Common Condition Research Articles

Epilepsy care and outcome in low- and middle-income countries: A scoping review.

Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs. Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs. A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients. In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.

Sterile inflammation via TRPM8 RNA-dependent TLR3-NF-kB/IRF3 activation promotes antitumor immunity in prostate cancer

Inflammation is a common condition of prostate tissue, whose impact on carcinogenesis is highly debated. Microbial colonization is a well-documented cause of a small percentage of prostatitis cases, but it remains unclear what underlies the majority of sterile inflammation reported. Here, androgen- independent fluctuations of PSA expression in prostate cells have lead us to identify a prominent function of the Transient Receptor Potential Cation Channel Subfamily M Member 8 (TRPM8) gene in sterile inflammation. Prostate cells secret TRPM8 RNA into extracellular vesicles (EVs), which primes TLR3/NF-kB-mediated inflammatory signaling after EV endocytosis by epithelial cancer cells. Furthermore, prostate cancer xenografts expressing a translation-defective form of TRPM8 RNA contain less collagen type I in the extracellular matrix, significantly more infiltrating NK cells, and larger necrotic areas as compared to control xenografts. These findings imply sustained, androgen-independent expression of TRPM8 constitutes as a promoter of anticancer innate immunity, which may constitute a clinically relevant condition affecting prostate cancer prognosis.

Comparison of the effect of topical triamcinolone 0.1% cream with sulfur 2.0% cream in the treatment of patients with hand eczema: A randomized controlled trial.

Hand eczema (HE) is a common and heterogeneous condition. It has a wide range of etiologies and clinical manifestations. In this study the efficacy of triamcinolone 0.1% cream and sulfur 2% creams was compared in treating patients with HE. This randomized, triple-blind clinical trial was performed on 70 patients with HE (including 70 right and 70 left hands). In this study, two creams were used including triamcinolone 0.1% and sulfur 2.0%. Patients were treated with these creams twice a day (once in every 12 h) for 4 weeks. Follow-up was 4 weeks after treatment. Hand Eczema Severity Index (HECSI), itching, dryness, burning sensation, and erythema scores were collected three times during the study and compared between treatment regimens. Findings showed that both triamcinolone (0.1%) and sulfur (2.0%) creams could significantly reduce the scores of HECSI, itching, dryness, burning sensation, and erythema, and the therapeutic effects lasted for at least 4 weeks after cessation of topical treatment. Topical sulfur cream (2.0%) is as effective as triamcinolone (0.1%) cream in treatment of HE without any prominent adverse reactions.

Patient activation and medication adherence in adults

BackgroundPatients’ level of medication adherence provides conflicting results in its relationship to patient activation. Multiple factors may be contributing to these mixed results. ObjectivesThe primary purpose was to assess the association of patient activation to medication adherence in adults with chronic health conditions and low health literacy (HL). Secondary objectives were to determine whether age, education, gender, and race were associated with activation. MethodsParticipants completed self-report questionnaires regarding chronic disease self-management. Patient activation was measured using Hibbard’s Patient Activation Measure (PAM). Self-report of medication adherence was determined using the Gonzalez-Lu adherence questionnaire. Block regressions first assessed the relation of demographic variables and education to adherence and then the added relation of patient activation in a second model. ResultsThe analyses included 301 participants (mean age 58 years; 53% female; mean chronic conditions of 6.6). Some of the most common chronic conditions included hypertension (60%), arthritis (51%), depression (49%), and hyperlipidemia (43%). The relation of older age to greater medication adherence was significant (P < 0.05) in both models. The addition of PAM was significantly related to better adherence (P < 0.001) and also increased the R squared value from 0.04 to 0.09. This change resulted in a moderate effect size (d = 0.50). ConclusionEvaluating patient activation at baseline may predict those more likely to be medication adherent in patients with low HL.

Dipeptidyl-Peptidase-4 and Glucagon-like-Peptide-1, a Link in the Connection between Periodontitis and Diabetes Mellitus—What Do We Know So Far?—A Scoping Review

