Differences In Symptom Severity Research Articles

Occurrence and Relative Prevalence of Fungal Pathogens on Durum Wheat

An assessment of six Bulgarian and six foreign varieties of durum wheat was carried out for the occurrence of foliar diseases caused by fungal pathogens on a natural background. Field experiments were performed at two locations (Chirpan and Sofia) situated in different climatic zones of Bulgaria for six successive growing seasons (2012 – 2017) with exception of 2015 in Chirpan. The results of this research showed that the population of foliar pathogens of durum wheat was heterogeneous and included 13 fungal species. Some differences in symptom severity and relative proportion of the pathogens among varieties and years and between locations were found. Of the leaf spotting fungi, the causal agent of tan spot (Pyrenophora tritici-repentis) was the most prevalent in both prospected areas. The fungi belonging to Septoria leaf blotch complex (Parastagonospora avenae f. sp. triticea, Pa. nodorum and Zymoseptoria tritici) and newly found species Phaeophleospora sp. were more frequently isolated from leaf samples taken in Sofia location. Monographella nivalis and Cladosporium herbarum had contribution to the leaf spotting in both surveyed locations in some of the studied years. Cochliobolus sativus occurred only occasionally. Of the three rust fungi, Puccinia striiformis f. sp. striiformis was the predominant species. The first record of yellow rust was made in 2013. It was the most common disease in both localities in 2014 and 2016 due to warmer winters, which favored the survival of YR. The race analysis performed in Global Rust Reference Center revealed the appearance and distribution of a new race (Warrior) in Bulgaria. The weather conditions were exceptionally favourable for the development of certain diseases in some years. In this relation the influence of some elements of the climate on the pathogen prevalence was discussed. Except the weather other factors like cultivar characteristics, inoculum level, soil type, and predecessor played a role in changing spectrum of phytopathogenic fungi. In common the level of fungal diseases in Sofia region was higher compared to Chirpan. The studied varieties differed in their susceptibility to fungal diseases.

Emotion Regulation in Social Anxiety Disorder: Reappraisal and Acceptance of Negative Self-beliefs

BackgroundSocial anxiety disorder (SAD) is characterized by negative self-beliefs (NSBs) that are thought to maintain symptom severity—at least in part—by impairing emotion regulation. Few studies to date have investigated the neural basis of emotion regulation during NSBs in SAD. Moreover, different regulation strategies have not been directly compared, leaving open questions about the generality of emotion regulation deficits in SAD. MethodsPatients with SAD (n = 113) and healthy control subjects (n = 35) underwent functional magnetic resonance imaging while reacting to NSBs or attempting to downregulate negative emotions occasioned by NSBs using either reappraisal (reinterpreting negative beliefs) or acceptance (nonjudgmentally experiencing thoughts and emotions). Ratings of negative emotion were collected after each trial. ResultsWhen cued to do so, patients with SAD were able to downregulate negative emotions using both reappraisal and acceptance and demonstrated effective recruitment of frontoparietal regulatory regions. Patients with SAD demonstrated greater activation of default mode network and somatomotor regions for the react versus accept contrast. Both groups demonstrated reductions in frontoparietal and default mode network activation during acceptance relative to reappraisal. Greater SAD symptom severity was associated with lower activation in frontoparietal regions during both regulation conditions. ConclusionsThere were no group differences in frontoparietal recruitment during two distinct emotion regulation strategies. However, individual differences in symptom severity within the SAD group were associated with frontoparietal regulation–related activation. Patients with SAD were differentiated from control subjects in default mode network recruitment patterns, suggesting that acceptance may be a useful task condition for revealing altered neural activity in SAD.

