Changes In Scores Research Articles

Comparison of Intensive Physical Therapy and Electrical Stimulation to Reduce Spasticity in Stroke

Background: Stroke is a leading cause of disability worldwide, often resulting in spasticity that significantly impairs the functional recovery of individuals. The comparative efficacy of intensive physical therapy and electrical stimulation in mitigating post-stroke spasticity remains a critical area of research. Understanding the impacts of these treatments can guide clinicians in optimizing rehabilitation strategies for stroke survivors. Objective: The study aimed to compare the effectiveness of intensive physical therapy and electrical stimulation in reducing spasticity among stroke patients, with an emphasis on how these interventions influence muscle tone and functional outcomes. Methods: This quasi-experimental trial was conducted at Nishtar Hospital, Multan, over six months, involving 30 participants aged 50-65 years who had experienced a stroke. Participants were randomly assigned to receive either intensive physical therapy or electrical stimulation. Baseline and post-treatment assessments of spasticity were conducted using the Modified Ashworth Scale (MAS). Data were analyzed using SPSS version 25, focusing on changes in MAS scores before and after the interventions. Results: Both interventions showed significant improvements in spasticity levels. The intensive physical therapy group exhibited notable reductions in MAS scores across various joints: shoulder flexors (from 3.13 ± 0.51 to 1.20 ± 0.41), shoulder extensors (from 3.00 ± 0.65 to 1.20 ± 0.67), and hip abduction (from 3.00 ± 0.65 to 1.33 ± 0.72). The electrical stimulation group also demonstrated significant improvements, with MAS scores in wrist flexion (from 2.73 ± 0.70 to 1.33 ± 0.61) and hip extension (from 2.80 ± 0.67 to 1.26 ± 0.45) showing notable reductions. However, no statistically significant differences were observed between the two groups in terms of overall effectiveness in reducing spasticity (p > 0.05). Conclusion: Both intensive physical therapy and electrical stimulation are effective in reducing post-stroke spasticity, with no significant difference in their overall efficacy. This suggests that either treatment can be considered as part of a comprehensive rehabilitation strategy for stroke survivors, depending on individual patient needs, preferences, and specific functional goals.

The Effects of Nurse-Led Supportive Care Program on Quality of Life in Women with Breast Cancer Receiving Adjuvant Chemotherapy: A Randomized Controlled Pilot Study

This study was to evaluate the effects of nurse-led supportive care program on quality of life in women with breast cancer receiving adjuvant chemotherapy. The study was carried out a parallel group randomized controlled pilot study with repeated-measures design in general surgery unit of a training and research hospital. Forty-two women with newly diagnosed breast cancer were randomly assigned to the intervention and control groups. The intervention group received nurse-led supportive care program for 8 weeks, 4 weeks in face-to-face sessions and 4 weeks through phone sessions. The control group received only routine treatment. The women in both groups completed the EORTC-QLQ-C30 (version 3.0) Quality of Life questionnaires at baseline and ninth week. There was a significant increase in the mean global health status and functional status scores of the women with breast cancer in the intervention group compared to the women in the control group in the ninth week compared to the baseline. The women in the intervention group had a lower mean symptom status score in the ninth week than the women in the control group and there was a statistically significant difference in the change in the mean scores of the groups over time. Our nurse-led supportive care program is an effective, safe and acceptable method to support women with BC receiving adjuvant chemotherapy. The nurse-led supportive care program can be used as a reliable and effective nursing intervention to increase the quality of life of women breast cancer receiving adjuvant chemotherapy. NCT05399160.