Periodontitis is a common condition affecting the tissues surrounding and supporting teeth. In addition to oral health concerns, periodontal disease increases the chance of developing systemic illnesses including type 2 diabetes mellitus. Porphyromonas gingivalis, a key-stone pathogen that has been linked to the pathophysiology of periodontal disease, can generate a series of dipeptide producing exopeptidases, dipeptidyl peptidases (DPP). DPP-4 levels in gingival crevicular fluid have been shown to increase during active periodontal disease, which may lead to their association with the disease’s progression. Following oral glucose administration, mice injected with DPP-4 had higher blood glucose than the control group. DPP-4 inhibitors are used to treat patients with type 2 diabetes mellitus in order to extend the half-life of incretins. Elevated glucagon-like peptide-1 (GLP-1) levels following periodontal therapy could be considered new and applicable real-world evidence confirming the experimental findings of a beneficial interaction between oral microbiota and incretin axis. GLP-1 receptor agonist exendin-4 enhanced the osteoblast proliferation and development of these stem cells and inhibited the effects of glucose on the cells. In addition to lowering blood sugar, liraglutide, a GLP-1 receptor agonist, also possesses anti-inflammatory and bone-protective properties. These findings support the use of GLP-1 in the management and prevention of diabetic periodontitis.

Treatment of Second-Degree Scald Burn with the Application of Madhuchistadi Ghrita

Burn is one of the common conditions affected by individuals in day-to-day activity which needs extra attention to prevent ugly scars and many more complications. Ayurveda has a wide range of herbal formulations to manage such types of burn wounds. Among them, one is Madhuchistadi Ghrita which has burn wound healing properties by its Vrana Ropana drugs. A 45-year-old male patient suffered second-degree scald burn along with blisters and burning over the right hand for four days. The patient was successfully treated with a local application of Madhuchistadi Ghrita twice daily for 15 days. After seven days of treatment, the wound was 70% covered with epithelialization and at the end of 15 days, the wound was completely healed. During the follow-up period of 1 month, the skin was completely remodeled with the presence of skin appendages. This is a single case report with a positive outcome on the treatment of second-degree scald burns with the application of Madhuchistadi Ghrita.

Measuring Costs of Cardiovascular Disease Prevention for Patients with Familial Hypercholesterolemia in Administrative Claims Data.

Familial hypercholesterolemia is a common genetic condition that significantly increases an individual's risk of cardiovascular events such as heart attack, stroke, and cardiac death and is a candidate for population-wide screening programs. Economic analyses of strategies to identify and treat familial hypercholesterolemia are limited by a lack of real-world cost estimates for screening services and medications for reducing cardiovascular risk in this population. We estimated the cost of lipid panel testing in patients with hyperlipidemia and the cost of statins, ezetimibe, and PCKS9 inhibitors in patients with familial hypercholesterolemia from a commercial claims database and report costs and charges per panel and prescription by days' supply. The mean cost for a 90-day supply for statins was $183.33, 2.3 times the mean cost for a 30-day supply at $79.35. PCSK9 inhibitors generated the highest mean costs among medications used by patients with familial hypercholesterolemia. Lipid testing and lipid-lowering medications for cardiovascular disease prevention generate substantial real-world costs which can be used to improve cost-effectiveness models of familial hypercholesterolemia screening and care management.

Nurses’ Knowledge, Confidence, Detection and Actions Related to Delirium Care in the Post-Acute Setting

Background Delirium is a common and under-recognized condition affecting patients during times of illness or injury and is associated with poor short and long- term outcomes. Although primarily considered a complication during hospitalization, delirium can persist, recur, or initially present during a post-acute stay in a skilled nursing facility. Little is known about delirium care knowledge, confidence, and practices by nurses in post-acute facilities. Objectives Measure post-acute care nurses’ knowledge and confidence levels related to delirium prevention, identification and management Describe post-acute care nurses’ documented assessments and actions related to delirious patients. Methods Nursing knowledge and confidence data was obtained from a query of 114 nurses working in three post-acute facilities. Documentation of nursing assessment and actions were analyzed from records of 22 patients determined to have experienced post-acute delirium using CHART-DEL methodology. Results Nurses averaged 75% correct on a written delirium knowledge test, with most deficits in identifying the key features of delirium and the assessment of delirium superimposed upon dementia. Most (89%) nurses accurately applied the Confusion Assessment Method Short Form to a video of an individual displaying hypoactive delirium with visual hallucinations, while only 49% did the same with the video depicting hypoactive delirium superimposed on mild cognitive impairment. The majority (85%) of nurses reported lack of confidence in performing delirium screening, specifically surrounding the identification of an acute change in mental status from baseline and the presence of inattention and 56% lacked confidence discussing results of a positive delirium screen with a provider. The term “confusion” was the most documented descriptor in records of patients experiencing delirium with nurses recognizing 40% of verified delirious cases and acting upon 83% of cases they recognized. Conclusion Nurses working in the post-acute care setting displayed gaps in knowledge, confidence and skills related to delirium prevention, assessment and management.

