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Objective: To assess effects of stabilization splints on signs and symptoms of temporomandibular disorders of muscular origin compared to other treatments. Methods: A search for articles via six electronic databases and gray literature was conducted. The risk of bias was evaluated with the Cochrane Collaboration tool. The Grading of Recommendations Assessment, Development and Evaluation approach determined the certainty of evidence. Results: Ten articles were included. Stabilization splints (n = 160 subjects) were reported to be as effective as other treatments (n = 209 patients) on analyzed outcomes (pressure pain threshold, pain during chewing, mouth opening, spontaneous pain intensity and by palpation). Five studies were judged at low and five at some concerns of risk of bias. The certainty of evidence was very low for all outcomes. Conclusion: Positive effect on signs and symptoms of temporomandibular disorders of muscular origin, when managed with stabilization splint, could not be confirmed or refuted. [ABSTRACT FROM AUTHOR]

Objective To analyze risk factors (maternal, obstetric and demographic) associated with congenital syphilis and the clinical characteristics of the newborns. Method A cross-sectional study carried out in ten public maternity hospitals in Fortaleza, Ceará, Brazil that included cases of live births reported with congenital syphilis in 2015. Results 469 cases were analyzed; 199 (42.4 %) showed some sign or symptom suggestive of congenital syphilis; of these, 65 (32.7 %) were preterm, 87 (43.7 %) had low birth weight, 116 (58.3 %) had jaundice that required phototherapy, 13 (6.5 %) had hepatomegaly, 10 (5 %) had skin lesions, eight (4.0 %) had splenomegaly and one (0.5 %) had limb pseudoparalysis. Records of other clinical changes were identified in 36 (7.7 %) children. Children whose mothers were not treated or who received a drug other than penicillin and those whose mothers had a VDRL titer ≥ 1:16 at birth were 3.7 and 3.2 times more likely to be born with signs of congenital syphilis (p < 0.001- 95 % CI 2.41–5.58; p < 0.001 – 95 % CI 2.41–5.58) respectively. Conclusions The findings of this study draw attention to the importance of improving the quality of prenatal care and the development of studies aimed at finding alternative drugs for the treatment of syphilis in pregnant women and the prevention of congenital syphilis. [ABSTRACT FROM AUTHOR]

Clinical congestion remains a major cause of hospitalization and re-hospitalizations in patients with chronic heart failure (HF). Despite the high prevalence of this issue and clinical concern in HF practice, there is limited understanding of the complex pathophysiology relating to the "congestion" of congestive HF. There is no unifying definition or clear consensus on what is meant or implied by the term "congestion." Further, the discordance in study findings relating congestion to physical signs and symptoms of HF, cardiac hemodynamics, or metrics of weight change or fluid loss with diuretic therapy has not added clarity. In this review, these factors will be discussed to add perspective to this issue and consider the factors driving "congestion." There remains a need to better understand the roles of fluid retention promoting intravascular and interstitial compartment expansions, blood volume redistribution from venous reservoirs, altered venous structure and capacity, elevated cardiac filling pressure hemodynamics, and heterogeneous intravascular volume profiles (plasma volume and red blood cell mass) with a goal to help demystify "congestion" in HF. Further, this includes highlighting the importance of recognizing that congestion is not the result of a single pathway but a complex of responses some of which produce symptoms while others do not; yet, we confine these varied responses to the single and somewhat vague term "congestion." [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsKnowledge gaps exist regarding the effects of interventions due to continuing respiratory symptoms in patients with post-COVID condition. The aim of the present study was to present the clinical outcomes of individualised treatments for patients with remaining respiratory symptoms due to post-COVID condition.This prospective longitudinal study included a consecutive series of 57 patients with remaining respiratory post-COVID symptoms. Breathing pattern, thoracic pain/mobility, occurrence of cough, and respiratory muscle strength were assessed before and after the administration of individually tailored physiotherapy interventions.The median treatment duration was 3 months (range 1–36 months). Dysfunctional breathing pattern was the most common symptom (n = 55/57) at inclusion. After treatment, 95% of patients had a normalised or improved breathing pattern (p < 0.001). The treatments for pain, productive and unproductive cough, and respiratory muscle strength resulted in significantly improved symptoms (p < 0.01). With other targeted treatments, inspiratory muscle strength improved by 20 cmH2O and expiratory muscle strength by 11 cmH2O (both p < 0.001).This study indicates positive outcomes of physiotherapy treatment based on the patient’s symptomatology and test results. Therefore, individualised physiotherapy treatment of post-COVID conditions may have an impact on recovery. [ABSTRACT FROM AUTHOR]

Background: Management of rheumatoid arthritis (RA) relies on symptoms reported by patients during infrequent outpatient clinic visits. These reports are often incomplete and inaccurate due to poor recall, leading to suboptimal treatment decisions and outcomes. Asking people to track symptoms in-between visits and integrating the data into clinical pathways may improve this. However, knowledge on how to implement this into practice and its impact on services and outcomes remains scarce in RA. Therefore, we evaluate the comparative effectiveness and cost-effectiveness of integrated symptom tracking in people with RA over and above usual care, while generating insights on factors for successful implementation. Methods: In this superiority stepped wedge cluster-randomized controlled trial with continuous recruitment short exposure design, 16 rheumatology outpatient departments (clusters) recruit a total of 732 people with active RA. They initially offer clinic visits according to standard of care before switching in pairs to visits with integrated symptom tracking. Clusters switch in randomized order every 3 weeks. Integrated symptom tracking consists of (1) a mobile app for patients to track their symptoms daily and other RA aspects weekly/monthly, and (2) an interactive dashboard visualizing the app data, which healthcare professionals access from their electronic health record system. Clinic visits happen according to usual practice, with tracked symptom data only reviewed during visits. Our primary outcome is a difference in marginal mean disease activity score at 12 ± 3 months between standard of care and integrated symptom tracking, after accounting for baseline values, cluster, and other covariates. Secondary outcomes include patient-reported disease activity, quality of life and quality-adjusted life-years, medication/resource use, consultation and decision-making experience, self-management, and illness perception. We also conduct interviews and observations as part of a parallel process evaluation to gather information on implementation. Discussion: Our trial will generate high-quality evidence of comparative and cost-effectiveness of integrated symptom tracking compared to standard of care in people with RA, with our process evaluation delivering knowledge on successful implementation. This optimizes the chances of integrated symptom tracking being adopted more widely if we find it is (cost-) effective. Trial registration: Registered 4-Jun-2024 on https://www.isrctn.com/, ISRCTN51539448. Trial open science framework repository: https://osf.io/sj9ha/. [ABSTRACT FROM AUTHOR]

