Diagnostic Symptoms Research Articles

Prevalence of adenomyosis in adolescents: diagnostic process and symptoms. Systematic review.

Adenomyosis is a uterine disorder commonly associated with painful menstrual cycles, abnormal uterine bleeding, and dyspareunia, which can significantly impact fertility, pregnancy outcomes and overall quality of life. Recent literature reports suggest that adenomyosis is increasingly being identified in adolescents, particularly in those presenting with severe dysmenorrhea and heavy menstrual bleeding. In this review we evaluate the frequency of adenomyosis diagnosis on imaging studies in relation to the occurrence of dysmenorrhea, pelvic pain and heavy menstrual bleeding (HMB). A thorough literature search was performed using PubMed, EMBASE and SCOPUS databases. It was confined to articles published from 1 January 2019, to 1 August 2024 and included only those available in English. Due to the very limited number of publications on this topic, an age range of 12-25 years was selected as the inclusion criteria. For articles that met the inclusion criteria, information regarding diagnosis on imaging and relation to the occurrence of symptoms was extracted. Five full-text articles were reviewed. Studies including adolescents and young women from 12-25 years of age who presented with HMB, pelvic pain, dysmenorrhea and an imaging-based diagnosis of adenomyosis. The prevalence of adenomyosis in this population ranged from 25 to 45%. It is crucial to consider adenomyosis in the differential diagnosis of adolescent girls presenting with dysmenorrhea, heavy menstrual bleeding, and pelvic pain. Dysmenorrhea was the most frequently reported symptom (from 81 to 100%) associated with imaging features of adenomyosis.

Olfactory Epithelium Infection by SARS-Cov-2: Possible Neuroinflammatory Consequences of COVID-19

Background: The loss of smell is a typical diagnostic symptom of coronavirus disease 2019 (COVID-19). This sensorial deprivation may be expressed as quantitative (anosmia or hyposmia) or qualitative (dysosmnia) alterations as a consequence of anatomical disturbances of the nasal epithelium structure. The olfactory system sends direct neuronal connections to brain structures that are involved in emotional processing, including deep temporal nuclei. This anatomical and functional feature may be related to the occurrence of emotional disorders among COVID-19 patients. Summary: We identify a possible sequence of events, from typical olfactory dysfunction that is associated with COVID-19 and caused by olfactory epithelium damage to disturbances in the quality of life and emotional state of infected patients that is attributable to possible neuroinflammatory processes. Sensorial deprivation causes deleterious actions on mood, negatively affecting quality of life. Olfactory dysfunction that is associated with COVID-19 occurs concurrently with psychological distress, symptoms of anxiety, and depressive disorders and impinges on self-perceived quality of life. Key messages: Changes in mood are certainly associated with multiple factors, including the environment and isolation, but the observation that the virus may penetrate the central nervous system through the olfactory bulb and the connection between the olfactory system and prefrontal and orbitofrontal cortices and the amygdala-hippocampus do not allow one to discard neural factors that are involved in the pathophysiology of emotional symptoms in post-COVID-19 patients. Behavioral symptoms of COVID-19 involve local olfactory actions and the participation of central neuronal systems.

SB7-H4 is a diagnostic biomarker in epithelial ovarian cancer and correlates to platinum resistance.

Ovarian cancer, with its high mortality rate among gynecological cancers, is often diagnosed late due to the lack of early diagnostic symptoms and biomarkers. The tumor immune microenvironment has become a focal point in cancer diagnostic and therapeutic research. Among these, B7-H4, a checkpoint protein, plays a crucial role in immune regulation and tumor suppression, contributing to immune evasion within the tumor microenvironment. This study aims to identify the concentration of soluble B7-H4(sB7-H4) in the plasma of patients with ovarian cancer and to evaluate its clinical significance. Through a comprehensive analysis involving enzyme-linked immunosorbent assay, immunohistochemistry, and multicolor immunofluorescence, we quantified sB7-H4 levels in patient plasma and ascites, correlating these findings with tissue expression and clinical outcomes. Results indicated a strong association between high sB7-H4 levels and advanced disease, surgical outcomes, lymphatic metastasis, and platinum resistance. When compared with traditional biomarkers CA125 and HE4, sB7-H4, especially in conjunction with these markers, enhances the diagnostic accuracy for epithelial ovarian cancer, offering insights into disease progression and therapeutic efficacy. This comprehensive analysis suggests that sB7-H4 is a promising biomarker for EOC, providing valuable insights into diagnosis, stage differentiation, treatment effectiveness, and prognosis.

