Absence Of Symptoms Research Articles

Exploring Therapeutic Outcomes Through Dyadic Interactions: The Role of Patient-Avatar Dynamics in Avatar Therapy.

Despite the efficacy of current therapies, a significant proportion of patients with schizophrenia, a complex mental disorder marked by both positive (present) and negative (absent) symptoms, are considered to have treatment-resistant schizophrenia. Avatar therapy (AT) allows patients to interact with a three-dimensional representation of their most distressing voices in a virtual reality setting. The therapy shows promise in reducing impairments and improving quality of life through the establishment of a therapeutic alliance and the exploration of dyadic interactions (verbal exchanges) between patients and their avatar. The purpose of this study was to investigate differences in dyadic interactions throughout the immersive sessions of AT and to clarify the relationship between these interactions and therapeutic success by analyzing dyads as predictive indicators of positive outcomes in AT. Mean frequencies for the 10 most prevalent dyads identified in previous AT research were reported for 35 patients. A logistic regression model was implemented, and these dyads were used to predict variances in Psychotic Symptom Rating Scales-auditory hallucination scores 1 month after the completion of AT. Variances in mean frequencies were reported for the dyads. A positive relation between the avatar (provocation)-patient (self-affirmation) dyad and the therapeutic outcome was found to be significant (OR=2.29, p=0.049). This research is pioneering in its in-depth examination of therapeutic interactions in AT, with a particular focus on dyadic interactions. Future studies should prioritize the quality rather than quantity of these interactions to more accurately forecast their effects on potential indicators of positive outcomes in AT.

Antimicrobial Stewardship in the Frail Elderly.

Antimicrobial therapy is essential to modern healthcare practice. However, years of injudicious use has contributed to the development of population and individual level harm from antimicrobial resistance. The frail elderly are particularly at risk from infection as well as antimicrobial adverse effects due to multimorbidity, polypharmacy and declining physiological reserve. Diagnosis and management decision making may be challenging in this vulnerable group due to subtle or absent symptoms and signs. Antimicrobial stewardship is the systematic approach to safe and effective use of antimicrobials to optimise outcomes, minimise harm and preserve future therapies. Herein, we consider the significance and importance of antimicrobial stewardship in the frail elderly and suggest ten steps to assist clinicians in the recognition, investigation and management of infection in this group.

The Importance of Recognizing Vaginal Melanoma, A Unique and Aggressive Subtype of Mucosal Melanoma with Undefined Staging and Treatment Protocols: Case Report and Literature Review

Abstract Introduction/Objective Primary vaginal melanoma is a highly aggressive subtype of mucosal melanoma, with few cases reported in the literature. Mucosal melanomas represent a very small subset of melanoma cases, with even fewer found in the vagina. There is a frequent delay in diagnosis due to absent or nonspecific symptoms. Methods/Case Report We report two cases of primary vaginal melanoma that were found on biopsy due to abnormal postmenopausal bleeding. Case 1 is a 62-year-old woman that was found to have a necrotic mass originating from the vaginal apex, while case 2 is a 66-year-old woman that had a vaginal polyp. Microscopic examination of both cases revealed sheets of malignant cells with prominent nucleoli, brisk mitotic activity, and patchy melanin pigment. Immunohistochemical stains for MART-1 and SOX10 were positive in both cases, supporting the diagnosis. The patient in case 1 had an upper vaginectomy and is currently on immunotherapy as part of a clinical trial. Further treatment and status of the patient in case 2 is unknown. Results (if a Case Study enter NA) N/A Conclusion Due to the rarity of cases, little is known about the etiology and risk factors. A standardized staging system is not yet accepted, with most using a combination of the AJCC and FIGO systems, however, neither are specific for vaginal melanomas. Patients are often metastatic at the time of diagnosis due to delayed diagnosis and aggressive nature of the disease. Specific treatment protocols have not yet been defined, and it is debated whether a more conservative or aggressive approach is favored. The disease control and survival rates are dismal with a poor prognosis. The role of adjuvant and targeted molecular therapies is still being investigated. The addition of our cases to the literature will hopefully bring more awareness to vaginal melanoma as a diagnostic possibility and encourage more research to be done.