Exposure to repetitive head impacts in contact sports is associated with neurodegenerative disorders including chronic traumatic encephalopathy (CTE), which currently can be diagnosed only at post-mortem. American football players are at higher risk of developing CTE given their exposure to repetitive head impacts. One promising approach for diagnosing CTE in vivo is to explore known neuropathological abnormalities at post-mortem in living individuals using structural MRI. MRI brain morphometry was evaluated in 170 male former American football players ages 45–74 years (n = 114 professional; n = 56 college) and 54 same-age unexposed asymptomatic male controls (n = 54, age range 45–74). Cortical thickness and volume of regions of interest were selected based on established CTE pathology findings and were assessed using FreeSurfer. Group differences and interactions with age and exposure factors were evaluated using a generalized least squares model. A separate logistic regression and independent multinomial model were performed to predict each traumatic encephalopathy syndrome (TES) diagnosis, core clinical features and provisional level of certainty for CTE pathology using brain regions of interest. Former college and professional American football players (combined) showed significant cortical thickness and/or volume reductions compared to unexposed asymptomatic controls in the hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, insula, temporal pole and superior frontal gyrus. Post hoc analyses identified group-level differences between former professional players and unexposed asymptomatic controls in the hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, insula and superior frontal gyrus. Former college players showed significant volume reductions in the hippocampus, amygdala and superior frontal gyrus compared to the unexposed asymptomatic controls. We did not observe Age × Group interactions for brain morphometric measures. Interactions between morphometry and exposure measures were limited to a single significant positive association between the age of first exposure to organized tackle football and right insular volume. We found no significant relationship between brain morphometric measures and the TES diagnosis core clinical features and provisional level of certainty for CTE pathology outcomes. These findings suggested that MRI morphometrics detect abnormalities in individuals with a history of repetitive head impact exposure that resemble the anatomic distribution of pathological findings from post-mortem CTE studies. The lack of findings associating MRI measures with exposure metrics (except for one significant relationship) or TES diagnosis and core clinical features suggested that brain morphometry must be complemented by other types of measures to characterize individuals with repetitive head impacts. [ABSTRACT FROM AUTHOR]

Objective: Most individuals with lower extremity peripheral artery disease (PAD) experience symptoms other than claudication and live with undiagnosed PAD yet no tools exist to detect atypical PAD symptoms. The purpose of this study was to identify discriminating PAD symptom descriptors from a community-based sample of patients with no current diagnosis of PAD. Methods: Symptoms descriptors were obtained in a sample of 22 participants with persistent lower extremity symptoms pre/post exercise. An ankle brachial index with exercise was used to classify participants as "PAD" or "No PAD." Results: Thirteen (59%) participants had a positive ankle brachial index (<0.9, ≥20% drop postexercise, or 30 mmHg drop postexercise). Symptoms do not disappear while walking, trouble keeping up with friends/family, positive response to pain or discomfort while sitting, and pain outside of the calves and thighs were associated with a positive ankle brachial index. Conclusion: Atypical symptoms were common among study participants. Symptoms while sitting and symptoms outside of the calf and thigh were negatively associated with a positive ankle brachial index. More precise descriptions of symptom characteristics are needed to improve PAD symptom recognition. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe the clinical characteristics associated with severity in children hospitalized with COVID-19. Method: This was an epidemiological cohort study conducted in two hospitals, one of which was a reference center for the treatment of COVID-19 cases. Data were collected from the reports generated by the hospital epidemiology centers and the medical records of patients aged between 0 and 14 years with a diagnosis of COVID-19, hospitalized between March 2020 and June 2021. To analyze the association between the clinical profile and severity, the cases were classified as severe (severe and critical) and non-severe (asymptomatic, mild, and moderate). Results: Of the 191 children followed up in the cohort, 73.3% developed the severe form. The percentage of children with oxygen saturation below 95% was 46.6%. In the multivariate analysis, a higher risk of severity was estimated among children with uncontrolled asthma (RR = 13.2), who were overweight or obese (RR = 3.21), who had cough symptoms (RR = 2.72), and those aged under one year (RR = 3.23). Conclusions: This result underscores the need to improve healthcare at every level for children and for the management of asthma and nutrition when considering children with this clinical profile who are diagnosed with COVID-19. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Trial Registration Physical therapy is the preferred conservative treatment for patients with temporomandibular disorder (TMD). However, few studies have investigated the application of physical therapy in adolescents, especially follow‐up studies on the long‐term prognosis of these patients. This study investigated the short‐term effects and long‐term prognosis of physical therapy in adolescent patients with TMD and the factors influencing long‐term symptoms.Information regarding baseline data, specific treatment methods, treatment times and evaluation results was collected retrospectively for adolescent patients with TMD who received physical therapy. Patients were followed up via telephone and online questionnaires, and the influence of age, sex, disease course, mouth opening, pain intensity, oral parafunctional habits and treatment methods on long‐term symptoms was analysed.Pain intensity, maximum mouth opening and the joint noise score improved significantly in 270/286 patients who received individualised comprehensive physical therapy. TMD‐related symptoms improved with no noticeable impact on daily life in 187/199 patients who were followed up for an extended period (average, 30.71 ± 10.86 months) and were divided into asymptomatic or symptomatic groups according to the persistence of symptoms. Logistic regression analysis revealed that uncorrected oral parafunctional habits and fewer treatments were related to long‐term symptoms.The long‐term prognosis of adolescent patients with TMD after physical therapy was satisfactory. However, 52.8% of the patients experienced persistent TMD‐related symptoms for an extended period, possibly due to insufficient treatment times and parafunctional habits.ClinicalTrials.gov identifier: NCT05781607 [ABSTRACT FROM AUTHOR]

Summary To investigate the association between symptoms of long‐term effects of coronavirus disease 2019 (long COVID) and sleep problems in a sample population from southern Brazil. This cross‐sectional study used data from the SULcovid‐19 survey, developed in the municipality of Rio Grande, RS, Brazil. The outcome, long COVID, was investigated through the presence of 18 symptoms, and the exposure variable was sleep problems. Poisson regression with robust adjustment for variance was used to estimate crude and adjusted prevalence ratios for the outcome–exposure relationship. Odds ratio was calculated through multinomial regression of the relationship between the number of symptoms of long COVID and sleep problems. Analyses were adjusted for sex, age, marital status, income, body mass index, smoking status, comorbidities, and hospital admission. A total of 2919 adults and older adults were interviewed. The prevalence of long COVID was 48.3% (95% confidence interval [CI] 46.5–50.1%) and sleep problems were reported by 41.2% of the sample (95% CI 39.4–43.0%). Individuals with sleep problems were more likely to exhibit altered sensitivity (prevalence ratio [PR] 3.27; 95% CI 1.96–5.45), nasal congestion (PR 2.75; 95% CI 1.53–4.94), musculoskeletal symptoms (PR 1.75; 95% CI 1.48–2.06), respiratory issues (PR 1.58; 95% CI 1.24–2.01), and one or more symptom of long COVID (PR 1.27; 95% CI 1.15–1.39). Approximately one‐half of the population analysed had long COVID, and four of 10 reported experiencing sleep problems. In addition, the sample tended to have experienced a greater number of symptoms compared with those who reported to sleep well. [ABSTRACT FROM AUTHOR]

