Early Symptoms Research Articles

Specific structural changes in Parkinson’s disease-related olfactory dysfunction compared to others forms of olfactory dysfunction

ContextOlfactory dysfunction (OD) is a common early symptom of Parkinson’s disease (PD). However, OD is not specific to PD, as approximatively 20% of the general population exhibit different forms of OD. To use olfactory measures for early Parkinson screening, it is crucial to distinguish PD-related OD from Non-Parkinsonian OD (NPOD).Objectives and hypothesisThis study aimed to compare the structural changes associated with PD-related OD (n = 15) with NPOD (n = 15), focusing on gray matter volumes and white matter fiber integrity in chemosensory regions. We hypothesized that PD-related OD presents specific structural alterations in these regions.MethodsParticipants underwent a 3 T MRI scan, which included anatomical T1 and diffusion-weighted imaging. Gray and white matter integrity were assessed using both whole-brain analyses (voxel-based morphometry—VBM and tract-based spatial statistics—TBSS, respectively) and localized approaches, including regions of interest and tractography.ResultsPD patients exhibited significantly higher gray matter volume in the left insula using restricted regions-of-interest analyses, while no other significant gray or white matter differences were found between groups.ConclusionStructural imaging of the gray matter, particularly the insula, but not of white matter, differentiates PD-related OD from NPOD.

Select Endocrine Disorders and Exosomes in Early PDAC Diagnosis

Disturbances in carbohydrate metabolism are suggested to be the early symptoms of pancreatic ductal adenocarcinoma (PDAC). The accumulated data suggests that endocrine function-related biomarkers may represent a breakthrough in the early detection of PDAC. Factors which may predispose one to the development of PDAC are insulin resistance and hyperinsulinemia. Elevated insulin levels induce the onset of carcinogenesis by altering the differentiation and function of islet cells through stimulating growth factors, including insulin-like growth factors (IGFs). Impaired β cell function, along with the impact of PDAC-released factors (e.g., adrenomedullin (ADM), IGF-1, and macrophage inhibitory factor (MIF) on pancreatic islets, may contribute to the induction of diabetes associated with PDAC. Recently, exosomes have attracted worldwide attention due to their role in varied features of cell function, particularly in cancer progression. Exosomes comprise of small extracellular vesicles produced by almost all cells. These vesicles contain a vast array of biomolecules, including proteins and microRNAs. Exosomes participate in cancer growth and promote angiogenesis. They promote tumorigenesis and metastasis, and are associated with the acquisition of cancer cells resistant to chemotherapy. Data have been accumulating recently on the role of exosomes in the rapid recognition, prognosis and potential therapy of pancreatic cancer.

Evaluation of the macula, retinal nerve fiber layer and choroid thickness in premature ovarian failure using spectral-domain optical coherence tomography.

The aim of our study is to describe the basal findings at the first diagnosis of the disease in patients with premature ovarian failure (POF) and to draw attention to the early changes in the macula, optic nerve head and choroid. In a prospective case-control study, 90 patients with POF and 90 control patients were evaluated. All participants underwent the same ophthalmic examination, including visual acuity, intraocular preasure measurement, anterior and posterior segment evaluation, macular and coroidal thickening, and retinal nerve fiber layer (RNFL) measurements with the same device (Spectral Domain OCT, software version 5.6.3.0, Heidelberg, Germany). The median age was 30.00 (28.00-31.00) in the control group and 29.00 (27.00-31.00) in the POF group (p = 0.249). The median thickness of the temporal outer macular region was statistically significantly thinner in the POF group (295.00 (289.00-303.25)) compared to the control group (306.00 (290.75-328.00)) (p < 0.001). There was a statistically significant decrease in all choroidal regions (p < 0.001), including the central, nasal 500, nasal 1500, temporal 500, and temporal 1500 regions in the POF group according to the control group. An increase in intraocular pressure in the postmenopausal period has been reported, suggesting a link between the postmenopausal decline in sex hormones and glaucoma. Our study is the first to monitor changes in choroidal, retinal thickness and RNFL in POF images showing early menopausal symptoms.

Dumping syndrome: Update on pathophysiology, diagnosis, and management.

