Analog Scale (VAS) were recorded. Internal consistency was assessed using Cronbach alpha coefficients. Reliability was evaluated using the test-retest correlation method. Results: The mean age of the patients was 37.2 ± 14.1 years and the median (IQR) duration of pain was 5.5 (9) months. The median total COSI score was determined as 13 (13) and the median subscores were 7 (7) for P, 1 (2) for SS, and 5 (6) for QoL. The test-retest correlation coefficient for each item was determined to be higher than r = 0.80 (p < 0.001). The Cronbach alpha values for the subscores were 0.80 for P, 0.71 for SS, and 0.80 for QoL. There was determined to be a statistically significant positive correlation between the VAS score and the COSI P, SS, QoL, and total scores (r : 0.63, p < 0.001; r = 0.32, p < 0.001; r = 0.56, p < 0.001; r = 0.59, p < 0.001, respectively). The optimal cutoff point of the COSI total score was determined to be 16.5 points (AUC:0.77, p < 0.001) for the determination of patients experiencing severe pain (⩾ 7.5) according to the VAS score. Conclusion: The Turkish version of the COSI questionnaire is a valid, reliable, and repeatable questionnaire that can be used to evaluate the effects of symptom severity in patients with CSCP. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is a multifactorial, pervasive, neurodevelopmental disorder, of which intestinal symptoms collectively represent one of the most common comorbidities. Methods: In this study, 1,222 children with ASD and 1,206 typically developing (TD) children aged 2-7 years were enrolled from 13 cities in China. Physical measurement and basic information questionnaires were conducted in ASD and TD children. The Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), and Autism Behavior Checklist (ABC) were used to evaluate the clinical symptoms of children with ASD. The six-item Gastrointestinal Severity Index (6-GSI) was used to evaluate the prevalence of intestinal symptoms in two groups. Results: The detection rates of constipation, stool odor, and total intestinal symptoms in ASD children were significantly higher than those in TD children (40.098% vs. 25.622%, 17.021% vs. 9.287%, and 53.601% vs. 41.294%, respectively). Autistic children presenting with intestinal comorbidity had significantly higher scores on the ABC, SRS, CARS, and multiple subscales than autistic children without intestinal symptoms, suggesting that intestinal comorbidity may exacerbates the core symptoms of ASD children. Conclusion: Intestinal dysfunction was significantly more common in autistic than in TD children. This dysfunction may aggravate the core symptoms of children with ASD. [ABSTRACT FROM AUTHOR]

Objective: Prostate cancer is one of the most common malignant neoplasms in elderly males, with radical prostatectomy being the established therapeutic approach for localized disease. Patients undergoing this surgical procedure frequently experience increased negative emotions and symptomatology during the perioperative period, likely due to concerns about the illness and its treatment. The present study aims to investigate the effects of a novel educational approach involving a whole-process visualization and collaborative nursing discussions on perioperative symptoms and emotional well-being in radical prostatectomy patients. Methods: Data were prospectively collected from 310 patients admitted to the hospital between June 2021 and December 2023, all of whom were scheduled to undergo radical prostatectomy. These patients were randomly assigned to either the intervention group (receiving new model education) or the control group (receiving conventional education), with 155 patients in each group. The study compared basic demographic information, anxiety and depression scores, fear of disease progression scores, quality-of-life scores, main symptom scores, and changes in perioperative vital signs between the two groups. Results: No statistically significant differences were observed between the two groups in terms of age, comorbidities, insurance type, education level, income, and tumor history (P > 0.05). Similarly, there were no significant differences in anxiety and depression scores, proportion of patients with anxiety and depression, vital signs, and fear of disease progression scores between the two groups at Time 1 stage (P > 0.05). During stages Time 2 and Time 3, the intervention group exhibited lower anxiety and depression scores, a lower proportion of anxious and depressed patients, as well as significantly reduced blood pressure and heart rate fluctuations compared to the control group (P < 0.05). Following radical prostatectomy, the main symptoms of patients, such as pain, nausea, and fatigue, were assessed using the MADIS Symptom Assessment Scale on days 1–3 post-surgery. The intervention group exhibited significantly lower scores for three symptoms compared to the control group (P < 0.05); at Time 4 stage, the patients in the intervention group also demonstrated significantly improved quality-of-life scores compared to the control group (P < 0.05). Additionally, blood pressure and heart rate of patients returned to baseline levels at Time 4 stage, with no significant difference between the two groups (P > 0.05). Nevertheless, the anxiety and depression scores in the intervention group at the Time 4 stage remained significantly lower than those in the control group (P < 0.05). Additionally, the fear of disease progression scores in both groups were lower than those at the Time 1 stage, with a more pronounced improvement observed in the intervention group compared to the control group (P < 0.05). Conclusion: Patients diagnosed with malignant tumors often experience fear and anxiety regarding the progression of their disease and upcoming surgery, as well as uncertainty surrounding their treatment and prognosis. This heightened emotional distress can contribute to a greater symptom burden during the perioperative period. Utilizing a whole-process visualization and collaborative nursing discussion approach, as compared to traditional communication methods, has been shown to alleviate patients' fears, reduce anxiety and depression, and ultimately lessen the symptom burden experienced during the perioperative phase. Ultimately, this approach can enhance the overall quality of life for patients facing malignant tumors. [ABSTRACT FROM AUTHOR]

Context: In Morocco, acute respiratory infections (ARI) are a frequent cause of consultations in the first level health facilities. Scientific reports indicate that honey has an important biochemical therapeutic activity. Aims: To explore the therapeutic effect of honey on ARI in the Guelmim region of southern Morocco. Methods: This was a prospective clinical study aiming to compare the therapeutic effect of honey in the population that consumes it versus a control population, at the level of the regional hospital and health centers, the period of the study was between September 2022 and March 2023, All the participants were questioned through a questionnaire and the study of their files and monitoring forms. Results: The study population was divided into two equal groups of 417 people each. Honey significantly reduced the overall symptom score at Day 5 (p

Objective: To investigate the application value of Pelvic Inflammation No. 1 formula of transdermal meridian pointtargeted drug delivery therapy in the treatment of patients with chronic pelvic inflammatory disease (damp-heat stasis type). Methods: All patients with chronic pelvic inflammatory disease (damp-heat stasis type) visited Danzhou Hospital of Traditional Chinese Medicine from August 2017 to March 2021 and were randomly grouped, 57 patients in the control group were treated with simple Western medicine, and 57 patients in the observation group were combined with Pelvic Inflammation No. 1 formula transdermal meridian targeted transdermal medication, and the therapeutic efficacies were compared after 3 months of treatment. Results: After treatment, serum matrix metalloproteinase-9 （MMP-9）, D dimer （D-D）, IL-6 and other indexes in the observation group were lower than those in the control group, and IL-10 was higher than that in the control group, the difference was statistically significant （P<0.05）. After treatment, the carbohydrate antigen CA125 in the observation group was lower than that in the control group, and the CD4+/CD8+ and CD4+ cells in the observation group were higher than those in the control group （P<0.05）. After treatment, the score of summary of health status surveys （SF-36） in the observation group was higher than that in the control group, and the total score of TCM symptoms was lower than that in the control group （P<0.05）. The total effective rate in the observation group was 96.49%（ 55/57）, which was higher than 82.46% （46/57） in the control group （P<0.05）. Conclusion: For patients with chronic pelvic inflammatory disease （damp-heat stagnation type）, combined with Pelvic Inflammation No. 1 formula transdermal via acupoints targeted drug therapy can help to regulate inflammatory factors, regulate immune function, and improve clinical efficacy. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the efficacy and safety profile of interferon α‑2b in vernal keratoconjunctivitis (VKC). Methods: In this prospective interventional study, VKC patients fulfilling the inclusion and exclusion criteria were included and their signs and symptoms were scored based on the Clinical Scoring System. Patients were treated with topical interferon α‑2b eye drop (1 MIU/ml) QID dosing for 6 weeks. Changes in symptoms and signs were evaluated at 2, 4, 8 weeks and 6 months after initiating treatment. A higher score meant severe disease, and a decline in score meant improvement in clinical signs and symptoms. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Post‑medication total subjective symptom score (TSSS) and total objective sign score (TOSS) were compared with baseline, and a P- value of <0.05 was considered significant. Possible ocular and systemic complications were evaluated. Results: The study included 40 patients (32 male and eight female) with a mean age of 8.05 ± 2.33 years. Mean baseline TSSS and TOSS were 6.71 ± 0.564 and 6.59 ± 0.262, respectively, which reduced to 2.71 ± 0.011 (P = 0.040) and 2.96 ± 0.210 (P = 0.032), respectively, at 4 weeks and further reduced to 0.42 ± 0.552 and 0.47 ± 0.434, respectively, at 8 weeks. After 6 months of stopping the drug, mean TSSS and TOSS did increase to 2.80 ± 0.820 (P = 0.044) and 2.50 ± 0.520 (P = 0.030), respectively, but was still statistically significant improvement compared to the baseline. Also, no ocular or systemic side effects were observed anytime during the study period. Conclusion: Eye drop interferon α‑2b (1 million IU/ml) is a safe and effective option as first‑line monotherapy for VKC. No side effects and recurrence were observed for 6 months. [ABSTRACT FROM AUTHOR]