Etiology and Clinical Presentation of Concussion: An Age- and Sex-matched Case Series

Abstract Purpose Differential patterns of clinical presentation in concussion have been explored previously based on etiology (e.g., sport vs. non-sport) and may be affected by biomechanical, pathophysiological, and psychological factors. The purpose of the study was to compare neurocognitive performance and symptom presentation across different etiologies in concussed patients. Methods 36 concussion patients, 12 slip-and-fall (SNF) were age- and sex-matched with motor vehicle accident (MVA) and sport-related concussions (SRC) (20.3±1.5 years; 4 males; 8 females per group). They were evaluated ≤ 2 weeks (7.2±3.7 days) after their injury. Patients completed medical history, an Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), and Post-Concussion Symptom Scale (PCSS) at initial visit. Descriptive statistics, a series of Kruskal-Wallis H Tests, χ² tests and one-way ANOVAs were performed using SPSS 24. Results The three groups exhibited no differences in verbal memory (p=0.11), visual memory (p=0.10), visual motor speed (p=0.19), or reaction time (p=0.19) composites. There were no differences in symptom severity (p=0.69) or symptom count (p=0.99) or the cognitive-migraine-fatigue (p=0.69), somatic (p=0.26), affective (p=0.92), or sleep (p=0.73) symptom clusters. Comorbidities (i.e., learning disorder, previous concussion, migraine, seizure, psychological condition, or motion sickness) were not significantly different across groups. Conclusion No significant differences were found on ImPACT or PCSS across etiologies. When controlling for comorbidities and demographic variables, these groups appear similar at the initial evaluation. Future research will focus on practice patterns and clinical outcomes.

Exploring cortical predictors of clinical response to electroconvulsive therapy in major depression.

Electroconvulsive therapy (ECT) is a rapid and highly effective treatment option for treatment-resistant major depressive disorder (TRD). The neural mechanisms underlying such beneficial effects are poorly understood. Exploring associations between changes of brain structure and clinical response is crucial for understanding ECT mechanisms of action and relevant for the validation of potential biomarkers that can facilitate the prediction of ECT efficacy. The aim of this explorative study was to identify cortical predictors of clinical response in TRD patients treated with ECT. We longitudinally investigated 12 TRD patients before and after ECT. Twelve matched healthy controls were studied cross sectionally. Demographical, clinical, and structural magnetic resonance imaging data at 3T and multiple cortical markers derived from surface-based morphometry (SBM) analyses were considered. Multiple regression models were computed to identify predictors of clinical response to ECT, as reflected by Hamilton Depression Rating Scale (HAMD) score changes. Symptom severity differences pre-post-ECT were predicted by models including demographic data, clinical data and SBM of frontal, cingulate, and entorhinal structures. Using all-subsets regression, a model comprising HAMD score at baseline and cortical thickness of the left rostral anterior cingulate gyrus explained most variance in the data (multiple R2 = 0.82). The data suggest that SBM provides powerful measures for identifying biomarkers for ECT response in TRD. Rostral anterior cingulate thickness and HAMD score at baseline showed the greatest predictive power of clinical response, in contrast to cortical complexity, cortical gyrification, or demographical data.

Limb Perfusion During Exercise Assessed by Contrast Ultrasound Varies According to Symptom Severity in Patients with Peripheral Artery Disease

In patients with peripheral artery disease (PAD), the severity of symptoms correlates poorly with ankle-brachial index (ABI). The aim of this study was to test the hypothesis that limb perfusion assessed using contrast-enhanced ultrasound (CEU) during contractile exercise varies according to functional class in patients with PAD, particularly those with ABIs in the 0.4 to 0.6 range whose symptoms vary widely. Bilateral quantitative CEU perfusion imaging of the calf was performed in normal control subjects (n=10) and patients with PAD who had at least one limb with a moderately reduced ABI (0.4-0.6; n=17). Imaging was performed at rest and immediately after 30sec of modest periodic (0.3-Hz) plantar flexion (10W). In patients with PAD, Rutherford symptom classification for each limb varied widely, including in limbs with ABIs of 0.4 to 0.6 (n=6 with mild or no symptoms, n=14 with moderate to severe symptoms). CEU perfusion imaging parameters at rest were similar between control subjects and patients with PAD irrespective of ABI. In normal control subjects, limb flow increased on average by>20-fold after only 30sec of moderate exercise. In patients with PAD, muscle exercise perfusion for all limbs was reduced compared with control subjects and decreased according to the severity of ABI reduction, primarily from reduced microvascular flux rate. Even limbs with ABIs > 0.9 in patients with PAD had lower exercise perfusion than in control subjects (P=.03). In subjects with PAD, exercise perfusion was lower in those with moderate to severe versus mild symptoms when analyzed for all limbs (median, 30 IU/sec [interquartile range (IQR), 21-52 IU/sec] vs 84 IU/sec [IQR, 36-177 IU/sec]; P=.01) and limbs with ABIs of 0.4 to 0.6 (median, 26 IU/sec [IQR, 14-41 IU/sec] vs 54 IU/sec [IQR, 31-105 IU/sec]; P=.05). In patients with PAD, CEU exercise perfusion imaging detects differences in limb muscle perfusion that are likely to be responsible for differences in symptom severity and can detect the flow abnormalities from microvascular dysfunction even in limbs with normal ABIs.

