Common Clinical Symptoms Research Articles

Development of a novel screening questionnaire for brain fog

IntroductionAmidst the widespread proliferation of the COVID-19 virus, brain fog has become one of the most critical issues of public health. Brain fog may lead to sub-health conditions, such as forgetfulness, difficulty thinking, and other related symptoms. Although they are not immediately life-threatening, these sub-health conditions could gradually erode the quality of life. Currently, there is no relevant screening tool for brain fog.ObjectivesThe aim of this study was to develop a reliable screening tool.Methods A web-based brain fog screening questionnaire was developed in the study. It was based on previous studies, which summarized five parts of the most common clinical symptoms after COVID-19: forgetfulness, difficulty thinking, difficulty concentrating, feeling confused, and difficulty finding words or phrases to speak. Unfortunately, these items were used only in a way of yes or no answers in previous studies. Each of these items was expanded to five anchors to evaluate their severity in the study. Cronbach’s alpha coefficient was used to assess internal consistency. K-means clustering was used as a second method to validate the cutoff points. Furthermore, the receiver operating characteristic (ROC) curve was applied to validate the appropriateness of the cutoff point.ResultsThere were 534 participants who completely finished the questionnaire. It includes 183 males and 351 females, and all of them aged between 19 and 81 years. The Cronbach’s Alpha value was 0.821. The cutoff point was at a total score of 6 in terms of K-means. Based on the result, the ROC curve revealed that an area under the curve (AUC) was 0.816 with a confidence interval of 0.784 to 0.849.ConclusionsThe study demonstrated the feasibility and reliability of the web-based screening test for brain fog.Disclosure of InterestNone Declared

Analysis of exhaled breath condensate in patients with asthma and recurrent wheezing

Wheezing is the most common clinical symptom of bronchial obstructive syndrome. The functions of pulmonary surfactant (PS) depend directly on the level of total phospholipids (TP). This can be used to assess the integrity of the cell membrane structure. Objective. To determine the level of total phospholipids and calcium in exhaled breath condensate in young children with recurrent wheezing and asthma. Materials and methods. The study included 77 patients divided into 3 groups. Group 1 included 30 patients (20 girls and 10 boys) with no more than 2 episodes of recurrent wheezing in their lifetime; Group 2 -10 patients (6 boys and 4 girls) with more than 3 episodes of recurrent wheezing, and 37 patients (15 girls, 22 boys) with asthma. The control group consisted of 20 conditionally healthy children (11 girls, 9 boys). All patients were aged from 3 months to 6 years. The determination of phospholipid levels and calcium (Ca) in the exhaled breath condensate was performed in dynamics - during the period of clinical manifestations and remission. Results. The level of phospholipids in the exhaled breath condensate was the highest in patients of all groups at the stage of clinical manifestations compared with the period of remission, while its lowest level was noted in the control group. During the peak of the disease, the level of Ca in the exhaled breath condensate was significantly lower compared to the period of remission. The control group had the highest level. Conclusions. The exhaled breath condensate's high level of phospholipids in the first days of the disease confirms cell damage in the presence of inflammation. Additionally, the exhaled breath condensate's Ca level is lowest during this period, possibly indicating its involvement in cell damage

Foreign body aspiration in children: our pediatric tertiary care experience.

Inhalation of a foreign body is a real emergency in pediatric age and requires prompt diagnosis and treatment to reduce mortality. The objective of this study is to analyze clinical and radiological details, types, and localization of foreign bodies in patients conducted or to our hospital with suspected inhalation. We conducted a retrospective analysis of all cases of foreign body inhalation admitted to our Pediatric Emergency Room between January 2009 and June 2022. 171 patients were included in the study. In 83 patients, the FB was detected. The mean age of presentation was 2.3years (SD: ± 2). Cough (73%) and unilateral reduced breath sound (51%) were the most common clinical symptom and clinical sign. The most frequent localization was the right main bronchus (43%). The foreign bodies retrieved were vegetable (83%), of which peanut was the most common. Chest radiographs were normal in 25%. The mean duration of hospitalization was 5days (± 2.9). Complications such as pneumothorax were seen in two cases. Foreign body inhalation represents a true pediatric emergency and still a challenge in clinical practice. The best way to manage it is an early diagnosis and removal by fully trained staff.