Background: It is difficult to recognize vitamin B12 deficiency and to evaluate the effect of B12 treatment due to a broad range of variable clinical symptoms overlapping with other diseases and diagnostic biomarkers that quickly normalize during treatment. This poses a risk of delay in diagnosis and a challenge to uniformly monitor the effect of B12 treatment. There is a need for a new clinical outcome measure suitable for clinical practice and clinical evaluation studies. Objective: To develop a Patient-Reported Outcome Measure (PROM) which measures the severity of vitamin B12 deficiency symptoms. Methods: The B12 PROM was developed by (1) gathering input from experts and literature review to define a construct and develop a conceptual model, (2) processing input from health care providers, scientists, and patients to develop items and response options, and (3) improving items based on the feedback from laypersons, test interviews, semi-structured cognitive interviews with patients, and forward and backward translation (ENG-NL). Results: The B12 PROM includes 62 items grouped into 8 categories of symptoms related to vitamin B12 deficiency (General, Senses, Thinking, In limbs and/or face, Movement, Emotions, Mouth & Abdomen, Urinary tract & Reproductive organs). Cognitive interviews demonstrated good comprehensibility and comprehensiveness. Conclusions: This study is the first step in the development of a disease-specific PROM for vitamin B12 deficiency to measure the burden of symptoms. Further validation and reliability testing are necessary before the PROM can be applied in clinical practice and research. Plain language title: Development of a Vitamin B12 Deficiency Questionnaire for Clinical Practice and Research Plain language summary: This study is the first step in the development of a questionnaire for vitamin B12 deficiency to measure the severity of vitamin B12 deficiency symptoms. The questionnaire includes 62 items grouped into 8 categories of symptoms related to vitamin B12 deficiency (General, Senses, Thinking, In limbs and/or face, Movement, Emotions, Mouth & Abdomen, Urinary tract & Reproductive organs). Interviews with patients demonstrated good comprehensibility and comprehensiveness of the questionnaire. Further testing is necessary before the questionnaire can be applied in clinical practice and research. [ABSTRACT FROM AUTHOR]

Purpose: To elucidate the efficacy and safety profile of interferon α-2b in vernal keratoconjunctivitis (VKC). Methods: In this prospective interventional study, VKC patients fulfilling the inclusion and exclusion criteria were included and their signs and symptoms were scored based on the Clinical Scoring System. Patients were treated with topical interferon α-2b eye drop (1 MIU/ml) QID dosing for 6 weeks. Changes in symptoms and signs were evaluated at 2, 4, 8 weeks and 6 months after initiating treatment. A higher score meant severe disease, and a decline in score meant improvement in clinical signs and symptoms. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Post-medication total subjective symptom score (TSSS) and total objective sign score (TOSS) were compared with baseline, and a P- value of

Background: Despite control strategies, tuberculosis remains a significant public health problem in many countries. Along with effective control measures currently available, it is essential to identify and target the risk factors of developing active TB to tackle the heavy burden of the disease. This study aims to find out the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. Materials and Methods: A case-control study was done to assess the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. The study was done from a parent study conducted in South India to study the prevalence of diabetes mellitus among registered tuberculosis patients. Those patients diagnosed with both tuberculosis and diabetes mellitus were taken as cases, and those patients with tuberculosis without diabetes mellitus were taken as controls. Cases and controls were above the age of 15 years. The calculated sample size was 115:345, as there were only 92 cases in the parent study. All were taken. Social factors like age, gender, occupation, and socio-economic status, as well as clinical factors like various symptoms, symptom score, type of tuberculosis, category, and treatment outcome, were studied in this study. Data was coded in Excel and analyzed using SPSS version 16. Chi-square analysis was done to find out the association and odd's ratio. Results: There was a significant difference in age between cases and controls. All symptoms are significantly higher (Chi-square 27.6p-0.0001) among those who have tuberculosis and diabetes co-morbidity when considering each symptom separately. Extrapulmonary tuberculosis was found more among controls. In this study, it was found that relapse and treatment after default were significantly higher among cases(Chi square 23.4 p-0.000034). Conclusion: A significant difference was found among TB patients with DM as co-morbidity when compared with patients without DM. Uncontrolled diabetes will be one challenge for TB elimination. Hence, periodic screening is necessary to find out DM and the proper measures to be followed to control. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis with nasal polyp (CRSwNP) is one of the major phenotypes of chronic rhinosinusitis (CRS) with a high symptom burden. Doxycycline can be used as add-on therapy in CRSwNP. We aimed to evaluate short-term efficacy of oral doxycycline on visual analog scale (VAS) and SNOT-22 (Sino-nasal outcome test) score for CRSwNP. Visual analog score (VAS) for nasal symptoms and total SNOT-22 scores of 28 patients who applied with the diagnosis of CRSwNP and received 100 mg doxycycline for 21 days were analyzed in this retrospective cohort study. Doxycycline efficacy was also evaluated in subgroups determined according to asthma, presence of atopy, total IgE and eosinophil levels. After 21-day doxycycline treatment, there was a significant improvement in VAS score for post-nasal drip, nasal discharge, nasal congestion, and sneeze, and total SNOT-22 score (p = 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). No significant improvement was observed in VAS score for the loss of smell (p = 0.18). In the asthmatic subgroup, there were significant improvements in all VAS scores and total SNOT-22 score after doxycycline. In the non-asthmatic subgroup, there was no significant change in any of the VAS scores, but total SNOT-22 score was significantly improved (42 [21–78] vs. 18 [9–33]; p = 0.043). Improvement in VAS score for loss of smell is significant in only some subgroups like asthmatic patients, non-atopic patients, and patients with eosinophil >300 cell/µL. Doxycycline can be considered as an add-on treatment for symptom control in patients especially with CRSwNP comorbid with asthma. [ABSTRACT FROM AUTHOR]

Background: Prognostics for patients with cancer is especially important for the supportive care of those who are terminally ill. We previously found that symptom scores as patient-reported outcomes (PROs)?such as dyspnea and fatigue scores?some biochemical parameters, the palliative performance scale (PPS) scores, and symptom clusters were useful prognostic factors; however, the predictability of a prognosis based on these factors remains unclear. Objective: To identify appropriate three-week survival predictive factor(s), in terms of performance, in patients who were terminally ill. Design: We collected symptom scores as PROs using the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL). Setting/Subjects: We used data from terminally ill patients with cancer who were hospitalized at the palliative care unit of the Higashisumiyoshi-Morimoto Hospital (Osaka, Japan) from June 2018 to December 2019 (n?=?130), as well as additional data obtained from the same clinical study from January to March 2020 (n?=?31). Measurements: To evaluate predictive performance, indices such as sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated. Results: We found that the presence of a symptom cluster showed high sensitivity but low specificity and that a higher PPS value (>30) showed high specificity but low sensitivity, suggesting that these factors could provide relevant information for survival prognosis (less than or equal to three weeks). Conclusion: Symptom clusters obtained from patients is important for effective supportive care of those who are terminally ill.