Identifying Racial and Ethnic Disparities in Acute Inpatient Rehabilitation

ObjectiveTo investigate whether racial, ethnic, and linguistic disparities exist at discharge from an acute inpatient rehabilitation facility (IRF) by examining change in Functional Independence Measure (FIM) scores and discharge destination. DesignThis is a retrospective study using our IRF's data from the Uniform Data System for Medical Rehabilitation from 2013-2019. FIM scores and discharge destination were compared between race, language, and ethnic groups, with adjustment for patient characteristics. SettingAn urban hospital with a level 1 trauma center, comprehensive stroke center, and IRF with Commission on Accreditation of Rehabilitation Facilities (CARF) certification. Participants2518 patients admitted to the IRF from 2013-2019 (N=2518). InterventionsNot applicable. Main Outcome MeasuresChange in FIM score and discharge destination. ResultsAfter adjusting for covariates, non-White patients and patients with limited English proficiency had significantly lower functional recovery, as measured by smaller changes in FIM scores from IRF admission to discharge. Additionally, both groups were more likely to be discharged home with home health care than to a skilled nursing facility, compared with White and English-speaking patients. Disparities in discharge destination persisted within patients with noncommercial insurance (Medicaid or Medicare) and a stroke diagnosis but not within those who had commercial insurance or a nonstroke diagnosis. ConclusionsRacial and linguistic disparities were identified within our CARF certified IRF; however, the organization is committed to reducing health care disparities. Next steps will include investigating interventions to reduce disparities.

Low Field MRI Surveillance 6-24 Months Post-acute COVID-19 Pneumonia: Factors Influencing Severity and Evolution of Lung Opacities

To determine factors influencing low-field MRI lung opacity severity 6-24 months after acute Covid-19 pneumonia. 104 post-acute Covid-19 patients with 167 MRI exams were included. 32 patients had more than one exam, and 63 exams were serial exams. Pulmonary findings were graded on a scale of 0-4 by quadrant, total score ranging from 0 (no opacity) to 16 (opacity > 75%), and score >8 considered moderate and >12 severe opacity. Kruskal-Wallis, Mann-Whitney, and Spearman rank correlation was used to assess the association of clinical and demographic factors with MR opacity severity at time intervals from acute infection. Random coefficients regression was used to assess whether opacity score changed over time. Severity of initial illness was associated with increased MR opacity score at timeframes up to 24 months (p<.05). Among the 167 exams, moderate to severe MR opacities (total opacity score >8) were identified in 33% of exams beyond 6 months: 37% at 6 - <12 months (n=23/63); 31% at 12- <18 months (n=13/42); 25% at 18- <24 months (n=6/24); and 50% at >24 months (n=3/6). No significant change in total opacity score over time was identified by random coefficients regression. Among the 32 patients with serial exams, 11 demonstrated no change in opacity score from initial to final exam, 10 decrease in score (mean 2.3, stdev 1.25, range 1-4), and 11 increase in score (average 2.8, stdev 1.48, range 1-7). Initial Covid-19 disease severity was associated with increased MRI total opacity score at time intervals up to 24 months, and moderate to severe opacities were commonly identified by low-field MRI beyond 6 months from acute illness.

THE SIGNIFICANCE OF LAPAROSCOPY IN THE PROGNOSIS AND TREATMENT OF ACUTE PANCREATITIS

A study was conducted on 102 patients with acute destructive pancreatitis and enzymatic peritonitis, who underwent laparoscopy within the first 72 hours after the onset of the disease. The results of this study led to the development of a scoring system for assessing pathological changes in the abdominal cavity, which allows predicting the severity of the disease. It turned out that the results of laparoscopy with a scoring of changes in the abdominal cavity largely coincide with the assessment of the severity of acute pancreatitis performed using computed tomography using the Balthazar scale (the sensitivity of the method was 84.0% and 86.3%, respectively).

Rotation of a Part of the Composite Flap for Simultaneous Gonion Reduction and Malar Augmentation During Rhytidectomy in Asians.

