Clinical State Research Articles

Exploring Associations between Grey Matter Volume and Clinical High-Risk for Psychosis: A Transdiagnostic Study Utilizing the NAPLS-2 Risk Calculator in the PRONIA Cohort

Introduction The clinical high-risk state for psychosis (CHR) is associated with alterations in grey matter volume (GMV) in various regions such as the hippocampus (Vissink et al. BP:GOS 2022; 2(2) 147-152). Within the scope of the North American Prodrome Longitudinal Study (NAPLS-2; Cannon et al. AM J Psychiatry 2016; 173(10), 980-988), a publicly available risk calculator based on clinical variables was developed to assess the likelihood of individuals to transition to psychosis within a 2-year period.Objectives In the current study, we aim to examine the association between GMV and NAPLS-2 risk scores calculated for individuals with CHR and recent-onset depression (ROD), taking a transdiagnostic approach on the transition to psychosis.Methods The sample consisted of 315 CHR (M = 23.85, SD = ± 5.64; female: 164) and 295 ROD (M = 25.11, SD = ± 6.21; female: 144) patients from the multi-site Personalised Prognostic Tools for Early Psychosis Management (PRONIA) Study (Koutsouleris et al. JAMA Psychiatry 2018; 57(11), 1156-1172). Risk scores were calculated using the six clinical and neurocognitive variables included in the NAPLS-2 risk calculator that were significant for predicting psychosis. Further, we derived smoothed GMV maps from T1-weighted structural magnetic resonance imaging using a full width at half maximum kernel size of 8 mm. We employed a multiple regression design in SPM12 to examine associations between risk scores and GMV. On the whole-brain level, we calculated permutation-based threshold-free cluster enhancement (TFCE) contrasts using the TFCE toolbox. Additionally, we calculated t-contrasts within a region-of-interest (ROI) analysis encompassing the hippocampus. All results were thresholded at p < 0.05 with family wise error correction to address multiple comparisons.ResultsOur analysis revealed that linear GMV increases in the right middle and superior frontal gyrus (kE= 2726 voxels) were significantly associated with higher risk for psychosis transition within two years (see figure 1, highlighted in blue). In the ROI analysis, we found a significant negative linear association between GMV decreases in the left hippocampus (kE = 353 voxels) and higher risk for psychosis transition (see figure 1, highlighted in red).Image:ConclusionsGMV reductions in the hippocampus have frequently been observed in CHR and psychosis patients (Vissink et al. BP:GOS 2022; 2(2) 147-152), therefore our results further highlight the crucial role of this region in the progression of the disease. There is limited evidence on GMV increases in CHR patients. However, the GMV increase we found in the frontal pole may reflect compensatory mechanisms of the brain in the development of psychosis. In addition, we were able to provide biological validation of the NAPLS-2 risk calculator and its assessment of risk for transition to psychosis.Disclosure of InterestNone Declared

Association of clinical response criteria and disease activity levels with axial spondyloarthritis core domains: results from two phase 3 randomised studies, BE MOBILE 1 and 2

ObjectiveTo assess how achievement of increasingly stringent clinical response criteria and disease activity states at week 52 translate into changes in core domains in patients with non-radiographic (nr-) and radiographic...

Multivariate associations between psychiatric drug intake and grey matter volume changes in individuals at early stages of psychosis and depression