ENaC gene variants and their involvement in Covid‑19 severity.

Epidemiological studies report the association of diverse cardiovascular conditions with coronavirus disease 2019 (COVID-19), but the causality has remained to be established. Specific genetic factors and the extent to which they can explain variation in susceptibility or severity are largely elusive. The present study aimed to evaluate the link between 32 cardio-metabolic traits and COVID-19. A total of 60 participants were enrolled, who were categorized into the following 4 groups: A control group with no COVID-19 or any other underlying pathologies, a group of patients with a certain form of dyslipidemia and predisposition to atherosclerotic disease, a COVID-19 group with mild or no symptoms and a COVID-19 group with severe symptomatology hospitalized at the Intensive Care Unit of Sotiria Hospital (Athens, Greece). Demographic, clinical and laboratory data were recorded and genetic material was isolated, followed by simultaneous analysis of the genes related to dyslipidemia using a custom-made next-generation sequencing panel. In the COVID-19 group with mild or absent symptoms, the variant c.112C>T:p.P38S was detected in the sodium channel epithelial 1 subunit α (SCNN1A) gene, with a major allele frequency (Maf) of <0.01. In the COVID-19 group with severe symptoms, the variant c.786G>A:p.T262T was detected in the SCNN1B gene, which encodes for the β-subunit of the epithelial sodium channel ENaC, with a Maf <0.01. None of the two rare variants were detected in the control or dyslipidemia groups. In conclusion, the current study suggests that ENaC variants are likely associated with genetic susceptibility to COVID-19, supporting the rationale for the risk and protective genetic factors for the morbidity and mortality of COVID-19.

Complications After Covid-19 Infection In Singapore Military Divers: A Retrospective Cohort Study

ABSTRACT Wei NC, Ming KW. Complications After Covid-19 Infection In Singapore Military Divers: A Retrospective Cohort Study. Undersea Hyperb Med. 2024 Third Quarter; 51(3):221-229. Studies suggest that COVID-19 infections may have longer-term and more significant complications, even with mild or absent symptoms. This may predispose divers to pulmonary barotrauma, arterial gas embolisms, and reduced exercise tolerance, and impact physical and cognitive performance during diving. Military diving is physically, physiologically, and psychologically taxing on the individual. This study aims to assess the incidence of complications after COVID-19 infections in a cohort of active military divers and the incidence of diving-related injuries such as decompression sickness and barotrauma following recovery from acute COVID-19 infections. A single-center, retrospective cohort study of complications after COVID-19 infections was done in a cohort of the Republic of Singapore Navy (RSN) Naval Diving Unit (NDU) Divers and involved the collection of retrospective data for 329 military divers who were diagnosed with COVID-19 infection from 25 Mar 2020 and 13 Feb 2023. We found no clinical or subclinical complications after COVID-19 infection in our fully vaccinated, low-risk population of NDU divers after asymptomatic or mild COVID-19 infection. There were also no incidences of diving-related injuries related to COVID-19 after recovery from the acute illness. Based on the study results, it is recommended that all military divers with asymptomatic or mild COVID-19 infections return to military diving activities immediately after recovery from acute COVID-19 infection with resolution of symptoms. As existing guidelines recommend, divers with moderate to critical COVID-19 infection should be reviewed by a diving physician and undergo necessary investigations before returning to military diving. Keywords: barotrauma; COVID-19; decompression sickness; diving medicine; military diving

Timing of Resection of Spinal Meningiomas and Its Influence on Quality of Life and Treatment.