Dumping syndrome is a complex of gastrointestinal symptoms originally studied in peptic ulcer surgery patients. At present, it is most prevalent in patients who underwent bariatric, upper gastrointestinal cancer or anti-reflux surgery. The symptom pattern comprises early and late dumping symptoms. Several management options have been reported including nutritional, pharmacological and surgical approaches. In this study, we aimed to review the current evidence on dumping syndrome definition, diagnosis and treatment, including preliminary data from newer pharmacological studies. Current pathophysiological concepts and analyses of provocative tests has led to a clear definition of dumping syndrome, including both early and late dumping symptoms. The term postbariatric hypoglycemia represents a limited focus on late dumping only. The diagnosis relies on recognition of symptoms and signs in a patient with appropriate surgical history; and can be confirmed by provocative testing or registration of spontaneous hypoglycemia. The initial treatment focuses on dietary intervention, to which meal viscosity enhancers and/or the glycosidase inhibitor acarbose can be added. The most effective therapy is the use of short- or long-acting somatostatin analogues, which is however expensive and entails side effect issues. In case of refractory hypoglycemia, diazoxide or SGLT2 inhibitors can be considered, based on limited evidence. In refractory patients, continuous enteral feeding or (rarely) surgical reinterventions have been advocated, although not supported by solid evidence. Therapies under current evaluation include the broad-spectrum somatostatin analogue pasireotide, GLP-1 receptor antagonists, GLP-1 receptor agonists and administration of stable forms of glucagon are currently under study. Dumping syndrome is a well-defined but probably under-diagnosed complication of upper gastrointestinal, especially bariatric, and surgeries. Diagnosis is confirmed by a provocative test and incremental therapies starting with diet, adding meal viscosity enhancers or glycosidase inhibitors and adding somatostatin analogues in refractory cases. A number of emerging therapies targeting intestinal propulsion, peptide hormone effects and hypoglycemic events are under evaluation.

Factors associated with severe malaria-related mortality among hospitalized children under five years of age in Eastern Province of Rwanda: a cross-sectional study using hospital records from 2017 to 2021.

Malaria remains a significant concern for children under five in malaria-endemic regions. Rwanda's successful efforts in malaria treatment reduced nationwide cases, but high mortality persists in the Eastern and Southern provinces. This study aimed to investigate the clinical features of severe malaria and to identify the death risk factors among under-five children in Eastern province Hospitals. This cross-sectional study assessed severe malaria-related mortality and associated factors among children aged under five years in hospitals of Eastern Province, Rwanda, from 2017 to 2021. Data were collected from hospital records, and descriptive statistics and logistic regression were used for data analysis. Factors associated with severe malaria-related mortality included coma (aOR: 10, 95% CI: 1.2-82.5, p = 0.03), Vomiting (aOR: 5.2, 95% CI: 1.0-26.0, p = 0.04), four or more days of illness before consultation (aOR: 30.9, 95% CI: 8.7-109.9, p < 0.01). On the other hand, a low parasitaemia level (aOR: 0.01, 95% CI: 0.0-0.1, p < 0.01). In conclusion, coma, vomiting, and healthcare delays increased mortality in children with severe malaria. Prompt treatment, proper assessments, protocol adherence, and caregiver education on early symptom recognition are crucial for improving outcomes.

Evaluating Tobacco Cessation Readiness in OPMD Patients Using the Transtheoretical Model in a tertiary care setting in Northeast India

Background: Oropharyngeal cancers pose significant global health challenges and addressing public awareness, early symptoms, and risk factors, alongside promoting tobacco cessation among individuals with potentially malignant oral disorders, is crucial for reducing the disease burden.Objective: Evaluating the degree of public knowledge of oral malignancy &amp; OPMD, initial signs &amp; risk factors amongst patients going to a dental college in North East India, as well as readiness to quit tobacco amongst OPMD patient.Methods: This cross-sectional investigation was undertaken at the Department of Public Health Dentistry, Tertiary care Hospital in Guwahati. 200 participants aged 15-65 years who consented were surveyed using a self-administered questionnaire. Collected data underwent thorough checks for completeness and accuracy. To determine the odd's ratio (OR) and to summarise the data, descriptive &amp; inferential statistics were used. To test the relationship, data were dichotomised. Oral lesions present or absent; behavioural phases were divided into two categories: (preparation + action) &amp; (precontemplation + contemplation). P &lt; 0.05 was used as the statistical significance threshold.Results: Most participants were in the contemplation stage regarding tobacco's risks, neglecting other risk factors like alcohol &amp; inadequate dental hygiene for oral malignancy/OPMD development.Conclusions: The lack of knowledge of oral malignancy &amp; potentially malignant disorders (OPMDs) amongst North Eastern Indian communities, underscores the immediate demand for targeted education and health promotion campaigns. Emphasizing early symptom recognition, risk factors, and prevention measures, tailored to diverse communication preferences, is crucial.