The desired facial shape that Asians aim to achieve through plastic surgery differs from that of westerners. The author facilitates facial volume deflation by using the rotation of a part of the composite flap to the malar area resulting in volumetric augmentation during rhytidectomy; simultaneously, a volumetric reduction was implemented in the gonion. Extended deep plane rhytidectomy with the rotation of a part of the composite flap was performed in 49 patients, whereas extended deep plane rhytidectomy without the rotation of a part of the composite flap was performed in 20 patients. For the results, the satisfaction survey of the surgery was conducted in all patients and by 2 surgeons during a follow-up visit 12 months later. To assess the surgical outcome objectively, the author used the Allergan photometric midface volume deficit scale to measure the midface volume. The midface contour and degree of projection were analyzed using lateral view photographs of the patients. The measurement of segment CM (distance between the lateral canthus and mouth corner) and segment MA (distance from segment CM to the most protruding malar area) was performed. The patients who underwent extended deep plane rhytidectomy with the rotation of a part of the composite flap reported higher overall satisfaction and achieved more favorable results, as evaluated by the 2 aesthetic surgeons (P < 0.05). The scores on the Allergan photometric midface volume deficit scale showed a significant increase before and after the surgery in both groups (P < 0.05), also as evaluated by the 2 aesthetic surgeons. However, the change in scores was found to be higher in the extended deep plane rhytidectomy with the rotation of a part of the composite flap group. The midface contour and degree of projection showed an increase of 20.6% on the right face and 22.7% on the left face, respectively (P < 0.001). Using the rotation of a part of the composite flap during rhytidectomy resulted in overall satisfactory outcomes for all patients. Based on these findings, it can be concluded that the use of this surgical method is beneficial and effective.

Sex Differences in Hydration Biomarkers and Test-Retest Reliability Following Passive Dehydration.

This study investigated (a)differences between males and females for changes in serum, tear, and urine osmolality, hematocrit, and urine specific gravity following acute passive dehydration and (b)assessed the reliability of these biomarkers separately for each sex. Fifteen males (age: 26.3 ± 3.5years, body mass: 76 ± 7kg) and 15 females (age: 28.8 ± 6.4years, body mass: 63 ± 7kg) completed a sauna protocol twice (5-28days apart), aiming for 4% body mass loss (BML). Urine, blood, and tear markers were collected pre- and postdehydration, and change scores were calculated. Male BML was significantly greater than that of females in Trial 1 (3.53% ± 0.55% vs. 2.53% ± 0.43%, p < .001) and Trial 2 (3.36% ± 0.66% vs. 2.53% ± 0.44%, p = .01). Despite significant differences in BML, change in hematocrit was the only change marker that displayed a significant difference in Trial 1 (males: 3% ± 1%, females: 2% ± 1%, p = .004) and Trial 2 (males: 3% ± 1%, females: 1% ± 1%, p = .008). Regression analysis showed a significant effect for sex (male) predicting change in hematocrit (β = 0.8, p = .032) and change in serum osmolality (β = -3.3, p = .005) when controlling for BML but not for urinary or tear measures. The intraclass correlation coefficients for females (ICC 2, 1) were highest for change in urine specific gravity (ICC = .62, p = .006) and lowest for change in tear osmolarity (ICC = -.14, p = .689), whereas for males, it was posthematocrit (ICC = .65, p = .003) and post tear osmolarity (ICC = .18, p = .256). Generally, biomarkers showed lower test-retest reliability in males compared with females but, overall, were classified as poor-moderate in both sexes. These findings suggest that the response and reliability of hydration biomarkers are sex specific and highlight the importance of accounting for BML differences.

Changes in depression symptom profile with gender-affirming hormone use in transgender persons

BackgroundWomen show higher prevalence of depression and different symptomatology than men, possibly influenced by sex hormones. Many transgender persons, who face a high risk of depression, use Gender-Affirming Hormone Therapy (GAHT), but the impact of GAHT on depressive symptom profiles is unknown. MethodsThis study examined depressive symptoms in transgender persons before GAHT and after 3- and 12 months of GAHT. We used the Inventory of Depressive Symptomatology-Self Report to assess depressive symptoms, exploratory factor analysis (EFA) to assess symptom clusters, and linear mixed models to assess changes in symptom clusters. ResultsThis study included 110 transmasculine (TM) and 89 transfeminine (TF) participants. EFA revealed four symptom clusters: mood, anxiety, lethargy, and somatic symptoms. Changes in total depressive symptoms significantly differed between TM and TF groups. After 3 months of GAHT, TM participants reported improvement in lethargy (−16 %; 95%CI: −29 %; −2 %), and after 12 months TF participants reported worsening in low mood (24 %; 95%CI: 3 %; 51 %), but absolute score changes were modest. Neither group showed changes in anxiety or somatic symptoms. LimitationsThis study had limited sample sizes at 12 months follow-up and did not include relevant biological or psychosocial covariates. DiscussionChanges in depressive symptoms after GAHT use differ in TM and TF persons: TM persons report slight improvements in lethargy, whereas TF persons report a slight increase in low mood. Starting GAHT represents a significant life event with profound social and physical effects, and further research should assess social and biological effects of GAHT on mood-related symptoms.

