Comprehensive Clinical Assessment Research Articles

Evidence Synthesis and Clinical Recommendations for Supporting School Students With Sensory Processing Challenges: A Rapid Review.

Children with sensory processing challenges often need supports to access, participate in, and achieve at school. However, research on best practice is varied, presenting difficulty for practitioners to assess the appropriateness of each support. To provide evidence-informed recommendations regarding best practices in school-based supports for students with sensory processing challenges via a Rapid Evidence Assessment of current literature. Searches were run in CINAHL Complete, Education Research Complete, ERIC, MEDLINE, PsycINFO, and Scopus (for articles published 2010 to 2023). Informed by a 2010 review, articles citing publications identified in the prior review were also included. A reviewer screened the title and abstract of each article for inclusion, and another screened the full texts, with 10% of each reviewer's articles assessed by the other. Interrater reliability was excellent. The review included 61 articles, with only 15% constituting good evidence (38% provided adequate evidence, 31% provided poor evidence, and 16% were reviews). No support could be wholly recommended without caveats, but there was some evidence that sound amplification systems, alternate seating, and multisensory environments may be beneficial in certain conditions or with certain populations. The use of weighted vests is not recommended. Most research had small sample sizes and inconsistent protocols, highlighting the importance of ongoing research. Evidence-informed practitioners should review research findings carefully and integrate evidence from comprehensive clinical assessment and understanding of the child, school, and family contexts when assessing the appropriateness of a support for each student. Plain-Language Summary: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. Occupational therapists provide school-based supports for children with sensory processing challenges with the goal of enabling access, participation, and achievement. It is difficult, however, for practitioners to assess the appropriateness of each support because research on best practice varies. This review of the current literature provides practitioners with evidence on supports for school children with sensory processing challenges to inform decision-making and the selection of appropriate supports for their clients. When assessing the appropriateness of a support for a student, practitioners should carefully review current research findings and integrate evidence from comprehensive clinical assessments along with an understanding of the student, school, and family contexts.

P30 A mysterious case of lymphadenopathy, joint pain and balance disturbance

Abstract Introduction A patient presented with a long-standing history of double vision, balance disturbance, widespread lymphadenopathy and joint pain. Sarcoid was suspected due to its multisystem inflammatory effects, non-specific presenting features and insidious onset. Tissue confirmation was sought. However, multiple non-diagnostic lymph node biopsies led the clinical team to reconsider their presumed diagnosis. Finally, after further investigations and multidisciplinary input, a surprising unifying diagnosis emerged when syphilis serology was requested. Case description A 51-year-old man attended the Emergency Department with a two-month history of double vision. Prior to this, he described a year-long history of dry cough, arthralgia, myalgia, pins and needles in his hands bilaterally, weight loss, persistent headaches and balance disturbance. There was no travel or sexual history documented. On examination there was evidence of palpable lymphadenopathy, small papules on his forearms and trunk, bilateral wrist tenderness with limited swelling. His chest was clear and muscle power was preserved. On further assessment, he was found to have raised protein on cerebrospinal fluid, low vitamin D, raised alkaline phosphatase and alanine transaminase with normal liver imaging and an elevated serum angiotensin converting enzyme (ACE). Other investigations included serum electrophoresis, liver auto-antibodies, paraneoplastic antineuronal antibody screen, nerve conduction studies and hand x-rays which were all unremarkable. In the context of widespread lymphadenopathy, a working diagnosis of sarcoid was considered however lymphoma needed to be excluded. Two lymph node biopsies and, subsequently, a surgical excision was conducted. The histology indicated follicular hyperplasia without features of malignancy, lymphoma or sarcoid. On follow-up, his outpatient blood tests normalised including the serum ACE and acute phase markers. He also reported improvement of lymphadenopathy and arthralgia although his balance disturbance remained. A Romberg’s test was noted to be positive. Initial management had included vitamin D replacement and bilateral wrist splints for presumed carpel tunnel syndrome. Given the inconclusive tissue diagnosis coupled with a degree of spontaneous clinical improvement, steroids were not initiated despite the suspicion of sarcoid. Instead, syphilis serology was requested and found to be positive thus revealing a unifying diagnosis for this mysterious case. Discussion Syphilis is the clinical manifestation of infection with spirochaete Treponema Palladium (T. Palladium) often transmitted through sexual contact or via vertical transmission. Multisystem involvement is owed to its ability to rapidly invade and infect endothelial tissue, resulting in vasculitis and generalised signs and symptoms as it progresses through its primary, secondary and tertiary phases. It has therefore been given the moniker the “great masquerader”, where it can mimic other multisystem diseases such as sarcoid. Musculoskeletal manifestations of syphilis can present with articular and periarticular pathologies as seen in other inflammatory arthropathies. Where polyarthalgia is a common form of presentation, inflammatory arthritis, periostitis, tensosynovitis, myositis and osteomyelitis have been reported in syphilis. Syphilis can remain latent until the tertiary stage at which point syphilitic arthritis may also manifest for example as a neuropathic joint. This may occur years after initial exposure. Although not seen here, granuloma formation is commonly seen in tertiary syphilis and can also occur in secondary stages, thus further imitating sarcoidosis where granuloma formation is a defining feature. The mainstay of syphilis eradication is treatment with penicillin antibiotics, often with curative results. In contrast, sarcoid is a chronic non-curable condition where steroids and immunomodulatory agents are used to limit disease progression. Our patient presented with nonspecific symptoms over a year-long period with follicular hyperplasia on lymph node biopsy, a non-specific histological finding with a wide range of differentials such as malignancy, infection and autoimmune disease. The definitive diagnosis of syphilis was made on positive serology. With the prevalence of syphilis in England rising (9% increase in new cases from 2022 to 2023), it is increasingly important for clinicians to consider it in their workup. Importantly, this case reinforced the need for a comprehensive travel and sexual history when presented with a complex multisystem disease. Key learning points • Due to its multi-organ involvement and non-specific symptoms, syphilis commonly mimics other diseases. This case highlights the need for a broad differential workup when faced with multisystem disease, particularly when clinical findings are discordant with seen pathology, as seen here where two sequential lymph node biopsies did not support the presumed diagnosis of sarcoid. In the instance of nonspecific symptoms, comprehensive clinical assessment with sexual and travel histories are also advisable, but it should be noted that the sexual history may not always be reliable. • As the incidence of syphilis rises across the UK, it is also important for clinicians to consider this disease within their workup, especially as detection via serological testing and treatment is relatively straightforward and can often yield positive outcomes.