Background: Elexacaftor–tezacaftor–ivacaftor (ETI) is a novel, highly effective CFTR modulator combination proven to enhance lung function and body weight in people with cystic fibrosis (pwCF) carrying a F508del mutation. Recently, we revealed significant reductions in abdominal symptoms (AS) in German, British, and Irish pwCF after 24–26 weeks of ETI using the CFAbd-Score, the first patientreported outcome measure (PROM) specifically developed and validated for pwCF following FDA guidelines. Notably, many pwCF reported marked changes in their AS during the first days of the new treatment. To capture these immediate effects, we developed the CFAbd-day2day, a CF-specific GI-diary, following FDA and COSMIN guidelines. Aim: To prospectively capture the immediate dynamics of AS using the CFAbdday2day 14 days before and 14–28 days after ETI initiation. In addition, we aim to provide validation steps of the novel PROM concerning sensitivity to changes. Methods: To develop the CFAbd-day2day, focus groups (community voice = pwCF and their proxies and CF specialists from different fields) were repeatedly consulted. Before and during the new ETI therapy, pwCF prospectively scored AS on a daily basis with the CFAbd-day2day. Results: Altogether, 45 pwCF attended in five CF centers prospectively completed the CFAbd-day2day before (mean ± sd:14 ± 7 days) and after (mean ± sd: 28 ± 23 days) ETI initiation. On the one hand, cumulative scores significantly decreased during the 3–4-week time frame after ETI initiation, compared to 2 weeks prior to therapy. On the other hand, many patients who revealed a relatively stable level of AS before ETI reported changes during the first days of treatment with the highly effective CFTR modulators. Factors like pain and flatulence increased in up to 21% of patients during the first 14 days of therapy, but they improved during days 15–27. Conclusion: The CFAbd-day2day, specifically developed and in the process of validation to prospectively capture GI symptoms in pwCF, provides new substantial insights into the dynamics of AS in pwCF receiving a new treatment with ETI. This novel tool is also helpful in prospectively monitoring patients with specific GI problems. International implementation and further validation steps of the diary are ongoing. [ABSTRACT FROM AUTHOR]

Background: Elexacaftor–tezacaftor–ivacaftor (ETI) is a novel, highly effective CFTR modulator combination proven to enhance lung function and body weight in people with cystic fibrosis (pwCF) carrying a F508del mutation. Recently, we revealed significant reductions in abdominal symptoms (AS) in German, British, and Irish pwCF after 24–26 weeks of ETI using the CFAbd-Score, the first patient-reported outcome measure (PROM) specifically developed and validated for pwCF following FDA guidelines. Notably, many pwCF reported marked changes in their AS during the first days of the new treatment. To capture these immediate effects, we developed the CFAbd-day2day, a CF-specific GI-diary, following FDA and COSMIN guidelines.Aim: To prospectively capture the immediate dynamics of AS using the CFAbd-day2day 14 days before and 14–28 days after ETI initiation. In addition, we aim to provide validation steps of the novel PROM concerning sensitivity to changes.Methods: To develop the CFAbd-day2day, focus groups (community voice = pwCF and their proxies and CF specialists from different fields) were repeatedly consulted. Before and during the new ETI therapy, pwCF prospectively scored AS on a daily basis with the CFAbd-day2day.Results: Altogether, 45 pwCF attended in five CF centers prospectively completed the CFAbd-day2day before (mean ± sd:14 ± 7 days) and after (mean ± sd: 28 ± 23 days) ETI initiation. On the one hand, cumulative scores significantly decreased during the 3–4-week time frame after ETI initiation, compared to 2 weeks prior to therapy. On the other hand, many patients who revealed a relatively stable level of AS before ETI reported changes during the first days of treatment with the highly effective CFTR modulators. Factors like pain and flatulence increased in up to 21% of patients during the first 14 days of therapy, but they improved during days 15–27.Conclusion: The CFAbd-day2day, specifically developed and in the process of validation to prospectively capture GI symptoms in pwCF, provides new substantial insights into the dynamics of AS in pwCF receiving a new treatment with ETI. This novel tool is also helpful in prospectively monitoring patients with specific GI problems. International implementation and further validation steps of the diary are ongoing.

Purpose: Vulvar lichen sclerosus (LS) is a chronic, progressive, autoimmune dermatologic condition that causes cutaneous changes accompanied by pruritus and pain. There remains a small population with vulvar LS refractory to topical corticosteroids. Injection of platelet-rich plasma (PRP) has been reported to have positive effects on tissue repair. The aim of this pilot study was to evaluate changes in symptom scores during and after PRP vulvar infiltration. Methods: Three PRP infiltrations were administered to 28 female postmenopausal patients with biopsy-proved LS with unsatisfactory response to steroid therapy. Change in score according to the Clinical Scoring System for Vulvar Lichen Sclerosus (CSS) was measured on six occasions over the course of a year. We used growth curve modeling to measure change over the period of the study. Results: Women in our study experienced a statistically significant improvement in auto-assessed symptoms of vulvar lichen sclerosus, and this improvement appears to be maintained throughout the monitoring year. Conclusion: Platelet-rich plasma may have a role in symptom relief in certain cases of patients with LS that do not respond to first-line therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Making high-quality decisions when selecting treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) requires a shared decision-making approach. However, older people with lower health literacy face barriers. The pilot study aimed to evaluate the feasibility of recruiting participants and evaluate the effectiveness of a multi-level intervention on decision quality for the treatment of LUTS/BPH. Method In this 2-arm, randomized controlled trial, multi-ethnic Asian men aged ≥ 50 years with moderate or severe symptoms (IPSS ≥ 8 and/or QOL ≥ 3) and physicians were recruited at a Singapore public primary care clinic. Men were randomized to either physicians trained in shared decision-making and used a pictorial patient-reported symptom score (Visual Analogue Uroflowmetry Score) during the consultation or to physicians untrained in shared decision-making who did not use the score. Decision quality was measured using SDMQ-9 scores from men and their physicians after the consultation. Results 60 men (intervention [n = 30], control [n = 30]) receiving care from 22 physicians were recruited. Men’s mean age was 70 ± 9 years: 87% were Chinese, 40% had no formal education, and 32% were of lower socioeconomic status. No difference in decision quality from the men’s nor their physicians’ perspectives was noted [for men: mean score = 70.8 (SD 20.3) vs. 59.5 (SD 22.4); adjusted p = 0.352] [for physicians: mean score = 78.1 (SD 14.1) vs. 73.2 (SD 19.8); adjusted p > 0.999]. Conclusion It was feasible to recruit the intended participants. There was no difference in decision quality between men who used shared decision-making and usual care for the treatment of LUTS/BPH.

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Psychological disturbances are frequent following COVID-19. However, there is not much information about whether pre-existing psychological disorders are associated with the severity and evolution of COVID-19. We aimed to explore the associations between regular psychotropic medication use (PM) before infection as a proxy for mood or anxiety disorders with COVID-19 recovery trajectories. We used data from the Predi-COVID study. We followed adults, tested positive for SARS-CoV-2 and collected demographics, clinical characteristics, comorbidities and daily symptoms 14 days after inclusion. We calculated a score based on 16 symptoms and modeled latent class trajectories. We performed polynomial logistic regression with PM as primary exposure and the different trajectories as outcome. We included 791 participants, 51% were men, and 5.3% reported regular PM before infection. We identified four trajectories characterizing recovery dynamics: “Almost asymptomatic,” “Quick recovery,” “Slow recovery,” and “Persisting symptoms“. With a fully adjusted model for age, sex, socioeconomic, lifestyle and comorbidity, we observed associations between PM with the risks of being in more severe trajectories than “Almost Asymptomatic”: “Quick recovery” (relative risk (95% confidence intervals) 3.1 (2.7, 3.4), “Slow recovery” 5.2 (3.0, 9.2), and “Persisting symptoms“11.7 (6.9, 19.6) trajectories. We observed a gradient of risk between PM before the infection and the risk of slow or no recovery in the first 14 days. These results suggest that a pre-existing psychological condition increases the risk of a poorer evolution of COVID-19 and may increase the risk of Long COVID. Our findings can help to personalize the care of people with COVID-19.