Phenotype harmonization and analysis for The Populations Underrepresented in Mental illness Association Studies (the PUMAS Project).

The Populations Underrepresented in Mental illness Association Studies (PUMAS) project is attempting to remediate the historical underrepresentation of African and Latin American populations in psychiatric genetics through large-scale genetic association studies of individuals diagnosed with a serious mental illness [SMI, including schizophrenia (SCZ), schizoaffective disorder (SZA) bipolar disorder (BP), and severe major depressive disorder (MDD)] and matched controls. Given growing evidence indicating substantial symptomatic and genetic overlap between these diagnoses, we sought to enable transdiagnostic genetic analyses of PUMAS data by conducting phenotype alignment and harmonization for 89,320 participants (48,165 cases and 41,155 controls) from four cohorts, each of which used different ascertainment and assessment methods: PAISA n=9,105; PUMAS-LATAM n=14,638; NGAP n=42,953 and GPC n=22,624. As we describe here, these efforts have yielded harmonized datasets enabling us to analyze PUMAS genetic variation data at three levels: SMI overall, diagnoses, and individual symptoms. In aligning item-level phenotypes obtained from 14 different clinical instruments, we incorporated content, branching nature, and time frame for each phenotype; standardized diagnoses; and selected 19 core SMI item-level phenotypes for analyses. The harmonization was evaluated in PUMAS cases using multiple correspondence analysis (MCA), co-occurrence analyses, and item-level endorsement. We mapped >6,895 item-level phenotypes in the aggregated PUMAS data, in which SCZ (44.97%) and severe BP (BP-I, 31.53%) were the most common diagnoses. Twelve of the 19 core item-level phenotypes occurred at frequencies of > 10% across all diagnoses, indicating their potential utility for transdiagnostic genetic analyses. MCA of the 14 phenotypes that were present for all cohorts revealed consistency across cohorts, and placed MDD and SCZ into separate clusters, while other diagnoses showed no significant phenotypic clustering. Our alignment strategy effectively aggregated extensive phenotypic data obtained using diverse assessment tools. The MCA yielded dimensional scores which we will use for genetic analyses along with the item level phenotypes. After successful harmonization, residual phenotypic heterogeneity between cohorts reflects differences in branching structure of diagnostic instruments, recruitment strategies, and symptom interpretation (due to cultural variation).

Clinical utility and impact of a diagnostic oncology clinic.