Epithelial overexpression of IL-33 induces eosinophilic esophagitis dependent on IL-13

BackgroundEosinophilic esophagitis (EoE) is an increasingly common inflammatory condition of the esophagus; however, the underlying immunologic mechanisms remain poorly understood. The epithelium-derived cytokine IL-33 is associated with type 2 immune responses and elevated in esophageal biopsies from EoE subjects. ObjectiveWe hypothesized that overexpression of IL-33 by the esophageal epithelium would promote the immunopathology of EoE. MethodsWe evaluated the functional consequences of esophageal epithelial overexpression of a secreted and active form of IL-33 (saIL-33) in a novel transgenic mouse, EoE33. EoE33 mice were analyzed for clinical and immunologic phenotypes. Esophageal contractility was assessed. Epithelial cytokine responses were analyzed in three-dimensional organoids. EoE33 phenotypes were further characterized in ST2-/-, eosinophil-deficient, and IL-13-/- mice. Finally, EoE33 mice were treated with dexamethasone. ResultsEoE33 mice displayed ST2-dependent, EoE-like pathology and failed to thrive. Esophageal tissue remodeling and inflammation included basal zone hyperplasia, eosinophilia, mast cells, and Th2 cells. Marked increases in levels of type 2 cytokines, including IL-13, and molecules associated with immune responses and tissue remodeling were observed. Esophageal organoids suggested reactive epithelial changes. Genetic deletion of IL-13 in EoE33 mice abrogated pathological changes in vivo. EoE33 mice were steroid responsive. ConclusionIL-33 overexpression by the esophageal epithelium generated immunopathology and clinical phenotypes resembling human EoE. IL-33 may play a pivotal role in the etiology of EoE by activating the IL-13 pathway. EoE33 mice are a robust experimental platform for mechanistic investigation and translational discovery.

Protocol for a pilot cluster randomised controlled trial of a multicomponent sustainable return to work IGLOo intervention.

Long-term sickness costs businesses in the United Kingdom (UK) approximately £7 billion per annum. Most long-term sickness absences are attributed to common mental health conditions, which are also highly prevalent in people with acute or musculoskeletal health conditions. This study will pilot the IGLOo (Individual, Group, Leaders, Organisation, overarching context) intervention which aims to support workers in returning to and remaining in work following long-term sickness absence. The potential impact of the intervention is a timely return to work (main trial primary outcome) and prevention of a further episode of long-term sick leave. The intervention will be piloted in a randomised controlled trial (RCT) to examine the feasibility of the intervention (pilot trial primary outcome) and to inform a fully powered definitive trial to evaluate sustainable return to work (RTW) in people with primary or secondary mental ill-health who go on long-term sick leave. A two-arm feasibility randomised controlled trial (with a 30-month study period including 12-month follow-up) of the IGLOo intervention will be conducted in large organisations (≥ 600 workers) from the Yorkshire and Humberside regions, in the UK. Eight consenting organisations will be recruited and randomised to the intervention or control arms of the study (1:1 ratio), with a minimum recruitment target of 13 workers eligible to participate from each. Organisations assigned to the control group will continue with their usual practice. Feasibility data will include data collected on recruitment, retention and attrition of participants; completion of research outcome measures; and intervention compliance. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 3, 6, 9 and 12 months in all participants. Qualitative interviews and survey data with all participants will explore the experiences of participants, acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial. The findings from this pilot study will help to inform the development of a definitive cluster RCT designed to examine the efficacy of this intervention on health and work-related outcomes in UK workers on long-term sick leave. ISRCTN11788559 (prospectively registered, date registered 6 October 2022).

Cervical Spinal Cord Stimulation for Failed Neck Surgery Syndrome.

Cervical spine pain with or without radicular symptoms is a common condition leading to high utilization of the healthcare system with over 10 million medical visits per year. Many patients undergo surgical interventions and unfortunately are still left with neck and upper extremity pain, sometimes referred to as "Failed Neck Surgery Syndrome." When these options fail, cervical spinal cord stimulation can be a useful tool to decrease pain and suffering as well as reduce prescription medication use. Spinal cord stimulation is a well-established therapy for chronic back and leg pain and is becoming more popular for neck and upper extremity pain. Recent studies have explored cervical spinal cord stimulation with successful outcomes regarding improved pain scores, functional outcomes, and reduction of prescription medication use. Continued research into cervical spinal cord stimulation is essential for maximizing its therapeutic potential for patients with chronic neck and upper extremity pain. This review highlights the importance of cervical spinal cord stimulation as an option for patients with failed neck surgery syndrome.

Management of paediatric sleep-disordered breathing.

Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is usually diagnosed clinically, with investigations such as polysomnography reserved for more complex cases. Management can involve watching and waiting, medical or adjunct treatments and adenotonsillectomy. National working groups have sought to standardise the pathway for surgery and improve the management of surgical and anaesthetic complications. Current guidelines use age, weight and comorbidities to stratify risk for these surgical cases. This article summarises these recommendations and outlines the important factors that indicate cases that may be more suitable for management in secondary and tertiary units. Appropriate case selection will reduce pressure on tertiary units while maintaining training opportunities in district general hospitals.

Neuroimaging characterization of multiple sclerosis lesions in pediatric patients: an exploratory radiomics approach.

Multiple sclerosis (MS), a chronic inflammatory immune-mediated disease of the central nervous system (CNS), is a common condition in young adults, but it can also affect children. The aim of this study was to construct radiomic models of lesions based on magnetic resonance imaging (MRI, T2-weighted-Fluid-Attenuated Inversion Recovery), to understand the correlation between extracted radiomic features, brain and lesion volumetry, demographic, clinical and laboratorial data. The neuroimaging data extracted from eleven scans of pediatric MS patients were analyzed. A total of 60 radiomic features based on MR T2-FLAIR images were extracted and used to calculate gray level co-occurrence matrix (GLCM). The principal component analysis and ROC analysis were performed to select the radiomic features, respectively. The realized classification task by the logistic regression models was performed according to these radiomic features. Ten most relevant features were selected from data extracted. The logistic regression applied to T2-FLAIR radiomic features revealed significant predictor for multiple sclerosis (MS) lesion detection. Only the variable "contrast" was statistically significant, indicating that only this variable played a significant role in the model. This approach enhances the classification of lesions from normal tissue. Our exploratory results suggest that the radiomic models based on MR imaging (T2-FLAIR) may have a potential contribution to characterization of brain tissues and classification of lesions in pediatric MS.

Nausea and vomiting in pregnancy

George F Winter discusses the latest research into the common pregnancy condition often referred to as ‘morning sickness’

Colonic diverticulosis as an isolated colonoscopy finding for iFOBT-positive patients

Colonic diverticular disease is a common medical condition throughout the world. It is one of the most common findings during the endoscopic evaluation of the colon, such as colonoscopy. A retrospective cohort single-centre study was carried out for all patients referred for colonoscopy with positive immunochemical faecal occult blood test (iFOBT) results in 2016-2018, mostly within The National Bower Cancer Screening Program (NBCSP) in QLD, Australia. The cohort of 319 patients were isolated from all iFOBT-positive individuals with such finding as a diverticular disease. Colonic diverticulosis affected the patients above 43 years old with positive iFOBT, more males than females in this study. In most cases, colonoscopy consisted of benign findings, and diverticular disease was revealed in 47.7% of the patients with such indication for colonoscopy as positive iFOBT. 28.8% of the patients were diagnosed with colonic diverticulosis only. The sigmoid colon was affected by diverticulosis in 96.2% of the cases. Overall, the colorectal cancer (CRC) diagnosis rate of 2.7% for the patients in the positive FOBT cohort (Group A) is comparable with other studies. However, the diverticulosis group's CRC rate of 1.6% (Group B) was lower than in available published data.

Diagnosing and managing psoriasis in primary care

This common chronic skin condition is distressing for patients affecting their well being and quality of life. Margaret Perry provides an overview of this condition, its symptoms and management. Psoriasis is a long-term chronic condition, which often follows a relapsing and remitting course, requiring treatment throughout the affected person's life. It can be distressing for patients affecting their well being and quality of life. This article aims to give nurses and non-medical prescribers an overview of this condition, its symptoms and management with the hope that they may feel more confident in recognising and treating this distressing disease.

Experiences and perceptions of people with celiac disease, food allergies and food intolerance when dining out.

Eating out is a common practice in modern society. Celiac disease (CeD) and food allergy (FA) are among the most common conditions responsible for adverse reactions to food. Despite their different origins, both require treatment with restrictive diets (avoidance of gluten and/or specific allergens) and this results posing similar challenges when eating out. Our objective was to learn about the experiences/perceptions of consumers with CeD and FA when dining out, as well as the challenges they face in food service environments. An ad hoc questionnaire was used to record consumer perceptions, food service characteristics and resulting adverse reactions. 377 individuals living in Santiago, Chile, provided complete information and were analyzed (160 CeD, 105 FA). 301 participants (79.8%) declared eating out, 33.6% reported experiencing an adverse reaction at least once while eating out. 94.4% of the 377 participants believed that the serving staff had little or no knowledge about his/her condition. Consumers reporting symptoms as severe adverse reactions were more common among celiac than allergic patients (p < 0.001). The study showed no significant differences based on consumer-related characteristics (p:NS). The consequences of eating out did not vary based on individual's data, including diagnosis, age, frequency of eating out, adverse reactions experienced, or intensity. These findings suggest that the most important determinants of risk associated with eating out are characteristics of the food service, like availability of information, staff training, and establishment's facilities like equipment available, exclusive utensils for customers with special dietary needs and kitchen and bathrooms organization.