The main treatment modality for spinal meningiomas (SM) is gross total resection (GTR). However, the optimal timing of surgery, especially in cases with absent or mild neurological symptoms, remains unclear. The aim of this study is to assess the impact of early-stage resection on neurological outcome, quality of life (QoL), and quality of care. The primary objective is a favorable neurological outcome (McCormick scale 1). We retrospectively analyzed data from patients who underwent operations for SM between 2011 and 2021. Patients with mild neurological symptoms preoperatively (McCormick scale 1 and 2) were compared to those with more severe neurological symptoms (McCormick scale 3-5). Disabilities and QoL were assessed according to validated questionnaires (SF-36, ODI, NDI). Age, spinal cord edema, thoracic localization, and spinal canal occupancy ratio were associated with more severe neurological symptoms (all p < 0.05). Patients presenting with mild symptoms were associated with favorable neurological outcomes (OR: 14.778 (95%CI 3.918-55.746, p < 0.001)), which is associated with shorter hospitalization, better QoL, and fewer disabilities (p < 0.05). Quality of care was comparable in both cohorts. Early surgical intervention for SM, before the development of severe neurological deficits, should be considered as it is associated with a favorable neurological outcome and quality of life.

Proliferation in malaria parasites: How resource limitation can prevent evolution of greater virulence.

For parasites, robust proliferation within hosts is crucial for establishing the infection and creating opportunities for onward transmission. While faster proliferation enhances transmission rates, it is often assumed to curtail transmission duration by killing the host (virulence), a trade-off constraining parasite evolution. Yet in many diseases, including malaria, the preponderance of infections with mild or absent symptoms suggests that host mortality is not a sufficient constraint, raising the question of what restrains evolution toward faster proliferation. In malaria infections, the maximum rate of proliferation is determined by the burst size, the number of daughter parasites produced per infected red blood cell. Larger burst sizes should expand the pool of infected red blood cells that can be used to produce the specialized transmission forms needed to infect mosquitoes. We use a within-host model parameterized for rodent malaria parasites (Plasmodium chabaudi) to project the transmission consequences of burst size, focusing on initial acute infection where resource limitation and risk of host mortality are greatest. We find that resource limitation restricts evolution toward higher burst sizes below the level predicted by host mortality alone. Our results suggest resource limitation could represent a more general constraint than virulence-transmission trade-offs, preventing evolution towards faster proliferation.

Unmasking Infection Risks in Multiple Myeloma: Insights from a Retrospective Analysis.

Multiple myeloma (MM) has witnessed significant therapeutic advancements through the introduction of proteasome inhibitors and immunomodulators, leading to improved treatment outcomes. However, infections remain a formidable challenge for MM patients. The objective of our research is to investigate the factors that can forecast infection risk in MM patients. In pursuit of this, we conducted a thorough retrospective examination of medical records from Kidwai Memorial Institute of Oncology, Bangalore, involving 145 MM patients. Out of the 145 patients analyzed, almost half (47.5%; n = 69) encountered at least one infection during the course of their disease. Respiratory-related infections were the most prevalent (76.2%), followed by urinary tract infections (10%) and instances of diarrhea (8.8%). Notably, gram-positive bacteria constituted the majority of identified causative organisms, accounting for 48.2% of isolated pathogens, while gram-negative bacteria comprised 37.9% of the isolated organisms. Most infections were observed either at the time of presentation or during the first month (40.5%). Overall mortality during the study period was 4.8% (n = 7). Infections contributed to 57.1% (n = 4 out of 7 deaths) of the mortality. Moreover, patients in advanced stages exhibited an elevated risk of infection at presentation. Infections remain a major cause of morbidity and mortality in patients with MM. Nearly half of MM patients experience an episode of infection during treatment.Gram-positive bacteria are the most common pathogens,with respiratory infections being the most common foci. Prompt identification and treatment of infections is essential, but can be challenging due to atypical or absent symptoms. Antibacterial prophylaxis is an important preventive strategy, but further research is needed to develop innovative approaches to infection prevention and targeted therapeutic interventions. We must strive to develop innovative approaches to infection prevention in MM patients. Also we need to advance our understanding of the interplay between infections and MM to improve quality of care and outcomes for these individuals. By addressing these challenges, we can aspire to offer MM patients a brighter and healthier future.