Introduction. The number of arrests of body packers, who are those people who ingest packages with narcotics for illegal trafficking, has gradually increased. The objective of this study was to present the cases of body packers treated in two health institutions in Florencia, a territory in southern Colombia, between 2003 and 2017. Methods. This is a descriptive retrospective study. A univariate analysis was performed in RStudio and Microsoft Excel® of sociodemographic and clinical variables. Measures of central tendency and dispersion were used for continuous variables, frequencies and proportions for categorical variables. Results. 72 patients were included. Most cases were reported between 2007 and 2012 (77.5%). The ratio between men and women was 4.9:1. The mean age was 29.1 years. The main reason for admission was for medical check-up after capture by national security agencies (76.4%). In nine out of ten admitted patients, imaging studies were performed (94.4%); the main diagnostic imaging was simple abdominal X-ray (84.7%), with a sensitivity of 91.6%. Expectant management was performed in three out of four patients (74.6%). 6.9% presented complications, with one mortality (1.4%). Conclusions. Simple abdominal x-ray is an adequate diagnostic tool for screening body packers. Conservative management is acceptable, taking into account the low percentage of complications. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that involving General Practitioners in the care of patients with palliative care needs may improve patient outcomes. Aim: To evaluate whether a two-tiered intervention involving training in palliative care and a new consultation model in primary care for patients with palliative care needs is feasible and could reduce patients' symptom burden. Design: Before-after study including an internal pilot. Setting/participants: Nine general practitioners working in a health region in Portugal and 53 patients with palliative care needs from their patient lists were recruited. General Practitioners received training in palliative care and used a new primary palliative care consultation model, with medical consultations every 3 weeks for 12 weeks. The primary outcome was physical symptom burden, self-reported using the Integrated Palliative care Outcome Scale (IPOS) patient version (min.0–max.1000). Secondary outcomes included emotional symptoms (min.0–max.400) and communication/practical issues (min.0–max.300). Results: Of the 35/53 patients completed the 12-week intervention (mean age 72.53 years, SD = 13.45; 54.7% female). All had advanced disease: one third had cancer (n = 13), one third had congestive heart failure (n = 12); others had chronic kidney disease and chronic obstructive pulmonary disease. After the 12 weeks of intervention, there was a reduction in physical symptom burden [mean difference from baseline of 71.42 (95%CI 37.01–105.85) with a medium-large effect size (0.71], and in emotional symptom burden [mean difference 42.86 (95%CI 16.14–69.58), with a medium effect size (0.55)]. No difference was found for communication/practical issues. Conclusions: Our intervention can be effective in reducing patients' physical and emotional symptoms. Trial registration: ClinicalTrials.gov ID – NCT05244590. Registration: 14th February 2022. [ABSTRACT FROM AUTHOR]

The incidence of diving accidents is increasing. Point-of-care ultrasound is the only imaging tool available in the field for the military physician who practices in isolated conditions. While ultrasound is integrated in the pre-hospital evaluation protocols of severe trauma patients, few applications are described for diving accident victims. Through a clinical case, we propose an algorithm of ultrasound triage for diving accidents with pulmonary symptoms. Point-of-care ultrasound makes it possible to avoid a risky transfer, by supporting a diagnosis and the treatment on the spot, to rule out contraindications to recompression, and to detect and monitor the treatment of high-risk complications such as the capillary leak syndrome. [ABSTRACT FROM AUTHOR]

Background: Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD. Methods: A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale—HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society—Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale. Results: A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms. Conclusion: Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications. [ABSTRACT FROM AUTHOR]

Background: Postoperative cerebrospinal fluid (CSF) leak remains a concerning complication of the endoscopic endonasal approach (EEA) for skull base pathology. Signs and symptoms suggesting CSF leak often trigger additional workup during the postoperative course. We systematically evaluate associations between subjectively reported clinical signs/symptoms noted during the immediate postoperative period and incidence of postoperative CSF leaks. Methods: Retrospective chart review was conducted at a tertiary academic medical centre including 137 consecutive patients with intraoperative CSF leak during EEA with primary repair between July 2018 and August 2022. Postoperative CSF leak associations with clinical signs and symptoms were evaluated using positive (PPV) and negative predictive values (NPV), sensitivity, specificity and odds ratio (OR) via univariate logistic regression. Results: Seventy‐nine patients (57.7%) had high‐flow leaks repaired and 5 (3.6%) developed CSF leaks postoperatively. Of reported symptoms, rhinorrhea was most common (n = 52, 38.0%; PPV [95% CI] = 7.6% [4.8%, 11.9%]), followed by severe headache (n = 47, 34.3%; 6.3% [3.1%, 12.5%]), dizziness (n = 43, 31.4%; 2.3% [0.4%, 12.1%]), salty or metallic taste (n = 20, 14.6%; 9.9% [3.3%, 25.8%]), and throat drainage (n = 10, 7.3%; 9.9% [1.7%, 41.4%]). Nausea or vomiting constituted the most reported sign concerning for CSF leak (n = 73, 53.3%; PPV [95% CI] = 4.1% [2.0%, 8.1%]). On univariate regression, no sign or symptom, including rhinorrhea (OR [95% CI] = 7.00 [0.76–64.44]), throat drainage (3.42 [0.35–33.86]), salty/metallic taste (4.22 [0.66–27.04]), severe headache (3.00 [0.48–18.62]), dizziness (0.54 [0.06–4.94]), fever (3.16 [0.50–19.99]), and nausea/vomiting (1.33 [0.22–8.21]), associated with postoperative CSF leak. Conclusions: A range of subjectively reported symptoms and signs failed to predict postoperative CSF leak. Further investigation is warranted to inform appropriate attention and response. [ABSTRACT FROM AUTHOR]

• ACS symptom knowledge, attitudes, and beliefs were suboptimal in this sample of hispanic and Latina/o/x/e individuals. • No differences in ACS symptom knowledge, attitudes, and beliefs were seen based on language proficiency. • Stronger knowledge and attitude scores were observed for participants endorsing previous exposure to symptom information. • The spanish version of the ACS response index showed favorable internal consistency, though more research is needed. Little attention has been placed on language proficiency as a potential variable affecting ACS symptom knowledge, attitudes, and beliefs. To compare the ACS symptom knowledge, attitudes, and beliefs of Hispanic and Latina/o/x/e individuals proficient in English and in those only proficient in Spanish. Secondary aims were to determine if there were differences in ACS symptom knowledge, attitudes, or beliefs based on participants' previous exposure to ACS symptom information and to evaluate instrument characteristics of the new Spanish version of the ACS Response Index. This cross-sectional, comparative study included participants (N = 99) from a community-based clinic in Illinois. Knowledge, attitudes, and beliefs related to ACS symptoms were measured using the ACS Response Index. The average participant was 39.8 (SD 15.6) years of age, female (n = 56, 56.6 %), and had a high school education or less (n = 61, 61.6 %). Participants correctly classified a mean 57.5 % (SD 12.8) of symptoms and had mean attitude and belief scores of 12.1 (SD 3.3) and 17.5 (SD 2.9), respectively. There were no significant differences in knowledge, attitudes, and beliefs based on language proficiency. However, there were some statistically significant differences for knowledge and attitude scores based on exposure to ACS symptom information. The ACS Response Index (Spanish Version) also demonstrated favorable internal consistency. Overall knowledge, attitude, and belief scores were modest in this sample. Higher knowledge and attitude scores were observed for some types of ACS information exposure, supporting the importance of future educational efforts in this population. [ABSTRACT FROM AUTHOR]

Pernicious anaemia is a rare condition which is classed as an autoimmune disease. It is most frequently diagnosed in those over the age of 60, but can occur at any age. It presents with variable symptoms, many of which are shared with those of other diseases, making the condition difficult to diagnose, leading to missed diagnosis and a greater risk of complications. This article gives an overview of its diagnosis, management, and complications, with the aim of helping general practice nurses (GPNs) and non-medical prescribers recognise symptoms and get early treatment, reducing the risk of long-term adverse effects and improving quality of life for all those affected by this complex disease. [ABSTRACT FROM AUTHOR]