74 Background: Oncologists have expertise in the work-up and management of patients with a suspected diagnosis of cancer. Patients diagnosed with cancer during acute care hospitalization often have poorer outcomes than those diagnosed as outpatients. For these patients, time to appropriate cancer diagnosis, management of cancer-related symptoms, and timely initiation of treatment are key to improved outcomes. Outpatient new diagnosis clinics may improve patient outcomes by improving access to subspecialty care. Methods: Patients seen by the inpatient oncology consult service over a two-month period (8/1/23-8/31/23 and 10/1/23-10/31/23) were included in this analysis. Inpatient management of disease was defined as an invasive procedure to treat the disease or a complication of the disease, initiation of systemic anti-neoplastic treatment, or radiation therapy. Surveys regarding perceived barriers to timely outpatient oncology care were distributed to oncology fellows and attendings. A Diagnostic Oncology Clinic (DOC) was started 2/1/2024 with the goal to decrease time to first outpatient oncology by a median of 12 days to less than 10 days, decrease hospital length of stay (LOS), improve outpatient management of cancer related symptoms, and improve time to treatment. Results: A total of 95 patients were evaluated. 74 (78%) of patients had a new diagnosis of cancer. Most patients had gastrointestinal cancer (n = 40, 42%) or thoracic cancer (n = 24, 25%). 51 patients (53.7%) had metastatic disease. 48 patients (50.5%) had an ECOG performance status of 0 or 1 at the time of consultation. The median hospital LOS was 11 days (IQR, 5-19). 13 patients (13.7%) had an inpatient PET scan and 43 patients (45.3%) required inpatient management of their disease or disease-related complication. 57 patients (60%) were discharged home, 21 (22%) to an extended care facility, and 17 (18%) expired or transitioned to hospice. 35 patients (37%) were seen as new outpatients with a median time to visit of 12 days (IQR 7-20). The median time to initiation of anti-neoplastic therapy as an outpatient was 24 days (IQR 18-33). There were 29 survey respondents corresponding to a response rate of 69%. 16 (55%) felt that about half the time or less patients will have timely follow-up with an oncologist after discharge, and 19 (65%) felt half the time or less patients will have appropriate cancer-related symptom management after discharge. Conclusions: Most patients seen by the inpatient oncology consult service with a new diagnosis of cancer have advanced and symptomatic disease. Historically, there has been significant time to outpatient care and cancer-specific management led by an oncologist. Creation of a diagnostic oncology clinic may shift some diagnostic testing and symptom management from the inpatient to outpatient setting, decrease time to first outpatient visit, and improve provider workflow for a vulnerable patient population. Analysis of this intervention is ongoing.

Clinical correlates of irritability, anger, hostility, and aggression in posttraumatic stress disorder.

Although irritability, anger, and aggression are diagnostic symptoms of posttraumatic stress disorder (PTSD), their clinical significance and associations with psychopathology remain unclear. In a sample of community adults with probable PTSD (n = 151), we measured irritability, physical aggression, verbal aggression, anger, and hostility with the Brief Irritability Test and the Brief Aggression Questionnaire. Participants' psychopathology, including depression, attention deficit and hyperactivity disorder (ADHD), psychotic-like experiences, insomnia, as well as suicidal behaviors were also assessed. Correlation analysis showed that irritability and anger were modestly related to all PTSD dimensions; physical aggression was related to avoidance, negative alterations in cognitions and mood (NACM), and hyperarousal; hostility was related to reexperiencing, NACM, and hyperarousal; while verbal aggression was not significantly related to any PTSD dimensions. After adjustment for trauma exposure and PTSD symptoms, irritability was associated with almost all psychopathology and suicidal behaviors, however, anger, hostility, and aggression were sparsely related to some psychopathology or suicidal behaviors. Particularly, anger was only related to ADHD and insomnia. Latent profile analysis based on PTSD, irritability, anger, hostility, and aggression indicated two discrete subgroups: the high severity group (33.8%) and the low severity group (66.2%), with high severity group reporting higher rates of comorbidity and suicidal behaviors. The findings support irritability, aggression, anger, and hostility as separate constructs; moreover, irritability, anger, and aggression should be independently measured in PTSD. Our findings also suggest the significance of irritability as a separate hallmark of PTSD and the need to incorporate PTSD dimensions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exercise interventions for mitigating the persistent side effects of COVID-19

AbstractFollowing infection with Sars-Cov2, a significant proportion of patients suffer from long-term symptoms afflicting many of the body’s systems. The understanding of these sequelae is still evolving, and as of the present diagnostic techniques and symptom management are still developing to effectively combat the wide variety of long-term symptoms. Many of the long-term symptoms observed following cases of COVID-19 are present in other chronic illnesses, and exercise intervention has been observed as a potent therapy for the alleviation of many of those symptoms. However, the effects of exercise regimens in the treatment of long COVID symptoms are not well documented, and there is little information regarding the nature of those interventions. A review of the available literature was conducted to determine the nature of the post-acute sequelae of COVID-19 (PASC) and identify the potential impact exercise intervention could have in alleviating these sequelae. Overall, intensity and modality of treatment are paramount to the success of a multifaceted exercise intervention to provide the greatest benefits to patients suffering from PASC. There are some limitations to the provision of exercise therapy as an intervention for COVID-19 patients, but nonetheless the benefits of exercise are sufficient that further research is implicated.