Abstract 7287: High-grade serous ovarian carcinoma detected with TP53 mutation panel and SiMSen-Seq

Abstract Background: Ovarian carcinoma (OC) has the highest mortality among gynecologic malignancies due to absent or unspecific symptoms. The high-grade serous ovarian carcinoma (HGSC) accounts for over 60% of the OC associated deaths. The most frequent genetic aberrations in HGSC are mutations in the TP53 gene, detected in approximately 96% of the tumors. Previous studies have proposed potential diagnostic utility of detecting mutations in circulating tumor DNA (ctDNA) from OC patients. However, the need for diagnostic methods capable of detecting asymptomatic HGSC is unmet. Objectives: The primary aims of this study were to design a screening tool for identification of HGSC and to evaluate the suitability of various clinical specimen types for diagnostic applications. Methods: In this study, we designed a highly sensitive and robust screening tool using the simple, multiplexed, PCR-based barcoding of DNA for sensitive mutation detection using sequencing (SiMSen-Seq) technique for identification of HGSC (n=11) by TP53 mutation profile in various clinical specimen for diagnostic applications. Specimens sampled included primary tumors, ascites, plasma, vaginal samples, and both liquid and solid samples from cyst-, endocervical-, and endometrial origin (n=94). Results: The in-house designed panel amplified 17 regions, encompassing 619 nucleotide positions within the TP53 gene. Pathogenic variants were identified in 10/11 of the primary tumors, with a VAF ≥ 9% (range: 9-91). Preliminary data indicated that all (100%) paired samples obtained corresponding somatic mutations between two or more of the different compartments from the same patient. In total 10/10 ascites-, 16/16 cyst-, 8/8 plasma-, 5/8 vaginal-, 17/22 endocervical-, and 14/19 endometrial samples showed somatic variants at a consensus read depth of 3 and a minimum VAF ≥ 0.1%. Conclusion: The present study suggests that the TP53 mutation panel can identify somatic variants in a variety of non-invasive liquid biopsies. Additionally, the assessment of the TP53 mutation panel exhibits potential for forthcoming clinical utilization as a diagnostic tool. Citation Format: Amanda Olsson Widjaja, Peter Micallef, Benjamin Ulfenborg, Maria Lycke, Ulf Gyllensten, Therese Carlsson, Tobias Österlund, Anders Ståhlberg, Anna Linder, Karin Sundfeldt. High-grade serous ovarian carcinoma detected with TP53 mutation panel and SiMSen-Seq [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7287.

Theoretical and Hypothetical Study of Premenstrual Syndrome According to Ayurveda

Introduction: Premenstrual syndrome generally occurs in response to change in levels of hormones progesterone &amp; estrogen. A condition which manifests with distressing physical, behavioral &amp; psychological symptoms in absence of organic or underline psychiatric disease. Symptoms of it may interfere females professional life &amp; may alter her interpersonal harmony at social life. There upon over the period of time topic is selected to review on PMS. Aim: To review PMS according to Ayurveda. Methodology: Ayurvedic classics &amp; modern literature were scrutinized to postulate theoretical &amp; hypothetical study for understanding PMS. Review of Literature: Raymond Greene &amp; Katharina Daltone wrote about it for the first time in 1953. Observation: Acne , Breast tenderness, Bloating, Fatigue, Mood Swings, Aggression, Reduce Concentration etc are observed at physical, psychological as well as behavioral level. Discussion: According to Ayurveda Premenstrual Syndrome is manifested due to imbalance of bodily elements such as Tridosha, Dhatu, Updhatu etc. if further scrutinized in detailed it was found that Apana vayu is involving factor to produce the symptoms. As the sight of Apana Vayu is pelvic region &amp; it helps in regular timely excretion of urine, stool, fetus, menstrual fluid etc .Conclusion: It is Observed that symptomology of PMS is ranged at physical, physiological &amp; psychological level. Involvement of Tridosha, specifically symptoms of Prana, Udana, Apana Vayu vitiation were observed. Keywords: Apana Vayu, Ayurveda, Premenstrual syndrome