Effect of family-centered care on the anxiety levels among family members of patients undergoing cardiac surgery: a randomized controlled trial.

The present study aims to determine the effect of family-centered care on anxiety levels among family members of patients undergoing cardiac surgery. This study was a randomized clinical trial study that was conducted on the families of Iranian cardiac surgery patients. In the intervention group, family-centered care was implemented, and the content of the intervention included providing informational and emotional support to the family member and the family member's participation in patient care according to the set framework. A total of 144 family members of patients undergoing cardiac surgery were included in this study. Among the 144 family members, 71 were in the intervention group, and 73 were in the control group. The changes in the state anxiety score before and after the intervention were significant between the two groups, and the changes were higher in the control group (P=0.043). Also, there was no significant difference in the changes in trait anxiety before and after the intervention between the two groups (P>0.05). In general, the high prevalence of anxiety in patients' families has negative functional consequences on both patients and their families. To reduce the level of anxiety, special attention should be paid to knowing the effective factors and appropriate coping methods. Nevertheless, it is important to note that additional research is warranted to delve deeper into this matter in future studies.

Cumulative Exposure to Oxidized Low-density Lipoprotein is a Potential Predictor for Prognosis in Acute Ischemic Stroke: A Cohort Study.

Oxidized Low-Density Lipoprotein (ox-LDL) is crucial in the recrudescence and prognosis of acute ischemic stroke (AIS). We aimed to probe into the influence of cumulative ox-LDL exposure on the 90-day prognosis of AIS. Patients with AIS were recruited in this research. AIS severity at admission was estimated with infarct volumes and National Institute of Health Stroke Scale (NIHSS) scores. AIS prognosis was assessed using Modified Rankin Scale (mRS) scores at 90 days and the change in NIHSS scores from admission to discharge. Cumulative ox-LDL exposure was defined as ox-LDL level (pg/mL) multiplied by age(y). Multivariate logistic regression analysis was employed to reveal the correlation between exposure factors and the prognosis of AIS. The prognostic prediction ability of cumulative ox-LDL exposure was compared with cumulative LDL exposure by the receiver operating characteristic curve (ROC). Higher cumulative ox-LDL exposure was related to worse prognosis, including neurological worsening at discharge (NIHSS increasing more than 2 points) (OR = 3.02, 95% CI, 1.30-6.98, P = 0.01) and poor functional prognosis at 90 days (mRS ≥ 3) (OR = 21.21, 95% CI, 4.72-95.36, P < 0.001). As multivariate regression analysis showed, significantly increased cumulative ox-LDL exposure was relevant to poor functional prognosis at 90 days (OR = 9.92, 95% CI, 1.23-79.76, P = 0.031), but not with neurological worsening at discharge (P = 0.414). ROC curve revealed that cumulative ox-LDL exposure had a higher predictive value (AUC = 0.843, P < 0.001) for functional prognosis of AIS than cumulative LDL exposure (AUC = 0.629, P = 0.023). Cumulative ox-LDL exposure has a positive correlation with poor prognosis at 90 days of AIS, and has a more accurate predictive ability than cumulative LDL exposure.

Eloquent noneloquence: redefinition of cortical eloquence based on outcomes of superficial cerebral cavernous malformation resection.