Food allergy is one of the major existing health problems, but no effective treatment is available. In the current work, a murine model that closely mimics pathogenesis of human food allergy and its quantifiable diagnostic parameter design, even for mild hypersensitivity reactions, were established. BALB/c mice were epicutaneously sensitized with 1 mg chicken egg ovomucoid (OVM) or cow's milk casein, free of adjuvants, five times a week for two consecutive weeks. Eleven days later, allergen-specific IgG1 and IgE in serum were measured by ELISA. On day 25, 20 mg OVM or 12 mg α-casein was administered orally, and allergic reactions such as the fall in rectal temperature, symptom scores during 90–120 min, serum mast cell protease-1 and cytokine levels were monitored. The detection of mild allergic reactions due to adjuvant-free allergen sensitization and oral allergen challenge routes was amplified by the combination of oral allergen and aspirin administration simultaneously or aspirin administration within 15–30 min before an allergen challenge. Quantification of the maximum symptom score and the frequency of symptoms during the monitoring period improved evaluation accuracy of food allergy signals. Based on these results, efficacy of casein oral immunotherapy for cow's milk allergies, which are generally difficult to detect, was monitored adequately. [ABSTRACT FROM AUTHOR]

Introduction: The evidence for prostatic urethral lift (PUL), in treating lower urinary tract symptoms/benign prostatic hyperplasia (BPH) in men with obstructive median lobes (OMLs), has grown. In this study, we present the first detailed comparison of outcomes between OML patients treated with PUL in controlled and real-world settings to relevant comparators (subjects treated with transurethral resection of the prostate [TURP] and sham in randomized controlled trials [RCTs]) to demonstrate similar symptom, safety, and patient experience outcomes. Materials and Methods: Symptom and safety outcomes and patient satisfaction were compared through 12 months among controlled PUL studies: BPH6 RCT (35 men randomized to TURP); L.I.F.T. pivotal RCT in subjects with lateral lobe obstruction (66 subjects randomized to sham) and MedLift, an U.S. Food and Drug Administration-approved Investigational Device Exemption (IDE) extension of the L.I.F.T. trial (45 men with OML). Symptom improvement, catheterization, and adverse event rates were compared between MedLift subjects and OML patients (n = 187) from the large real-world retrospective (RWR) study of PUL filtered on baseline characteristics to approximate the MedLift population. Results: Posttreatment, International Prostate Symptoms Score (IPSS) improvement for MedLift subjects was 170% greater compared with sham at 3 months with significantly better quality of life (QoL), Qmax, and benign prostatic hyperplasia impact index (BPHII). Compared with TURP, MedLift IPSS and QoL improved significantly better at 1 and 3 months and with superior ejaculatory function scores at all time points after PUL. IPSS, QoL, postvoid residual (PVR), and Qmax outcomes were equivalent between MedLift and RWR OML groups at 3, 6, and 12 months. RWR OML patients did not experience higher rates of overall adverse events compared with MedLift. Conclusion: Controlled and real-world outcomes confirm PUL is a safe and effective treatment for BPH patients with and without OML. [ABSTRACT FROM AUTHOR]

Purpose: The Eckardt score (ES) is a famous scoring system used for assessing achalasia patients. We studied the correlation between our scoring system and the ES and examined the relationship between each score and the pathophysiology of achalasia. Methods: The subjects were 143 patients with diagnosed achalasia. We assessed the frequency and degree of dysphagia, regurgitation (vomiting), and chest pain on a 5-point scale from 0 to 4, with the product of the frequency and degree score defined as each symptom score (0–16). The sum of the three symptom scores was the Total Symptom Score (TSS). We then studied the correlation between the TSS and the ES, including whether these scores reflected the pathophysiology. Results: The median scores were 20 for TSS and 6 for the ES, indicating a high correlation between the two scores (r = 0.7280, p < 0.0001). A relationship was found between the morphologic type and both scores (TSS: p = 0.002, ES: p = 0.0036). On creating a receiver operating characteristic (ROC) curve for the Straight type and each score, the AUC was 0.6740 for TSS and 0.6628 for ES. Conclusions: A high positive correlation was found between the TSS and the ES. Both scoring systems reflected the morphologic type well, demonstrating that the TSS was a scoring system comparable to the ES. [ABSTRACT FROM AUTHOR]

Background: The total naso-ocular symptom score (TSS) is widely used as an endpoint to evaluate the severity of seasonal allergic rhinitis. However, it is not a generic preference-based measure. We sought to develop an algorithm for mapping between the TSS and health utility in Japanese cedar pollinosis (JCP). We also performed a cost-utility analysis of sublingual immunotherapy (SLIT) for JCP by using this algorithm. Methods: Patients with JCP filled out the TSS questionnaire and EQ-5D-5L simultaneously during the pollen season in 2019 and in 2020. We estimated a direct utility mapping model by regressing responses to individual TSS questions directly onto utility. The incremental cost-effectiveness ratio (ICER) of active SLIT to a placebo was determined by examining the drug expense and the estimated quality-adjusted life year (QALY) using a dataset from a double-blind placebo-controlled clinical trial. Results: A total of 238 records were included for analysis. The estimated utility decreased with increasing severity of rhinitis. Patients with comorbid asthma showed lower utility. A negative and significant correlation was seen between the TSS and utility in both 2019 and 2020. The estimated equations were: Y(utility) = −0.0161∗X(TSS) + 1.005 in non-asthmatic JCP patients. The ICER of active SLIT to the placebo was estimated to be 4,049,720 and 6,011,218 JPY/QALY in the first and second year, respectively. Conclusions: It is possible to reasonably predict utility from the total naso-ocular symptom score by using regression models. In the estimated algorithm, pre-seasonal SLIT for JCP is cost-effective.

Background: Making high-quality decisions when selecting treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) requires a shared decision-making approach. However, older people with lower health literacy face barriers. The pilot study aimed to evaluate the feasibility of recruiting participants and evaluate the effectiveness of a multi-level intervention on decision quality for the treatment of LUTS/BPH. Method: In this 2-arm, randomized controlled trial, multi-ethnic Asian men aged ≥ 50 years with moderate or severe symptoms (IPSS ≥ 8 and/or QOL ≥ 3) and physicians were recruited at a Singapore public primary care clinic. Men were randomized to either physicians trained in shared decision-making and used a pictorial patient-reported symptom score (Visual Analogue Uroflowmetry Score) during the consultation or to physicians untrained in shared decision-making who did not use the score. Decision quality was measured using SDMQ-9 scores from men and their physicians after the consultation. Results: 60 men (intervention [n = 30], control [n = 30]) receiving care from 22 physicians were recruited. Men's mean age was 70 ± 9 years: 87% were Chinese, 40% had no formal education, and 32% were of lower socioeconomic status. No difference in decision quality from the men's nor their physicians' perspectives was noted [for men: mean score = 70.8 (SD 20.3) vs. 59.5 (SD 22.4); adjusted p = 0.352] [for physicians: mean score = 78.1 (SD 14.1) vs. 73.2 (SD 19.8); adjusted p > 0.999]. Conclusion: It was feasible to recruit the intended participants. There was no difference in decision quality between men who used shared decision-making and usual care for the treatment of LUTS/BPH. [ABSTRACT FROM AUTHOR]

Background: Computed tomographic (CT) scan is important in the evaluation of chronic rhinosinusitis (CRS). The usefulness of CT scan in predicting the severity of symptoms is still debatable. The aim of this study is to determine the correlation between a CT scan scoring and the severity of clinical symptoms in patients with CRS. Methods: A cross-sectional study of patients with clinically diagnosed CRS. Their symptoms severity was assessed using the Sinonasal Outcome Test-20 (SNOT-20) scoring system. All eligible patients had CT scans using BrightSpeed (GE) computed tomographic scanner. The CT scan findings of each subject were scored according to the Lund-Mackay scoring system. The correlation between the CT score and the SNOT-20 symptom score was determined. Results: There were 120 participants comprised 70 (58.3%) males and 50 (41.7%) females with male: female ratio of 1.4:1. The mean and standard deviation of SNOT-20 were 38.9 ± 17.5 (range: 6–81) and that of Lund-Mackay score were 9.8 ± 5.5 (range: 0–24). There was statistical significant correlation between Lund-Mackay score and SNOT-20 score (r = 0.653 P = 0.000). The correlation was strongest in relation to nasal symptom domain (r = 0.746, P = 0.000), but it was weak with the facial symptom domain (r = 0.225, P = 0.013). Conclusion: This study found a strong positive correlation between the Lund-Mackay score and SNOT-20 symptoms score among patients with CRS. [ABSTRACT FROM AUTHOR]