Probing Neurophysiological Processes Related to Self-Referential Processing to Predict Improvement for Depressed Adolescents Receiving Cognitive Behavioral Therapy

BACKGROUNDCognitive Behavior Therapy (CBT) is a gold standard approach for treating major depressive disorder (MDD) among adolescents. However, nearly half of adolescents receiving CBT do not improve. In order to personalize treatment, it is essential to identify objective markers that predict treatment responsiveness. Toward addressing this aim, this study investigated neurophysiological processes related to self-referential processing that predicted CBT response among depressed, female adolescents. METHODSAt baseline, female adolescents ages 13-18-years-old (N=80) completed a comprehensive clinical assessment, and a self-referential encoding task was administered while electroencephalogram (EEG) data were recorded. Baseline EEG data were utilized to identify oscillatory differences between healthy (HC, n=38) and depressed (MDD, n=42) adolescents. Following the baseline assessment, depressed youth received up to 12-weeks of CBT. Baseline differences in EEG oscillations between healthy and depressed youth were used to guide CBT prediction analysis. Cluster-based event-related spectral perturbation analysis (ERSP) probed theta and alpha event-related synchronization/desynchronization (ERS/ERD) response to negative and positive words. RESULTSBaseline analyses showed that, relative to the healthy adolescents, depressed youth exhibited higher levels of frontal theta ERS and a greater posterior alpha ERD. Multilevel modeling identified primary neural pre-treatment predictors of treatment response: greater theta ERS in the right prefrontal cortex (PFC) after the onset of negative words and lower alpha ERD in both the right PFC and posterior cingulate cortex (PCC). ERS and ERD associations with treatment response remained significant, with baseline depressive and anxiety symptoms included as covariates in all analyses. CONCLUSIONSConsistent with prior research, results highlighted that relative to healthy youth, depressed adolescents are characterized by prominent theta synchronization and alpha desynchronization over PFC and PCC, respectively. Cluster-based ERSP analysis also identified key mechanisms underlying depression-related self-referential processing that predicted improved symptoms during the CBT course. Ultimately, a better characterization of the neural underpinnings of adolescent depression and its treatment may lead to more personalized interventions.