PERFIL EPIDEMIOLÓGICO DE ADOLESCENTES COM TRANSTORNOS PSIQUIÁTRICOS ATENDIDAS EM UM PRONTO SOCORRO INFANTIL

The study investigates the epidemiological profile of adolescents with psychiatric disorders treated in a pediatric emergency room, identifying clinical and socioeconomic characteristics of the main psychiatric disorders, based on the assumption of adolescents' vulnerability to mental health issues. A retrospective analytical documentary study was conducted using electronic medical records of patients treated between January 2019 and December 2021 at the Regional Hospital of Taguatinga. Data on age, sex, reasons for attendance, diagnoses, and comorbidities were analyzed to identify patterns and correlations, contributing to the improvement of care and prevention in mental health. A total of 2000 attendances were evaluated for ages 0 to 17 years. Information was collected from the electronic medical records of patients aged 2 to 17 years. A total of 183 hospitalizations were identified over the studied period, with frequent psychotic episodes occurring in adolescents, especially at ages 12 and 13. These episodes often involved aggression, hallucinations, and self-harm, requiring multidisciplinary interventions. Anxiety disorders were also significant, with adolescents displaying early physical symptoms. Suicide attempts commonly involved medication overdose and were linked to family conflicts and trauma. The conclusion emphasizes the need for a multidisciplinary approach and early interventions to minimize risks and promote mental health.

Marijuana use in pregnancy rises in tandem with legalization moves

Results of two newly published studies suggest that any warnings pregnant women might be receiving about the health risks of marijuana use are being drowned out by assurances that smoking marijuana can relieve early pregnancy symptoms such as morning sickness.

A call for globally responsive screening materials to account for heterogeneity in dementia syndromes.

Effective screening for communicative ability in dementia is vital to drive theoretical understanding and optimize care responsiveness globally. Communication is central to the human experience; however, routine clinical screening for progressive communication change remains limited due to a variety of resource constraints. Other challenges include the subtlety of early communication-led symptoms, heterogeneous underlying pathologies, and a lack of culturally diverse research and tools. To address the scarcity of dedicated assessment resources, future initiatives must maximize responsiveness to and representation of our global population to appropriately respond to the rising, and vastly diverse, dementia crisis.

Predicting Post-Mortem α-Synuclein Pathology by the Combined Presence of Probable REM sleep behavior disorder and Hyposmia.

Idiopathic rapid eye movement sleep behavior disorder (RBD) is a strong known predictor of a final clinicopathological diagnosis of a Lewy type α-synucleinopathy (LTS). Olfactory dysfunction is an early symptom of synucleinopathies and has been repeatedly associated with the presence of post-mortem LTS. To assess the combined value of a clinician diagnosis of probable RBD (PRBD) and hyposmia in predicting the post-mortem presence of LTS in a broader, less-selected, volunteer elderly population. We studied 652 autopsied subjects from the Arizona Study of Aging and Neurodegenerative Disorders, which were evaluated for PRBD, had completed annual movement and cognitive assessments, and had at least one the University of Pennsylvania Smell Identification Test (UPSIT) olfactory test. Histological evidence of LTS was significantly more frequent in those who had PRBD (112/152: 73.7%) than those without (177/494: 35.8%) (P < 0.001). LTS was more frequent in cases with PRBD and a low UPSIT score (90.8%) compared to cases with PRBD only (73.7%) (P < 0.001) or cases with a low UPSIT score only (69.4%) (P < 0.001). Sensitivity of PRBD diagnosis for predicting LTS was 38.8% and specificity 88.8%, whereas sensitivity of a low UPSIT score was 74.4% and specificity 73.4% (Youden's index = 0.276 for PRBD, 0.478 for UPSIT). When combining both measures, sensitivity was 34.3% and specificity increased to 97.2%. PRBD, diagnosed without sleep study confirmation, combined with a reduced olfactory performance is highly specific for predicting post-mortem presence of LTS. The combination of both measures may provide a cost-effective means of predicting LTS in a broader community.