Disease stage dependency of motor and non-motor fluctuations in Parkinson's disease.

Recent data suggested a decrease in non-motor fluctuations in late-stage Parkinson's disease (PD), but systematic data on non-motor fluctuations over the whole disease course are mainly lacking. We performed a meta-analysis of two studies with very similar cross-sectional cohort designs, namely the German multicenter Non Motor Fluctuation in PD study and the Swedish part of the European multicenter study Care for Late Stage Parkinsonism. We included only patients with documented motor fluctuations in the analyses. Disease stage was estimated using the Hoehn and Yahr score, motor symptoms using the Unified PD Rating Scale part III motor score and non-motor symptom (NMS) fluctuations using the modified version of the NMS scale assessing a broad range of NMS in motor On and Off state. We included 101 patients (55% men; median age: 71 (interquartile range, IQR 65-78) years with Hoehn and Yahr stages ranging from 1 to 5 [median (IQR) 3.0 (2.0-4.0); distribution of patients in Hoehn and Yahr stages was n = 42 (42%) in stages 2/3 and n = 48 (48%) in stages 4/5]. We found a clear dependency of non-motor burden on Hoehn and Yahr stage with increasing symptom severity, but decreasing fluctuation amplitudes for motor and NMS (difference of symptom severity between On and Off state) with disease stage progression. Indeed, in Hoehn and Yahr stage 5, we did not detect significant NMS fluctuations. Multivariate regression with major demographic and clinical covariates confirmed these results. In conclusion, NMS fluctuations showed a similar disease stage dependency as observed for motor fluctuations with decreasing fluctuation amplitude with disease progression.

A single nucleotide change in the overlapping MP and CP reading frames results in differences in symptoms caused by two isolates of Youcai mosaic virus.

Two isolates of Youcai mosaic virus (YoMV) were obtained, and their full-length genomic sequences were determined. Full-length infectious cDNA clones of each isolate were generated in which the viral sequence was under the control of dual T7 and 35S promoters for both in vitro transcript production and agro-infiltration. Comparison of the predicted amino acid sequences of the encoded proteins revealed only four differences between the isolates: three in the RNA-dependent RNA polymerase (RdRp) (V383I and M492I in the 125-kDa protein and T1245M in the 182-kDa protein); and one in the overlapping region of the movement protein (MP) and coat protein (CP) genes, affecting only the N-terminal domain of CP (CP M17T). One of the isolates caused severe symptoms in Nicotiana benthamiana plants, while the other caused only mild symptoms. In order to identify the amino acid residues associated with symptom severity, chimeric constructs were generated by combining parts of the two infectious YoMV clones, and the symptoms in infected plants were compared to those induced by the parental isolates. This allowed us to conclude that the M17T substitution in the N-terminal domain of CP was responsible for the difference in symptom severity. The M17T variation was found to be unique among characterized YoMV isolates. A difference in potential post-translational modification resulting from the presence of a predicted casein kinase II phosphorylation site only in the CP of isolate HK2 may be responsible for the symptom differences.