Cerebral cavernous malformations (CMs) are pathological lesions that cause discrete cortical disruption with hemorrhage, and their transcortical resections can cause additional iatrogenic disruption. The analysis of microsurgically treated CMs might identify areas of "eloquent noneloquence," or cortex that is associated with unexpected deficits when injured or transgressed. Patients from a consecutive microsurgical series of superficial cerebral CMs who presented to the authors' center over a 13-year period were retrospectively analyzed. Neurological outcomes were measured using the modified Rankin Scale (mRS), and new, permanent neurological or cognitive symptoms not detected by changes in mRS scores were measured as additional functional decline. Patients with multiple lesions and surgical encounters for different lesions within the study interval were represented within the cohort as multiple patient entries. Virtual object models for CMs and approach trajectories to subcortical lesions were merged into a template brain model for subtyping and Quicktome connectomic analyses. Parcellation outputs from the models were analyzed for regional cerebral clustering. Overall, 362 CMs were resected in 346 patients, and convexity subtypes were the most common (132/362, 36.5%). Relative to the preoperative mRS score, 327 of 362 cases (90.3%) were in patients who improved or remained stable, 35 (9.7%) were in patients whose conditions worsened, and 47 (13.0%) were in patients who had additional functional decline. Machine learning analyses of lesion objects and trajectory cylinder mapping identified 7 hotspots of novel eloquence: supplementary motor area (bilateral), anterior cingulate cortex (bilateral), posterior cingulate cortex (bilateral), anterior insula (left), frontal pole (right), mesial temporal lobe (left), and occipital cortex (right). Transgyral and transsulcal resections that circumvent areas of traditional eloquence and navigate areas of presumed noneloquence may nonetheless result in unfavorable outcomes, demonstrating that brain long considered by neurosurgeons to be noneloquent may be eloquent. Eloquent hotspots within multiple large-scale networks redefine the neurosurgical concept of eloquence and call for more refined dissection techniques that maximize transsulcal dissection, intracapsular resection, and tissue preservation. Human connectomics, awareness of brain networks, and prioritization of cognitive outcomes require that we update our concept of cortical eloquence and incorporate this information into our surgical strategies.

Longitudinal study of cognitive decline among women with and without urinary incontinence

BACKGROUNDCross-sectional and short-term cohort studies have demonstrated an association between urinary incontinence and dementia as well as lower performance on cognitive testing. The Health and Retirement Study, a longitudinal study of community-dwelling older adults, offers an opportunity to assess the temporal association between these conditions, as this study included an assessment of incontinence symptoms as well as biennial assessments of cognitive function. OBJECTIVESThis study aimed to evaluate if urinary incontinence before age 70 had an effect on changes in cognitive function among women participating in the Health and Retirement Study. STUDY DESIGNThis secondary analysis included data from female respondents in the Health and Retirement Study ages 58 to 67 years with ≥2 cognitive assessments. Urinary incontinence was defined as any involuntary loss of any urine in the preceding 12 months. A control group without incontinence was reweighted for better comparability using coarsened exact matching for age and comorbidities. Validated methods, including neuropsychological test data, estimated a Memory score and DP for each participant biennially. Coprimary outcomes were the changes in Memory score and dementia probability.Linear regression models were used to estimate the association of urinary incontinence with change in Memory score and dementia probability, adjusting for baseline demographics and comorbidities. A subgroup analysis was performed to assess the effects of urinary incontinence frequency on these outcomes. The infrequent subgroup reported less than fifteen days of leakage per month and the frequent subgroup reported fifteen or more days of leakage per month. RESULTSAmong eligible female respondents, 40.6% reported urinary incontinence between ages 58 to 69 years. Baseline Memory scores and dementia probability were similar between those with urinary incontinence (n=1706) and controls (n=2507). Memory score declined significantly in both cohorts, indicating poorer memory over time -0.222 among those with incontinence (95% confidence interval (CI) -0.245, -0.199) versus -0.207 in controls (95% CI: -0.227, -0.188). The decline of Memory score was not statistically different between cases and controls (mean difference -0.015, 95% CI: -0.045, 0.015). Dementia probability increased significantly in both groups, indicating a greater probability of dementia: 0.018 among those with incontinence (95% CI: 0.015, 0.020) and by 0.020 among controls (95% CI: 0.017, 0.022). The change in DEMENTIA PROBABILITY was not significantly different between groups (mean difference -0.002, 95% CI: -0.006, 0.002).Frequent urinary incontinence was reported in 105/1706 (6%) with urinary incontinence. Memory score declined and dementia probability increased with time (p<0.001) in frequent and infrequent UI subgroups. There was no dose-response relationship. CONCLUSIONSMeasures of cognitive performance declined with approximately 10 years of observation; the changes in performance were not associated with the presence of urinary incontinence in their younger years.