CHALLENGES IN THE DIAGNOSIS OF FEMALE GENITAL TUBERCULOSIS

Genital tuberculosis (GTB) is a difficult disease to diagnose. It is nearly always secondary to primary elsewhere in the body and after spread to the genital tract it remains dormant in the latent foci to get reactivated at a later date. During periods of immunosuppression or around the time of puberty when the vascularity of the genital organs increases, the dormant bacilli get reactivated and the clinical features develop 10-15 years after the primary infection. In GTB, significant damage is seen in the fallopian tubes and the endometrium. Clinical diagnosis of GTB is difficult, because it is a disease of absent or few symptoms which are non-specific. A high degree of suspicion aided by intensive investigations is important in the diagnosis of the disease. Except when there are typical features such as tubercles/caseation, laparoscopic findings may be non-specific and the early disease can be easily missed when the infection is still confined to the mucosa. Conventional methods of diagnosis such as HPE, AFB smear and culture have low pick up rates. Molecular studies including GeneXpert show good specificity but, the sensitivity is poor to rule out the disease. As on now, there is no single investigation modality with good sensitivity and specificity available to diagnose GTB. These diagnostic difficulties are encountered both in low resource as well as and in high resource countries.

The Impact of Exposure Therapy on Cancer-Related Future Cognitions in Severe Health Anxiety

The Impact of Exposure Therapy on Cancer-Related Future Cognitions in Severe Health Anxiety

Mammogram perceptions, communication, and gaps in care among individuals with non-English language preference in Oregon and Washington states

This study examined perceptions of and communication about mammography as drivers of gaps in screening among individuals with non-English language preference (NELP). A survey was fielded in fall 2021 in five languages (Cantonese, English, Russian, Spanish, or Vietnamese) to individuals identified using electronic medical records in Oregon and Washington. The analytic sample consisted of 420 respondents with a median age of 61; approximately 45% of respondents identified as Asian, 37% as Hispanic, Latino, or Spanish origin, and 18% as some other race, ethnicity, or origin. Logistic regression models examined associations between screening and perception and communication items. Individuals who believed mammograms are unnecessary when healthy (aRR=0.72 [0.57, 0.91]) or absent symptoms (aRR=0.85 [0.72, 1.00]) were less likely to report a mammogram within the past two years (i.e., be current). Having a provider recommend (aRR=1.27 [1.09, 1.47]) and discuss mammography (aRR=1.18 [1.05, 1.32]) were associated with a higher likelihood of being current. Few respondents received written or verbal information in their preferred language (35% and 28.3%, respectively). Financial and logistical support, including language services were most frequently identified as types of support needed to obtain a mammogram. Overall, misperceptions about mammography may act as a barrier but communication may act as a facilitator for individuals with NELP. Provider-patient communication could be an effective way to encourage mammography. Culturally-responsive health promotion materials and provider communication, available in patients' preferred language, are needed to combat misperceptions and support ongoing, on-time mammography for NELP patients.

Predictors of congruency between clinical and radiographic Oxfordshire Community Stroke Project Classification subtypes