Abstract Background Management of rheumatoid arthritis (RA) relies on symptoms reported by patients during infrequent outpatient clinic visits. These reports are often incomplete and inaccurate due to poor recall, leading to suboptimal treatment decisions and outcomes. Asking people to track symptoms in-between visits and integrating the data into clinical pathways may improve this. However, knowledge on how to implement this into practice and its impact on services and outcomes remains scarce in RA. Therefore, we evaluate the comparative effectiveness and cost-effectiveness of integrated symptom tracking in people with RA over and above usual care, while generating insights on factors for successful implementation. Methods In this superiority stepped wedge cluster-randomized controlled trial with continuous recruitment short exposure design, 16 rheumatology outpatient departments (clusters) recruit a total of 732 people with active RA. They initially offer clinic visits according to standard of care before switching in pairs to visits with integrated symptom tracking. Clusters switch in randomized order every 3 weeks. Integrated symptom tracking consists of (1) a mobile app for patients to track their symptoms daily and other RA aspects weekly/monthly, and (2) an interactive dashboard visualizing the app data, which healthcare professionals access from their electronic health record system. Clinic visits happen according to usual practice, with tracked symptom data only reviewed during visits. Our primary outcome is a difference in marginal mean disease activity score at 12 ± 3 months between standard of care and integrated symptom tracking, after accounting for baseline values, cluster, and other covariates. Secondary outcomes include patient-reported disease activity, quality of life and quality-adjusted life-years, medication/resource use, consultation and decision-making experience, self-management, and illness perception. We also conduct interviews and observations as part of a parallel process evaluation to gather information on implementation. Discussion Our trial will generate high-quality evidence of comparative and cost-effectiveness of integrated symptom tracking compared to standard of care in people with RA, with our process evaluation delivering knowledge on successful implementation. This optimizes the chances of integrated symptom tracking being adopted more widely if we find it is (cost-) effective. Trial registration Registered 4-Jun-2024 on https://www.isrctn.com/ , ISRCTN51539448. Trial open science framework repository https://osf.io/sj9ha/ .

Background Drug-induced liver injury is one of the most common adverse drug reactions, and atorvastatin is one of the widely used statin lipid-lowering drugs in clinical practice, which is susceptible to hepatic injury. Currently, there is limited research data on the clinical characteristics of liver injury induced by atorvastatin. Objective To investigate the clinical characteristics of liver injury induced by atorvastatin, so as to improve clinicians' understanding of liver injury induced by atorvastation. Methods The patients who were hospitalized and treated with atorvastatin in the First Affiliated Hospital of Guangxi Medical University from January 2012 to August 2022, developed liver injury and were evaluated as liver injury induced by atorvastation based on Roussel Uclaf Causality Assessment Method were selected, and analyzed on clinical characteristics. Results A total of 84 cases of liver injury induced by atorvastation were diagnosed by Causality Assessment Method. The patients with liver injury induced by atorvastation were more male (72.6%), with an average age of (60.2±11.5) years, and all of them were comorbid with the underlying diseases (100.0%) ; two cases (2.4%) reached moderate liver injury, and the cure or improvement rate after treatment reached 100.0%. According to the stage of the disease, the main manifestation was an acute course (100.0%) ; according to the damaged target cells, the mixed type was the most frequent (60.7%), followed by the cholestasis type (26.2%) and the hepatocyte type (11.9%). The statistical results showed that 78.6% of the patients with liver injury occurred within 3 months after taking atorvastation and predominantly in the 1st to 2nd week; and 81.0% of the patients developed liver injuryat 80 defined daily dose (DDD) of cumulative atorvastation. Conclusion Liver injury induced by atorvastation occurs mostly in male, middle-aged and elderly patients patients with underlying diseases, mostly have mild liver injury and good prognosis, and the clinical types were mostly mixed type and cholestasis type. Liver injury occurs mainly within 3 months and the occurrence of liver injury induced by atorvastation was dose-dependent.

Cheng Cheng,1,2 Martin Christensen1 1School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, People’s Republic of China; 2School of Nursing, Fudan University, Xuhui, Shanghai, People’s Republic of ChinaCorrespondence: Martin Christensen, School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, People’s Republic of China, Tel +852 27667475, Email martin.christensen@polyu.edu.hkAbstract: This umbrella review was to synthesize the summarized evidence-based research regarding interventions addressing symptoms in older populations with multimorbidity. Three databases including PsycINFO, MEDLINE, and CINAHL were searched systematically. The JBI Methodology for Umbrella Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were used to report this review. Six reviews published between 2016 and 2010 were included for analysis. Interventions were mixed and included components on health-related behaviors, body systems or functions, activities and participation domains, and the environment. Outcomes concerning physiological/clinical functioning were most reported. The evidence regarding the symptoms-related interventions was mixed, but all showed promising outcomes compared with usual care or not. To sum up, this umbrella review reveals the lack of strong empirical evidence for the effectiveness of intervention addressing symptoms in older adults with multimorbidity. It highlights the need to evaluate the established approach of interventions further to support this population.Keywords: chronic disease, multimorbidity, systematic review, signs and symptoms

Background To address the public’s fear of coronavirus disease 2019 (COVID-19), understanding the clinical features of the disease is essential. However, research on the clinical features of COVID-19, including illness duration and post-acute COVID-19, in Korean pediatric patients has been limited. Therefore, this study investigated the clinical features of COVID-19 based on the medical records of pediatric patients with a history of COVID-19 who visited a single center. Methods In total, 311 patients were included in this study. The presence and duration of 19 symptoms were examined. Additionally, clinical features were investigated by dividing the patients into different age ranges. Patients aged 6 and above were further categorized according to the presence of asthma, while adolescent patients were divided into vaccinated and unvaccinated groups. Results Fever and cough were the most common symptoms. The mean illness duration was 2–4 days. Only 3.5% of the patients were asymptomatic. Post-acute COVID-19 was observed in 13.2% of the patients. The incidence of most symptoms tended to increase with age. Post-acute COVID-19 was observed more frequently in patients with asthma than in those without asthma. Vaccinated patients experienced less fever, vomiting, and fatigue than unvaccinated patients. Conclusions Our data suggest that most patients had mild disease lasting less than a week, and the clinical course may differ depending on the presence of asthma. The findings also indicate that vaccination may alleviate the symptoms of COVID-19 in breakthrough infections.

Background: As acute stroke remains an important leading cause of morbidity and mortality in the world, this study sought to survey the general public in four different countries, in four different continents to ascertain the level of knowledge of the public for the risk factors, and the signs and symptoms of stroke. Methods: This was a cross-sectional survey of the general public that was conducted via a self-administered online survey using the SurveyMonkey® platform in the United States, the United Kingdom, the Kingdom of Saudi Arabia, and Egypt. Questions on identifying the risk factors, as well as the signs and symptoms of stroke were asked. A score was given to all subjects, and they were then asked to identify the life-style changes that they thought would reduce the risk of getting a stroke. Results: A total of 2000 subjects were recruited via the electronic search engine at the SurveyMonkey®, 500 from each country. The data showed that subjects in Western countries agreed on dyslipidemia and lack of exercise being the top two risk factors for stroke. While the Middle Eastern subjects mostly identified smoking and having a previous stroke as the top risk factors. Regarding the signs and symptoms, Western subjects agreed perfectly that the top three were hemiparesis, heavy tongue and facial asymmetry. Conclusion: It was clear from the data collected in this study that the knowledge level of signs and symptoms of stroke in the general public, irrespective of the country was poor. [SJEMed 2024; 5(1.000): 001-009]