Clinico-pathological specificities of gingival carcinoma among 32 patients with oral cancer: a cross sectional retrospective and observational study

BackgroundThe study aimed to examine the prevalence of gingival cancers compared to other oral mucosal sites, analyze patient profiles, and identify risk factors.Materials and MethodsA retrospective monocentric study was conducted at the Department of Oral Medicine of Bretonneau Hospital in Paris, France. 32 patients diagnosed with oral mucosal cancer were included. Data extracted from electronic medical records encompassed patient demographics, cancer type, lesion location, and tobacco/alcohol use.Results46.9% were diagnosed with gingival cancer. Patients with gingival cancer had a mean age of 74.2 years old, higher than the mean age of 63.9 years old for those with non-gingival cancer. Men accounted for 60% of cases in the gingival cancer group. Squamous cell carcinoma was the predominant cancer type observed in both gingival and non-gingival cancers. Notably, 26.7% of gingival cancer patients used both alcohol and tobacco, all of them male. Among non-gingival cancer patients, 23.5% used both substances, with both sexes represented.ConclusionThis study provides insights into the higher prevalence of oral squamous cell carcinoma among men with risk factors and highlights characteristics of gingival squamous cell carcinoma. Effective management strategies should include comprehensive clinical assessments to ensure early detection and intervention for improved outcomes.

The identification, referral and management of patients with cardiac-related distress: a new model to support psychological recovery after a cardiac event

Abstract Background Identification, referral and management of patients with psychological distress is an important component of cardiac rehabilitation (CR). We developed a protocol to identify patients in hospital, CR and primary care settings, and refer them to a specialist psychocardiology clinic. Using the newly developed Cardiac Distress Inventory (CDI), we demonstrated that counselling resulted in reduced rates of cardiac-related distress. This study demonstrates the importance of having a clear pathway from screening to referral to intervention to support cardiac patients in their recovery. Purpose The team identified a dearth of high-quality research on distress in cardiac patients, including a lack of data on the resolution of cardiac-related distress after psychotherapeutic intervention. This was due to the lack of appropriate measurement of cardiac distress, and the absence of clear pathways for identification, referral and management of cardiac distress. Methods The Cardiac Emotions Study is a multi-site, multi-component study of cardiac-related distress. The team first developed the 55-item Cardiac Distress Inventory (CDI), a comprehensive clinical assessment tool. A brief screening version, the 12-item Cardiac Distress Inventory Short Form (CDI-SF), was then developed. Patients referred to the specialist psychocardiology clinic over a 6-month period (N=113) were administered the CDI-SF, together with the Generalised Anxiety Disorder 7 (GAD7) and the Patient Health Questionnaire (PHQ9), with all measures re-administered at discharge. Results More than half the clients presented to the Clinic within the first 3 months post-event (58%), while 84% presented within the first year. At presentation, over half the clients were anxious (GAD7>10; 53%), depressed (PHQ9>10; 57%), or distressed (CDI-SF>13; 56.4%). Levels of particular aspects of cardiac distress are shown in the Figure. On completion of counselling, distress had resolved for the majority of clients, with the distress rate of 18.6% at discharge equivalent to that seen in a normative sample of cardiac patients. Rates of anxiety and depression also significantly decreased after counselling. Conclusion This study demonstrated that distressed cardiac patients could be appropriately identified in settings such as hospital, CR and primary care and referred for counselling, and that counselling resulted in significant reductions in rates of cardiac distress, anxiety and depression. Undergoing counselling through a specialist psychocardiology clinic assisted clients in obtaining normative rates of post-cardiac event distress. The analysis showed the necessity of having a clear clinical pathway from screening to psychological treatment, and the utility of having a validated measure of cardiac distress that is sensitive to change after intervention.

Assessment and Management of Depressive Disorder: A Case Report of an Unmarried Adult

This case study examines the psychological and social aspects impacting the mental well-being of a 32-year-old unmarried woman. Based on comprehensive clinical assessment, Client D.A. was diagnosed with Major Depressive Disorder (MDD) using Structured Clinical Interview for DSM-5 (SCID-5), Minnesota Multiphasic Personality Inventory (MMPI-2), Rotter Incomplete Sentences Blank College Form (RISB), Draw-a-Person (DAP), clinical interviews, and behavioral observations. A multifaceted treatment plan was developed, combining cognitive behavioral therapy (CBT), interpersonal therapy (IPT), pharmacotherapy, mindfulness, and relaxation techniques. This study provides insights into her experiences of depression, social isolation, societal expectations, and self-esteem. Over the course of the treatment, Client D.A. demonstrated significant improvement in her depressive symptoms. Her negative thought patterns were effectively restructured through CBT and her interpersonal relationships improved with IPT. Additionally, pharmacotherapy stabilized her mood, while mindfulness techniques helped manage anxiety and stress. This case study highlights the complex interplay of factors influencing mental health and underscores the importance of culturally sensitive, personalized treatment approaches, as evidenced by Client D.A.’s increased social engagement, reduced loneliness, and improved well-being, with regular evaluations confirming sustained progress and the efficacy of the integrated treatment plan in promoting recovery.

Chronic Rheumatologic Disease in Chikungunya Virus Fever: Results from a Cohort Study Conducted in Piedecuesta, Colombia.