Longitudinal stability of reading profiles in individuals with higher functioning autism.

The reading difficulties of individuals with autism spectrum disorders have been established in the literature, with particular attention drawn toward reading comprehension difficulties. Recent papers have highlighted the heterogeneous nature of reading abilities in this population by utilizing statistical methods that allow for investigations of unique reading profiles. This article extends this literature by investigating reading profiles longitudinally, to investigate the stability of reader profiles across time. Latent profile and transition analyses were conducted to establish categorically distinct reading profiles at two time points, 30 months apart. This study also examined whether age and autism symptom severity were related to the profiles at each time point. Finally, transitions between profiles at each time point were identified. Age did not predict profile membership, but there were significant differences in symptom severity that were largely stable over time. Results indicate that heterogeneous reading profiles exist within the autism population, ranging from average reading ability to severe difficulties across different reading subskills. The data from this study demonstrate that reading profiles of children and adolescents with autism spectrum disorders shift when examined across time.

Helpful ways providers can communicate about persistent medically unexplained physical symptoms

BackgroundCommunication between patients and providers about persistent “medically unexplained” physical symptoms (MUS) is characterized by discordance. While the difficulties are well documented, few studies have examined effective communication. We sought to determine what veterans with Gulf War Illness (GWI) perceive as the most helpful communication from their providers. Veterans with GWI, a type of MUS, have historically had complex relationships with medical providers. Determining effective communication for patients with particularly complex relationships may help identify the most critical communication elements for all patients with MUS.MethodsTwo hundred and-ten veterans with GWI were asked, in a written questionnaire, what was the most useful thing a medical provider had told them about their GWI. Responses were coded into three categories with 10 codes.ResultsThe most prevalent helpful communication reported by patients was when the provider offered acknowledgement and validation (N = 70). Specific recommendations for managing GWI or its symptoms (N = 48) were also commonly reported to be helpful. In contrast, about a third of the responses indicated that nothing about the communication was helpful (N = 63). There were not differences in severity of symptoms, disability or healthcare utilization between patients who found acknowledgement and validation, specific recommendations or nothing helpful.ConclusionsPrevious research has documented the discord between patients and providers regarding MUS. This study suggests that most patients are able to identify something helpful a provider has said, particularly acknowledgement and validation and specific treatment recommendations. The findings also highlight missed communication opportunities with a third of patients not finding anything helpful.

SA85 - PHARMACOGENOMICS OF METHYLPHENIDATE TREATMENT OF DANISH CHILDREN WITH ADHD

Background The first choice drug for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Denmark and several other countries is Methylphenidate (MPH). More than 30% of the children treated with MPH have been reported to switch to another drug due to lack of efficacy or adverse reactions. Most likely, a significant fraction of this individual variation in treatment outcome is caused by genetic differences. Previous studies have not identified genes or genetic variants conclusively implicated in the response to MPH. Methods We performed a pharmacogenomics study of the efficacy and adverse reactions of MPH in a sample of 207 Danish children with ADHD, who were drug-naive at baseline and were monitored for 12 weeks. Each week the ADHD symptom severity was scored on the ADHD-RS questionnaire, and any adverse reactions were recorded. We divided the ADHD symptom scores into inattention and hyperactivity/impulsive sub-scores, and performed GWAS on the outcome of MPH treatment defined as the difference in symptom severity from baseline to end of study. This was followed by calculation of pair wise epistatic interaction coefficients on the top SNPs from the GWAS. Moreover, we used functional principal component analysis to derive proxies that describe the longitudinal nature of the data for both the efficacy measurements and the adverse reactions. Subsequently, we performed GWAS using the proxies as phenotypes for the MPH outcome across the entire treatment period. Results None of the GWAS resulted in genome-wide associated hits. However, among the top SNPs for the inattention sub-score were some that fell in: RAS guanyl releasing protein 1 (RASGRP1), sodium/potassium transporting ATPase interacting 2 (NKAIN2) and tetratricopeptide repeat domain 12 (TTC12). For the hyperactivity/impulsive sub-score one of the top SNPs is in the vicinity of gamma-aminobutyric acid type A receptor gamma3 subunit (GABRG3). In the interaction analysis we identified the SNPs with the largest difference in connectivity between the inattention and hyperactivity/impulsive sub-scores and found that some of these were located in or near: myelin transcription factor 1 like (MYT1L), synaptotagmin 17 (SYT17), potassium voltage-gated channel subfamily Q member 5 (KCNQ5) and potassium voltage-gated channel modifier subfamily S member 3 (KCNS3). Discussion Despite the lack of genome-wide significant SNPs, some of the top hits from the GWAS reside in or near genes that could modulate the response to MPH. Some of these genes have previously been implicated in psychiatric disorders (RASGRP1, NKAIN2 and MYT1L), are involved in neurotransmission (GABRG3, KCNQ5, KCNS3 and NKAIN2) or has been implicated in substance abuse, e.g. TTC12 has been implicated in heroin dependence and SYT17 in alcoholism.