Background: COPD (chronic obstructive pulmonary disease) and bronchiectasis are common, and exacerbations contribute to their morbidity and mortality. Predictive factors for the frequency of future exacerbations include previous exacerbation frequency and airway colonization. Earlier treatment of exacerbations is likely to reduce severity., Objective: This study tested the hypothesis that, in a population with bronchiectasis, COPD, or both who have frequent exacerbations and airway colonization, changes in symptom scores or physiological variables within 10 days prior to an exacerbation would allow the prediction of the event., Methods: We performed a 6-month, longitudinal, observational, cohort study among 30 participants with bronchiectasis, COPD, or both; at least 2 exacerbations per year; and colonization with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected, comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight, and temperature. Exacerbations (defined as the onset of new antibiotic use for respiratory symptoms) were collected, and predictive values for abnormal values in the 10 days prior to an exacerbation were calculated., Results: A total of 30 participants were recruited, collecting a total of 39,534 physiological and 25,334 symptom data points across 5358 participant-days; these included 78 exacerbations across 27 participants, with the remaining 3 participants not having exacerbations within the 6-month observation period. Peak flow rate, oxygen saturation, and weight were significantly different at the point of exacerbation (all P<.001), but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in the overall or individually adjusted model. Symptom scores tended to worsen for 10 days on either side of an exacerbation but were of insufficient magnitude for prediction, with area under the receiver operating characteristic curve values of ranging from 0.4 to 0.6., Conclusions: Within this small cohort with bronchiectasis, COPD, or both and airway colonization, physiological and symptom variables did not show sufficient predictive value for exacerbations to be of clinical utility. The self-management education provided as standard of care may be superior to either of these approaches, but benefit in another or larger cohort cannot be excluded., International Registered Report Identifier (irrid): RR2-10.2196/resprot.6636., (©Thomas Llewelyn Jones, Claire Roberts, Scott Elliott, Sharon Glaysher, Ben Green, Janis K Shute, Anoop J Chauhan. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 08.10.2024.)

Background: Patient‐reported outcomes such as the Patient Perception of Bladder Condition (PPBC) score are frequently used to characterize overactive bladder syndrome (OAB) patients and their treatment outcomes. However, little information is available on the relationship of such scores to OAB symptoms at the individual patient level. Methods: We have performed a post hoc analysis of two large noninterventional studies (n = 1345 and 745) in which patients received propiverine extended release (30 or 45 mg/day) for 12 weeks to determine the strength of nonparametric correlations between PPBC and OAB symptoms at baseline, after treatment and with treatment‐associated changes thereof. Results: PPBC was not correlated with age but with episode frequencies of urgency, incontinence, micturitions, and nocturia, but the strength of correlations was only moderate (Spearman rank correlation coefficient 0.2045−0.3553). Similarly moderate correlations were observed after treatment and when changes in PPBC were compared to those of OAB symptoms, although these correlations were somewhat stronger. Conclusions: PPBC is only moderately correlated to OAB symptoms indicating that it characterizes patients beyond what is captured by their symptoms. [ABSTRACT FROM AUTHOR]

Background: Validated combined symptom‐medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real‐life data from the MASK‐air® app to generate and validate hypothesis‐ and data‐driven CSMSs. Methods: We used MASK‐air® data to assess the concurrent validity, test‐retest reliability and responsiveness of one hypothesis‐driven CSMS (modified CSMS: mCSMS), one mixed hypothesis‐ and data‐driven score (mixed score), and several data‐driven CSMSs. The latter were generated with MASK‐air® data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK‐air®, and Work Productivity and Activity Impairment: Allergy Specific [WPAI‐AS]), (ii) quality‐of‐life (EQ‐5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]). Results: We assessed 317,176 days of MASK‐air® use from 17,780 users aged 16‐90 years, in 25 countries. The mCSMS and the factor analyses‐based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate‐to‐strong correlations with the tested comparators, high test‐retest reliability and moderate‐to‐large responsiveness. Among data‐driven CSMSs, a better performance was observed for cluster analyses‐based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC‐ROC = 0.904) and for the mixed CSMS (AUC‐ROC = 0.820). Conclusion: The mixed CSMS and the cluster‐based CSMSs presented medium‐high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials. [ABSTRACT FROM AUTHOR]

Background: The novel and highly effective CFTR modulator combination of elexacaftor-tezacaftor-ivacaftor (ETI) has been shown to improve lung function and body weight in people with Cystic Fibrosis (pwCF) carrying a F508del mutation. However, the impact of these modulators on gastrointestinal (GI) symptoms is relatively unknown. Therefore, the CFAbd-Score was developed and validated following FDA recommendations for development of a PROM including focus groups, multidisciplinary CF specialists, people with CF and their families. The aim of this study was to assess effects of ETI on GI symptoms using the CFAbd-Score. Methods: Gastrointestinal symptoms were prospectively assessed in pwCF using the CFAbd-Score before and up to 26 weeks during therapy. The CFAbd-Score was also administered to a healthy control (HC) group. The one-sided questionnaire includes 28 items grouped in five domains. Data analysis included calculation of scores with a weighting tool, developed according to FDA recommendations. Results: A total of 107 pwCF attended in four CF centres in Germany and four centres in the UK completed the CFAbd-Score on at least two occasions. Results were compared to those obtained from the questionnaire of 45 HCs. Despite differences in demographics, age and proportion of pancreatic insufficiency between German and UK patients, analyses based on linear mixed-effects models at week 24 of ETI therapy revealed that estimated marginal means (EMMs) of total CFAbd-Scores significantly reduced (mean ± SE: 14.9 ± 1.2→10.6 ± 1.4; p < 0.01). Also EMMs of all five domains significantly declined ("pain" 16.3 ± 1.6→10.2 ± 2.3, "GERD" 15.8 ± 1.8→8.2 ± 1.9, "disorders of bowel movement" 20.9 ± 1.5→16.0 ± 1.7, "disorders of appetite" 7.9 ± 1.1→2.6 ± 1.1 and "quality of life impairment" 10.1 ± 1.92→3.9 ± 1.9). However, during 24 weeks, CF participants' symptoms mostly still did not reach the reference levels of HCs. Discussion: Using the CFAbd-Score, the first PROM specifically developed for assessment of CF-related abdominal symptoms, we demonstrate comprehensive improvements in GI symptoms after initiation of the highly effective modulator therapy ETI. [ABSTRACT FROM AUTHOR]

Background: The novel and highly effective CFTR modulator combination of elexacaftor-tezacaftor-ivacaftor (ETI) has been shown to improve lung function and body weight in people with Cystic Fibrosis (pwCF) carrying a F508del mutation. However, the impact of these modulators on gastrointestinal (GI) symptoms is relatively unknown. Therefore, the CFAbd-Score was developed and validated following FDA recommendations for development of a PROM including focus groups, multidisciplinary CF specialists, people with CF and their families. The aim of this study was to assess effects of ETI on GI symptoms using the CFAbd-Score.Methods: Gastrointestinal symptoms were prospectively assessed in pwCF using the CFAbd-Score before and up to 26 weeks during therapy. The CFAbd-Score was also administered to a healthy control (HC) group. The one-sided questionnaire includes 28 items grouped in five domains. Data analysis included calculation of scores with a weighting tool, developed according to FDA recommendations.Results: A total of 107 pwCF attended in four CF centres in Germany and four centres in the UK completed the CFAbd-Score on at least two occasions. Results were compared to those obtained from the questionnaire of 45 HCs. Despite differences in demographics, age and proportion of pancreatic insufficiency between German and UK patients, analyses based on linear mixed-effects models at week 24 of ETI therapy revealed that estimated marginal means (EMMs) of total CFAbd-Scores significantly reduced (mean ± SE: 14.9 ± 1.2→10.6 ± 1.4; p < 0.01). Also EMMs of all five domains significantly declined (“pain” 16.3 ± 1.6→10.2 ± 2.3, “GERD” 15.8 ± 1.8→8.2 ± 1.9, “disorders of bowel movement” 20.9 ± 1.5→16.0 ± 1.7, “disorders of appetite” 7.9 ± 1.1→2.6 ± 1.1 and “quality of life impairment” 10.1 ± 1.92→3.9 ± 1.9). However, during 24 weeks, CF participants’ symptoms mostly still did not reach the reference levels of HCs.Discussion: Using the CFAbd-Score, the first PROM specifically developed for assessment of CF-related abdominal symptoms, we demonstrate comprehensive improvements in GI symptoms after initiation of the highly effective modulator therapy ETI.