This study aimed to determine the incidence of post-chikungunya chronic rheumatism (pCHIK-CR) and its impact on quality of life (QoL) and chronic fatigue in adults seven years after the 2014-2015 CHIKV outbreak in Piedecuesta, Colombia. We evaluated 78 adults (median age: 30 years, IQR: 21.0; women 60.3%) with confirmed CHIKV infection. In 2022, participants underwent a GALS examination and completed surveys on disability, stiffness, health status, and fatigue. A rheumatologist evaluated patients who reported arthralgia, morning stiffness, and abnormal GALS examination. Chronic fatigue was defined as fatigue persisting for over six months. Seven years after infection, 14.1% of participants were classified as pCHIK-CR cases, 41.0% as having non-inflammatory pain, likely degenerative (NIP-LD), and 44.9% without rheumatic disease (Wo-RM). Patients with pCHIK-CR and NIP-LD exhibited significantly worse QoL compared to Wo-RM cases. Chronic fatigue prevalence increased from 8.6% in Wo-RM patients to 25.0% in NIP-LD and 54.6% in pCHIK-CR cases. This study implemented a comprehensive clinical assessment to objectively estimate and characterize the incidence of chronic rheumatological disease attributed to CHIKV infection. One in seven cases with CHIKV infection develops pCHIK-CR, which impacts both QoL and chronic fatigue. This study contributes to understanding the burden of these arboviruses in the medium term.

Clinical diagnosis and management of spinocerebellar Ataxia in a resource-constrained setting: a case report from Eastern Nepal

Introduction: Spinocerebellar ataxias (SCA) are a diverse group of neurodegenerative disorders with autosomal dominant inheritance, primarily affecting the cerebellum and its connections. Diagnosis typically involves genetic testing, but in resource-limited settings, clinical and neuroimaging assessments become critical. This case report highlights the role of non-genetic methods in diagnosing SCA and outlines management strategies in such settings. Case Presentation: A 41-year-old male presented with a two-year history of progressive gait imbalance, headache, and abnormal speech. He had a family history of similar symptoms in two siblings, but no significant past medical history. Clinical examination revealed scanning speech, dysmetria, and a broad-based gait. Clinical and neuroimaging findings, including cerebellar atrophy, led to a diagnosis of SCA in the absence of genetic testing. Patient management with speech, occupational, and physical therapies, showed gradual improvement. Discussion: SCA, characterized by cerebellar atrophy and a range of clinical symptoms, is typically diagnosed through genetic testing, but clinical and imaging assessments are crucial when genetic resources are limited. This case illustrates that a comprehensive clinical evaluation, including neuroimaging, can support the diagnosis of SCA even without genetic testing. Strategic management emphasizing symptomatic relief and functional improvement through a multidisciplinary approach, including regular follow-up and personalized therapy, are crucial, as evidenced by the timely improvement observed in our case. Conclusion: In resource-limited settings, a comprehensive clinical and neuroimaging assessment is essential for diagnosing Spinocerebellar Ataxia when genetic testing is not feasible. Effective management through multidisciplinary therapies can improve patient outcomes, underscoring the need for innovative strategies to enhance diagnostic and treatment capabilities in such environments.

Effect of continuous inhaled corticosteroids on glycated hemoglobin in asthmatic children: a pilot study

BackgroundAsthma is a prevalent chronic disease with significant impact on patients, families, and communities. Inhaled corticosteroids (ICS) are the mainstay of treatment for persistent and uncontrolled asthma. However, concerns remain about the potential adverse effects of ICS, including HbA1c level. This study aims to evaluate the influence of ICS on Hemoglobin A1c (HbA1c) levels in children with bronchial asthma.MethodsThis prospective cohort study included 48 pediatric asthma patients aged 2 to 15 years who had been using ICS for at least 6 months. Comprehensive clinical assessments and measurements of HbA1c levels were conducted at the start of recruitment and after 6 months of ICS use. The types and doses of ICS used followed the guidelines provided by the Global Initiative for Asthma (GINA).ResultsThe initial HbA1c levels ranged from 4.46 to 6.11, with a mean of 5.32 ± 0.35. Three patients (6.3%) had persistent prediabetes status after 6 months. There was no significant relationship between glycemic status and the characteristics of ICS. The duration of ICS therapy and the doses used did not significantly affect HbA1c levels. A weak positive correlation was observed between initial and subsequent HbA1c levels.ConclusionThe study found no significant difference in HbA1c levels among asthmatic children using ICS after six months of treatment. Additionally, there was no significant difference in HbA1c levels between patients using different types of ICS. Regular monitoring of HbA1c levels is recommended, particularly for children on high doses or prolonged use of inhaled Fluticasone.