Associations of Demographic and Social Factors on Health-Related Quality-of-Life Changes Among Older Women With Breast or Gynecologic Cancer.

To examine associations of sociodemographic factors and social limitations with health-related quality of life (HRQOL) from pre- to postdiagnosis in older female cancer survivors. 9,807 women aged 65 years or older with breast or gynecologic cancer from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey. Physical and mental HRQOL were assessed using the physical component summary (PCS) and mental component summary (MCS) of the Veterans RAND 12-Item Health Survey. Descriptive statistics and mixed-effects models for repeated measures were used. Social limitations were the only significant factor associated with changes in MCS scores. Race and ethnicity, rurality, and social interference were associated with significant decreases in PCS scores. Nurses can assess mental and physical HRQOL after diagnosis and advocate for appropriate referrals. Oncology care should be tailored to cultural considerations, including race and ethnicity, rurality, and social support.

Development of a Nomogram Using the Inflammatory Risk Score for Prognostication in Moderate and Advanced Hepatocellular Carcinoma Associated with Hepatitis B Virus.

The changes in risk scores of inflammatory markers among patients diagnosed with hepatocellular carcinoma (HCC) remain unknown. To investigate the relationship between the inflammation risk score and other contributing factors and the prognostic outcomes in patients with moderate and advanced hepatitis B virus (HBV)-related HCC. A retrospective cohort study. A total of 174 patients with moderate and advanced HBV related HCC were recruited to investigate the impact of stratified inflammatory risk scores and other associated risk factors on disease prognosis. Based on the optimal cut-off values calculated by the Youden index, the patients were divided into high-risk and low-risk groups based on their inflammation risk scores. The study found a significant difference in median survival time between the low-risk and high-risk groups based on the inflammation risk score. Furthermore, the inflammation risk score, alpha-fetoprotein levels, transarterial chemoembolization treatment, and Barcelona Clinic Liver Cancer stage were identified as independent prognostic factors. The four variables were used to construct a prognostic nomogram for HCC. Subsequent evaluations using time-dependent receiver operating characteristic analysis and calibration curve tests revealed the nomogram's commendable discriminatory ability. As a result, the nomogram proved to be an effective tool for predicting survival at 2- to 4-years. The inflammation risk score has been identified as a significant prognostic factor for HBV-related HCC. The development of nomogram models has provided a practical and effective tool for determining the prognosis of patients affected by HBV-related HCC.

Cognitive Outcomes After Antidepressant Pharmacotherapy for Late-Life Depression: A Systematic Review and Meta-Analysis.

The authors evaluated whether treatment of late-life depression (LLD) with antidepressants leads to changes in cognitive function. A systematic review and meta-analysis of prospective studies of antidepressant pharmacotherapy for adults age 50 or older (or mean age of 65 or older) with LLD was conducted. MEDLINE, EMBASE, and PsycInfo were searched through December 31, 2022. The primary outcome was a change on cognitive test scores from baseline to after treatment. Secondary outcomes included the effects of specific medications and the associations between changes in depressive symptoms and cognitive test scores. Participants with bipolar disorder, psychotic depression, dementia, or neurological disease were excluded. Findings from all eligible studies were synthesized at a descriptive level, and a random-effects model was used to pool the results for meta-analysis. Twenty-two studies were included. Thirteen of 19 studies showed an improvement on at least one cognitive test after antidepressant pharmacotherapy, with the most robust evidence for the memory and learning (nine of 16 studies) and processing speed (seven of 10 studies) domains and for sertraline (all five studies). Improvements in depressive symptoms were associated with improvement in cognitive test scores in six of seven relevant studies. The meta-analysis (eight studies; N=493) revealed a statistically significant overall improvement in memory and learning (five studies: effect size=0.254, 95% CI=0.103-0.404, SE=0.077); no statistically significant changes were seen in other cognitive domains. The evaluated risk of publication bias was low. Antidepressant pharmacotherapy of LLD appears to improve certain domains of cognitive function, particularly memory and learning. This effect may be mediated by an improvement in depressive symptoms. Studies comparing individuals receiving pharmacotherapy with untreated control participants are needed.