Human T-lymphotropic virus type 1 (HTLV-1) is classically associated with the HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), although the mechanisms of this neurological disorder remain unclear. In addition, some patients who develop "minor" neurological signs that do not meet diagnostic criteria for HAM/TSP are classified as asymptomatic carriers. This study aims to demonstrate the neurological symptoms of Brazilian patients living with HTLV-1 classified as not-HAM.TSP. This observational study evaluated patients treated in an HTLV reference center in Bahia, Brazil, between February 2022 and July 2023. The data were obtained through the analysis of medical records and neurological consultation. Those individuals classified as HAM/ TSP were excluded from this study. 74 patients were submitted to a careful neurological evaluation: 23 HAM/TSP, 22 were classified with intermediate syndrome (IS), and 29 were oligosymptomatic. Self-reported symptoms were significantly more common in the IS group, including urinary symptoms such as nocturia, urgency, incontinence, dysuria, weakness, paresthesia, lumbar pain, xerostomia, and xerophthalmia. Physical examination findings consistent with reduced vibratory and tactile sensitivity were more common in the IS group (p = 0.017 and p = 0.013). Alterations in the V and VIII cranial nerves were present in both groups. HTLV-1 can lead to the development of important neurological signs and symptoms in apparently asymptomatic individuals. This data highlights the need for more research into the neurological aspects of HTLV-1 infection and emphasizes the importance of early diagnosis, treatment, and support for individuals living with this virus. [ABSTRACT FROM AUTHOR]

This study aimed to comprehensively investigate the prevalence of ABPA and AFRS, scrutinize existing diagnostic criteria and immunoassays, pinpoint their limitations, highlight ABPA as an occupational health implication, and identify suggestive measures to improve ABPA diagnosis in the context of Occupational Health Nursing and primary healthcare. The data sources such as PubMed, Health and Safety Science Abstracts, OSH Update, Medline, and Google Scholar were searched. All published studies in the English language from 1990 till Oct, 2023 using Mesh terms keywords "Allergic bronchopulmonary aspergillosis," "Allergic fungal rhinosinusitis," "Signs and Symptoms," "Rapid Diagnostic Tests," "Diagnosis," "Occupational Health," "Occupational Health Nursing," "Prevalence," "Allergens" following "Boolean operators" search strategy were selected. This review succinctly covered signs, symptoms, and prevalence data concerning ABPA and AFRS. It briefly discussed existing diagnostic criteria and immunoassays, highlighted factors influencing the assay's variability, and underscored the role and scope of specific allergens toward improved, simple, and early ABPA diagnosis. ABPA as a neglected occupational health concern was emphasized, and the importance of RDTs in the context of healthcare professionals and OHNs was stated. Finally, this study suggested analyzing the impact of compromised post-pandemic immune status and the use of immunosuppressive drugs on ABPA prevalence among vulnerable communities and occupations. To conclude, global and Indian ABPA and AFRS prevalence data, factors influencing existing assay variability, and the scope of improvement in RDTs for ABPA diagnosis in the background of primary healthcare professionals and OHNs were addressed. [ABSTRACT FROM AUTHOR]

Hereditary pancreatitis (HP) is one of the major causes of pancreatitis in children and has a high risk of carcinogenesis after they become adults. This article reviews the recent research advances in HP, including historical development, epidemiology, pathogenic mechanism, and related pathogenic genes, clinical features, and diagnosis and treatment, in order to provide new reference information for delaying the progression of HP in children and conducting related basic research. [ABSTRACT FROM AUTHOR]

The aim was to estimate the effect of reported history of smallpox vaccination prior to 1980 on clinical expression of mpox. We included all confirmed mpox cases identified by the national mpox surveillance system in France between May and July 2022. Cases tested positive for monkeypox virus or orthopoxviruses by PCR. Cases were interviewed by phone using a questionnaire documenting demographics, symptoms and exposures. To estimate the effect of smallpox vaccination on the presence of marked mpox symptoms (association of fever, lymphadenopathy and extensive mucocutaneous lesions), we estimated prevalence ratios (PRs) and 95% CIs using Poisson regression models with robust standard errors. There were 1888 confirmed mpox cases with date of symptom onset between 7 May and 31 July 2022. Overall, 7% (93/1394) presented marked mpox symptoms. Among patients who provided information about their vaccination status, 14% (207/1469) reported smallpox vaccination prior to 1980. The proportion of cases with marked symptoms was 2% (3/170) among those reporting smallpox vaccination prior to 1980 and 8% (76/974) among those who reported no vaccination. The proportion of marked symptoms was four times lower among cases reporting previous smallpox vaccination than in cases reporting no vaccination (PR, 0.24; 95% CI: 0.08–0.76). There was no evidence of an effect of smallpox vaccination on development of complications (PR, 0.65; 95% CI: 0.35–1.22) or hospitalization due to mpox (PR, 0.64; 95% CI: 0.23–1.80). Our results suggest that smallpox vaccination during childhood attenuated the clinical expression of monkeypox virus infection, but there was no evidence of an effect on complications or hospitalization. [ABSTRACT FROM AUTHOR]