Exploring women’s chronic disease experiences: A mixed-methods analysis of endometriosis narratives

Endometriosis is a chronic gynecological illness faced by an estimated one-tenth of women worldwide. Despite being a common condition, studies of the disease in Latin American settings are still scarce. This paper presents a study of 30 autobiographical interviews with Chilean patients who are L1 Spanish speakers. Our study aims to fill the gap in understanding the endometriosis experience of Latin American women, unveiling how to assist the patients better and improve their quality of life. It is one of the first studies to describe the experience of Chilean women in navigating the disease and the impacts on their routines. We used a mixed-methods approach to achieve our goal, employing a combination of NLP and content analysis. First, we generated word embeddings for three main keywords, "pain," "endometriosis," and "menstruation." Furthermore, we processed the data to locate occurrences of "pain" in the corpus. We coded the occurrences into nine semantic domains of the endometriosis pain experience: intensity, normalization, treatment, frequency, menstruation, feeling, pain location, symptom, and impact. Our results shed light on the details of the journey with endometriosis and may lead to improvements in patient-doctor communication and policymaking to benefit patients.

Osteoarthritis Increases the Frequency and Duration of Postoperative Hand Clinic Visits after Carpal Tunnel Release.

Carpal tunnel syndrome affects up to 6% of the general population, and surgical intervention is often required to ameliorate symptoms. Osteoarthritis (OA) is a common condition that often coexists with carpal tunnel syndrome. We hypothesized that patients with preexisting OA use more healthcare resources after carpal tunnel release (CTR) than patients without arthritis. This was a retrospective cohort study at a single academic center between January 1, 2018 and November 1, 2021. Patients who underwent CTR were included. Preoperative carpal tunnel symptoms, diagnostic tests, medications, and concomitant OA were abstracted. Hand, wrist, and basal joint arthritis were specified. The primary outcome was healthcare utilization represented by duration and frequency of hand clinic and occupational therapy (OT) follow-up. In total, 312 hands were included. Multivariable analysis was performed. The average duration of hand clinic follow-up among patients without arthritis was 25.3 days compared with 87.1 days for patients with any arthritis (P = 0.0375) and 172 days for patients with wrist arthritis (P = 0.012). The average number of postoperative surgeon visits was increased in patients with hand arthritis, with an average of 2.3 visits versus 1.34 visits for patients without arthritis (P = 0.003). Both the number of OT visits and the duration of OT follow-up did not differ between cohorts. After CTR, patients with preexisting OA use more healthcare resources than patients without OA.

Pseudomelanoma diagnosis in a tertiary ophthalmologic centre in Spain

ObjectiveTo determine the types and frequency of lesions that can be misdiagnosed as choroidal or ciliary body melanomas (posterior uveal tract melanoma [PUM]). MethodsThis is a retrospective, descriptive study examining data from patients referred to Hospital La Paz in Madrid with the diagnosis of possible PUM between January 2005 and March 2020. All patients referred for PUM were studied. In collaboration with an oncology-specialized ophthalmologic centre, each patient underwent a full ophthalmic examination, ultrasonography, and optical coherence tomography, with agreed clinical criteria used to differentiate melanomas from pseudomelanomas. ResultsIn our cohort of 715 patients, 48.9% had pseudomelanomas. Thirty-five different conditions were misdiagnosed as melanomas. The 5 most common conditions were choroidal nevus (40.5%), peripheral exudative hemorrhagic chorioretinopathy (12%), choroidal hemangioma (10.5%), choroidal metastasis (8%), and age-related macular degeneration (4%). ConclusionsAltering the diagnosis and changing the treatment and prognosis for patients can be difficult for a referral centre. Herein we present the largest European cohort investigated and highlight the importance of identifying the correct diagnosis to prevent mistreatment and possible overtreatment. These misdiagnoses can have an emotional effect on patients and their families, which could be avoided with a correct diagnosis. We analyze the most common pseudomelanoma diagnoses to help physicians better diagnose patients in their care.