Comparing cognitive styles in social anxiety and major depressive disorders: An examination of rumination, worry, and reappraisal.

Social anxiety disorder (SAD) and major depressive disorder (MDD) are commonly occurring and frequently comorbid disorders. Though individuals with SAD and MDD are more likely to engage in rumination and worry, relatively few studies have compared individuals with SAD, MDD, or both disorders on their use of these cognitive styles. Similarly, the extent to which the disorders differ in their use of reappraisal remains unclear. Thus, the current study sought to systematically examine rumination, worry, and reappraisal in individuals with and without SAD, MDD, or both disorders. The study comprised 330 participants recruited from the community (n=54 with SAD, n=61 with MDD, n=69 with comorbid SAD/MDD, and n=146 healthy controls). Following confirmation of diagnostic status via clinical interview, participants completed measures of rumination, worry, and reappraisal. Healthy controls reported less use of rumination (i.e., brooding and reflection) and worry than individuals with a psychiatric diagnosis. Individuals with SAD or MDD did not differ from each other, but participants in both groups reported less rumination, particularly brooding, than individuals with comorbid SAD/MDD. Diagnostic group differences in reappraisal only emerged when reappraisal was considered alongside other cognitive styles. Further, moderation analyses indicated that reappraisal was only associated with SAD or MDD when participants also reported high levels of rumination and worry. Results support transdiagnostic conceptualizations of rumination and worry. They also suggest that reappraisal is only useful when it is used by people who experience frequent and habitual negative cognitions. Individuals with SAD or MDD report more rumination and worry than healthy controls, but do not differ from each other in their reliance on these cognitive styles. Individuals with comorbid SAD/MDD endorse more rumination than individuals with SAD or MDD alone, even after adjusting for differences in symptom severity. Reappraisal may only predict diagnostic group status when considered alongside other cognitive styles. In particular, high reappraisal may be associated with reduced risk of psychiatric disorder, but only when rumination and worry are also high. The study was limited by its cross-sectional design and reliance on self-report measures. Participants were diagnosed using DSM-IV-TR criteria for SAD and MDD.

Subacromial impingement syndrome: management challenges.

The painful shoulder is the most common condition seen in specialist shoulder clinics. It is often associated with lack of range of motion and reduced shoulder function. Lack of sleep and difficulties in performing basic daily life activities are common findings. Subacromial Impingement Syndrome (SAIS) has been considered as the most common cause of shoulder pain since it was described in 1852. Charles Neer, in 1972, described the presence of a “proliferative spur and ridge” on the undersurface of the acromion, which needs to be removed to improve the symptoms (acromioplasty). Neer’s “impingement” hegemony was undisputed for at least 30 years. A more extensive knowledge of the pathogenesis of SAIS, however, has led authors to challenge the role of “impingement” in the shoulder pain and the role of surgical intervention. The aim of this review was to understand if there is still a role for surgical decompression in patients with SAIS. A literature review was performed in PubMed, PEDro, Embase, and the Cochrane Central Register of Controlled Trials using impingement, subacromial space, rotator cuff tears, tendinopathy, and tendinitis as key words. Randomized clinical trials (RCTs) with long-term follow-up comparing surgical intervention and conservative treatments in SAIS were preferred; however, prospective articles studying the outcome of surgical decompression and physiotherapy were also included. The majority of the studies showed no difference in the outcome between patients randomized to surgical decompression or conservative management. However, some studies reported better results after surgery, especially in the long term. Interpretation of the results is very difficult as most of the studies are of poor quality and have short follow-up. In our opinion, the type of subacromial lesion needs to be considered; this may offer an explanation to the difference in severity of symptoms and to the varying degrees of response to certain treatments, including surgery. Further studies are mandatory to better understand the role of surgery in SAIS.