Strokes represent a major global health challenge, as they now affect up to 15 million people annually, with increasing mortality rates accompanying growing prevalence. In Saudi Arabia, hypertension (HTN) and diabetes mellitus (DM) have been identified as major contributors to stroke risk, with a combination of HTN and DM significantly magnifying the risk of strokes. While there have been global improvements in stroke prevention, recently knowledge levels vary significantly worldwide, and multiple studies in Saudi Arabia show inconsistent awareness levels. This study seeks to develop insights for the development of tailored prevention programs that align with Saudi Vision 2030 in terms of enhancing quality of life. Thus, the aim of the study is to assess knowledge levels of stroke risk factors, warning signs, symptoms, and prevention methods among high-risk groups (HTN and DM patients) at King Saud University Medical City (KSUMC). This was an analytical cross-sectional study conducted among 422 participants from June 2022 to January 2023, using a validated Arabic questionnaire taken, with permission, from previous studies. All HTN and T2DM patients in the waiting areas of the outpatient clinics at KSUMC, Riyadh were included as part of the random sampling, though patients below 20-years-old and those with other endocrine disorders were then excluded. The majority of participants were male (64.5 %). The analysis showed that 66.1 % of participants had "poor total knowledge" of stroke factors. Half of the participants (50.5 %) had "poor knowledge" about stroke risk factors, though the most commonly identified risk factor was "hypertension". Additionally, the findings showed that 46.4 % of participants had "poor knowledge" of stroke warning signs and symptoms, with the most commonly identified warning sign being "difficulty in speaking." Nearly half of participants (46.4 %) had "good knowledge" of stroke prevention methods; however, "regular exercise" was the most commonly identified prevention method. Although the participants displayed decent knowledge of stroke prevention methods, several notable deficits in overall knowledge of stroke factors emerged. In particular, knowledge of stroke risk factors and warning signs and symptoms among participants was inadequate. This implies that healthcare providers should seek to launch campaigns addressing stroke knowledge mainly among high-risk groups, potentially distributing brochures about stroke knowledge in the relevant clinics and seeking to provide a range of educational content by means of social media. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background This study compared trends in norovirus cases to determine whether chief complaint–based emergency department (ED) visit data could reflect trends of norovirus in Korea. Methods The ED visits from the National Emergency Department Information System database and the weekly reported number of noroviruses from the sentinel surveillance system were collected between August 2017 and December 2020. The correlation between weekly norovirus cases and weekly ED visits considering the chief complaint and discharge diagnosis code was estimated using a 3-week moving average. Results In total, 6 399 774 patients with chief complaints related to digestive system disease visited an ED. A higher correlation between reported norovirus cases and ED visit with chief complaint of vomiting and discharge diagnosis code of gastroenteritis and colitis of unspecified origin or other and unspecified gastroenteritis and colitis of infectious origin was observed (R = 0.88, P <.0001). The correlation was highest for the age group 0–4 years (R = 0.89, P <.0001). However, no correlation was observed between the reported norovirus cases and the number of ED visits with norovirus identified as a discharge diagnosis code. Conclusions ED visit data considering a combination of chief complaints and discharged diagnosis code would be useful for early detection of infectious disease trends. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The persistence of symptoms for more than three months following infection with severe acute respiratory syndrome coronavirus 2 is referred to as "Long COVID". To gain a deeper understanding of the etiology and long-term progression of symptoms, this study aims to analyze the prevalence of Long COVID and its associated factors in a cohort of Brazilian adults and elders, twelve months after hospital discharge. An observational, prospective, and follow-up study was performed with a cohort of adults and older adults diagnosed with COVID-19 in 2020 in the State of Paraná, Brazil. Twelve months after hospital discharge, patients answered a phone questionnaire about the persistence of symptoms after three levels of exposure to COVID-19's acute phase (ambulatory, medical ward, and intensive care unit). According to the characteristics of participants, the prevalence of Long COVID-19 was calculated, and logistic regression analyses were conducted. We analyzed data from 1822 participants (980 adults [≥18–<60 years] and 842 older people [≥60 years]) across three exposure levels. The overall Long COVID prevalence was 64.2%. Long COVID was observed in 646 adults (55%; of which 326 were women) and 523 older people (45%; of which 284 were women). Females had a higher prevalence of long-term symptoms (52%) compared with men. The most common post-COVID-19 conditions in the 12-month follow-up were neurological (49.8%), followed by musculoskeletal (35.1%) and persistent respiratory symptoms (26.5%). Male individuals were less likely to develop Long COVID (aOR = 0.50). Other determinants were also considered risky, such as the presence of comorbidities (aOR = 1.41). Being an adult and having been hospitalized was associated with the development of Long COVID. The risk of developing Long COVID was twice as high for ward patients (aOR = 2.53) and three times as high for ICU patients (aOR = 3.56) when compared to non-hospitalized patients. Presenting clinical manifestations of digestive (aOR = 1.56), endocrine (aOR = 2.14), cutaneous (aOR = 2.51), musculoskeletal (aOR = 2.76) and psychological systems (aOR = 1.66) made adults more likely to develop Long COVID. Long COVID was present in a large proportion of people affected by the SARS-CoV-2 infection. Presence of Long COVID symptoms displayed a dose–response relationship with the level of disease exposure, with a greater prevalence of symptoms associated with the severe form in the acute period. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the complexity of the needs of people with delirium superimposed on dementia • To enhance your knowledge of second-generation activity theory • To recognise the consequences of the separation of physical health and mental healthcare. Background: Delirium superimposed on dementia (DSD) affects the physical, mental and cognitive well-being of the person. The separation of physical health and mental health means that the care of people with DSD is at odds with the multifaceted aetiology and presentation of the condition. There is a lack of research on DSD from a mental health perspective. Aim: To explore UK mental health nurses’ experiences of providing care for people with DSD. Method: Individual semi-structured interviews were conducted with seven mental health nurses from one NHS trust in England. Participants’ experiences were considered through the lens of second-generation activity theory. Data were analysed using framework analysis. Findings: Six themes were identified: awareness of guidance and tools; guidance or tools as ‘paper exercises’; knowing the patient; the multidisciplinary team; care burden; and mental health versus physical health. Conclusion: When providing care for people with DSD, mental health nurses use their skills in knowing patients as individuals. However, this aspect of ‘knowing’ cannot be readily translated into the use of a numerical scoring tool. An integrated approach is required to support the care of people with DSD. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Schistosomiasis is a debilitating neglected tropical disease endemic in sub-Saharan Africa. The role of health facilities in the prevention, diagnosis, control, and elimination of schistosomiasis is poorly documented. In a setting targeted for schistosomiasis elimination in Zanzibar, we assessed the prevalence of Schistosoma haematobium among patients seeking care in a health facility and investigated schistosomiasis-related knowledge of staff, and health facilities' capacities and needs for schistosomiasis diagnosis and management. Methods: We conducted a health facility-based mixed-method study on Pemba Island from June to August 2023. Patients aged ≥ 4 years seeking care in four health facilities were screened for S. haematobium infection using urine filtration and reagent strips. Those patients aged ≥ 10 years were additionally interviewed about signs and symptoms. Staff from 23 health facilities responded to a questionnaire assessing knowledge and practices. Ten staff participated in a focus group discussion (FGD) about capacities and needs for schistosomiasis diagnosis and management. Results: The prevalence of S. haematobium infection in patients attending the health facilities, as determined by the presence of eggs in urine, was 1.1% (8/712). Microhaematuria was detected in 13.3% (95/712) of the patients using reagent strips. Among patients responding to the questionnaire, pelvic pain, pain during sex, and painful urination were reported by 38.0% (237/623), 6.3% (39/623), and 3.2% (20/623), respectively. Among the health facility staff, 90.0% (44/49) and 87.8% (43/49) identified blood in urine and pelvic pain, respectively, as symptoms of urogenital schistosomiasis, 81.6% (40/49) and 93.9% (46/49) reported collecting a urine sample and pursuing a reagent strip test, respectively, for diagnosis, and 87.8% (43/49) administered praziquantel for treatment. The most reoccurring themes in the FGD were the need for more staff training about schistosomiasis, requests for diagnostic equipment, and the need to improve community response to schistosomiasis services in health facilities. Conclusions: The prevalence of S. haematobium infection in patients seeking care in health facilities in Pemba is very low and similar to what has been reported from recent community-based cross-sectional surveys. The health facility staff had good schistosomiasis-related knowledge and practices. However, to integrate schistosomiasis patient management more durably into routine health facility activities, scalable screening pathways need to be identified and capacities need to be improved by regular staff training, and an unbroken supply of accurate point-of-care diagnostics and praziquantel for the treatment of cases. [ABSTRACT FROM AUTHOR]

Background Aim Methods Results Conclusions Pain in cancer patients is a complex clinical problem. Pain is systematically assessed and treated during palliative care, but little is known about how it is addressed before starting palliative care.This study primarily analyzed pain, symptoms, ongoing therapy at patients' admittance to the palliative care unit, and the relationships between pain and tumor, comorbidities, performance status and quality of life (QoL). Notably, patient satisfaction with the received antalgic therapy was assessed.A multicentric, prospective, observational study was conducted in seven Italian palliative centers. The population consisted of adult cancer patients admitted to specialist palliative care units in hospice and home care.The sample consisted of 476 patients. Ninety‐three patients reported moderate pain of 4.0 and worst pain of 5.9 at the initial medical examination. The pain was high, and QoL was lower in breakthrough pain. The pain was lower in older subjects when it was discontinuous and when it was also treated with corticosteroids. A total of 61% of the patients were unsatisfied with the prescribed pain therapy.Before the beginning of palliative care, physicians do not manage pain adequately. We support the idea that palliative care is not only intended for the last days of life but must be started early and simultaneously with oncological treatments. All that, in our opinion, is often ignored, and we hope that our study could have a positive influence and that the study results stimulate further research in this area with in‐depth studies. [ABSTRACT FROM AUTHOR]