Unraveling the interplay of β-amyloid pathology and Parkinson's disease progression: Insights from autopsy-confirmed patients

BackgroundParkinson's disease (PD) is a prevalent neurodegenerative disorder that manifests with both motor and non-motor symptoms, with α-synuclein misfolding recognized as a key contributor. Cognitive decline in advanced PD stages prompts interest in amyloid deposition, a hallmark of Alzheimer's disease (AD), as a potential factor. This study explores the impact of β-amyloid (Aβ) pathology in PD patients on disease progression, aiming to elucidate the role of Aβ in PD development and progression. MethodsThis study included autopsy-confirmed PD patients with post-mortem analyses from the Parkinson's Progression Markers Initiative. Comprehensive clinical assessments, including demographic data, clinical features, CSF markers, and neuroimaging, were conducted. Statistical analyses assessed differences between groups based on the severity of AD neuropathological changes. ResultsAll 16 PD participants exhibited severe Lewy body pathology, with 75 % displaying AD neuropathological changes. At baseline, PD patients with severe or moderate AD neuropathological changes had a lower Aβ42 levels (p = 0.022) and Aβ42/tau ratio (p = 0.001). Longitudinal follow-up data indicated that individuals with severe or moderate AD neuropathological changes exhibited a more rapid decline in MOCA score and BJLOT score, along with a quicker increase in MDS-UPDRS Ⅲ score. ConclusionsThe study underscores the presence of severe Aβ pathology in PD, suggesting a role in accelerated disease progression. Cross-seeding between Aβ and α-synuclein may contribute to rapid clinical symptom progression. Further research is needed for a comprehensive understanding of neurodegenerative disease complexities and exploring potential therapeutic interventions targeting protein aggregation.

Volumetric Classification: Unveiling the True Extent of Rotator Cuff Tears

Rotator cuff injury diagnosis involves comprehensive clinical, physical, and imaging assessments, with MRI being pivotal for detecting and classifying these injuries. However, the absence of a universally accepted classification system necessitates a more precise approach, advocating for the use of three-dimensional (3D) modeling to better understand and categorize rotator cuff tears. This research was conducted as a prospective, single-institution study on 62 patients exhibiting full-thickness rotator cuff tears. Utilizing preoperative 1.5T MRI, the study aimed to create a more detailed classification system based on volumetric and surface area measurements. Advanced 3D modeling software was employed to transform MRI data into precise 3D representations, facilitating a more accurate analysis of the lesions. The study unveiled a novel classification system rooted in volumetric and surface area assessments, revealing significant discrepancies in the existing two-dimensional classifications. Approximately 45% of the cases demonstrated inconsistencies between traditional classifications and 3D measurements. Notably, medium-sized lesions were often overestimated, while small and large lesions were consistently underestimated in their severity. The volumetric and surface area-based classifications provided a more accurate depiction, highlighting the limitations of relying solely on coronal plane assessments in MRI. Comparative analysis confirmed the improved accuracy of the 3D method. The integration of 3D imaging and volumetric analysis offers novel advancement in diagnosing and classifying rotator cuff injuries. This study's findings challenge the conventional reliance on 2D MRI, proposing a more detailed and accurate classification system that enhances the precision of surgical planning and potentially improves patient outcomes. The incorporation of comprehensive 3D assessments into the diagnostic process represents a significant step forward in the orthopedic imaging field.

Energy availability and its association with health-related outcomes among national athletes at risk of relative energy deficiency in sports (REDs)

BackgroundLow energy availability (LEA) occurs when athletes’ energy intake fails to match the energy expended during exercise, resulting in insufficient energy to support essential functions for optimal health, a condition...

Dystonic Tremor as Main Clinical Manifestation of SCA21.

Spinocerebellar ataxia type 21 (SCA21) is a rare inherited neurological disorder characterized by motor, cognitive, and behavioral disturbances, caused by autosomal dominant TMEM240 variants. To identify the genetic cause of a dystonic tremor with autosomal dominant inheritance. Six subjects of a multi-generational French family affected by tremor and dystonia were studied. Each patient underwent a comprehensive clinical assessment and a whole-exome sequencing analysis. All six subjects presented with early-onset prominent hand dystonic tremor and multifocal/generalized dystonia, secondarily developing mild cerebellar ataxia. The younger generation showed more pronounced cognitive and behavioral impairment. The known pathogenic TMEM240 c.509C>T (p.P170L) variant was found in heterozygosis in all subjects. Dystonic tremor can represent the core clinical feature of SCA21, even in absence of overt cerebellar ataxia. Therefore, TMEM240 pathogenic variants should be considered disease-causing in subjects displaying dystonic tremor, variably associated with ataxia, parkinsonism, neurodevelopmental disorders, and cognitive impairment.