Cognitive and Behavioral Differences Between Subtypes in Refractory Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal syndrome consisting of different bowel pattern subtypes: diarrhea predominant (IBS-D), constipation predominant (IBS-C), and alternating (IBS-A). This paper aimed to identify whether (a) psychological factors implicated in the cognitive behavioral model of IBS were differentially associated with bowel pattern subtypes, (b) whether there were differences in symptom severity and work and social adjustment across the IBS-subtypes. Analysis was conducted on baseline data of 557 individuals with refractory IBS recruited into the Assessing Cognitive Therapy in Irritable Bowel (ACTIB) randomized controlled trial. Correlations assessed the associations between psychological factors, stool patterns, symptom severity, and work and social adjustment. Hierarchical regressions identified whether cognitive and behavioral factors were significantly associated with frequency of loose/watery stools, hard/lumpy stools and symptom severity while controlling for affective (anxiety and depression) and demographic factors (age, gender, symptom duration). One-way ANOVAs were conducted to assess differences across Rome III classified subtypes (IBS-A, D and C) in cognitive, behavioral, affective, symptom severity, and adjustment measures. Psychological factors were significantly associated with symptom severity and work and social adjustment. Increased avoidance behavior and unhelpful gastrointestinal (GI) cognitions were significantly associated with higher frequency of loose/watery stools. Increased control behaviors were associated with higher frequency of hard/lumpy stools. Cognitive and behavioral differences were significant across the Rome III classified IBS subtypes. There were no differences in anxiety, depression, overall symptom severity, or work and social adjustment. The results are discussed in terms of their utility in tailoring cognitive behavioral treatments to IBS subtypes.

Anhedonia as a clinical correlate of inflammation in adolescents across psychiatric conditions

Objectives: Peripheral inflammation has been associated with multiple psychiatric disorders, particularly with depression. However, findings remain inconsistent and unreproducible, most likely due to the disorder’s heterogeneity in phenotypic presentation. Therefore, in the present study, in an effort to account for inter-individual differences in symptom severity, we utilised a dimensional approach to assess the relationships between a broad panel of inflammatory cytokines and key psychiatric symptoms (i.e. depression, anhedonia, anxiety, fatigue and suicidality) in adolescents across psychiatric disorders. We hypothesised that only anhedonia (reflecting deficits of reward function) will be associated with inflammation.Methods: Participants were 54 psychotropic medication-free adolescents with diverse psychiatric conditions and 22 healthy control (HC) adolescents, aged 12–20. We measured 41 cytokines after in vitro lipopolysaccharide stimulation. Mann-Whitney U and Spearman correlation tests examined group comparison and associations, respectively, while accounting for multiple comparisons and confounds, including depression severity adolescent.Results: There were no group differences in cytokine levels. However, as hypothesised, within the psychiatric group, only anhedonia was associated with 19 cytokines, including haematopoietic growth factors, chemokines, pro-inflammatory cytokines, and anti-inflammatory cytokines.Conclusions: Our findings suggest that general inflammation may induce reward dysfunction, which plays a salient role across psychiatric conditions, rather than be specific to one categorical psychiatric disorder.

Life Program: Pilot Testing a Palliative Psychology Group Intervention.