Analysis of Clinical Features of Pulmonary TB Patients at Dr. Hospital. P.P. Magretti Saumlaki in 2022

Pulmonary Tuberculosis is the most common disease in 2022 at RSUD dr. P.P. Magretti Saumlaki Tanimbar Islands, Maluku. This study aims to determine the clinical picture of patients according to the characteristics of person, place and time. The retrospective approach is presented in descriptive form. The sampling technique uses purposive sampling. The sample was 51 pulmonary TB patients in the isolation room in 2022 with complete medical record files. The research results showed that the largest age group was 19-44 years, 24 people (47.1%). The male gender was more numerous, numbering 28 people (54.9%). The most common clinical symptoms were shortness of breath, 15 people (29.4%); The highest number of supporting examinations with Ro Thorax was 36 people (70.6%). The most common diagnoses were pulmonary TB on OAT as many as 22 people (43.1%). More patients returned home and recovered, namely 17 people (33.3%). The longest length of stay was 21.6% (3 days). The conclusion of this study is that pulmonary TB patients in the isolation room at RSUD dr. P.P. More Magretti in 2022: male gender, age 19-44 years, clinical symptoms of shortness of breath, AP/PA Thorax X-ray examination, discharged home recovered, and 3 days of hospitalization.

Neuroinflammation-induced neurodegeneration and associated microglia activation in Parkinson’s disease: a novel neurotherapeutic avenue

Parkinson’s disease (PD) is classified as one type of neurodegenerative disorder. Movement disorder, which includes resting tremors and slowness of movement, is a common clinical symptom in PD patients. Neuroinflammation is one of the most important processes involved in the pathogenesis of PD. An inflammatory response in the brain can induce neuronal cell death. Microglia, a type of immune cell, plays a crucial role in neuroinflammation. In this review, we discussed the information on microglia-activated neuroinflammation, its relationship with PD, and therapeutic approaches for neuroinflammation in PD. Under normal conditions, microglia in their inactive state (M0) act as surveillance agents in the brain to investigate potential invasions. They regulate neuron production, remodel synapses, and secrete growth factors to protect the neurons. Under pathological conditions, the M0 transforms into active phenotypes, dividing into pro-inflammatory (M1) and anti-inflammatory (M2) microglia. The M1 and M2 microglia exhibit opposite functions, where M1 microglia promote pro-inflammatory responses, and M2 microglia promote anti-inflammatory responses. This dichotomy of functions is essential for maintaining a healthy level of inflammation in the brain. Presently, multiple therapeutic strategies are available for PD, encompassing anti-inflammatory drugs, neuroprotective compounds, antioxidants, nanoparticles targeting neuroinflammation, stem cell interventions, lifestyle adjustments, and microglia-focused treatments. These treatments improve patients' movement, allowing them to have lifestyles like others, consequently benefiting their mental and emotional well-being. Preventing microglia from polarising into the M1 phenotype and promoting their polarisation into the M2 phenotype could be a challenging and promising approach for treating PD.

A case series of co-infection in Mycobacterium tuberculosis and other pathogens: insights from nanopore sequencing

BackgroundTuberculosis (TB) continues to be a major global health burden, and co-infection with other pathogens further complicates the diagnosis and treatment of this infectious disease. The present retrospective study aimed to evaluate the clinical utility of nanopore sequencing in identifying co-infection caused by Mycobacterium tuberculosis (M.tb) and other pathogens.MethodsPatients with M.tb co-infection from December 2021 to March 2023 at the Jiangxi Provincial Chest Hospital were retrospectively studied. Data were collected including demographics, symptoms, imaging findings, pathogen diagnosis tests, and treatment history. Pathogen tests involved culture, AFB smear, Xpert MTB/RIF, and nanopore sequencing.ResultsThe enrolled patients included 20 M.tb cases and three nontuberculous mycobacteria (NTM) cases co-infected with other pathogens. Common clinical symptoms included cough (47.83%), expectoration (34.78%), and asthma (17.39%). Radiological examinations showed typical features of pulmonary tuberculosis, including nodules (73.91%), cord-like shadows (34.78%), cavities (34.78%), and destroyed lung manifestations (17.39%). Nanopore sequencing identified M.tb in a significant majority of the cases (86.96%), outperforming traditional culture tests (39.13%), acid-fast bacilli (AFB) tests (27.27%), and Xpert MTB/RIF (53.84%) tests. Notably, nanopore sequencing revealed that M.tb was frequently co-infected with Candida albicans, Klebsiella pneumoniae, and Mycobacterium abscessus. Three specific cases of co-infection with distinct diagnosis and treatment characteristics were presented in detail. They illustrated the complexity of TB co-infection management and the potential of nanopore sequencing for accurate diagnosis and informing the tailored therapeutic approaches.ConclusionNanopore sequencing-based metagenomics method can help clinicians to identify TB co-infection patterns and formulate a rational drug regimen in time.