Peak width of skeletonized mean diffusivity as a neuroimaging biomarker in first-episode schizophrenia.

Peak width of skeletonized mean diffusivity (PSMD), a fully automated diffusion tensor imaging (DTI) biomarker of white matter (WM) microstructure damage, has been shown to be associated with cognition in various WM pathologies. However, its application in schizophrenic disease remains unexplored. This study aims to investigate PSMD along with other DTI markers in first-episode schizophrenia patients compared to healthy controls (HCs), and explore the correlations between these metrics and clinical characteristics. A total of 56 first-episode drug-naive schizophrenia patients and 64 HCs were recruited for this study. Participants underwent structural imaging and DTI, followed by comprehensive clinical assessments, including the Positive and Negative Syndrome Scale (PANSS) for patients and cognitive function tests for all participants. We calculated PSMD, peak width of skeletonized fractional anisotropy (PSFA), axial diffusivity (PSAD), radial diffusivity (PSRD) values, skeletonized average mean diffusivity (MD), average fractional anisotropy (FA), average axial diffusivity (AD), and average radial diffusivity (RD) values as well as structural network global topological parameters, and examined between-group differences in these WM metrics. Furthermore, we investigated associations between abnormal metrics and clinical characteristics. Compared to HCs, patients exhibited significantly increased PSMD values (t = 2.467, p = 0.015), decreased global efficiency (Z = -2.188, p = 0.029), and increased normalized characteristic path length (lambda) (t = 2.270, p = 0.025). No significant differences were observed between the groups in the remaining metrics, including PSFA, PSAD, PSRD, average MD, FA, AD, RD, local efficiency, normalized cluster coefficient, small-worldness, assortativity, modularity, or hierarchy (p > 0.05). After adjusting for relevant variables, both PSMD and lambda values exhibited a significant negative correlation with reasoning and problem-solving scores (PSMD: r = -0.409, p = 0.038; lambda: r = -0.520, p = 0.006). No statistically significant correlations were observed between each PANSS score and the aforementioned metrics in the patient group (p > 0.05). Multivariate linear regression analysis revealed that increased PSMD (β = -0.426, t = -2.260, p = 0.034) and increased lambda (β = -0.490, t = -2.994, p = 0.007) were independently associated with decreased reasoning and problem-solving scores respectively ( = 0.295, F = 2.951, p = 0.029). But these significant correlations did not withstand FDR correction (p_FDR > 0.05). PSMD can be considered as a valuable neuroimaging biomarker that complements conventional diffusion measurements for investigating abnormalities in WM microstructural integrity and cognitive functions in schizophrenia.

Comprehensive Clinical Assessment of Patients With Acute Organophosphorus Poisoning in a Tertiary Care Hospital.

Background The use of organophosphorus (OP) compounds as pesticides is widespread, particularly in developing nations such as India. These substances are easily accessible and often linked to suicide poisoning incidents, especially among distressed farmers. In India, OP poisoning remains a significant cause of emergency hospital admissions. This study aims to analyze the clinical profile of patients admitted with OP poisoning, focusing on the various clinically significant characteristics and aspects associated with these cases. Methods Throughout the course of two years (from June 2022 to May 2024), five hospitals with critical care units participated in this prospective observational study. These hospitals referred patients to the Prathima Institute of Medical Sciences, which served as the central facility for the study. The study focused on individuals who arrived at the emergency room within 24 hours of acute exposure to organophosphate pesticides. A total of 150 patients meeting the inclusion criteria were enrolled. Data collection included a comprehensive clinical examination, detailed patient history, and monitoring of the response to intravenous atropine. The severity of the poisoning was evaluated using the Peradeniya Organophosphorus Poisoning (POP) scale, adapted for this study. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York), with descriptive statistics used to summarize the categorical and continuous variables. Results The results of the study demonstrated a notable relationship between the arrival time at the health facility and mortality rates among patients with OPpoisoning. Patients who arrived within three hours had a mortality rate of 13.2% (five out of 38 cases), while those arriving between three and six hours had a slightly higher rate of 14.3% (10 out of 70 cases). The mortality rate sharply increased to 28.6% (12 out of 42 cases) for patients who arrived after six hours. Among the OP compounds, monocrotophos showed the highest mortality rate at 80% (eight out of 10 cases), followed by dimethoate with 42.9% (12 out of 28 cases) and dichlorvos with 62.5% (five out of eight cases). The overall mortality rate in the study was 22.7% (34 out of 150 cases). Conclusions Poisoning with OP has primarily impacted young, productive men. Considerable mortality results from a disease condition that is more severe at presentation. It is advised to selectively outlaw the riskier substances that account for a larger percentage of fatalities.