The Oxfordshire Community Stroke Project (OCSP) classification has been widely used to assess ischemic stroke patients based on clinical characteristics alone. However, the correlation between the clinical presentation evaluated using OCSP and imaging findings is yet to be determined. Our study aimed to describe the baseline characteristics of the OCSP subtypes of patients admitted with ischemic stroke and evaluate the predictors of the relationship between clinical and neuroimaging findings. Patients with a confirmed diagnosis of ischemic stroke admitted to a comprehensive stroke center in Brazil between February 2015 and October 2017 were eligible for the study. All participants underwent computed tomography (CT) at admission and follow-up neuroimaging within seven days, per the institutional protocol. Trained staff classified patients according to the OCSP at hospital admission. The radiographic OCSP classification was retrospectively assessed based on the last follow-up neuroimaging by investigators unaware of the clinical classification. The overall agreement rates ranged from 65.5% to 88.7%. Lower NIHSS scores, absent hyperdense MCA sign, higher ASPECTS, and absent brainstem symptoms were related to a higher risk of misclassification. Treatment with intravenous tPA was associated with reclassification in patients with total anterior circulation syndrome. For predicting radiographic posterior circulation involvement, vertigo (OR 2.9, 95% CI 1.7-5.1, p<0.001) and brainstem symptoms (OR 35, 95% CI 20.5-60.2, p<0.001) were directly associated with correct classification, but motor and higher cerebral function were not correlated. The clinical OCSP classification presented good congruency rates with the neuroimaging findings. However, patients with lacunar syndromes are often misclassified when radiological criteria are considered.

Virtual Bronchoscopy – An emerging tool to diagnose ‘H’ type Tracheoesophageal Fistula (TEF)

Most of the pediatric surgical conditions or major congenital malformations are diagnosed on spot or with simple radiological imaging just like Tracheoesophageal Fistula (TEF), e.g., Inability to pass NG tube with coiling of NG tube on chest X-ray. But a few of them are still challenging to diagnose, just like ‘H’ type TEF because of delayed presentation as well as absent classical symptoms. (1) And even in today’s era where radiological accuracy has reached to a new level, this diagnosis is missed many times and only confirmed on table. Here we are reporting a case of ‘H’ type TEF, a 17 days old male child, whom we diagnosed on single attempt with virtual bronchoscopy.

Imaging of Pancreatitis, Panniculitis, and Polyarthritis Syndrome

HomeRadiologyVol. 307, No. 4 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyImaging of Pancreatitis, Panniculitis, and Polyarthritis SyndromeLakhdeep Singh Brar , Yatin ChadhaLakhdeep Singh Brar , Yatin ChadhaAuthor AffiliationsFrom the Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, Canada N6A 3K7 (L.S.B.); and Department of Medical Imaging, North York General Hospital, Toronto, Canada (Y.C.).Address correspondence to L.S.B. (email: [email protected]).Lakhdeep Singh Brar Yatin ChadhaPublished Online:May 2 2023https://doi.org/10.1148/radiol.222426MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 64-year-old man initially presented with pancreatitis that required hospitalization. Several months later, he developed knee pain and a fluctuant soft tissue mass at the lateral aspect of the left knee. Rheumatologic and metabolic workups (serum calcium and phosphate, and parathyroid hormone) were negative. Radiography performed 10 months after the initial onset of pancreatitis (Figure, A) showed bilateral symmetric osteopenia involving the knees with a permeative appearance of the bones. Subsequent bilateral knee MRI scans (Figure, B and C) demonstrated bilateral multifocal osteonecrosis with rim enhancement in the soft tissues of the left knee, supporting panniculitis. Subsequent imaging showed improvement of all imaging findings. The patient was referred to orthopedic oncology at a tertiary care center as a precaution. The diagnosis of pancreatitis, panniculitis, and polyarthritis (PPP) syndrome was made based on the clinical and imaging findings.Images in a 64-year-old man presenting with knee pain 10 months after hospitalization for pancreatitis. (A) Anteroposterior radiograph of both knees shows a permeative appearance of the bones (arrows). (B) Coronal T1-weighted knee MRI scan shows osteonecrosis. (C) Coronal T1-weighted postgadolinium MRI scan shows bilateral multifocal osteonecrosis (arrowheads) and panniculitis (rim enhancing) in the lateral soft tissues of the left knee (arrow).Download as PowerPointOpen in Image Viewer PPP syndrome is rare and occurs in the setting of pancreatitis or an underlying pancreatic mass (1). Patients may report mild or absent abdominal symptoms, making it difficult to diagnose. It has been reported to occur in all age groups, with a mean age ± SD of 51 years ± 16, and has a higher prevalence rate in men than in women (2:1 ratio) (2). While any joint may be involved, it most commonly affects the knees, ankles, and wrists (2). The pathophysiology is thought to result from the release of pancreatic lipase into the circulation, causing lipolysis and inflammation (2). The clinical symptoms and imaging findings can be transient or persist over time (3). Treatment involves addressing the underlying pancreatitis (3).Disclosures of conflicts of interest: L.S.B. No relevant relationships. Y.C. No relevant relationships.