The clinical, subclinical characteristics and treatment result of meningitis patients at Thai Nguyen National Hospital

Introduction: Meningitis is a devastating disease with a high case fatality rate, which can lead to serious long-term sequelae if not timely diagnosed, and treated.Objectives: Describing on the clinical, subclinical characteristics and analysing some factors related to the treatment results in meningitis patients at Thai Nguyen National Hospital.Methods: A cross-sectional descriptive study was conducted on 48 meningitis patients were treated at the Department of Neurology and Department of Tropical Diseases at Thai Nguyen National Hospital.Results: The average age of patients in the study was 43.27±15,31 (year); The percentage of male patients was 75,0%. The most common clinical symptom was headache (89.6%), fever (75%); The average white blood cell count in the CSF on admission was 509.92±681.27 (cells/ml) and at discharge was 94.42±102.60 (cells/ml); Protein in CSF on admission was 1.70±1.45 (g/L) and at discharge was 0.72±0.55 (g/L). The everage day of treatment was 12.57.Conclusion: The popularr symptoms of patients with bacterial meningitis are headache, fever, vomiting, nausea, constipation, and stiff neck. There was no relationship between age, gender, white blood cell count and white blood cell count in the CSF at admission to the number of treatment days in meningitis patients.

Less common phenotypes of myelin oligodendrocyte glycoprotein antibody-related diseases in children deserve more attention

BackgroundTo facilitate the identification of less common clinical phenotypes of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in children.MethodsWe retrospectively reviewed medical records of 236 patients with MOGAD. The following phenotypes were considered to be typical for MOGAD: ADEM, ON, TM, and NMOSD. Less common onset clinical phenotypes were screened out; their clinical and magnetic resonance imaging (MRI), diagnosis, treatment, and prognosis were summarized and analyzed.Results16 cases (6.8%) presented as cortical encephalitis, with convulsions, headache, and fever as the main symptoms. 15 cases were misdiagnosed in the early period. 13 cases (5.5%) showed the overlapping syndrome of MOGAD and anti-N-methyl-D aspartate receptor encephalitis (MNOS), with seizures (92.3%) being the most common clinical symptom. 11 cases (84.6%) showed relapses. The cerebral leukodystrophy-like phenotype was present in seven cases (3.0%), with a recurrence rate of 50%. Isolated seizures without any findings on MRI phenotype was present in three cases (1.3%), with the only clinical symptom being seizures of focal origin. Three cases (1.3%) of aseptic meningitis phenotype presented with prolonged fever.Conclusion40/236 (16.9%) of children with MOGAD had less common phenotypes. Less common clinical phenotypes of pediatric MOGAD are susceptible to misdiagnosis and deserve more attention.ImpactThis is the first comprehensive analysis and summary of all less commonl clinical phenotypes of MOGAD in children, while previous studies have only focused on a specific phenotype or case reports.We analyzed the characteristics of MOGAD in children and further revealed the reasons why these less common clinical phenotypes are prone to misdiagnosis and deserve more attention.Our research on treatment has shown that early detection of MOG antibodies and early treatment are of great significance for improving the prognosis of these patients.