Feasibility of Using Wavelet Analysis and Machine Learning Method in Technical Diagnosis of Car Seats

This paper presents the results of preliminary research aimed at developing a method for rapid, noncontact diagnostics of the electric drive of car seats. The method is based on the analysis of acoustic signals produced during the operation of the drive. Pattern recognition and machine learning processes were used in the diagnosis. A method of feature extraction (diagnostic symptoms) using wavelet decomposition of acoustic signals was developed. The discriminative properties of a set of diagnostic symptoms were tested using the “Classification Learner” application available in MATLAB. The obtained results confirmed the usefulness of the developed method for the technical diagnostics of car seats.

Acylcarnitines metabolism in depression: association with diagnostic status, depression severity and symptom profile in the NESDA cohort.

Acylcarnitines (ACs) are involved in bioenergetics processes that may play a role in the pathophysiology of depression. Previous genomic evidence identified four ACs potentially linked to depression risk. We carried forward these ACs and tested the association of their circulating levels with Major Depressive Disorder (MDD) diagnosis, overall depression severity and specific symptom profiles. The sample from the Netherlands Study of Depression and Anxiety included participants with current (n = 1035) or remitted (n = 739) MDD and healthy controls (n = 800). Plasma levels of four ACs (short-chain: acetylcarnitine C2 and propionylcarnitine C3; medium-chain: octanoylcarnitine C8 and decanoylcarnitine C10) were measured. Overall depression severity as well as atypical/energy-related (AES), anhedonic and melancholic symptom profiles were derived from the Inventory of Depressive Symptomatology. As compared to healthy controls, subjects with current or remitted MDD presented similarly lower mean C2 levels (Cohen's d = 0.2, p ≤ 1e-4). Higher overall depression severity was significantly associated with higher C3 levels (ß=0.06, SE = 0.02, p = 1.21e-3). No associations were found for C8 and C10. Focusing on symptom profiles, only higher AES scores were linked to lower C2 (ß=-0.05, SE = 0.02, p = 1.85e-2) and higher C3 (ß=0.08, SE = 0.02, p = 3.41e-5) levels. Results were confirmed in analyses pooling data with an additional internal replication sample from the same subjects measured at 6-year follow-up (totaling 4141 observations). Small alterations in levels of short-chain acylcarnitine levels were related to the presence and severity of depression, especially for symptoms reflecting altered energy homeostasis. Cellular metabolic dysfunctions may represent a key pathway in depression pathophysiology potentially accessible through AC metabolism.

Diagnostic Signs and Symptoms of Cyanocobalamin Deficiency at Rural Setting in India: Novel Method of Supplementation.

Cyanocobalamin or B12 deficiency is common in the Indian population, and responsible for anemia. Various clinical manifestations include central nervous system and cardiovascular manifestations, secondary to a rise in serum homocysteine levels. In a routine outpatient department at Bawaskar Hospital and Clinical Research Centre, Mahad, patients with suspected clinical signs and symptoms suggestive of cyanocobalamin deficiency were studied in detail regarding their dietary habits, serum hemoglobin, B12, and homocysteine levels. A total of 1,992 (female 1,009, 50.75%) were clinically examined in detail. Of these, 945 (49.94%), 999 (50.17%), and 48 (2.40%) were strict vegetarians, both vegetarian and nonvegetarian, and strict nonvegetarians, respectively. Common occupations associated with B12 deficiency include 666 (33.4%) housewives, 396 (19.9%) service workers, 316 (15.9%) businesspeople, 180 (9%), and 198 (9.9%) retired and industrial populations, respectively. Clinical manifestations include recurrent scalp hair loss in 268 (13.5%), poor memory in 240 (12%), tingling and numbness in 200 (10%), and generalized weakness in 387 (19.4%) patients. Additionally, 541 (27.15%) patients had pigmentation of the nail bed, knuckles, oral mucosa, and tongue, while 237 (10.81%) suffered from hypertension and ischemic heart disease. During the process of preparation of vegetarian and nonvegetarian food, there is a 30-48% reduction in vitamin content. Supplementation of vitamin by adding table salt to food on a plate at the time of eating improves the vitamin level in the blood. In the absence of laboratory investigations in rural settings, clinical signs and symptoms are helpful in detecting B12 deficiency. Directly adding vitamin powder, similar to table salt, to cooked food on the plate improved blood vitamin levels.