Snakebites result from snake bites, causing a major impact on public health in Brazil. Snakes of the genus Bothrops, popularly known as "jararacas", are responsible for the vast majority of snakebites reported in Central and South America, requiring immediate medical treatment due to the actions of their venom, which can affect the circulatory system and lead to tissue damage. and hemorrhages. Antivenom serum is effective and essential for neutralizing the effects of venom in humans, reducing the severity of symptoms and helping to save lives. The purpose of the present study was to present a literature review on the predominant clinical manifestations in cases of snakebites with the genus Bothrops, thus increasing the population's knowledge regarding the main signs and symptoms that should be given more attention in the face of such accidents. According to the results obtained, it was found that the main and most recurrent clinical manifestations involving accidents with "jararaca" are: pain, edema, erythema, ecchymosis and serious complications such as blister formation, abscess and necrosis. Early recognition and treatment of clinical manifestations aims to reduce mortality and improve the quality of life of injured patients. [ABSTRACT FROM AUTHOR]

Objective: To establish relationship between train-of-four ratio and clinical signs including head lift during emergence from general anesthesia. Study Design: Cross Sectional Study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: A total of 93 patients with age range 18-60 years and ASA (American society of Anesthesiologist's) physical Status I or I undergoing an elective procedure lasting more than 60 minutes under general anesthesia were included in study. Train-of-four ratio was calculated using a nerve stimulator at the time of extubation folowed by the appearance of each clinical sign. Results: Of 93 patients 63(67.7%) were males while 30(32.2%) were females with mean age 35.6±12.5 years. 77(82.7%) patients were graded as ASA-I and 16(17.2%) were graded as ASA-I. The mean duration of surgery was 83.5±8.3 mins however the mean TOFR was 0.35±1.1. At the appearance of each clinical sign mean TOFR was calculated and recorded. The results showed significant relationship between clinical signs (sustained head lift, ability to retain tongue depressor, hand grip 60% of control and ability to cough) and Train-of-four ratio. Conclusion: There is a significant relationship between clinical signs (sustained head lift, ability to retain tongue depressor, hand grip 60% of control and ability to cough) and Train-of-four ratio. [ABSTRACT FROM AUTHOR]

The article focuses on the epidemiology, symptoms, diagnosis, and management of Pelvic inflammatory disease, highlighting its impact on women's health globally. It emphasizes the challenges in diagnosis due to varied symptoms and the necessity of prompt treatment to prevent long-term complications. It discusses risk factors, causative organisms, and differential diagnoses, providing guidance for healthcare providers to improve recognition and management of this prevalent condition.

To date, many randomized studies have proven the importance of evaluating clinical and anamnestic data in the initial diagnosis of genital endometriosis. Clinical assessment of “classic” complaints of patients, which are characteristic of genital endometriosis, allows to predict the presence of endometriosis with a high probability, which is an important component of choosing the optimal treatment tactics. Despite a fairly significant number of developed questionnaires for the assessment of endometriosis symptoms, none of them has been widely used among domestic clinicians. Implementation of a diary of symptoms of endometriosis in practice will allow to more carefully assess the general pain of endometriosis, the impact on the patient’s quality of life, and also to evaluate the quality of the chosen method of treatment. The aim of the study: on the basis of a retrospective analysis of patients’ disease histories, assessment of the presence of clinical and anamnestic data characteristic of genital endometriosis in accordance with the obtained results of pathohistologically confirmed endometriosis. Materials and methods. We performed a retrospective analysis of 160 patient histories. The criteria for selecting patients with genital endometriosis were the presence of the following symptoms: premenstrual pain syndrome, dysmenorrhea, dyspareunia, the nature of menstrual discharge (brown discharge before and after menstruation), chronic pelvic pain, as well as confirmation, with the help of histopathological examination, of genital endometriosis. Results. By comparing the obtained data on pain symptoms with the clinical diagnosis made on the basis of histopathological examination, it can be concluded that the symptoms were most likely caused by endometriosis. Conclusions. Clinical and anamnestic data most characteristic of genital endometriosis were found in 138 (86.25 %) patients, data on the frequency of combination of painful symptoms were as follows: combination of two symptoms in 27.50 % (n = 44), three symptoms in 26.88 % (n = 43), four symptoms in 14.38 % (n = 23) and five studied symptoms in 6.25 % (n = 10), which in turn influenced the choice of the expected volume of surgical intervention and contributed to the establishment of a clinical diagnosis. The description of pain symptoms is quite limited, since the assessment of the characteristic symptoms of genital endometriosis did not include: conducting additional examinations in order to exclude additional causes of functional pain in the pelvis, the description of pain symptoms was incomplete, which, in turn, minimized the assessment of the adverse impact on daily activities, work or the quality of life in general, characteristic of pain symptoms, there is no clear difference between chronic pelvic pain and dysmenorrhea, the absence of data regarding the work of the gastrointestinal tract and urinary system, regarding the symptoms of genital endometriosis, which may indicate damage to the above-mentioned departments.

Background The current classification of cesarean scar pregnancy (CSP) is only based on the ultrasonic characteristics. At present, there is a lack of analysis and summarization of the clinical characteristics of different types of CSP cases under this classification criteria. Objective To investigate the clinical characteristics and management variance of different types of CSP. Methods A total of 862 patients with CSP admitted to the Department of Obstetrics and Gynecology, Peking University Third Hospital from July 2014 to June 2022 were enrolled and divided into the type Ⅰ, type Ⅱ and type Ⅲ groups. The clinical characteristics and indicators of diagnosis and treatment were analyzed retrospectively. Results Among the total CSP patients, 36.5% (315/862) were typeⅠ, 53.1% (458/862) were typeⅡ, and 10.3% (89/862) were type Ⅲ. The incidence of abdominal pain was 24.2% (209/862) and vaginal bleeding was 65.0% (560/862) in CSP patients. There was no statistically significant difference in the age, history of pregnancy and childbirth, and proportion of previous uterine cavity surgery among the three groups of patients (P>0.05). There was no significant difference in abdominal pain (P=0.261) and vaginal bleeding (P=0.062) among the three groups. In typeⅢ patients, the average gestational age was 55 (46, 64) days, the average diameter of gestational mass was 29.6 (19.1, 43.3) mm, and the serum β-HCG level was 60 673 (17 164, 122 203) mU/mL at diagnosis. The proportion of patients who needed adjuvant pharmacologic embryocidal therapy, laparoscopic surgery and uterine artery occlusion was 27% (24/89), 33.7% (30/89) and 32.6% (29/89), respectively. The operation duration was 101 (67, 125) min, the hospitalization duration was 4 (3, 7) days, and the treatment cost was 11 933.7 (8 760.7, 15 250.6) CNY for typeⅢpatients. The accumulated bleeding volume within 24 hours after surgery, the proportion of patients with perioperative bleeding≥200 mL and requiring blood transfusion was 24.7% (22/89) and 7.9% (7/89) in typeⅢ patients, respectively, which were higher than the other two groups (P

Background: COVID-19 was declared a pandemic by the World Health Organization (WHO) on 11th March 2020. The SARS-CoV-2 virus has mutated over time, which has resulted in genetic variation among population of circulating viral strains over the course of the COVID-19 pandemic. Preventive measures like vaccination, social distancing, using of face mask and hand hygiene practices played a vital role in mitigating the spread of this pandemic. But were these measures effective enough to curtail this pandemic. Purpose: To assess the presenting features of COVID 19 in the third wave and to assess the effectiveness of preventive measures against COVID 19 during the third wave. Methods: This is a hospital based prospective study where participants were regularly followed up till 14 days, conducted in rural part of North of India. Results: A total of 239 participants were included in this study. The study found that 95% of these participants received first dose of COVID vaccine as compared to 49.8% who received second dose. Some of the participants (39.7%) were not obeying the norms of social distancing. 52.1% of the subjects were using masks, which has been proven to be one of the effective measures for prevention of transmission of COVID 19. 71.1% were practicing hand hygiene measures. Conclusion: Vaccination and using face mask were significantly associated with mitigating the spread of COVID-19 among rural population who visited the health care facility.