Investigation of Laboratory Indicators, Clinical Symptoms, and COVID-19 Vaccination History in Children Referred to Imam Khomeini Hospital in Jiroft City, South Iran

Background: The commencement of COVID-19 vaccination has had an impact on hospitalizations and deaths of patients. This study aims to investigate the effect of COVID-19 vaccination on children›s hospitalizations and deaths. Methods: This cross-sectional study examined 893 children infected with COVID-19 referred to Imam Khomeini hospital in Jiroft City in the south of Iran in 2022. Data collected and analyzed included demographic variables including age, sex, place of residence, underlying disease, vaccination status, injection dose of vaccine, history of contact with a patient with COVID-19, and clinical and laboratory characteristics such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), creatinine (CR) and days of hospitalization. The data were analyzed using SPSS-v20 software. Results: The average age±SD of the patients is 4.6±3.9 years. There were 302 (33.81%) children in the age group of 9 to 12 years and 133 (14.89%) of children were in the age group under one year. The most common clinical symptoms in children with COVID-19 were fever (67.41%), diarrhea (38.63%), and cough (30.57%). ESR and CRP were 27.72±20.8, and 25.51±32.8 respectively amongst the participants. Out of 893 children, 480 (53.75%) were vaccinated and 413 (46.24%) had not received the vaccine. Out of 480 vaccinated children, 460 (95.83%) were outpatient, and only 20 (4.16%) were hospitalized, and out of 413 non-vaccinated children, 241 (58.35%) were outpatient, and 172 (41.64%) were hospitalized. Conclusion: The results showed that vaccination led to a 95.83% reduction in hospitalization and a 100% reduction in long-term hospitalization. The COVID-19 vaccination is very effective in preventing the harmful effects of COVID-19 in future trends and pandemics.

Summary of the clinical characteristics of tuberculous otitis media

Objective:The purpose of this study was to analyze and summarize the clinical characteristics and diagnostic methods of tuberculous otitis media（TOM）, to enrich clinical experience in diagnosis and treatment of tuberculous otitis media, so as to reduce missed diagnosis and misdiagnosis, and facilitate timely and effective therapy for better prognosis. Methods:This study retrospectively analyzed the clinical data of patients with tuberculous otitis media who were hospitalized in the Ear ward of our hospital and received surgical treatment from 2008 to 2022. The data of patients' clinical characteristics, radiological examination, intraoperative findings and therapeutic strategies were recorded and summarized. Results:A total of 23 cases （26 ears） of tuberculous otitis media were included in this retrospective study. The most common clinical symptoms were otorrhea（thin odorless fluid）（100%） and conductive hearing loss（100%）, with a high incidence of facial paralysis（23.1%）. It was not sensitive to traditional antibiotic treatment, eg. Levofloxacin （50% effective rate only）, and relapsed soon after drug withdrawal. It was revealed that all the surgical views had gray and white tough granulation tissue hyperplasia（100%）, and 23.1% with caseous necrosis. The purpose of surgery was to clear the lesion, reduce the recurrence rate of suppurative infection, and repair the function （hearing reconstruction or facial nerve decompression） as appropriate. The paraffin pathology of granulation tissue were reported as typical granulomatous inflammation and caseous necrosis with positive acid-fast staining, which was consistent with tuberculosis. Conclusion:It was easily confused by the clinical manifestations of tuberculous otitis media and common chronic suppurative otitis media. When met with the following conditions, we should pay highly attention to suspect tuberculous otitis media: The severity of local manifestations did not match with the length of the disease; with poor tympanic membrane at the early stage with no obvious cholesteatomas, with facial paralysis or hearing loss early onset; insensitive to traditional antibiotic treatment; with extensive granulation appeared in the tympanum and or mastoid cavity, with or without caseous necrosis or dead bone in the early days. The diagnosis should be confirmed based on the acid-fast staining of the histopathological section to detect positive acid-fast bacilli. Meanwhile, multiple laboratory examination methods（such as T-spot and PCR） should be integrated synchronously to help support the diagnosis.