The association between dietary intake of fats and transient global amnesia (TGA)

ABSTRACT Background: Different types of dietary fat may influence memory and cognitive functions. This study aimed to investigate the association between dietary fat intake and transient global amnesia (TGA). Methods: This case–control study was conducted using Persian Sabzevar cohort data on 258 individuals with TGA and 520 individuals without amnesia in Sabzevar Iran. The food frequency questionnaire (FFQ) was used to assess the intake of dietary fats of the participants. All study participants were screened for TGA by a neurologist and their status was determined based on the diagnostic symptoms defined by the Kaplan and Hodges criteria. Results: There was an inverse association between the risk of TGA and dietary intake of alpha-linolenic acid (ALA) (OR = 0.94, CI95%:0.88-0.99, P = 0.01). Also, a positive association was observed between TGA and dietary intake of n-6 fatty acids (OR = 1.18, CI 95%: 1.04-1.33, P = 0.01). The results remained significant after adjustment for age, sex, education, job, marital status, physical activity, BMI, and calorie intake. Conclusion: Omega-3 fatty acids may have beneficial effects; however, omega-6 fatty acids may have adverse effects on the risk of amnesia. Further longitudinal studies are warranted.

Neural substrates of predicting anhedonia symptoms in major depressive disorder via connectome-based modeling.

Anhedonia is a critical diagnostic symptom of major depressive disorder (MDD), being associated with poor prognosis. Understanding the neural mechanisms underlying anhedonia is of great significance for individuals with MDD, and it encourages the search for objective indicators that can reliably identify anhedonia. A predictive model used connectome-based predictive modeling (CPM) for anhedonia symptoms was developed by utilizing pre-treatment functional connectivity (FC) data from 59 patients with MDD. Node-based FC analysis was employed to compare differences in FC patterns between melancholic and non-melancholic MDD patients. The support vector machines (SVM) method was then applied for classifying these two subtypes of MDD patients. CPM could successfully predict anhedonia symptoms in MDD patients (positive network: r = 0.4719, p < 0.0020, mean squared error = 23.5125, 5000 iterations). Compared to non-melancholic MDD patients, melancholic MDD patients showed decreased FC between the left cingulate gyrus and the right parahippocampus gyrus (p_bonferroni = 0.0303). This distinct FC pattern effectively discriminated between melancholic and non-melancholic MDD patients, achieving a sensitivity of 93.54%, specificity of 67.86%, and an overall accuracy of 81.36% using the SVM method. This study successfully established a network model for predicting anhedonia symptoms in MDD based on FC, as well as a classification model to differentiate between melancholic and non-melancholic MDD patients. These findings provide guidance for clinical treatment.