IntroductionPsychiatric drugs, including antipsychotics and antidepressants, are widely prescribed, even in young and adolescent populations at early or subthreshold disease stages. However, their impact on brain structure remains elusive. Elucidating the relationship between psychotropic medication and structural brain changes could enhance the understanding of the potential benefits and risks associated with such treatment.Objectives Investigation of the associations between psychiatric drug intake and longitudinal grey matter volume (GMV) changes in a transdiagnostic sample of young individuals at early stages of psychosis or depression using an unbiased data-driven approach.Methods The study sample comprised 247 participants (mean [SD] age = 25.06 [6.13] years, 50.61% male), consisting of young, minimally medicated individuals at clinical high-risk states for psychosis, individuals with recent-onset depression or psychosis, and healthy control individuals. Structural magnetic resonance imaging was used to obtain whole-brain voxel-wise GMV for all participants at two timepoints (mean [SD] time between scans = 11.15 [4.93] months). The multivariate sparse partial least squares (SPLS) algorithm (Monteiro et al. JNMEDT 2016; 271:182-194) was embedded in a nested cross-validation framework to identify parsimonious associations between the cumulative intake of psychiatric drugs, including commonly prescribed antipsychotics and antidepressants, and change in GMV between both timepoints, while additionally factoring in age, sex, and diagnosis. Furthermore, we correlated the retrieved SPLS results to personality domains (NEO-FFI) and childhood trauma (CTQ).ResultsSPLS analysis revealed significant associations between the antipsychotic classes of benzamides, butyrophenones and thioxanthenes and longitudinal GMV decreases in cortical regions including the insula, posterior superior temporal sulcus as well as cingulate, postcentral, precentral, orbital and frontal gyri (Figure 1A-C). These brain regions corresponded most closely to the dorsal and ventral attention, somatomotor, salience and default network (Figure 1D). Furthermore, the medication signature was negatively associated with the personality domains extraversion, agreeableness and conscientiousness and positively associated with the CTQ domains emotional and physical neglect.Image:ConclusionsPsychiatric drug intake over a period of one year was linked to distinct GMV reductions in key cortical hubs. These patterns were already visible in young individuals at early or subthreshold stages of mental illness and were further linked to childhood neglect and personality traits. Hence, a better and more in-depth understanding of the structural brain implications of medicating young and adolescent individuals might lead to more cautious, sustainable and targeted treatment strategies.Disclosure of InterestNone Declared

Correlation between Cardiac Output and Disease Severity in Intubated COVID-19 Patients: Insights from Ultrasonic Cardiac Output Monitoring in Intensive Care Unit Settings

Abstract Background: The COVID-19 pandemic has affected millions globally, and still continues to do so. Regarding the cardiovascular influences of COVID-19, this study aimed to investigate the relationship between cardiac indices, particularly cardiac output (CO), and severity of disease. Methods: This retrospective cohort study was conducted on intubated COVID-19 patients admitted to the intensive care unit (ICU). The study involved analyzing data from mechanically ventilated patients, excluding those with preexisting cardiovascular or pulmonary comorbidities. Hemodynamic parameters were evaluated by ultrasonic cardiac output monitoring (USCOM), and the severity of disease was evaluated by acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scoring systems. Results: The study included 41 patients, predominantly male with an average age of 63.1 years. Hemodynamic parameters and scores were reported for 6 days. This showed significant changes in CO, SOFA, and APACHE II over time (with P = 0.02, 0.04, 0.03, respectively). A negative correlation was found between CO and both SOFA and APACHE II scores (P < 0.05), indicating that as CO increased, the severity scores decreased. Conclusion: This study emphasizes the importance of continuous hemodynamic monitoring in ICU settings for COVID-19 patients. The correlation between CO and severity scores suggests that USCOM, along with APACHE II and SOFA, can be crucial in assessing the dynamic clinical state of patients, contributing to better management and potentially improving outcomes.

Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study.

Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.

Tethered spinal cord syndrome associated with spina bifida: clinical and radiological characteristics and indications for surgery (systematic review of the literature)

Objective. To analyze literature data on clinical and radiation characteristics of the tethered spinal cord syndrome in spina bifida and to define criteria for indications for surgical treatment.Material and Methods. A search for prospective cohort clinical studies evaluating the clinical and radiation picture and indications for surgicalcorrection of the tethered spinal cord syndrome associated with spina bifida, published in 2005–2023 was performed in the Pubmed, EMBASE, eLibrary and the Сochrane Library databases. The literature search was carried out by one researcher. The study was carried out in accordance with the international recommendations for writing systematic reviews and meta-analyses PRISMA. The levels of evidencefor reliability and grades of the strength of recommendations were evaluated according to the ASCO Guidelines.Results. A total of 394 literature sources were found in the databases. Duplicate materials (n = 81) have been removed. When non-fulltext articles were excluded, only 28 out of 251 remained studies met the inclusion criteria and were analyzed. According to the level of evidence, 18 of them were classified as B level, and 10 – as C level.Conclusion. The components of the tethered spinal cord syndrome are a dystopic spinal cord cone, a shortened fixed filum terminale, and the presence of a lumbosacral lipoma. At the same time, there are currently no clear criteria for the integral assessment of the clinical and morphofunctional state of patients, and the available scales are not specific. The described MRI criteria are limited by the level of evidence, but despite this, they reflect a high level of consensus among experts, including that on the defining indications for surgical spinal corduntethering. The lack of clear indications for surgical intervention and the debatability of performing preventive untethering of the spinal cord require further study of the problem with an emphasis on analyzing the criteria for tethered spinal cord syndrome.