Association between depressive symptoms and socioeconomic status in head and neck cancer patients attending rural tertiary health care center.

To study the association between depressive symptoms and socio-economic status (SES) in patients with head and neck cancer (HNC). Histopathology-proven non-metastatic and non-recurrent HNC patients attending radiation oncology services in February and June 2021 who consented to the study were evaluated with an interview. Hamilton Depression Rating Scale (HDRS) and modified BG Prasad classification were used to assess depressive symptoms and SES, respectively. Statistical analysis was done using SYSTAT version 12 (by Crane's software, Bangalore). The study cohort comprised 100 patients. The median age was 55 years (minimum: 28, maximum: 86) with a male-to-female ratio of 2.57:1. The majority of patients were educated beyond middle-school level (44%), of middle SES (47%), oral cavity subsite (68%), stage IVA (36%) disease, and were on treatment (79%). HDRS scores showed absent, moderate, and severe depressive symptoms in 21, 63, and 16 patients, respectively, that is, the prevalence of depressive symptoms was 79%. Lower socioeconomic strata showed a significantly higher prevalence of severe depressive symptoms (P-value = 0.01). HDRS score was significantly higher in females (P-value = 0.024) and in patients who were illiterate or were educated less than middle-school level (P-value = 0.010). No statistically significant difference was found between HDRS score and age of patient, stage and site of disease, and on treatment or follow-up status. Depressive symptoms are common in patients with head and neck cancer. Low socioeconomic status (SES), female gender, and education less than middle school are associated with severe depressive symptoms. Psycho-oncological and psychotherapeutic interventions are the need of the hour.

Parkinson's Disease and Diabetes Mellitus: Synergistic Effects on Pathophysiology and GI Motility.

Parkinson's disease and diabetes affect an increasing proportion of the aging global population. Both conditions extensively affect gastrointestinal (GI) motility with similar and differing clinical symptoms. Nonetheless, GI symptoms in Parkinson's disease and diabetes pose significant morbidity and impairment of quality of life. Their pathophysiology is poorly understood, and therefore, effective treatment options are lacking. Parkinson's disease patients have oropharyngeal dysphagia and constipation. They also have mild or absent upper GI symptoms associated with delayed gastric emptying, which is prevalent in 70% of patients. Delayed gastric emptying in Parkinson's disease leads to erratic medication absorption and fluctuating motor symptoms. Half of diabetics have upper GI symptoms, which correlate to gastric emptying and changes in brain activity of the insular cortex. The majority of diabetics also have constipation. Diabetics have an increased risk for developing Parkinson's disease and anti-diabetic medications are associated with risk reduction of developing Parkinson's disease. Hyperglycemia is associated with advanced glycated end products formation and acceleration of α-synuclein aggregation. GLP-1 receptor agonists have also demonstrated efficacy in improving motor symptoms and cognition in Parkinson's disease patients with diabetes. Parkinson's disease and diabetes are pan-enteric disorders with significant GI symptoms and impairment of gut motility. Both conditions have synergistic pathophysiologies that propagate neurodegenerative changes. Treatment options for GI symptoms in diabetic and Parkinson's disease patients are lacking. Anti-diabetic treatment improves motor symptoms in Parkinson's disease, however, its effect on GI symptoms is unclear.