Symptom-based survey diagnoses may serve to identify more homogenous sub-groups of fatigue and postviral diseases

ABSTRACT Background and objective A range of diagnostic criteria are applied for the heterogenous patient group with fatigue or postviral fatigue syndromes with or without Post Exertional Malaise (PEM). We explored whether DePaul Symptom Questionnaires (DSQ) based symptoms reported in an open online survey called MECOV, served to identify more homogenous sub-groups. Method Patients living in Norway were invited to participate in an open online survey in 2022. The questionnaire covered diagnostic history, SARS-CoV-2, general health, RAND-36 and DSQ symptoms, treatments and background information. Results 2362 patients responded to the survey. 1904 respondents had Fatigue or Postviral disease. 1026 fulfilled CCC criteria with multi-dimensional PEM and 14 h recovery period or ICC criteria for ME. 384 fulfilled IOM/NICE or CCC criteria with only less rigid PEM, while 494 respondents fulfilled only broad fatigue and Fukuda criteria. Self-reported health status, number of treatments tried, and reported effect of activity-based treatments varied significantly across the three groups. Conclusion DSQ symptom-based survey diagnoses served to identify more homogenous subgroups of patients with Fatigue or Postviral diseases (ME and CFS) and may serve as a valid supplement to standard medical examinations. Symptoms, treatment, management strategies and further research may gain from being tailored to the three sub-groups.

Assessment of metabolomic variations among individuals returning to plain areas after exposure to high altitudes: a metabolomic analysis of human plasma samples with high-altitude de-acclimatization syndrome.

High altitude de-acclimatization (HADA) is gradually becoming a public health concern as millions of individuals of different occupations migrate to high-altitude areas for work due to economic growth in plateau areas. HADA affects people who return to lower elevations after exposure to high altitudes. It causes significant physiological and functional changes that can negatively impact health and even endanger life. However, uncertainties persist about the detailed mechanisms underlying HADA. We established a population cohort of individuals with HADA and assessed variations in metabolite composition. Plasm samples of four groups, including subjects staying at plain (P) and high altitude (H) as well as subjects suffering from HADA syndrome with almost no reaction (r3) and mild-to-moderate reaction (R3) after returning to plain from high altitude, were collected and analyzed by Liquid Chromatography-Mass Spectrometry metabolomic. Multivariate statistical analyses were used to explore significant differences and potential clinical prospect of metabolites. Although significantly different on current HADAS diagnostic symptom score, there were no differences in 17 usual clinical indices between r3 and R3. Further multivariate analyses showed isolated clustering distribution of the metabolites among the four groups, suggesting significant differences in their metabolic characteristics. Through K-means clustering analysis, we identified 235 metabolites that exhibited patterns of abundance change consistent with phenotype of HADA syndrome. Pathway enrichment analysis indicated a high influence of polyunsaturated fatty acids under high-altitude conditions. We compared the metabolites between R3 and r3 and found 107 metabolites with differential abundance involved in lipid metabolism and oxidation, suggesting their potential role in the regulation of oxidative stress homeostasis. Among them, four metabolites might play a key role in the occurrence of HADA, including 11-beta-hydroxyandrosterone-3-glucuronide, 5-methoxyindoleacetate, 9,10-epoxyoctadecenoic acid, and PysoPC (20:5). We observed the dynamic variation in the metabolic process of HADA. Levels of four metabolites, which might be provoking HADA mediated through lipid metabolism and oxidation, were expected to be explore prospective indices for HADA. Additionally, metabolomics was more efficient in identifying environmental risk factors than clinical examination when dramatic metabolic disturbances underlying the difference in symptoms were detected, providing new insights into the molecular mechanisms of HADAS.

Evaluation of the 2021 ESC recommendations for family screening in hereditary transthyretin cardiac amyloidosis.