INTRODUCTION: The primary occurrence and persistence of negative symptoms observed in patients with schizophrenia is deficit syndrome. Although the association between thyroid hormones and schizophrenia symptoms has been reported, no studies have investigated thyroid function in patients with deficit schizophrenia (DS). This study aims to investigate the clinical features and thyroid function in DS patients by comparing them with patients with non-deficit schizophrenia (NDS) and a control group. METHODS: 33 subjects from DS, 35 subjects from NDS and 35 healthy control subjects were included in the study. Patients with schizophrenia were classified into DS and NDS using the deficit syndrome table. Thyroid function was assessed by the levels of TSH, free T3 (fT3), and free T4 (fT4). Sociodemographic data and clinical characteristics were evaluated using the Sociodemographic Data Form, the Positive Symptoms Evaluation Scale (SAPS), the Negative Symptoms Evaluation Scale (SANS), and the Calgary Depression in Schizophrenia Scale (CDSS). RESULTS: There was no significant difference between DS and NDS groups in terms of age, gender, marital status and education (p>0.05). The percentage of unemployed was significantly higher in the DS group than in the NDS group (p=0.005). There were 14 (42.4%) suicide attempts in the DS group and 11 (31.4%) in the NDS group, and there was no significant difference between the groups (p>0.05). There was no significant difference between the groups when comparing the thyroid functions of the DS, NDS and healthy control groups regarding fT4, fT3 and TSH (p>0.05). There was no significant correlation between TSH, free T3, free T4 and total SANS, total SAPS and CDSS scores (p>0.05). DISCUSSION AND CONCLUSION: According to our study thyroid function is not different in DS, NDS and healthy controls and is not associated with positive, negative and depressive symptoms in patients with schizophrenia.

The COVID-19 pandemic presents unique requirements for accessible, reliable testing, and many testing platforms and sampling techniques have been developed over the course of the pandemic. Not all test methods have been systematically compared to each other or a common gold standard, and the performance of tests developed in the early epidemic have not been consistently re-evaluated in the context of new variants. We conducted a repeated measures study with adult healthcare workers presenting for SARS-CoV-2 testing. Participants were tested using seven testing modalities. Test sensitivity was compared using any positive PCR test as the gold standard. A total of 325 individuals participated in the study. PCR tests were the most sensitive (saliva PCR 0.957 ± 0.048, nasopharyngeal PCR 0.877 ± 0.075, oropharyngeal PCR 0.849 ± 0.082). Standard nasal rapid antigen tests were less sensitive but roughly equivalent (BinaxNOW 0.613 ± 0.110, iHealth 0.627 ± 0.109). Oropharyngeal rapid antigen tests were the least sensitive (BinaxNOW 0.400 ± 0.111, iHealth brands 0.311 ± 0.105). PCR remains the most sensitive testing modality for the diagnosis of COVID-19 and saliva PCR is significantly more sensitive than oropharyngeal PCR and equivalent to nasopharyngeal PCR. Nasal AgRDTs are less sensitive than PCR but have benefits in convenience and accessibility. Saliva-based PCR testing is a viable alternative to traditional swab-based PCR testing for the diagnosis of COVID-19. [ABSTRACT FROM AUTHOR]

Loss-of-function mutation of ABCC9 , the gene encoding the SUR2 subunit of ATP sensitive-potassium (KATP) channels, was recently associated with autosomal recessive ABCC9 -related intellectual disability and myopathy syndrome (AIMS). Here we identify nine additional subjects, from seven unrelated families, harbouring different homozygous loss-of-function variants in ABCC9 and presenting with a conserved range of clinical features. All variants are predicted to result in severe truncations or in-frame deletions within SUR2, leading to the generation of non-functional SUR2-dependent KATP channels. Affected individuals show psychomotor delay and intellectual disability of variable severity, microcephaly, corpus callosum and white matter abnormalities, seizures, spasticity, short stature, muscle fatigability and weakness. Heterozygous parents do not show any conserved clinical pathology but report multiple incidences of intra-uterine fetal death, which were also observed in an eighth family included in this study. In vivo studies of abcc9 loss-of-function in zebrafish revealed an exacerbated motor response to pentylenetetrazole, a pro-convulsive drug, consistent with impaired neurodevelopment associated with an increased seizure susceptibility. Our findings define an ABCC9 loss-of-function-related phenotype, expanding the genotypic and phenotypic spectrum of AIMS and reveal novel human pathologies arising from KATP channel dysfunction. [ABSTRACT FROM AUTHOR]

We report a case of paravertebral retroperitoneal ancient schwannoma (RPAS) with symptoms suggestive of irritable bowel syndrome that was relieved after resection. Very few cases have been reported of RPAS with gastrointestinal symptoms. Increased bowel activity associated with RPAS has not been reported. Our case report suggests that RPAS may present with increased bowel frequency that could be relieved after surgical resection. [ABSTRACT FROM AUTHOR]

Introduction Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly progressive neurodegenerative disease with public health implications. Mean age of onset is 68 years. Age-specific incidence declines after 80 years. This may arise from under-ascertainment or other biological features of the disease. Accurate characterisation of late-onset sCJD is important for early diagnosis, avoiding unnecessary investigations and improving ascertainment for public health purposes. Objective To phenotype the clinical features and investigation profile of sCJD in adults >80 years. Methods We analysed all probable and definite sCJD cases identified by the UK National CJD Research & Surveillance Unit over a 10-year period (2011–2021). Individuals were grouped by age of onset. Clinical features and investigation profiles were compared. Results 10.3% (123/1196) had an age of onset over 80. Median survival was shorter (3.2 vs 4.3 months; P  < 0.001). Pyramidal signs (48.3% vs 34.2%; P  = 0.008) and akinetic mutism (55.1% vs 33.2%; P  < 0.001) were more frequent. Psychiatric symptoms (26.3% vs 39.6%; P  = 0.01) and cerebellar signs (65.4% vs 78.6%, P  = 0.007) were less frequent. Cognitive impairment and myoclonus were highly prevalent regardless of age. Between age groups, the diagnostic sensitivity of cerebrospinal fluid real-time quaking-induced conversion (CSF RT-QuIC) (92.9% vs 91.9%, P  = 0.74) was comparable, electroencephalography was superior (41.5% vs 25.4%; P  = 0.006) and MRI was inferior (67.8% vs 91.4%; P  < 0.001). Conclusions Late-onset sCJD has distinct clinical features, shorter survival and a different profile of investigation sensitivity. CSF RT-QuIC, MRI brain and specialist CJD review is recommended in older adults with a rapidly progressive neurological disorder. Autopsy is valuable when the cause remains elusive. [ABSTRACT FROM AUTHOR]