The effect of subthalamic nucleus deep brain stimulation on speech performance: a prospective clinical and tractography study.

Speech changes significantly impact the quality of life for Parkinson's disease (PD) patients. Deep Brain Stimulation (DBS) of the Subthalamic Nucleus (STN) is a standard treatment for advanced PD, but its effects on speech remain unclear. This study aimed to investigate the relationship between STN-DBS and speech changes in PD patients using comprehensive clinical assessments and tractography. Forty-seven PD patients underwent STN-DBS, with preoperative and 3-month postoperative assessments. Speech analyses included acoustic measurements, auditory-perceptual evaluations, and fluency-intelligibility tests. On the other hand, structures within the volume tissue activated (VTA) were identified using MRI and DTI. The clinical and demographic data and structures associated with VTA (Corticospinal tract, Internal capsule, Dentato-rubro-thalamic tract, Medial forebrain bundle, Medial lemniscus, Substantia nigra, Red nucleus) were compared with speech analyses. The majority of patients (36.2-55.4% good, 29.7-53.1% same) exhibited either improved or unchanged speech quality following STN-DBS. Only a small percentage (8.5-14.9%) experienced deterioration. Older patients and those with worsened motor symptoms postoperatively were more likely to experience negative speech changes (p < 0.05). Interestingly, stimulation of the right Substantia Nigra correlated with improved speech quality (p < 0.05). No significant relationship was found between other structures affected by VTA and speech changes. This study suggests that STN-DBS does not predominantly negatively impact speech in PD patients, with potential benefits observed, especially in younger patients. These findings underscore the importance of individualized treatment approaches and highlight the need for further long-term studies to optimize therapeutic outcomes and better understand the effects of STN-DBS on speech.

Structure of Restricted Repetitive Behaviors of Individuals Referred for Autism Spectrum Disorder Assessment.

Restricted and/or repetitive displays of behavior, interests, or activities (RRBs) are one of the core symptom domains of autism spectrum disorder (ASD). Current and past research indicates two 'clusters' of RRBs in children with ASD: repetitive sensorimotor (e.g., hand/finger and more complex motor mannerisms) and insistence on sameness (e.g., resistance to changes in the environment) behaviors. The current study aims to fill a gap by examining how RRBs may diverge in individuals with ASD and with other neurodevelopmental disorders (ONDD) in a clinical sample. A total of 558 individuals were seen at a tertiary care clinic for a comprehensive clinical assessment of ASD. The sample was split into ASD (n = 292 individuals) and ONDD (n = 266) groups based on clinical diagnosis. Exploratory factor analyses were conducted using Autism Diagnostic Interview-Revised (ADI-R) RRB item scores for the overall sample, the ASD group, and the ONDD group. Exploratory factor analysis of ADI-R RRB items indicated a 2-factor solution for the full sample and ASD group. Items loaded onto two factors comprised of "Repetitive Sensorimotor" and "Insistence on Sameness" behaviors, consistent with previous literature. Results demonstrated a unique loading pattern for the non-ASD group, with items clustering into "Higher Order" (e.g., circumscribed interests) and "Lower Order" (e.g., hand and finger mannerisms) behaviors. The results of the current study may point towards using RRBs to guide screening of children who are referred for an ASD evaluation to better identify children who are at higher risk of having ASD.

A systematic review of suicide risk management strategies in primary care settings.