A Comparative Study of Homoeopathic Decimal Versus Centesimal Potency Medicine in the Treatment of Cervical Spondylosis

Background: Cervical spondylosis (CS) is a degenerative condition of the cervical spine found almost universally in persons over50 years of age. It has become one of the common problems globally.Methods: An experimental study was conducted on 60 patients diagnosed with cervical spondylosis as per the inclusion and exclusion criteria. All 60 cases of cervical spondylosis were randomized into 2 groups of 30 patients each. One group was prescribed with Individualized Homoeopathic medicine in decimal scale potency and the other group was prescribed with centesimal scale potencies of Individualized Homoeopathic medicine. The Remedy Response Evaluation Form was used to assess and interpret the follow up of the patients. The improvement of the patients was assessed by the Neck Disability Index (NDI). Result: Intra-group changes in NDI score were found statistically significant (P &lt; 0.001, unpaired t test) group difference though favored centesimal against decimal. Conclusion: On statistical analysis, the p value was less than 0.001. Hence there is a significant difference between post treatment score of centesimal potency group as compared to decimal potency group. &#x0D;

Dynamic assessment of CHA2DS2-VASc and HAS-BLED scores for predicting ischemic stroke and major bleeding in atrial fibrillation patients

Introduction and objectivesStroke and bleeding risks in atrial fibrillation (AF) are often assessed at baseline to predict outcomes years later. We investigated whether dynamic changes in CHA2DS2-VASc and HAS-BLED scores over time modify risk prediction. MethodsWe included patients with AF who were stable while taking vitamin K antagonists. During a 6-year follow-up, all ischemic strokes/transient ischemic attacks (TIAs) and major bleeding events were recorded. CHA2DS2-VASc and HAS-BLED were recalculated every 2-years and tested for clinical outcomes at 2-year periods. ResultsWe included 1361 patients (mean CHA2DS2-VASc and HAS-BLED 4.0±1.7 and 2.9±1.2). During the follow-up, 156 (11.5%) patients had an ischemic stroke/TIA and 269 (19.8%) had a major bleeding event. Compared with the baseline CHA2DS2-VASc, the CHA2DS2-VASc recalculated at 2 years had higher predictive ability for ischemic stroke/TIA during the period from 2 to 4 years. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) showed improvements in sensitivity and better reclassification. The CHA2DS2-VASc recalculated at 4 years had better predictive performance than the baseline CHA2DS2-VASc during the period from 4 to 6 years, with an improvement in IDI and an enhancement of the reclassification. The recalculated HAS-BLED at 2-years had higher predictive ability than the baseline score for major bleeding during the period from 2 to 4 years, with significant improvements in sensitivity and reclassification. A slight enhancement in sensitivity was observed with the HAS-BLED score recalculated at 4 years compared with the baseline score. ConclusionsIn AF patients, stroke and bleeding risks are dynamic and change over time. The CHA2DS2-VASc and HAS-BLED scores should be regularly reassessed, particularly for accurate stroke risk prediction.

The effect of 8-week mindfulness counseling on sexual self-efficacy of women suffering from human immunodeficiency syndrome: A randomized controlled trial in Iran.

Sexual self-efficacy refers to a woman's belief that she can be sexually active and attractive for her sexual partner and has acceptable sexual function. One of the issues that may negatively affect sexual self-efficacy is HIV infection. The present study aimed to evaluate the effect of 8 weeks of counseling based on mindfulness on sexual self-efficacy of women affected with HIV. This was a randomized controlled trial involving 62 HIV-positive women in their reproductive age. Women in the intervention group were further divided into four groups. Each group received eight sessions of counseling based on mindfulness, while the control group received no intervention. A demographic questionnaire and sexual self-efficacy questionnaire were used to collect the data. The independent t test, χ 2, and repeated measure tests were used to analyze the data. The mean change of total score of sexual self-efficacy in Week 8 compared with before intervention was 37.04 (95% CI: 31.38-42.70, p < 0001) and in Week 12 compared with before intervention was 36.97 (95% CI: 31.59-42.34, p < 0.0001), while in the control group, it almost remained unchanged. The score of readiness for sexual relationship, sexual self-stimulation, intimacy without sexual intercourse, and orgasm improved significantly 8 and 12 weeks after intervention (p < 0.0001), whereas no significant differences were observed in these dimensions in the control group. The results of this study showed that 8 weeks of counseling based on mindfulness could significantly improve all dimensions of sexual self-efficacy and its total score in women affected with HIV. Thus, this method of counseling is recommended for HIV-positive women.