The 2021 European Society of Cardiology (ESC) screening recommendations for individuals carrying a pathogenic transthyretin amyloidosis variant (ATTRv) are based on expert opinion. We aimed to (i) determine the penetrance of ATTRv cardiomyopathy (ATTRv-CM) at baseline; (ii) examine the value of serial evaluation; and (iii) establish the yield of first-line diagnostic tests (i.e. electrocardiogram, echocardiogram, and laboratory tests) as per 2021 ESC position statement. We included 159 relatives (median age 55.6 [43.2-65.9] years, 52% male) at risk for ATTRv-CM from 10 centres. The primary endpoint, ATTRv-CM diagnosis, was defined as the presence of (i) cardiac tracer uptake in bone scintigraphy; or (ii) transthyretin-positive cardiac biopsy. The secondary endpoint was a composite of heart failure (New York Heart Association class ≥II) and pacemaker-requiring conduction disorders. At baseline, 40/159 (25%) relatives were diagnosed with ATTRv-CM. Of those, 20 (50%) met the secondary endpoint. Indication to screen (≤10 years prior to predicted disease onset and absence of extracardiac amyloidosis) had an excellent negative predictive value (97%). Other pre-screening predictors for ATTRv-CM were infrequently identified variants and male sex. Importantly, 13% of relatives with ATTRv-CM did not show any signs of cardiac involvement on first-line diagnostic tests. The yield of serial evaluation (n = 41 relatives; follow-up 3.1 [2.2-5.2] years) at 3-year interval was 9.4%. Screening according to the 2021 ESC position statement performs well in daily clinical practice. Clinicians should adhere to repeating bone scintigraphy after 3 years, as progressing to ATTRv-CM without signs of ATTRv-CM on first-line diagnostic tests or symptoms is common.

Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study.

Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients' quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA's effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA's potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA's role in enhancing patient engagement and disease management through a patient-centered digital solution. The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios.

Autism Symptom Presentation and Hierarchical Models of Intelligence.

There is a substantial history studying the relationship between general intelligence and the core symptoms of autism. However, a gap in knowledge is how dimensional autism symptomatology associates with different components of clinically-relevant hierarchical models of intelligence. We examined correlations between autism diagnostic symptom magnitude (Autism Diagnostic Observational Schedule; ADOS) and a hierarchical statistical model of intelligence. One autistic cohort was tested on the fourth edition of Wechsler Intelligence Scale for Children (WISC-IV; N = 131), and another on the fifth edition (WISC-V; N = 83). We anticipated a convergent pattern of results between cohorts. On WISC-IV, ADOS scores were correlated significantly with g and three out of four intermediate factor scores, which was a broader pattern of correlations than anticipated from the literature. In the WISC-V cohort, only one intermediate factor correlated significantly with the ADOS; correlations with g and the other intermediate factors were less statistically certain. ADOS-factor correlations were larger in the WISC-IV than WISC-V cohort; this difference was significant at the 90% level. WISC-IV shows dimensional relationships with ADOS at multiple points in the hierarchical model of intelligence. Moreover, the current results provide evidence that relationship between core autism symptomatology and the construct of general intelligence may depend on how intelligence is measured. Known cohort effects in the relationship between categorical autism diagnosis and general intelligence have previously been attributed to changes in autism diagnostic practices. To our knowledge, this is the first evidence that differing versions of IQ tests may be implicated.

Prognostic Value of B-Type Natriuretic Peptide in Hospitalized Patients with Pneumonia

Background: Pneumonia is a major medical problem and is foremost infectious cause of death in developed countries. A rapid and reliable predictor might aid physicians in identifying hospitalization, intensive care unit admission, and treatment changes. B-type natriuretic peptide (BNP) has consistently been observed to improve the diagnosis and management of hospitalized patients with pneumonia. This investigation aimed to study the importance of BNP in the assessment of severity of pneumonia in a tertiary care center in South India. Subjects and Methods: A hospital-based observational research was carried out on patients admitted during the period of September 2016 to July 2018 with sample size of 108. All patients satisfying the inclusion criteria were enrolled. Detailed clinical history and physical examination findings were noted. Diagnostic criteria symptoms were recorded following the standard protocol. BNP was measured using the double-antibody sandwich enzyme-linked immunosorbent assay. The statistical analyses were done using the statistical software R version 3.6.3 and MS Excel. Results: Out of 108 patients, 48 (44.44%) were female and 60 (55.56%) were male. Of these, 45 (41.67%) patients identified with community-acquired pneumonia, 27 (25%) with health-care-associated pneumonia, 26 (24.07%) with aspiration pneumonia, and 10 (9.26%) with pneumonia with comorbid conditions. BNP levels among survivors and nonsurvivors were 193.52 ± 124.93 and 413.08 ± 149.38 pg/ml, respectively. The total mortality was 13/108 (12.04%). Out of 13 patients, 12 (92.31%) nonsurvivors had BNP level ≥200 pg/ml and 1 (7.69%) had 100–200 pg/ml. Conclusion: BNP levels could be a useful single prognostic marker for pneumonia. BNP levels correlated with the clinical severity of pneumonia.