Suicide is a major public health concern. Recently, suicide rates have increased among traditionally low-risk groups (e.g., white, middle-aged males). Suicide risk assessments and prevention strategies should be tailored to specific at-risk populations. This systematic review examines suicide risk detection and management in primary care, focusing on treatments to reduce suicide rates and improve prevention efforts. A systematic review was conducted following PRISMA guidelines. Literature was collected and analyzed using Boolean operators with relevant keywords in databases (e.g., PubMed, Google Scholar, PsycINFO) to identify randomized and non-randomized studies focusing on suicide risk factors and management strategies in primary care, published in the past 10 years. The risk of bias 2.0 and Newcastle Ottawa scale was used to assess risk of bias, and data from moderate-quality studies were synthesized. Thirteen moderate-quality studies were reviewed. Key findings include the need for assessing modifiable risk factors like substance use and mental health. General practitioner (GP) engagement post-suicide attempt (SA) improves outcomes and reduces repeat SAs. Effective strategies include comprehensive risk assessments, collaborative treatment, and enhanced GP support. Barriers to effective suicide prevention include insufficient information, judgmental communication, lack of positive therapeutic relationships, and inadequate holistic assessments. These findings highlight the need for tailored suicide prevention strategies in primary care. However, the evidence sample size is small with reduced statistical power that limits generalizability. The included studies were also regional examinations, which restrict their broader relevance. Significant risk factors, barriers, and effective strategies for suicide prevention were identified. For children aged 12 or younger, preexisting psychiatric, developmental, or behavioral disorders, impulsive behaviors, aggressiveness, and significant stressful life events within the family were critical. For adults, loneliness, gaps in depression treatment, and social factors are significant. Barriers to suicide prevention included insufficient information, judgmental communication, lack of positive therapeutic relationships, inadequate holistic risk assessments, lack of individualized care, insufficient tangible support and resources, inconsistent follow-up procedures, variability in risk assessment, poor communication, stigma, and negative attitudes. Effective methods include the Postvention Assisting Bereaved by Suicide training program, continued education, comprehensive clinical assessments, individualized care, and community-based interventions like the SUPRANET program. https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024550904.

Serum retinol binding protein 4 in individuals with essential hypertension and type 2 diabetes: A cross-sectional study.

Cardiometabolic disorders, notably primary hypertension and type 2 diabetes, present substantial global health challenges. The intricate interplay between metabolic and cardiovascular pathways has prompted extensive research into molecular mechanisms linking these conditions. The adipokine Retinol Binding Protein 4 (RBP4), initially recognized for retinol transport, has emerged as a potential biomarker in the network of metabolic and cardiovascular dysfunction. Recent studies implicate RBP4 in insulin resistance and its complications, including hypertension. This study explores RBP4 dynamics in patients with primary hypertension and type 2 diabetes, aiming to contribute valuable insights into diagnostic and therapeutic advancements in managing these interconnected disorders. This cross-sectional study, conducted over 2 years in a tertiary healthcare centre of North India, aimed to investigate the serum concentration of Retinol Binding Protein 4 (RBP4) in 119 participants diagnosed with primary hypertension and type 2 diabetes. Ethical guidelines were strictly followed, and comprehensive clinical assessments, including blood pressure measurements, were performed. RBP4 levels were quantified using an ELISA kit, alongside markers of insulin resistance. Statistical analyses, involving t-tests and correlation assessments, sought to unravel potential associations between RBP4, insulin resistance, and blood pressure parameters using SPSS 20.0. The study comprised 61 healthy control (HC) participants and 58 individuals diagnosed with both essential hypertension and type 2 diabetes (EH+T2D). EH+T2D participants were on average older (45.71 ± 9.29 years vs. 40.34 ± 9.47 years, P = 0.002). Dyslipidemia prevalence was markedly higher in EH+T2D (72.4% vs. 11.4%, P < 0.0001), accompanied by disrupted lipid profiles. Serum RBP4 concentration was significantly elevated in EH+T2D (49.17 ± 19.37 mg/L, P < 0.0001), suggesting its potential role in the shared pathophysiology of primary hypertension and type 2 diabetes. Pearson's correlation analysis revealed associations between RBP4 levels, metabolic, and cardiovascular parameters, underscoring its potential as a link between these conditions. Elevated serum RBP4 levels suggest its potential as a novel biomarker in the shared pathophysiology of primary hypertension and type 2 diabetes. The correlation analysis highlights the intricate interplay between metabolic, lipid, and cardiovascular parameters, emphasizing the need for holistic interventions.

ADHD in children and adolescents: Guideline-based online assessment in the consortium project INTEGRATE-ADHD.

The consortium project INTEGRATE-ADHD compared administrative data on the presence of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with the results of a parent survey and a comprehensive clinical assessment based on the S3 guideline of the Association of the Scientific Medical Societies in Germany (AWMF). Due to the COVID-19 pandemic, the clinical assessment was carried out online. The article describes how a guideline-based clinical assessment of ADHD can be implemented in an online setting. A specially developed diagnostic matrix is presented to illustrate the assessment procedures and the diagnostic decision-making process. The matrix is intended to help the diagnostician to gain an overview of the numerous individual findings that have been collected using different assessment perspectives and methods (e.g. diagnostic interviews, rating scales, performance tests) in order to make a well-founded and transparent diagnostic decision. The consortium project INTEGRATE-ADHD has shown that an online assessment can be implemented in a guideline-compliant manner and allows a valid clinical decision. The diagnostic strategy is discussed with reference to international guidelines and recommendations for online diagnostics (e.g. aspects of feasibility, acceptability and safety of the assessment procedures). The challenges and opportunities of using online assessments in clinical practice are also described.