Use of ResNets for HLB Disease Detection on Orange Leaves Using Terrestrial Multispectral Images

Abstract. Huanglongbing (HLB) is a bacterial disease transmitted by different vectors of sap-sucking insects. It affects all crops of citrus trees, decreasing the values of those fruits in the market and eventually the decay of orchards. In Brazil, the world's leading orange producer, citriculture faces severe issues with HLB and substantial economic loss. Technical means of scanning the orchards with high-throughput becomes essential for the sustainability of this industry. In this study, we propose to investigate an operational strategy consisting of scanning large portions of foliage (the canopy of one tree or more) in which there can few early foliage symptoms. It is proposed to investigate deep learning tools to solve this complex binary classification problem. The study is based on a dataset comprising 1,297 terrestrial multispectral (14 channels) images captured at high spatial resolution in a commercial orange orchard in Brazil. It is proposed to adapt and retrain standard neural network architectures, namely ResNets18 and ResNets34, to process such images. Our analysis reveals promising results, with both models demonstrating convergence and achieving stable performance. Notably, ResNet18 outperformed ResNet34, achieving an accuracy of 76.45% compared to 66.79% from ResNet34. These findings suggest that deep neural network methods can effectively manage non-radiometrically calibrated data and accurately distinguish images with HLB symptoms from healthy plants . However, with reduced datasets and limited possibilities for transfer learning and fine-tuning, it seems that only reasonable sized networks can be trained. Thus, more advanced state-of-the-art tools of the are still challenging to deploy for agricultural multi- or hyperspectral data.

The Potential Role of the Microbiome in the Pathogenesis of Nasal Tumors: A Comprehensive Review

Cancers of the nose, and especially the nose vestibule, represent a significant challenge for clinicians due to their rarity, the intricate nature of surrounding vital structures, the nonspecific early symptoms, and the etiological factors that are not completely understood. Emerging research suggests that alterations in the nasal microbiome, also known as microbial dysbiosis, may contribute to the pathogenesis of those malignancies through mechanisms involving chronic inflammation, immune modulation, and cellular changes. The aims of this paper are to review the current literature covering the nasal microbiome’s role in carcinogenesis, particularly in the context of squamous cell carcinoma, and to explore how microbial dysbiosis might foster a pro-tumorigenic environment. It further discusses potential future directions for research and therapeutic approaches.

Mapping the diagnostic odyssey of congenital disorders of glycosylation (CDG): insights from the community

BackgroundCongenital disorders of glycosylation (CDG) are a group of rare metabolic diseases with heterogeneous presentations, leading to substantial diagnostic challenges, which are poorly understood. Therefore, this study aims to elucidate this diagnostic journey by examining families’ and professionals’ experiences.Results and discussionA questionnaire was designed for CDG families and professionals, garnering 160 and 35 responses, respectively. Analysis revealed the lack of seizures as a distinctive feature between PMM2-CDG (11.2%) with Other CDG (57.7%) at symptom onset. Hypotonia and developmental disability were prevalent symptoms across all studied CDG. Feeding problems were identified as an early onset symptom in PMM2-CDG (Cramer’s V (V) = 0.30, False Discovery Rate (FDR) = 3.8 × 10− 9), and hypotonia in all studied CDG (V = 0.34, FDR = 7.0 × 10− 3). The average time to diagnosis has decreased in recent years (now ~ 3.9 years), due to advancements namely the increased use of whole genome and exome sequencing. However, misdiagnoses remain prevalent (PMM2-CDG – 44.9%, non-PMM2-CDG – 64.8%). To address these challenges, we propose adapting medical training to increase awareness of CDG and other rare diseases, ongoing education for physicians, the development of educational resources for relevant medical units, and empowerment of families through patient organizations and support networks.ConclusionThis study emphasizes the crucial role of community-centered research, and the insights families can offer to enhance CDG management. By pinpointing existing gaps and needs, our findings can inform targeted interventions and support systems to improve the lives of those impacted by CDG.