Background: Myasthenia Gravis (MG) is a disorder of neuromuscular transmission bringing mild ocular weakness to severe generalized muscle weakness and disability. The conventional treatments have long-term side effects, and Chinese herbal medicines (CHM) have shown possible effect and safety for MG patients, but the existing evidence was not robust enough and the results were out of date. Methods: Searching for randomized controlled trials (RCTs) was conducted in 7 databases and clinical trial registries until July 2021. The ROB 2 tool was used to assess the study quality and GRADE was used to assess the quality of whole evidence. Meta-analyses were conducted and the results were presented as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results: Nineteen RCTs (1283 participants) testing 13 kinds of CHM with adequate randomization were included and six RCTs investigating Compound Huangqi were included in the meta-analyses. In addition to conventional treatment, nine CHMs reduced symptom scores of MG. Compound Huangqi plus conventional treatment (pyridostigmine bromide or prednisone or both) reduced the symptom scores compared with conventional treatment (MD = -3.56, 95%CI -4.86 to -2.26). Less adverse events happened in the CHM groups (3/247 in the CHM groups, 52/245 in the control groups, RR = 0.13, 95%CI 0.06 to 0.30, 9 RCTs, a total of 492 participants). The effect on quality of life was inconsistent. Conclusion: Nine CHMs could probably bring benefit for MG symptom improvement. Moderate to low certainty of evidence supported Compound Huangqi added-on conventional treatment probably bring extra benefit of improving MG symptoms. Adding CHMs could be safer than giving only conventional treatment. Study registration: The protocol was registered in PROSPERO (ID: 32718).

The total naso-ocular symptom score (TSS) is widely used as an endpoint to evaluate the severity of seasonal allergic rhinitis. However, it is not a generic preference-based measure. We sought to develop an algorithm for mapping between the TSS and health utility in Japanese cedar pollinosis (JCP). We also performed a cost-utility analysis of sublingual immunotherapy (SLIT) for JCP by using this algorithm. Patients with JCP filled out the TSS questionnaire and EQ-5D-5L simultaneously during the pollen season in 2019 and in 2020. We estimated a direct utility mapping model by regressing responses to individual TSS questions directly onto utility. The incremental cost-effectiveness ratio (ICER) of active SLIT to a placebo was determined by examining the drug expense and the estimated quality-adjusted life year (QALY) using a dataset from a double-blind placebo-controlled clinical trial. A total of 238 records were included for analysis. The estimated utility decreased with increasing severity of rhinitis. Patients with comorbid asthma showed lower utility. A negative and significant correlation was seen between the TSS and utility in both 2019 and 2020. The estimated equations were: Y(utility) = −0.0161∗X(TSS) + 1.005 in non-asthmatic JCP patients. The ICER of active SLIT to the placebo was estimated to be 4,049,720 and 6,011,218 JPY/QALY in the first and second year, respectively. It is possible to reasonably predict utility from the total naso-ocular symptom score by using regression models. In the estimated algorithm, pre-seasonal SLIT for JCP is cost-effective. [ABSTRACT FROM AUTHOR]

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Objectives: To determine whether subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT) better improves patient outcomes and quality of life for adults with allergic rhinitis or rhinoconjunctivitis (AR/C) with or without mild to moderate asthma. Methods: Systematic review methodology was based on the Cochrane Collaboration handbook and Preferred Reporting Items for Systematic Reviews and Meta‐analyses. Four databases (PubMed, Cochrane Library, EMBASE, and Web of Science) were queried from inception to July 30, 2020. Two independent reviewers screened potentially relevant studies and assessed risk of bias. Outcomes of interest were symptom score (SS), medication score (MS), combined symptom medication score (CSMS), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Meta‐analyses with an adjusted indirect comparison were conducted in RevMan 5.4.1. Results: Seven SCIT versus SLIT randomized controlled trials (RCTs) demonstrated no significant differences for any outcomes, but insufficient data precluded direct meta‐analysis. For the adjusted indirect comparison, 46 RCTs over 39 studies were included for SCIT versus placebo (n = 13) and SLIT versus placebo (n = 33). Statistically significant results favoring SCIT were found for SS (standardized mean difference [SMD] = 0.40; 95% confidence interval [CI] = 0.31–0.49), MS (SMD = 0.26; 95% CI = 0.14–0.39), CSMS (SMD = 0.42; 95% CI = 0.17–0.67), and RQLQ (MD = 0.24; 95% CI = 0.04–0.44). Statistically significant results favoring SLIT were found for SS (SMD = 0.42; 95% CI = 0.32–0.53), MS (SMD = 0.40; 95% CI = 0.28–0.53), CSMS (SMD = 0.37; 95% CI = 0.29–0.45), and RQLQ (MD = 0.32; 95% CI = 0.20–0.43). No significant differences were found between SCIT and SLIT for SS (SMD = −0.02; 95% CI = −0.15 to 0.11), MS (SMD = −0.14; 95% CI = −0.31 to 0.03), CSMS (SMD = 0.05; 95% CI = −0.21 to 0.31), or RQLQ (MD = −0.08; 95% CI = −0.31 to 0.15). Conclusion: SCIT and SLIT are comparably effective treatments for adults with AR/C. More RCTs analyzing SCIT versus SLIT are needed to directly compare the two. Laryngoscope, 132:499–508, 2022 [ABSTRACT FROM AUTHOR]

Abstract Background Being a newly emerging disease, little is known about its long-lasting post-COVID-19 consequences. The aim of this work is to assess the frequency, patterns, and determinants of persistent post-COVID-19 symptoms and to evaluate the value of a proposed novel COVID-19 symptom score. Patients with confirmed COVID-19 in a hospital-based registry were included in a cross-sectional study (the hospitals including Assiut University Hospital, Assiut Chest Hospital, Aswan University Hospital, and Aswan Specialized Hospital). The patient demographics, comorbid disorders, the mean duration since the onset of the symptoms, history of hospital or ICU admittance, and the treatment taken during the acute state, as well as symptom score before and after convalescence, were recorded. Results The most frequent constitutional and neurological symptoms were myalgia (60.0%), arthralgia (57.2%), restriction of daily activities (57.0%), and sleeping troubles (50.9%), followed by anorexia (42.6%), chest pain (32.6%), gastritis (32.3%), cough (29.3%), and dyspnea (29.1%). The mean total score of acute stage symptoms was 31.0 ± 16.3 while post-COVID 19 symptom score was 13.1 ± 12.6 (P 18 to predict occurrence of post-COVID-19 symptoms. Conclusions COVID-19 can present with a diverse spectrum of long-term post-COVID-19 symptoms. Increased acute phase symptom severity and COVID-19 symptom score > 18 together with the presence of any comorbid diseases increase the risk for persistent post-COVID-19 manifestations and severity.

Objective: Allergen-specific immunotherapy (allergen-SIT) is a treatment method with variable efficacy in allergic diseases. This study aimed to investigate the effectiveness of allergen immunotherapy, frequency of LRs and SRs and variables affecting these parameters in patients who underwent allergen-SIT. Materials and Methods: In this study, the recorded data of 81 patients, who received subcutaneous (SCIT) or sublingual (SLIT) allergen immunotherapy for respiratory allergic diseases between 2014 and 2019, were analyzed. In asthma and/or allergic rhinoconjunctivitis (ARC) patients, the effectiveness of treatment was evaluated by analysing the change rates in disease symptom, medication and combined scores (symptom + medication) and visual analog score (VAS). Treatment success was defined by the degree of decrease in scores as; high response above 50%; low response between 20-50%; and failure <20%. Results: The mean age of allergen-SIT initiation was 11.4± 3.1 years. Diagnostic distributions of the patients were asthma (± ARC) in 64.2%, and ARC (without asthma) in 35.8%. The mode of allergen-SIT was SCIT in 77.8% (65% asthma and 35% ARC) and SLIT in 22.2% (61.1% asthma and 38.9% ARC). The main allergens used in allergen-SIT were mite (79%), grass-grain pollen (33.3%), alternaria (9.9%) and olea (8.6%). There was a significant decrease in symptoms, medication, combined and VAS scores in the asthma and ARC groups (p <0.0001), when end-SCIT values were compared to baseline. SLIT also resulted in significant decreases in these scores except asthma medication score. Among the asthma patients the rate of high-responders was 88.8% by SCIT and 50% by SLIT, according to combined asthma score. Among the ARC (without asthma) patients the rate of high-responders was 100% for both SCIT and SLIT. SCIT resulted in local (LR) and systemic side effects (SR) in 18% and 0.6% (all Grade I and Grade II) of the total injections performed. A high number of total injections was significantly associated with higher LR and SR rates. While LR was observed in 16.6% of the patients who underwent SLIT, no systemic reaction was found in any of the patients. Conclusion: SCIT was highly successful in the treatment of asthma and ARC in terms of the degree of therapeutic response. SLIT resulted in a high rate of good response in ARC patients, but a lower response degree in asthmatic patients. Systemic side effects were very low as a result of close risk monitoring and the dose adjustments performed. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) is a chronic disease that is becoming increasingly common worldwide and has a negative impact on school performance, work performance, and quality of life. The aim of this study was to investigate the effect of vitamin D on the symptoms of AR in children. Methods: Serum vitamin D levels of children with AR and age-matched healthy controls were compared using the high-pressure liquid chromatography method. The relationship between serum vitamin D levels and symptoms and severity of AR was then examined. Results: The study included 137 patients diagnosed with AR (76 males, 61 females; median age: 11 years). Serum vitamin D levels were lower in the patient group than in the control group (P = 0.001), lower in all aeroallergen groups (mites, pollen, and multiple inhalants) than in the healthy control group (P = 0.001), and lower in both the perennial AR group and the seasonal AR group than in the control group (P = 0.001). Spearman correlation analysis showed that there was no correlation between symptom score and vitamin D level (rs = −0.099; P = 0.25). Conclusions: We found no correlation between serum vitamin D level and symptoms and severity of AR. Serum vitamin D levels were lower in children with AR than in healthy children. [ABSTRACT FROM AUTHOR]