Medicine in the 21st Century: How Not to Lose the Art of Healing?

In our time of advanced technologies, the Internet, and the enormous acceleration of all areas of humanitarian activity, medical scientists make outstanding discoveries and innovations that revolutionize diagnostic approaches and treatment options, improve patient care, and enrich the way to a healthier world. Is there still a place for the art of medicine in the era of innovations and artificial intelligence? Although modern technology in the field of medicine with computerization of every aspect (including electronic medical records, laboratory data entry, images, patients' monitoring systems, etc.), young physicians, while embracing that innovation, should be trained in the development of clinical thinking and the establishment of personalized connections to the patients. Young physicians should be taught to adopt the ability to see, hear, and feel a patient's problems, formulate optimal management, and be empathetic to the patient's emotions and suffering. Communication skills are a key to successful medical practice and a part of "the Introduction to Clinic" course in almost all medical schools, but a substantial lack of time in clinical settings creates new challenges for communication between medical students, clinical teachers, and patients in medical schools. In many areas around the world, including Ukraine, this problem has been aggravated by wars, epidemics, pandemics, and natural disasters. At the same time, developing clinical observational skills remains an integral part of medical education and the basis of medical art. The art of a careful physical exam should not be lost behind a computer screen. Dnipro State Medical University has traditions of integrating centuries-old world historical experiences of teaching the art of healing into the philosophical concept of forming the critical clinical thinking of medical students. Our medical school has incorporated "diagnosing the canvas" into its curriculum. A thematic gallery of diagnostic symptoms and signs from great artists of all times and peoples has been created, expanding the young physicians' educational horizons in clinical thinking, empathy, and mercy.

Psychometric Evaluation of the Thai Male Depression Risk Scale (MDRS-TH)

Previous studies have reported that males frequently suffer from major depression. However, due to the norms of masculine roles, in which emphasis is placed in displaying strength, invulnerability, and control, the ways that some men exhibit depression may differ from traditional diagnostic symptoms of major depressive disorder. To this end, the Male Depression Risk Scale (MDRS) has been developed in order to better identify those men, who experience low moods and are at risk for suicide. This study evaluated the psychometric properties of the Thai version of the MDRS (MDRS-TH). A cross-sectional study was conducted with 600 participants, who were recruited through social media (male N=300). The average age was 38.74 years. About half of the participants were married (51.5%). The majority identified themselves as Buddhist (94.66%) and had completed postgraduate education (31.16%). The samples had a variety of occupations, including farmer, employee, student, retired, own business, etc. The data were analyzed using confirmatory factor analysis, Cronbach's alpha coefficient, and criterion-related validity using Pearson's correlation. The overall analysis (N=600) found that the MDRS-TH was consistent with the empirical data (CFI=0.918, TLI=0.905, SRMR=0.05, and RMSEA=0.05). The final model consisted of 5 components: 1) emotional suppression, 2) alcohol use, 3) anger &amp; aggression, 4) somatic symptoms, and 5) risk-taking behaviors. The internal consistency of the MDRS-TH total score was 0.89, and the correlation criterion-related validity with the PHQ-9 was r=0.77. The results supported the fact that the MDRS-TH is a useful screening tool. Utilizing the MDRS-TH in primary care settings may assist to identify those men who are at risk for male-specific symptoms of depression so that early identification and intervention can be facilitated. In future studies, the generalizability of the scale would be strengthened if efforts to improve cross-cultural validation involving different cultural groups in Thailand were prioritized.