Viperidae snake envenomation from a highly complex hospital in southwestern Colombia

BackgroundSnake envenomation is a medical condition with high morbidity and mortality in southwestern Colombia. ObjectivesTo describe the characteristics of the envenomation caused by Viperidae snakes view in a highly complex hospital in Southwestern Colombia. MethodsA cross-sectional study was carried out. Patients treated for Viperidae snake envenomation from 2001 to 2020 in a Hospital Fundación Valle del Lili, Cali, Colombia, were studied. ResultsTwenty-eight patients were included. Envenomation was caused by the genera Bothrops, Bothriechis, Porthidium, and Bothrocophias. The median age was 37.7 (±20.6), and they were predominantly male (19, 68%). Bites occurred on the upper extremities in 16 (57%) patients. Pain (23, 81%) and edema (22, 78%) were the most common clinical symptoms. Thirteen (46%) patients presented coagulopathy. Prolonged prothrombin and activated partial thromboplastin times were common: (22, 78% and 15, 53%, respectively). Twenty (71%) patients were treated with polyvalent antivenom (median dose of 6 (2–15) vials). The median time between the accident and antivenom administration was 9 h (5.5–17). Door-to-needle time was 37.5 (0–62) min. Eighteen (64%) patients were admitted to the intensive care unit. Three (11%) patients had serum sickness. Seven (25%) developed infectious complications, four (14%) had surgery, one (3%) had compartment syndrome, one (3%) underwent amputation of the affected limb, and one (3%) patient died. ConclusionsLocal manifestations and coagulopathy were common clinical features. Polyvalent antivenom was an effective treatment for disease control. Significant complications were associated with delays in seeking medical care.

SARS-CoV-2 reinfection with Omicron variant in Shaanxi Province, China: December 2022 to February 2023

BackgroundPrior to December 2022, there were no reports of reinfection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Shaanxi province, China. Since then, China has refined its strategy in response to coronaviruses. The purpose of this study was to determine the incidence of SARS-CoV-2 reinfections and its contributing factors, as well as to compare clinical characteristics between first and second episodes of infection in Shaanxi Province, China between December 2022 and February 2023.MethodsWe conducted a cross-sectional study using an epidemiological survey system and electronic questionnaires to investigate the incidence of SARS-CoV-2 reinfection among previously infected individuals during the epidemic wave owing to the Omicron variant that began in December 2022. A logistic regression model was used to determine those factors influencing SARS-CoV-2 reinfections.ResultsAccording to the virus variant that caused the first infection, the rate of reinfection for the Omicron variants was 1.28%, 1.96%, and 5.92% at 2–3 months, 4–5 months, and 7–9 months after the primary infection, respectively. The rate of reinfection for the Delta variants was 25.10% 11–12 months after the primary infection. Females, adults between 18 and 38 years and being a medical worker were associated with an increased risk of reinfection. Fever, cough, sore throat and fatigue were the four most common clinical symptoms during both first and second COVID-19 infections.ConclusionsIn our study, the rate of SARS-CoV-2 reinfection increased over time during epidemic waves predominantly involving the Omicron variant in Shaanxi province, China. Large-scale infections are less likely in subsequent Omicron epidemic waves. Nevertheless, it is essential to continuously monitor cases of infection as well as continue surveillance for emerging SARS-CoV-2 variants.

EXPERT SYSTEM FOR DISEASE IDENTIFICATION BASED ON HEMATOCHEZIA SYMPTOMS WITH NAÏVE BAYES METHOD

Hematochezia is a common clinical symptom in various gastrointestinal diseases, requiring accurate diagnosis for effective treatment. This study aims to develop an expert system for the rapid and precise identification of hematochezia-causing diseases. The expert system is designed to assist patients in efficiently recognizing diseases, minimizing treatment failure risks. It employs the Naïve Bayes method, a data calculation approach involving summing combinations and frequencies of each dataset. The expert system methodology begins with training using a dataset comprising hematochezia symptoms and corresponding disease diagnoses. The dataset is input into a database as training data. Subsequently, it undergoes classification and training stages. Symptom data can then be processed using the Naïve Bayes method. The system's end result displays probability values for each disease based on provided symptoms. This analysis relies on specific symptoms selected by the user, such as Rectal Pain, Hematochezia, Constipation, Fatigue, and Abdominal Cramps. It yields a Hemorrhoids diagnosis with a posterior probability of 0.514738. In testing with 35 sample cases, the expert system exhibited a remarkable accuracy rate of 94.29%. This expert system efficiently supports disease diagnosis based on hematochezia symptoms, aiding in swift and accurate identification.

Clinical presentations and complications of parapneumonic effusion and pleural empyema in children presenting in a tertiary care setup.