The role of manual correction methods and extracorporeal shock wave therapy in the prevention of chronic tension headaches

Introduction. Tension-type headache is an urgent problem in the modern medicine due to a significant decrease in the efficiency and quality of patient′s life, despite the benign nature of the disease.The aim of the study is to develop and scientifically substantiate the comprehensive application of extracorporeal shock wave therapy and manual methods of preventive treatment of the chronic tension-type headache.Materials and methods. The prospective randomized study included 90 patients with tension-type headache (chronic), G44.2, and 20 healthy patients in the age from 24 to 50 years. Participants were divided into 3 equal groups with 30 participants in each one. In the I group the pharmacotherapy with amitriptyline was performed, in the II group — manual treatment, and in the III group — complex rehabilitation with manual methods of treatment and extracorporeal shockwave therapy. Additionally, 20 healthy patients were included in the study (group IV). To assess the treatment effectiveness the following methods were used: a headache diary, manual examination, NRS scale, HADS scale.Results. The data obtained demonstrated that the combined use of manual treatment and extracorporeal shock wave therapy, as well as single-impact manual treatment methods, contributes to clinical improvement to a greater extent than pharmacotherapy. A comparative analysis of the study groups in the long-term follow-up period (after 3 months) showed more significant results in the group with comprehensive rehabilitation, which is clearly reflected in the form of a significant decrease in pain intensity and overall pain score. The methods used significantly improved the psycho-emotional status of patients, however, pharmacotherapy with amitriptyline was accompanied by side effects.Conclusion. The comprehensive application of extracorporeal shock wave therapy and manual methods of treatment leads to a significant improvement in both clinical and psycho-emotional states of patients with tension-type headache.

Predictive Value of Serial Model of End-Stage Liver Disease Score Determination in Patients with Postcardiotomy Extracorporeal Membrane Oxygenation.

(1) Background: The use of extracorporeal membrane oxygenation (ECMO) in low cardiac output states after cardiac surgery may aid in patient recovery. However, in some patients, the clinical state may worsen, resulting in multiple organ failure and high mortality rates. In these circumstances, calculating a model of end-stage liver disease (MELD) score was shown to determine organ dysfunction and predicting mortality. (2) Methods: We evaluated whether serial MELD score determination increases mortality prediction in patients with postcardiotomy ECMO support. (3) Results: Statistically, a cutoff of a 2.5 MELD score increase within 48 h of ECMO initiation revealed an AUC of 0.722. Further, we found a significant association between hospital mortality and 48 h MELD increase (HR: 2.5, 95% CI: 1.33-4.75, p = 0.005) after adjustment for possible confounders. (4) Conclusions: Therefore, serial MELD score determinations on alternate days may be superior to single measurements in this special patient cohort.

Satellite Glial Cells in Human Disease.

Satellite glial cells (SGCs) are the main type of glial cells in sensory ganglia. Animal studies have shown that these cells play essential roles in both normal and disease states. In a large number of pain models, SGCs were activated and contributed to the pain behavior. Much less is known about SGCs in humans, but there is emerging recognition that SGCs in humans are altered in a variety of clinical states. The available data show that human SGCs share some essential features with SGCs in rodents, but many differences do exist. SGCs in DRG from patients suffering from common painful diseases, such as rheumatoid arthritis and fibromyalgia, may contribute to the pain phenotype. It was found that immunoglobulins G (IgG) from fibromyalgia patients can induce pain-like behavior in mice. Moreover, these IgGs bind preferentially to SGCs and activate them, which can sensitize the sensory neurons, causing nociception. In other human diseases, the evidence is not as direct as in fibromyalgia, but it has been found that an antibody from a patient with rheumatoid arthritis binds to mouse SGCs, which leads to the release of pronociceptive factors from them. Herpes zoster is another painful disease, and it appears that the zoster virus resides in SGCs, which acquire an abnormal morphology and may participate in the infection and pain generation. More work needs to be undertaken on SGCs in humans, and this review points to several promising avenues for better understanding disease mechanisms and developing effective pain therapies.