Long-term exposure to transportation noise in relation to global cognitive decline and cognitive impairment: Results from a Swedish longitudinal cohort

Background and aimsTransportation noise is an environmental exposure with mounting evidence of adverse health effects. Besides the increased risk of cardiovascular and metabolic diseases, recent studies suggest that long-term noise exposure might accelerate cognitive decline in older age. We examined the association between transportation noise and cognitive function in a cohort of older adults. MethodsThe present study is based on 2594 dementia-free participants aged 60 + years from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Global cognition score and CIND (cognitive impairment, no dementia) were assessed with a comprehensive neuropsychological battery at baseline and up to 16 years. Residential transportation noise resulting from road traffic, railway, and aircraft were estimated at the most exposed façade and the time-weighted average exposure was assessed. Linear mixed-effect models were used to assess the effect of long-term traffic noise exposure on the rate of change in global cognition score. Hazard ratios (HRs) and 95 % confidence intervals (CIs) of CIND by transportation noise exposure were obtained with Cox proportional hazard models. ResultsGlobal cognition score decreased at an average rate of −0.041 (95 %CI −0.043, −0.039) per year. Aircraft noise was associated with a 0.007 (per 10 dB Lden; 95 %CI −0.012, −0.001) faster annual rate of decline. Global cognition score seems to be not affected by road traffic and railway noise. During the follow-up, 422 (21 %) participants developed CIND. A 10-dB Lden difference in exposure to aircraft and railway noise was associated with a 16 % (HR 1.16, 95 %CI 0.91, 1.49) and 26 % (HR 1.26, 95 %CI 1.01, 1.56) increased hazard of CIND in the multi-pollutant model, respectively. No association was found for road traffic (HR 1.00, 95 %CI 0.83, 1.21). ConclusionsTransportation noise was linked to cognitive impairment and faster cognitive decline among older adults. Future studies are warranted to confirm our results.

Impact of subthalamic nucleus stimulation on urinary dysfunction and constipation in Parkinson's disease.

The effect of subthalamic nucleus (STN) deep brain stimulation (DBS) on urinary dysfunction and constipation in Parkinson's disease (PD) is variable. This study aimed to identify potential surgical and nonsurgical variables predictive of these outcomes. The authors used the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part I to assess urinary dysfunction (item 10) and constipation (item 11) preoperatively and at 6-12 months postoperatively. A multiple linear regression model was used to investigate the impact of global cerebral atrophy (GCA) and active electrode contact location on the urinary dysfunction and constipation follow-up scores, controlling for age, disease duration, baseline score, motor improvement, and levodopa-equivalent dose changes. An electric field model was applied to localize the maximal-effect sites for constipation and urinary dysfunction compared with those for motor improvement. Among 74 patients, 23 improved, 28 deteriorated, and 23 remained unchanged for urinary dysfunction; 25 improved, 15 deteriorated, and 34 remained unchanged for constipation. GCA score and age significantly predicted urinary dysfunction follow-up score (R2 = 0.36, p < 0.001). Increased GCA and age were independently associated with worsening urinary symptoms. Disease duration, baseline constipation score, and anterior active electrode contacts in both hemispheres were significant predictors of constipation follow-up score (R2 = 0.31, p < 0.001). Higher baseline constipation score and disease duration were associated with worsening constipation; anterior active contact location was associated with improvement in constipation. Anterior active contact location was associated with improvement in constipation in PD patients after STN DBS. PD patients with greater GCA scores before surgery were more likely to experience urinary deterioration after DBS.