Objective: To evaluate the clinical presentations and complications of parapneumonic effusion (PPE) and pleural empyema (PE) in children presenting in a tertiary care setup in Karachi. Study Design: Cross-sectional study. Setting: Medical Units of National Institute of Child Health, Karachi, Pakistan. Period: July 2022 to June 2023. Material & Methods: Hospitalized children of either gender, aged between 1 month and 12 years diagnosed with PPE or PE on the basis of radiological findings were analyzed. Baseline laboratory investigations were done. Complications of PPE/PE were noted. Outcome was observed in the form of discharged, referred or mortality. Results: In a total of 86 with PPE/PE, 61.6% were boys while the overall mean age was 4.35±3.17 years. Common clinical symptoms included fever (100%), decreased air entry (86%), cough (75.6%), and respiratory difficulty (74.4%). Blood cultures revealed bacterial infections in 10.5% of cases, while most common isolates were Staphylococcus aureus and Pseudomonas. Positive pleural fluid cultures noted in 39.5% of cases while pseudomonas and staphylococcus aureus were the most common bacterial isolates. Most commonly used antimicrobials were Vancomycin, Ceftriaxone, Tazobactum+Piperacillin, and Linezolid. Tube thoracostomy was performed in 96.5% of patients. Most frequent complications of PPE/PE included residual organized empyema (36%), pneumothorax (9.3%), and sepsis (9.1%). Overall, the mortality was noted in 5.8% cases. Conclusion: Most frequent clinical presentations of PPE/PE include fever, cough, respiratory difficulty, and abdominal pain, with fever being universal. Staphylococcus aureus and Pseudomonas were the most common bacterial isolates. The most common complications were residual organized empyema, pneumothorax, and sepsis.

Spontaneous recurrent menstrual pneumothorax: a case report

Introduction and importance: Endometriosis is most commonly found in the pelvic area, ~12% of people have it in other areas or organs, which is known as extrapelvic endometriosis. Thoracic endometriosis, which is also classified as extrapelvic endometriosis, manifests with four distinct forms: catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, or lung nodules. Catamenial pneumothorax is the most common clinical symptom of these; however, it is frequently neglected by clinicians and goes undiagnosed and untreated. As a result, it is critical to raise awareness of this medical condition among clinicians. Case presentation: The authors present a case report of a 34-year-old woman of reproductive age who had recurrent episodes of spontaneous pneumothorax during menstruation and underwent treatment with thoracoscopic surgery as well as gynaecological hormonal drugs including oral progesterone and dienogest throughout this time. Based on her symptoms, a catamenial pneumothorax caused by thoracic endometriosis was suspected. Clinical discussion: The clinical symptoms, pathogenesis, diagnosis, and treatment of Catamenial Pneumothorax are analyzed. Furthermore, the usage of gynaecological hormone medications in this condition has been discussed. The mechanisms of oral contraceptives and progestin-based medications are evaluated by comparing the patient’s treatment process, highlighting their pros and cons. Conclusions: Thoracoscopic surgery combined with postoperative gynaecological hormonal medications may be the most effective treatment for this issue. Several gynaecological hormonal medicines are available, each of which has its own set of pros and cons, and must be thoroughly evaluated as well as correctly tailored to the patient’s specific circumstances to have a positive therapeutic outcome.

Guidelines for Rational Clinical Use of Fentanyl Transdermal Patch.

Pain is one of the most common clinical symptoms of cancer patients, seriously affecting the quality of life of patients and bringing heavy mental and economic burden to families and society. The treatment of cancer pain in China is facing numerous challenges, one of which includes the irrational usage of analgesic drugs in clinical practice. As a strong opioid analgesic, transdermal fentanyl patch has been widely used due to its convenient clinical application and obvious therapeutic effect. Several basic-level hospitals and even general hospitals in China fail to appropriate the application of drugs in clinical application due to the lack of understanding of the pharmacological characteristics and clinical application of fentanyl transdermal patch by medical staff, seriously affecting the treatment quality. Therefore, it is imperative to strengthen the rational use and management of fentanyl transdermal patches. Accordingly, the initiation by the Cancer Rehabilitation and Palliative Treatment Professional Committee of the Hubei Anti-cancer Association launched the compilation of the "Guidelines for Rational Clinical Use of Fentanyl Transdermal Patch" (from now on referred to as the "Guidelines") in Hubei Province, China. The experts in the preparation group are experts in many disciplines, such as medicine, pharmacy, and nursing. The expert group determines the outline, prepares the required regulations, and revises it repeatedly. Moreover, these experts put forward suggestions for revision to strictly control the accuracy and scientific authenticity of the contents of the "Guide". Finally, all experts of the preparation team certify and finalize the draft. This "Guide" prepared by experts of the Cancer Rehabilitation and Palliative Treatment Professional Committee of the Hubei Anti-cancer Association and the expert advisory group with joint efforts, aims to play a positive role in promoting the rational clinical use of fentanyl transdermal patch, reducing the mental and economic burden of patients, and ensuring medical quality and medical safety.