Herpes zoster in an immunocompetent adolescent – A case of rare occurrence

ABSTRACT Herpes zoster is an acute viral infection caused by the reactivation of the varicella zoster virus. It occurs commonly in immunocompromised adults. Odontalgia may be an early prodromal symptom when herpes zoster involves the oral and maxillofacial region, which lays significant emphasis on the role of a dentist in early diagnosis and treatment of the infection. Herpes zoster infection commonly affects adult and elderly patients and is very rare in children. This article shows cases of herpes zoster infection in a 14-year-old immunocompetent boy who presented with dental pain as a prodromal sign. Herpes zoster may occur in children and thus should be considered in the differential diagnosis of acute multiple ulcers occurring in that population.

What are the barriers and facilitators to help-seeking behaviour for symptoms in patients with ovarian cancer in China? A qualitative study

ObjectivesTo explore the barriers and facilitators to help-seeking behaviour for symptoms among patients with ovarian cancer in China.DesignThis semistructured interview-based study used a descriptive phenomenological research method.SettingThe study was conducted...

Self-Care Practices and Perspectives in Managing Coronary Heart Disease Patients: A Qualitative Study

Background/Objectives: Self-care experiences and understanding of coronary heart disease (CHD) play a pivotal role in the management of CHD and can contribute to positive health outcomes. This qualitative study aimed to explore the views and experiences of CHD patients, their families, and Indigenous leaders about self-care practices of CHD. Methods: A qualitative design employing semi-structured interviews and a focus group discussion was used. Employing purposive sampling, 49 respondents, comprising 30 patients, 10 family members, and 9 Indigenous leaders, were recruited and interviewed from April to September 2022. The data were analyzed using content analysis. Results: Five major categories were constructed: (1) inadequate knowledge and early symptom identification; (2) self-care activities for physical, psychosocial, and spiritual needs; (3) family and kinship support for self-care efforts; (4) barriers to self-care including physical, psychological, and access issues; and (5) health improvement expectations based on culturally sensitive health education. Conclusions: The study reveals significant gaps in knowledge about CHD and the identification of early symptoms among patients, families, and Indigenous leaders. Despite efforts to meet physical, psychosocial, and spiritual needs, self-care is hindered by various barriers, including limited access to healthcare and entrenched habits. The support from family and kinship systems is crucial for self-care. Participants expressed a strong desire for culturally tailored health education and better health control to improve heart health outcomes.

Analysis of Health Promotion Strategies for Treatment of Cervical Cancer at Awal Bros Hospital Pekanbaru Riau

Cancer is one of the main causes of death, as many as 8.2 million people die from cancer. According to GLOBOCAN data in IARC (2020), cervical cancer cases in Indonesia increased by 36,633 (17.2%) with 234,511 deaths. Cervical cancer generally attacks women aged 30-39 years. Symptoms of cervical cancer are post-coital bleeding, smelly vaginal discharge, vaginal bleeding continuously without stopping, pain in the genitals are reported as early symptoms of cervical cancer. The aim of this research is to analyze Health Promotion Strategies in the treatment of cervical cancer at Awal Bros Hospital Pekanbaru. This type of research is qualitative. The number of informants was 4 informants. The results of research conducted by the health promotion program at Awal Bros Hospital in Pekanbaru show a holistic and sustainable approach in overcoming the challenge of cervical cancer. By focusing on education and empowerment, as well as addressing identified obstacles, these efforts have had a positive impact in increasing awareness, treatment compliance and quality of life for patients affected by cervical cancer. However, there is still a need to continue evaluating and adapting to increase the effectiveness of the program and ensure better access for all patients. The health promotion (advocacy) strategy for cervical cancer treatment was carried out quite well through a lobbying process and outreach to various agencies, Awal Bros Hospital carried out this by building an individual atmosphere and building a group atmosphere. By increasing participation in early screening and ensuring continuity of treatment for optimal effectiveness in preventing cervical cancer. Awal Bros Pekanbaru Hospital implements a health promotion strategy for cervical cancer with a focus on empowerment and a personal approach to patients and their families.