Psychosocial interventions for palliative care populations, individuals with life-limiting illness, improve distress; however, less is known about these interventions among military Veterans. This quality improvement project evaluated a palliative psychology group intervention to reduce depression, anxiety, and stress among Veterans with advanced life-limiting illness. Veterans receiving palliative care at a mid-Atlantic VA healthcare system were referred by a mental health provider. The group intervention was delivered face-to-face in six to eight weekly sessions, with groups of four to eight participants. The intervention (Life Program), was a hybrid of cognitive-behavioral therapy and acceptance and commitment therapy that targeted: personal values, mindfulness, and psychological flexibility. A single-arm pre-post-test design was used to assess depression, anxiety, and stress, and satisfaction with the intervention. Seventy-five percent (39/52) of all Veterans who were contacted expressed interest and agreed to participate. Seventeen of 39 enrolled Veterans completed all sessions. The mean age of participants who completed the program was 63.06 (standard deviation = 8.47). Most participants were male (88%), Caucasian (58%), and had a cancer diagnosis (65%). Mean pre-post reductions in depression (18.82 vs. 13.20), anxiety (16.59 vs. 14.59), stress (19.18 vs. 13.88), and psychological inflexibility were observed. Mean differences in symptom severity were clinically meaningful. Barriers to feasibility included transportation issues and illness burden. Veterans who completed all sessions of a palliative psychology group intervention had reductions in depression, anxiety, and stress. Estimates of the treatment effects may be inflated using completer data alone. Further research is needed to inform ways to improve program engagement and adherence and examine efficacy in Veterans with advanced life-limiting illness.

Annular pancreas with duodenal obstruction- case report and review of literatures

Annular pancreas as a cause of extrinsic duodenal obstruction is rare; with estimated incidence of one in 12,000-15,000 live births. Age of presentation varies due to differences in severity of symptoms of upper gastrointestinal tract obstruction. The band of pancreatic tissue encircling the 2nd part of Duodenum is responsible for narrowing of duodenal luminal diameter which subsequently determines the degree of obstruction. Various methods of bypassing the constriction without injuring the pancreatic tissue, are available; of them diamond shaped duodeno- duodenostomy as described by Kimura is widely practiced. The surgical outcome is satisfactory if there are no associated risk factors like prematurity, low birth weight, sepsis and other congenital anomalies. We have treated only three cases in last five years from January, 2011 to December, 2015. Two of them were neonate with acute presentation and one aged five and half years with chronic symptoms. Diamond shaped duodeno-duodenostomy was done in all patients. One of the neonate expired postoperatively due to sepsis and rest of the two had uneventful surgical recovery.
 Journal of Paediatric Surgeons of Bangladesh (2016) Vol. 7 (1): 22-25

THE DEGREE OF TENDINOSIS IS RELATED TO SYMPTOM SEVERITY AND PHYSICAL ACTIVITY LEVELS IN PATIENTS WITH MIDPORTION ACHILLES TENDINOPATHY

Achilles tendinopathy negatively affects a person's ability to be physically active. However, remaining physically active during the rehabilitation process does not impact clinical outcomes when a pain-monitoring model is followed. There are several factors, such as the progression of pain and structural changes, kinesiophobia, functional impairments, or medical advice, which may explain why some patients become physically inactive while others maintain a physically active lifestyle. The purposes of this study were 1) to compare the clinical presentation of patients with Achilles tendinopathy with high and low activity levels 2) to examine the relationship between tendon thickening and symptom severity in patients with Achilles tendinopathy and 3) to determine the proportion of patients with Achilles tendinopathy who have a high degree of kinesiophobia and if this proportion differs based on activity level. Cross-sectional. Fifty-three patients with Achilles tendinopathy were dichotomized into low activity (n=30) and high activity (n=23) groups based on their physical activity level. Patient characteristics, symptom severity, kinesiophobia, tendon thickening, and lower leg function were quantified and analyzed to test the study hypotheses. Patients with low activity levels had greater tendon thickening and a larger body mass compared to patients with high activity levels. There were no differences in symptom severity, kinesiophobia, or lower leg function between groups. A negative relationship (r=-0.491; p<0.001) was found between tendon thickening and symptom severity. Thirty-eight percent of patients demonstrated a high degree of kinesiophobia, but the proportion did not differ between groups. Patients with Achilles tendinopathy who have low physical activity levels demonstrate greater tendinosis than patients who are highly active. These structural changes are negatively associated with symptom severity. However, symptom severity, kinesiophobia, and functional deficits do not differ between patients with different activity levels. Level 3.