Prediction of psychotic disorder in individuals with clinical high-risk state by multimodal machine-learning: A preliminary study

Objective markers which can reliably predict psychosis transition among individuals with at-risk mental state (ARMS) are warranted. In this study, sixty-five ARMS subjects [of whom 17 (26.2%) later developed psychosis] were recruited, and we performed supervised linear support vector machine (SVM) with a variety of combinations of.modalities (clinical features, cognition, structural magnetic resonance imaging, eventrelated.potentials, and polyunsaturated fatty acids) to predict future psychosis onset. While single-modality SVMs showed a poor to fair accuracy, multi-modal SVMs revealed better predictions, up to 0.88 of the balanced accuracy, suggesting the advantage of multi-modal machine-learning methods for forecasting psychosis onset in ARMS.

Glucokathexis.

Glucokathexis is a clinical state characterized by low plasma glucose levels, in the presence of adequate glucose precursor stores. We conceive and construct this rubric to initiate interest and inspire insight into this field of metabolic medicine. We list various conditions that can cause true as well as pseudo-glucokathexis.

Bacteriome and mycobiome dysbiosis in oral mucosal dysplasia and oral cancer.

It has long been considered that the oral microbiome is tightly connected to oral health and that dysbiotic changes can be detrimental to the occurrence and progression of dysplastic oral mucosal lesions or oral cancer. Improved understanding of the concepts of microbial dysbiosis together with advances in high-throughput molecular sequencing of these pathologies have charted in greater microbiological detail the nature of their clinical state. This review discusses the bacteriome and mycobiome associated with oral mucosal lesions, oral candidiasis, and oral squamous cell carcinoma, aiming to delineate the information available to date in pursuit of advancing diagnostic and prognostic utilities for oral medicine.

Технология предварительной радиальной ИАГ-лазерной факофрагментации в хирургическом лечении катаракты

Purpose. To represent the technology of preliminary radial YAG laser phacofragmentation in the surgical treatment of cataracts. Material and methods. The technology of preliminary radial YAG laser phacofragmentation has been used in the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution since 2016. The basis of the technology is the transcorneal endocapsular formation of radial cracks of the lens core for its subsequent fragmentation during ultrasonic phacoemulsification of cataracts (FEC). The total number of pulses ranges from 95 to 150. Results. In the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution, preliminary radial YAG laser phacofragmentation was performed on 9468 eyes with cataracts of 2–4 degrees of density from 2016 to 2023. After YAG laser fragmentation of the lens core, its radial separation occurs according to the «snowflake» type, which consists of 3 layers and «petals» extending from cavitation bubbles that clearly outline the core. The clinical and functional state of the eyes after preliminary YAG laser phacofragmentation indicated the absence of reactive inflammation from the anterior and posterior segment of the eye, which was confirmed by biomicroscopy and ultrasound ophthalmoscanning data. Conclusion. The technology of preliminary radial YAG laser phacofragmentation is a safe and effective method that allows you to achieve uniform separation of lens fibers along the formed fragmentation zones, which correspond to subsequent nuclear fracture zones during the nuclear fragmentation stage during ultrasonic FEC. Key words: radial YAG laser phacofragmentation, cataract, ultrasonic phacoemulsification of cataract

Influence of Hydroponic Feed With Phytobiotic Action on the Poultry Slaughter Parameters

The article describes the study of feeding birds by adding fenugreek plants, licorice root, amaranth grains to the feed ration of chickens, which have a phytobiotic effect and hydroponic grown grains of corn, barley, amaranth and fenugreek, which have high nutritional qualities and influence on the slaughter performance of birds in farms and private farms. The main indicators of the slaughter yield of the products of slaughter of young hens are analyzed: slaughter live weight, the mass of non-stranded carcass, the mass of half-gutted carcasses, the mass of gutted carcasses, and also the slaughter yield. Studies have established that the live weight of broilers of the experimental group before slaughter is higher by 13.19% (p≤0.001), an indicator of the control group. The differences are established due to the positive influence of chelating microelements on the biochemical processes in the bird's body, which in turn leads to the effective assimilation of the nutritional components of the diet, as well as the feed supplement, do not cause changes in the clinical state, pathological changes at macro- and microscopic levels in the body of broiler chickens.