Heart rate variability in patients presenting with anginal symptoms in absence of cardiac and other diseases

Objectives: Angina is a symptom of coronary artery disease (CAD). Modulation of cardiac autonomic tone as assessed by heart rate (HR) variability (HRV) is found reduced in patients with CAD; myocardial ischemia, myocardial infarction and some other cardiovascular diseases. Reduced HRV has been found associated with sudden cardiac death in these CAD patients. Several patients present with anginal symptoms clinically in absence of CAD or other diseases. The status of HRV is not much clear in these patients. Thus, we aimed to assess HRV in patients with angina with and without myocardial ischemia and compare it with HRV of healthy subjects of similar age groups and follow-up patients for 1 year for cardiac/health events. Materials and Methods: The study included 61 consecutive male patients clinically presenting with angina and 30 healthy subjects. Based on Thallium-201 myocardial perfusion Single-photon emission computerized tomography (SPECT) imaging, patients were divided into two groups; patients with myocardial perfusion defects (MPD), (n = 33, age 54.91 ± 7.43 years) and patients with no MPD (NMPD), NMPD (n = 28, age 53.04 ± 8.50 years). Short-term HRV was assessed in all patients and subjects in resting supine position following standard protocol. All MPD and 25 NMPD patients could be followed up for 1 year for cardiac/health events. Results: Surprisingly, the NMPD patients showed significantly reduced HRV, Standard deviation of the N-N intervals, The square root of the mean squared differences of successive N-N intervals, Percentage of the number of interval differences of successive N-N intervals greater than &gt;50 ms divided by total number of R-R intervals, low frequency (LF) power, High Frequency (HF) power and total power as compared to both MPD patients and healthy subjects. (Total power [NMPD vs. MPD]: 610.1 [379.9–1072.8] vs. 1508.0 [748.4–2339.4] millisecond squares (ms2), P = 0.001), healthy subjects (Total power: 1414.6 [1104.6-2141.5] ms2, P = 0.001). The markers of sympathetic tone; LF (normalised unit) and LF/HF ratio were higher in NMPD patients as compared to MPD patients resulting in an altered sympathovagal balance. During a 1-year follow-up, sudden death was seen in one MPD patient (3.1%) and two NMPD patients (8%). Conclusion: The NMPD patients showed significantly reduced HRV as compared to both MPD patients and Healthy subjects with an altered sympathovagal balance. Sudden death was also seen in NMPD patients as MPD patients.

Do the negative symptoms of schizophrenia reflect reduced responsiveness to reward? Examination using a reward prediction error (RPE) task.

A leading theory of the negative symptoms of schizophrenia is that they reflect reduced responsiveness to rewarding stimuli. This proposal has been linked to abnormal (reduced) dopamine function in the disorder, because phasic release of dopamine is known to code for reward prediction error (RPE). Nevertheless, few functional imaging studies have examined if patients with negative symptoms show reduced RPE-associated activations. Matched groups of DSM-5 schizophrenia patients with high negative symptom scores (HNS, N = 27) or absent negative symptoms (ANS, N = 27) and healthy controls (HC, N = 30) underwent fMRI scanning while they performed a probabilistic monetary reward task designed to generate a measure of RPE. In the HC, whole-brain analysis revealed that RPE was positively associated with activation in the ventral striatum, the putamen, and areas of the lateral prefrontal cortex and orbitofrontal cortex, among other regions. Group comparison revealed no activation differences between the healthy controls and the ANS patients. However, compared to the ANS patients, the HNS patients showed regions of significantly reduced activation in the left ventrolateral and dorsolateral prefrontal cortex, and in the right lingual and fusiform gyrus. HNS and ANS patients showed no activation differences in ventral striatal or midbrain regions-of-interest (ROIs), but the HNS patients showed reduced activation in a left orbitofrontal cortex ROI. The findings do not suggest that a generalized reduction of RPE signalling underlies negative symptoms. Instead, they point to a more circumscribed dysfunction in the lateral frontal and possibly the orbitofrontal cortex.