Lysosomal acid lipase deficiency: features of manifestation in patients of the Moscow region

Lysosomal acid lipase deficiency (LALD) is a rare, chronic, progressive disease based on a defect in the LIPA gene encoding lysosomal acid lipase, early diagnosis of which may be difficult due to the diversity of the clinical picture. The purpose of the study. To evaluate the early clinical and laboratory symptoms of LALD, the timing of manifestation and diagnosis in patients of the Moscow region. Materials and methods. The analysis of the medical documentation of 6 patients with a confirmed diagnosis of lysosomal acid lipase deficiency by the results of enzyme diagnostics and DNA-diagnostics registered in the Moscow region: 5 children aged 2 to 16 years, one patient aged 19 years. Boys - 3, girls - 3. Results. In 3 patients (50%), the first symptoms of the disease were detected before the age of 1 year, in two children (33%) - from 1 to 2 years, in one child - at the age of 5 years. The most common early clinical symptom was cytolysis syndrome and hepatosplenomegaly, less often dyspeptic manifestations (flatulence, diarrhea). The average age of onset of the disease is 1.5 years. The duration of follow-up ranged from 1 year to 14 years. On average, the duration of the diagnostic search was 6.75 years, and the average age of diagnosis was 8.25 years. At the time of diagnosis confirmation, all patients showed signs of hepatosplenomegaly, diffuse changes in liver parenchyma, increased serum transaminases, hypercholesterolemia, increased LDL and decreased HDL. Excess of ALT values up to 2 norms was diagnosed in one child (17%), from 2 to 3 norms - in 3 children (50%), from 3 to 5 norms - in 2 children (33%). AST is less than 2 norms - in 2 children (33%), from 2 to 3 norms - in 3 (50%), in 1 child - 5-6 norms (17%). The absolute majority of patients (83%) had c894G>A mutations in the LIPA gene in a homozygous state. Conclusion. LALD is a rare disease, the diagnosis of which is difficult due to the frequent asymptomatic course or non-specific clinic. In most children, the disease manifests at an early age (up to 3-5 years), and the most common symptoms are increased liver transaminases and hepatosplenomegaly. ALT and AST activity, as a rule, does not exceed 2-3 norms. The signs characteristic of DL are detected randomly during examination for other diseases. Due to the non-specificity of clinical symptoms, the duration of diagnosis varies from several months to several years. The main modern method of diagnosing LALD is enzyme diagnostics and DNA diagnostics. If a child has hepatolienal syndrome, a persistent increase in markers of cytolysis and dyslipidemia, caution should be exercised and the necessary diagnostic examinations should be carried out in a timely manner to exclude LALD.

Microbial community structure in dementia and depression as a mirror of ageing “intestinal microbiota - immune system - brain” axis