Anti-NMDA antibody autoimmune encephalitis post-HSV encephalitis: A rare case report

Introduction: Autoimmune encephalitis is a group of neuropsychiatric disorder in which antibodies interact directly to their target antigen and produce neuronal dysfunction. Generally herpes simplex encephalitis is a monophasic illness although in few patients neurological worsening can develop some weeks later. This worsening is generally due to autoimmune encephalitis after herpes simplex encephalitis (AEaHSE). Case Report: We report an interesting case report of 67 years old female patient who initially was diagnosed to have herpes simplex virus (HSV) encephalitis, showed improvement in her clinical status followed subsequently by deterioration in cognitive status. Anti-N-methyl-D-aspartate (NMDA) antibody was positive in cerebrospinal fluid (CSF) and serum. The patient was managed with intravenous immunoglobulin (IVIG) and subsequently showed improvement in her clinical state. Conclusion: The discovery and clinical application of anti-NMDA receptor antibodies has helped to define the mechanism behind immune-based relapse of herpes simplex virus encephalitis (HSVE). This case illustrates the usefulness of testing for anti-NMDA receptor antibodies following worsening few weeks after treatment of herpes simplex encephalitis.

Alterations of Functional Connectivity Dynamics in Affective and Psychotic Disorders

BackgroundPatients with psychosis and patients with depression exhibit widespread neurobiological abnormalities. The analysis of dynamic functional connectivity (dFC) allows for the detection of changes in complex brain activity patterns, providing insights into common and unique processes underlying these disorders. MethodsWe report the analysis of dFC in a large sample including 127 patients at clinical high risk for psychosis, 142 patients with recent-onset psychosis, 134 patients with recent-onset depression, and 256 healthy control participants. A sliding window–based technique was used to calculate the time-dependent FC in resting-state magnetic resonance imaging data, followed by clustering to reveal recurrent FC states in each diagnostic group. ResultsWe identified 5 unique FC states, which could be identified in all groups with high consistency (mean r = 0.889 [SD = 0.116]). Analysis of dynamic parameters of these states showed a characteristic increase in the lifetime and frequency of a weakly connected FC state in patients with recent-onset depression (p < .0005) compared with the other groups and a common increase in the lifetime of an FC state characterized by high sensorimotor and cingulo-opercular connectivities in all patient groups compared with the healthy control group (p < .0002). Canonical correlation analysis revealed a mode that exhibited significant correlations between dFC parameters and clinical variables (r = 0.617, p < .0029), which was associated with positive psychosis symptom severity and several dFC parameters. ConclusionsOur findings indicate diagnosis-specific alterations of dFC and underline the potential of dynamic analysis to characterize disorders such as depression and psychosis and clinical risk states.

Fatal Adverse Events in Femoral Neck Fracture Patients Undergoing Hemiarthroplasty or Total Hip Arthroplasty-A Retrospective Record Review Study in a Nationwide Sample of Deceased Patients.

Patient safety is a core component of quality of hospital care and measurable through adverse event (AE) rates. A high-risk group are femoral neck fracture patients. The Dutch clinical guideline states that the treatment of choice is cemented total hip arthroplasty (THA) or hemiarthroplasty (HA). We aimed to identify the prevalence of AEs related to THA/HA in a sample of patients who died in the hospital. We used data of a nationwide retrospective record review study. Records were systematically reviewed for AEs, preventability and contribution to the patient's death. We drew a subsample of THA/HA AEs and analyzed these cases. Of the 2998 reviewed records, 38 patients underwent THA/HA, of whom 24 patients suffered 25 AEs (prevalence = 68.1%; 95% confidence interval, 51.4-81.2), and 24 contributed to death. Patients with a THA/HA AE were of high age (median = 82.5 y) and had severe comorbidity (Charlson score ≥5). The majority of THA/HA AEs had a patient-related cause and was considered partly preventable. Examples of suggested actions that might have prevented the AEs: refraining from surgery, adhering to medication guidelines, uncemented procedures, comprehensive presurgical geriatric assessment, and better postsurgical monitoring. Our study shows a high prevalence of (fatal) adverse events in patients undergoing THA/HA. This seems particularly valid for cemented implants in frail old patients, indicating room for improvement of patient safety in this group. Therefore, we recommend physicians to engage in comprehensive shared decision making with these patients and decide on a treatment fitting to a patient's preexisting health status, preferences, and values.