Food allergy is one of the major existing health problems, but no effective treatment is available. In the current work, a murine model that closely mimics pathogenesis of human food allergy and its quantifiable diagnostic parameter design, even for mild hypersensitivity reactions, were established. BALB/c mice were epicutaneously sensitized with 1 mg chicken egg ovomucoid (OVM) or cow’s milk casein, free of adjuvants, five times a week for two consecutive weeks. Eleven days later, allergen-specific IgG1 and IgE in serum were measured by ELISA. On day 25, 20 mg OVM or 12 mg α-casein was administered orally, and allergic reactions such as the fall in rectal temperature, symptom scores during 90–120 min, serum mast cell protease-1 and cytokine levels were monitored. The detection of mild allergic reactions due to adjuvant-free allergen sensitization and oral allergen challenge routes was amplified by the combination of oral allergen and aspirin administration simultaneously or aspirin administration within 15–30 min before an allergen challenge. Quantification of the maximum symptom score and the frequency of symptoms during the monitoring period improved evaluation accuracy of food allergy signals. Based on these results, efficacy of casein oral immunotherapy for cow’s milk allergies, which are generally difficult to detect, was monitored adequately.

Background: Cow's milk protein allergy (CMPA) is an immune‐mediated allergic response to proteins in milk that is common in infants. Broad CMPA symptoms make diagnosis a challenge, particularly in primary care. Symptom scores may improve a clinician's awareness of symptoms, indicating a need for further testing. This systematic review examined the development and evaluation of such symptom scores for use in infants. Methods: CENTRAL, MEDLINE, EMBASE and CINAHL databases were searched from inception to 3 December 2019 (Updated 14 November 2020) for diagnostic accuracy studies, randomised controlled trials, observational studies, economic evaluations, qualitative studies and studies reporting development of the tools. Data were not suitable for meta‐analysis due to clinical and methodological heterogeneity, so were narratively synthesised. Results: We found two symptom scores evaluated in one and fourteen studies, respectively. Estimated sensitivity and specificity ranged from 37% to 98% and 38% to 93%. The evaluations of each tool were at high risk of bias or failed to address issues such as clinical and cost‐effectiveness. Conclusions: Estimates of accuracy of symptom scores for CMPA offered so far should be interpreted cautiously. Rigorous, conflict‐free research based on well‐defined roles for the tools is urgently required. [ABSTRACT FROM AUTHOR]

Objectives: To determine how well ultrasound- guidance percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) performed for benign symptomatic thyroid nodules in terms of clinical and functional outcomes. Methods: Patients who had a thyroid nodule- linked symptoms acting as dysphagia, cosmetic issues, pain, a foreign body sense, hyperthyroidism secondary to autonomous nodules, or concern of malignancy were involved in the study. The primary was the comparison in symptom scores obtained at 1, 3, and 6 months after RFA and MWA. The volume alterations in nodules and alterations in thyroid gland functions were secondary objectives. Results: This prospective study carried out from November 2014 and January 2017 at the General Surgery Department, Marmara University, Faculty of Medicine, Istanbul, Turkey included a total of 100 nodules (50% MWA, 50% RFA). There were statistically significance in pain scores, dysphagia scores, and foreign body sensation scores at 1, 3, and 6 months after therapy in both ablation groups (p=0.0006, p=00004, p=0.0005). At the same time, there were statistically significant reductions in size and volume of the nodules for RFA and MWA (p=0.0004, p=0.0003). There was no significant difference between the RFA and MWA groups' cosmetic scoring and volume changes (p=0.68, p=0.43). Conclusion: Alternative therapies for benign symptomatic thyroid nodules include RFA and MWA. The findings of this research revealed that both approaches are safe and effective. [ABSTRACT FROM AUTHOR]

Background: Asthma is a long-term inflammatory disorder of the airways characterized by wheezing, dyspnea, and cough. For the last few decades, inhalational devices have been used in the management of the disease, but compliance remains the problem. Higher doses of oral medications used with prominent side effects precluded the use of oral beta-agonist bronchodilators, and the search for an ideal beta-adrenergic bronchodilator continues. This study was conducted for evaluation of the role of oral bambuterol in the management of bronchial asthma. Aims and Objectives: Our study aimed to evaluate the potency and effectiveness of oral bambuterol in the management of the disease in fifty patients followed up over 2 weeks with objective assessment of symptom scores and changes in the frequency of rescue bronchodilator after 2 weeks of treatment. Side effects, if any, were documented for all patients. Methods: The study was conducted on fifty patients with chronic bronchial asthma. They were given 10 mg of bambuterol once daily orally for 14 days. Pulmonary function tests were performed at days 1, 7, and 14. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow rate (PEFR) were measured. Patients were assessed for symptom score and side effects at days 1, 7, and 14. Results: After completion of the study, significant improvement in the symptom score, FVC, FEV1, and PEFR was obtained with minimal side effects. Conclusion: Bambuterol 10 mg oral tablet once a day provides significant improvement in pulmonary function tests and effectively reduces asthmatic symptoms with minimal side effects.

Objective:To investigate the prevalence of voiding dysfunction (VD) and nocturnal enuresis (NE) in Turkish primary school children using a previously validated Dysfunctional Voiding Scoring System (DVSS) questionnaire and a self-administered questionnaire.Materials and Methods:The previously validated DVSS questionnaire was completed by the parents of 3015 randomly selected children. Another questionnaire was also administered for studying VD and NE rates, demographic characteristics, and learning or behavioral problems of children.Results:Of all children, 6.6% (n=199) had a score suggesting VD and 6.1% (n=185) had NE. No significant differences were found between children with and without VD in terms of age, gender, and fluid intake. Children with VD had significantly high rates of constipation (19.7% vs 5.2%; p

The win ratio is a general method of comparing locations of distributions of two independent, ordinal random variables, and it can be estimated without distributional assumptions. In this paper we provide a unified theory of win ratio estimation in the presence of stratification and adjustment by a numeric variable. Building step by step on the estimate of the crude win ratio we compare corresponding tests with well known non-parametric tests of group difference (Wilcoxon rank-sum test, Fligner–Policello test, van Elteren test, test based on the regression on ranks, and the rank analysis of covariance test). We show that the win ratio gives an interpretable treatment effect measure with corresponding test to detect treatment effect difference under minimal assumptions. [ABSTRACT FROM AUTHOR]

Abstract Objective Gastro-esophageal reflux disease (GERD) affects all age groups, and various lifestyle as well as psychological factors are recognized as risk factors for GERD. Undergraduate medical students are exposed to lifestyle changes and psychological stressors. We aimed to study the prevalence of GERD among undergraduate students of a medical school in southern India in a cross-sectional survey using a validated symptom score. Results A total of 358 undergraduate medical students participated in the study. There were 188 (52.5%) males and 170 (47.4%) females; the mean (SD) age of the participants was 20.3 (1.5) years. A total of 115 (31.2%) participants had at least one episode of heartburn per week, while 108 (30.1%) participants had at least one episode of regurgitation per week. Heartburn or regurgitation of at least mild severity was present in 115 (32.1%) and 108 (30.16%) of participants respectively. Based on the symptom score, a diagnosis of GERD was made in 18 (5.02%) students. Frequent consumption of carbonated drinks (OR = 3.63 [95% CI 1.39–9.5]; P = 0.008) and frequent consumption of tea or coffee (OR = 4.65 [95% CI 1.2–17.96]; P = 0.026) were significantly associated with a diagnosis of GERD.