Short-term clinical outcome of orthosis alone vs combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome

Study DesignProspective randomized study. IntroductionCarpal tunnel syndrome (CTS) has been described as the most common compression neuropathy. Many modalities exist for conservative treatment. Efficacy of each modality has been described in the literature. However, the effectiveness of combination of these modalities is not well established. The purpose of this study is to assess the short-term clinical outcome of conservative treatment for CTS comparing orthosis alone with combination of orthosis, nerve/tendon gliding exercises, and ultrasound therapy. MethodsForty-one patients who presented to Upper Limb Reconstructive and Microsurgery Clinic, University Malaya Medical Centre with CTS and positive electrodiagnostic study were recruited. Fifteen patients had bilateral CTS. Fifty-six wrists were equally randomized to orthosis alone and a combined therapy of orthosis, nerve/tendon gliding exercise, and ultrasound therapy. All patients were required to complete the Boston Carpal Tunnel Questionnaire during the first visit and 2 months after treatment. ResultsBoth the orthosis and combined therapy groups showed a significant improvement in symptoms and function after treatment. The mean difference of symptoms in the orthosis group was 0.53; 95% confidence interval [CI]: 0.23-0.83 (P = .001) and in the combined therapy group was 0.48; 95% CI: 0.24-0.72 (P < .001). Mean difference of function in the orthosis group was 0.59; 95% CI: 0.28-0.91 (P = .001) and combined group was 0.69; 95% CI: 0.49-0.89 (P < .001). However, there was no significant difference in symptom severity and functional status scores between the groups. DiscussionOur findings support other findings where orthosis and exercises improved symptom severity and functional status scores, however, there was no significant difference between orthosis alone and combined treatment. ConclusionPatients who underwent conservative management for CTS showed improvement in symptoms and function. However, the combination of orthosis, nerve/tendon gliding exercises, and ultrasound therapy did not offer additional benefit compared to orthosis alone.

Sociodemographic differences in symptom severity and duration among women referred to secondary care for menorrhagia in England and Wales: a cohort study from the National Heavy Menstrual Bleeding Audit

ObjectiveTo examine symptom severity and duration at time of referral to secondary care for heavy menstrual bleeding (HMB) by socioeconomic deprivation, age and ethnicityDesignCohort analysis of data from the National...

Ethnic variations regarding clinical profiles and symptom representation in prisoners with psychotic disorders

Black and minority ethnic (BME) groups are known to have higher prevalences of psychotic disorders and are over-represented in western penitentiaries and forensic psychiatric institutions. Research from regular mental healthcare settings suggests that they could show different and more severe psychotic symptoms. Aims To explore ethnic variations in severity of symptomatology of BME and non-BME detainees with psychotic disorders. In this study, 824 patients with psychotic disorders from seven different ethnic groups, imprisoned in a penitentiary psychiatric centre in the Netherlands, were compared on symptom severity and symptom representation using the BPRS-E clinical interview. Data were analysed by means of a multilevel analysis. BME patients with psychotic disorders are over-represented in forensic psychiatry, and symptom profiles of prisoners with psychotic disorders vary by ethnicity. Additionally, severity levels of overall psychopathology differ between ethnic groups: patients with an ethnic majority status show more severe levels of psychopathology compared with BME patients. There are differences in symptom severity and symptom profiles between BME patients and non-BME patients. Disregarding these differences could have an adverse effect on the outcome of the treatment. Possible explanations and clinical impact are discussed. Declaration of interest None.