Posttraumatic epilepsy in chronic disorders of consciousness due to severe traumatic brain injury after traffic accidents

PurposeTo evaluate the clinical state of posttraumatic epilepsy (PTE) in patients with chronic disorders of consciousness (CDC) due to severe traumatic brain injury (STBI) after traffic accidents and clarify the risk factors for seizure occurrence in such patients. MethodsTwo hundred ninety-three patients with CDC due to STBI (mean age at admission [±standard deviation]: 36.4 ± 17.9 years; men: 71.7 %; mean duration of injury to admission: 416 ± 732 days; mean hospitalization time: 899 ± 319 days) were enrolled in this study. We retrospectively investigated the relationship between seizure conditions (type and frequency) and clinical data, including age, sex, pathological types of brain injury, with/without surgical intervention, degree of CDC, and administration of antiseizure medications (ASMs). ResultsOverall, 52.9 % (n = 155/293) and 64.2 % of the patients (n = 183/of 285 patients surviving at discharge) were administered ASMs at admission and discharge, respectively. One hundred thirty-two patients (45.1 %) experienced epileptic seizures during hospitalization, and the mean seizure frequency was 4.0 ± 0.4 times per year. In multivariate analysis, significant and independent risk factors of seizure occurrence were revealed to be male sex, high National Agency for Automotive Safety and Victims’ Aid score, hypoxic encephalopathy, and history of the neurosurgical operations. ConclusionThe high prevalence of PTE in patients with CDC due to STBI, and the significant and independent risk factors for seizure occurrence in the chronic clinical phase were revealed. We expect that this study will aid toward improving clinical assessment and management of epileptic seizures in the population.

A time trade-off study to determine health-state utilities of transplant recipients with refractory cytomegalovirus infection with or without resistance

BackgroundHealth-state utility values (HSUVs) for post-transplant refractory cytomegalovirus (CMV) infection (with or without resistance [R/R]) were determined using a time trade-off (TTO) survey completed by 1,020 members of the UK general public.MethodsExisting literature and qualitative interviews with clinicians experienced in treating R/R CMV were used to develop initial draft vignettes of health states. The vignettes were refined to describe three clinical states of R/R CMV: clinically significant and symptomatic (CS-symptomatic CMV); clinically significant and asymptomatic (CS-asymptomatic CMV); and non-clinically significant (non-CS CMV). Each clinical state was valued independently and combined with three events of interest: graft-versus-host disease; kidney graft loss; and lung graft loss to generate twelve vignettes. The final vignettes were evaluated by a sample of the UK general public using an online TTO survey. Exclusion criteria were applied to the final data to ensure that responses included in the analysis met pre-defined quality control criteria.ResultsOverall, 738 participants met the inclusion criteria and were included in the analysis. The sample was representative of the UK general population in terms of age and sex. Non-CS CMV had the highest mean HSUV (95% confidence interval) (0.815 [0.791, 0.839]), followed by CS-asymptomatic CMV (0.635 [0.602, 0.669]), and CS-symptomatic CMV (0.443 [0.404, 0.482]). CS-symptomatic CMV with lung graft loss had the lowest mean HSUV (0.289), with none of the health states considered on average worse than dead.ConclusionsPost transplant R/R CMV has substantial impact on the health-related quality of life of patients. The utility values obtained in this study may be used to support economic evaluations of therapies for R/R CMV infection.

Perceptions of the spiritual dimension of patients under palliative care for gastric câncer

Introduction: The relationship between health and spirituality gained relevance from the recognition of the importance of multidimensional patient care, respecting the biopsychosocial and spiritual aspects. Spirituality integrated into Palliative Care (PC) allows patients affected by neoplasms in the non-curative phase of treatment to have greater understanding and acceptance of the diagnosis of the disease, thus enabling the humanization of care. Methodology: Qualitative and descriptive cross-sectional research, carried out with patients diagnosed with GC in PC. The assessment of the spiritual dimension of the chosen patients was conducted through the application of the Spiritual Anamnesis, using the FICA script. Based on the results, discourse analysis was carried out using the thematic content analysis technique. Results: Of the total of 83 patients with GC, between 2021 and 2023, 35 eligible to form the study sample were included. Following the analysis of the FICA script, it was observed that in the “Faith or Belief” category, 44.44% of patients demonstrated that they had faith or belief in God and 26.38% considered spirituality as a positive factor in their lives. In the “Importance” category, 23.77% used faith as support to deal with psychological issues and 22.13% believed in the improvement of the clinical state through faith/belief in God. In relation to the “Community” category, 33.05% reported having spiritual support from a religious community and 26.27% found support related to family/friend ties. In the “Action” category, 40.0% of patients considered the medical/health team approach to spirituality during treatment to be relevant and 31.42% denied the approach to spirituality during medical treatment. Conclusions: The analysis of spiritual anamnesis revealed that spirituality had positive impacts on patients with GC under PC, playing, for the majority, a significant supporting role at the time of diagnosis and throughout the treatment of the disease.