Aim. To assess changes in the structure of the small intestine microbial community in the context of the “gut microbiota-immune system-brain axis” in healthy aging, depression and dementia. Materials and methods. 74 elderly people included in the groups: “Healthy ageing”, “Depression”, “Dementia” were investigated. Evaluation of 5 main types of microorganisms of the small intestine (Bacteroidetes, Firmicutes, Actinobacteria, Proteobacteria, Fusobacteria) by method of gas chromatography - mass spectrometry of microbial markers was carried out. For statistics, hierarchical cluster analysis with the construction of a heat map was used. Results. Reconstruction affected 15 out of 30 studied bacterial species of the phylums Firmicutes, Actinobacteria, Proteobacteria in the “Dementia” and “Depression” groups in relation to the “Healthy ageing” group. In depression, the number of all types of bacteria involved in the fermentation of food polysaccharides increased in relation to the “Healthy ageing” group. In dementia, low levels of Clostridium spp., Eubacterium spp., Bifidobacterium spp. was shown, in relation to depression, but number of C. perfringens, С. difficile and facultative anaerobes: Streptococcus spp., Enterococcus spp., Lactobacillus spp., S. aureus, S. epidermidis was increased, compared to “Healthy ageing” group. Conclusions. The indicators of the systems included in the axis “intestinal microbiota - immune system - brain” indicated a pronounced disintegration of the axis in dementia in relation to depression and healthy ageing. The results can be used as biological markers in the differential diagnosis of these pathologies (dementia/depression), which have common risk factors and clinical symptoms.

Prevalence, incidence and healthcare burden of eosinophilic granulomatosis with polyangiitis in the UK.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare but serious disease characterised by the combination of small-to-medium vessel vasculitis, blood and tissue eosinophilia, and asthma and/or sinonasal disease. This study estimated the prevalence and incidence of diagnosed EGPA in the United Kingdom (UK), and described the demographics, clinical characteristics and healthcare resource utilisation (HCRU) of this population. This retrospective longitudinal study of patients with newly diagnosed EGPA (index) (2005-2019) used the Clinical Practice Research Datalink AURUM and Hospital Episode Statistics databases. The primary outcomes were the annual prevalence (2005-2019) and incidence (2006-2019) of EGPA, and secondary outcomes included patient demographics and clinical characteristics, and HCRU in the year pre- and post-index (diagnosis). Populations of patients with EGPA comprised 940 prevalent cases and 502 incident cases, of which 377 were linked to Hospital Episode Statistics. EGPA prevalence increased from 22.7 to 45.6 cases per 1 000 000 (2005-2019), driven by patients aged ≥18 years. Incidence ranged from 2.3 to 4.0 per 1 000 000 person-years (2006-2019). Pre-index, the most common clinical symptoms were respiratory related, and the most common comorbidities were asthma (80.6%) and nasal polyps (32.1%). Post-index, 19.1% had an EGPA-related inpatient stay (median length of stay 11.0 days) and 38.7% had five or more oral corticosteroid (OCS) prescriptions with a mean OCS possession ratio per patient of 47.0%. Although EGPA incidence in the UK remains relatively stable, prevalence is increasing, and HCRU and OCS use remain frequent, suggesting considerable healthcare burden for patients with EGPA.

Prevalence of depression and clinical depressive symptoms in community-dwelling older adults with cognitive frailty.

The present study determines the prevalence of depression and the extent of clinical depression symptoms among community-dwelling older adults with cognitive frailty and its associated factors. A total of 755 older adults aged ≥60 years were recruited. Their cognitive performance was determined using the Clinical Dementia Rating. Fried's criteria was applied to identify physical frailty, and the Beck Depression Inventory assessed their mental states. A total of 39.2% (n = 304) of the participants were classified as cognitive frail. In this cognitive frail subpopulation, 8.6% (n = 26) had clinical depressive symptoms, which were mostly somatic such as disturbance in sleep pattern, work difficulty, fatigue, and lack of appetite. Older adults with cognitive frailty also showed significantly higher depression levels as compared with the noncognitive frail participants (t (622.06) = -3.38; P = 0.001). There are significant associations between depression among older adults with cognitive frailty and multimorbidity (P = 0.009), polypharmacy (P = 0.009), vision problems (P = 0.046), and hearing problems (P = 0.047). The likelihood of older adults with cognitive frailty who experience impairments to their vision and hearing, polypharmacy, and multimorbidity to be depressed also increased by 2, 3, 5, and 7-fold. The majority of the Malaysian community-dwelling older adults were in a good mental state. However, older adults with cognitive frailty are more susceptible to depression due to impairments to their hearing and vision, multimorbidity, and polypharmacy. As common clinical depressive symptoms among older adults with cognitive frailty are mostly somatic, it is crucial for health professionals to recognize these and not to disregard them as only physical illness. Geriatr Gerontol Int 2024; 24: 225-233.