Purpose To evaluate the correlations among the Overactive Bladder Symptom Score (OABSS), International Prostate Symptom Score–Storage Subscore (IPSS-S), and the modified Urgency Severity Scale (USS) in patients with overactive bladder (OAB) and hypersensitive bladder (HSB) and to identify the most useful diagnostic tool for classifying the severity of OAB. Methods We retrospectively reviewed the charts of consecutive patients with OAB who visited our urologic clinics for treatment. All patients underwent a detailed history, physical examination, urinalysis, uroflowmetry, and postvoid residual volume measurement, and completed a 3-day voiding diary. All patients answered the Chinese versions of the IPSS, OABSS, and USS, according to which they were classified as having wet or dry OAB based on whether their chief complaint was urgency urinary incontinence or urgency without incontinence. HSB was defined as a functional bladder capacity OABSS>IPSS-S. The simplest survey, the USS, with a single item scored from 0 to 4, had the strongest correlation with the OAB severity subgroups.

Objective: The present study was conducted to assess the validity of symptom score and Genital Health Clinical Evaluation (GHCE) score as diagnostic tools for urogenital atrophy in females of 40–75 years of age group. Materials and Methods: A cross-sectional study including 600 females in the age group of 40–75 years attending gynecology outpatient department was conducted. They were given a symptom score based on their history. GHCE score and smears for vaginal maturation index (VMI) were taken and percentages of superficial cells were counted. Statistical tests of significance such as Karl Pearson's coefficient of correlation were applied. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy of GHCE score, and symptom score with VMI score were calculated. Results: The prevalence of urogenital atrophy in females of 40–75 years of age group using VMI scoring was 38.1%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of total symptom score for diagnosing urogenital atrophy were 66.4%, 75.3%, 56.3%, 82.4%, and 72.5%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GHCE score for diagnosing urogenital atrophy were 43.4%, 80.7%, 75.3%, 51.3%, and 59.3%, respectively. Conclusion: Both symptom score and GHCE score can be used as valid alternatives to VMI as diagnostic tools for urogenital atrophy in females of 40–75 years of age group at least in resource-poor settings.

Currently, there are no simple tools to evaluate the acute heart failure (HF) symptom severity in children hospitalized with acute decompensated HF (ADHF). We sought to develop an inpatient HF score (HFS) that could be used as a clinical tool and for clinical trials. Pediatric HF clinicians at Stanford reviewed the limitations of existing HFSs, which include lack of calibration to the inpatient setting, omission of gastrointestinal symptoms, need for multiple age-based tools, and scores that prioritize treatment intensity over patient symptoms. To address these, we developed an acute HFS corresponding to the 3 cardinal symptoms of HF: difficulty with breathing, feeding, and activity. The score was iteratively improved over a 3-year pilot phase until no further changes were made. The inter-rater reliability (IRR) across a range of providers was assessed using the final version. Peak HFSs were analyzed against mortality and length of stay (LOS) for all pediatric HF discharges between July and October 2019. The final HFS was a 4-point ordinal severity score for each of the 3 symptom domains (total score 0–12). Among clinicians who scored 12 inpatients with ADHF simultaneously, the intraclass correlation (ICC) was 0.94 (respiratory ICC = 0.89, feeding ICC = 0.85, and activity ICC = 0.80). Score trajectory reflected our clinical impression of patient response to HF therapies across a range of HF syndromes including 1- and 2-ventricle heart disease and reduced or preserved ejection fraction. Among the 28 patients hospitalized during a 3-months period (N = 28), quartiles of peak score were associated with LOS (p < 0.01) and in-hospital mortality (p < 0.01): HFS 0 to 3 (median LOS of 5 days and mortality of 0%), HFS 4 to 6 (median LOS of 18 days and mortality of 0%), HFS 5 to 9 (median LOS of 29 days and mortality of 23%), and HFS 10 to 12 (median LOS of 121 days and mortality of 50%). This simple acute HFS may be a useful tool to quantify and monitor day-to-day HF symptoms in children hospitalized with ADHF regardless of etiology or age group. The score has excellent IRR across provider levels and is associated with major hospital outcomes supporting its clinical validity. Validation in a multicenter cohort is warranted. [ABSTRACT FROM AUTHOR]

Objective: To develop an orthostatic intolerance symptom scoring system to assess orthostatic intolerance and then to compare the symptom score among different head-up tilt test responses. Methods: 272 subjects (5-18 years) presenting with orthostatic intolerance symptoms finished questionnaire and head-up tilt test. According to head-up tilt test hemodynamic responses, the subjects were divided into head-up tilt test negative, vasovagal syncope, and postural tachycardia syndrome groups. Results: We built up a symptom score according to the frequency of dizziness, headache, blurred vision, palpitations, chest discomfort, gastrointestinal symptoms, profuse perspiration, and syncope. The median score in postural tachycardia syndrome subjects was highest. A score of 2.5 for predicting vasovagal syncope yielded a sensitivity of 75.0% and specificity of 50.3%, a score of 5.5 for predicting postural tachycardia syndrome yielded a sensitivity of 69.7% and specificity of 72.0%. Furthermore, the median score in postural tachycardia syndrome subjects was significantly higher than that in head-up tilt test negative subjects with heart rate increment of 30-39 beats/min (P <.01). Conclusions: This suggests that the symptom score has some predictive value in head-up tilt test results, which can be served as a preliminary assessment instrument. [ABSTRACT FROM AUTHOR]

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Introduction and aims: Family physicians are limited by lack of tools to monitor benign prostate hyperplasia. VAUS provides a cost-effective, easily administered non-invasive tool. Our primary aim was to validate VAUS correlation with uroflowmetry measured maximal flow rate (Qmax), voided volume and International Prostate Symptom Scores (IPSS) symptom scores. Secondary aim was to study how the VAUS fared at predicting poor flow (Qmax < 10 ml/s) compared to age, voided volume and IPSS. Tertiary aim was to predict the best VAUS as a cutoff for poor flow. Methods: After IRB approval, 1000 patients were prospectively recruited. They had VAUS, uroflowmetry and IPSS performed. VAUS is a novel five-point visual analogue scoring of urine flow, with one being the weakest and five the strongest. Data were analysed using SPSS where spearman's correlation coefficient and logistic regression analysis were performed looking for significance. Receiver operating curves (ROC) curves were used to identify best VAUS cutoff. Results: 1000 patients were studied with mean age of 68.99 (50–95). VAUS showed good correlation with Qmaxp < 0.001, voided volume p = 0.006 and IPSS p <0.001. On multivariate analysis both VAUS and voided volume predicted poor flow significantly with p value of<0.001 and p =0.001, respectively. On ROC analysis VAUS of 2.5 was identified as best value for predicting poor flow with p value <0.001. Conclusion: VAUS is a validated tool for monitoring of lower urinary tract symptoms in our patients showing significant correlation with uroflowmetry, voided volume and IPSS. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide. Indacaterol is a new once daily inhaled bronchodilator, recently approved for the treatment of COPD. Once daily dosing is an important step to improve the adherence and compliance of the patients. Methods: Efficacy and Safety of Indacaterol and Tiotropium in Patients of COPD with Stage-2 and Stage-3 GOLD criteria were compared. Total 119 patients were divided into Indacaterol group and Tiotropium group receiving 150 mcg daily of Indacaterol and 18 mcg daily of Tiotropium in each group respectively. Efficacy treatment was determined by assessment of Pulmonary function test (PFT), Symptom score and SGRQ (St. George's Respiratory Questionnaires) score at day zero (before therapeutic intervention) and at two weeks of interval till 24 weeks. Results: The treatment with inhaled indacaterol 150 mcg once daily and inhaled tiotropium 18 mcg once daily improved spirometric variable, FEV1, decrease in mean Symptoms score and in mean SGRQ in Grade-2 and Grade-3 COPD patients. Conclusion: Indacaterol (150 mcg/day) is non-inferior to tiotropium (18 mcg /day) in efficacy and safety profile of Grade-2 and Grade-3 patients with COPD. [ABSTRACT FROM AUTHOR]