Expert opinion elicitation for assisting deep learning based Lyme disease classifier with patient data

BackgroundDiagnosing erythema migrans (EM) skin lesion, the most common early symptom of Lyme disease, using deep learning techniques can be effective to prevent long-term complications. Existing works on deep learning based EM recognition only utilizes lesion image due to the lack of a dataset of Lyme disease related images with associated patient data. Doctors rely on patient information about the background of the skin lesion to confirm their diagnosis. To assist deep learning model with a probability score calculated from patient data, this study elicited opinions from fifteen expert doctors. To the best of our knowledge, this is the first expert elicitation work to calculate Lyme disease probability from patient data. MethodsFor the elicitation process, a questionnaire with questions and possible answers related to EM was prepared. Doctors provided relative weights to different answers to the questions. We converted doctors' evaluations to probability scores using Gaussian mixture based density estimation. We exploited formal concept analysis and decision tree for elicited model validation and explanation. We also proposed an algorithm for combining independent probability estimates from multiple modalities, such as merging the EM probability score from a deep learning image classifier with the elicited score from patient data. ResultsWe successfully elicited opinions from fifteen expert doctors to create a model for obtaining EM probability scores from patient data. ConclusionsThe elicited probability score and the proposed algorithm can be utilized to make image based deep learning Lyme disease pre-scanners robust. The proposed elicitation and validation process is easy for doctors to follow and can help address related medical diagnosis problems where it is challenging to collect patient data.

Impaired striatal glutathione-ascorbate metabolism induces transient dopamine increase and motor dysfunction.

Identifying initial triggering events in neurodegenerative disorders is critical to developing preventive therapies. In Huntington's disease (HD), hyperdopaminergia-probably triggered by the dysfunction of the most affected neurons, indirect pathway spiny projection neurons (iSPNs)-is believed to induce hyperkinesia, an early stage HD symptom. However, how this change arises and contributes to HD pathogenesis is unclear. Here, we demonstrate that genetic disruption of iSPNs function by Ntrk2/Trkb deletion in mice results in increased striatal dopamine and midbrain dopaminergic neurons, preceding hyperkinetic dysfunction. Transcriptomic analysis of iSPNs at the pre-symptomatic stage showed de-regulation of metabolic pathways, including upregulation of Gsto2, encoding glutathione S-transferase omega-2 (GSTO2). Selectively reducing Gsto2 in iSPNs in vivo effectively prevented dopaminergic dysfunction and halted the onset and progression of hyperkinetic symptoms. This study uncovers a functional link between altered iSPN BDNF-TrkB signalling, glutathione-ascorbate metabolism and hyperdopaminergic state, underscoring the vital role of GSTO2 in maintaining dopamine balance.

Prediction of mental health risk in adolescents via a smartphone app: a feasibility pilot study

Abstract Background The prevalence of mental health problems in adolescents is a global public health concern. Machine learning (ML) can analyse multidimensional data collected by phone sensors (passive tracking) and symptom self-reporting (active tracking) to model and predict mental health states. However, research in adolescents is lacking. This study investigated the feasibility of using ML to predict mental health in a non-clinical population of adolescents from active and passive data collected through the Mindcraft mobile app. Methods We recruited 103 secondary students (aged 14-18) who first completed the Strengths and Difficulties Questionnaire (SDQ) and then used the Mindcraft app for two weeks. The app integrates sensor data (location, steps, noise, light, battery, app usage) and self-reports. We extracted 85 sensor-based features and 19 from questionnaires to develop a gradient-boosted ensemble ML model. This model identifies students with abnormal SDQ scores and was evaluated using leave-one-out cross-validation. Results All students completed the active questionnaires; 67 also provided passive sensor data. 31 had abnormal SDQ scores. Using passive data, the ML model reached a balanced accuracy of 0.64 and an AUC score of 0.57. Incorporating both data types improved accuracy to 0.67 and AUC to 0.70. Feature importance scores showed step count and questionnaire on racing thoughts and hopefulness as most significant. Conclusions Our findings affirm the potential of integrating passive and active data collection to monitor mental health in real-world settings. Our ML model demonstrated moderate accuracy in predicting adolescents’ mental health risk measured with a behavioural screening questionnaire. This study will guide the development of a ML-driven, personalised mobile intervention for early symptom detection and mental health self-management, which might constitute an innovative and scalable tool for mental health prevention and intervention in adolescents. Key messages • This study shows the feasibility of using active and passive data to predict mental health risk in adolescents. • This study informs the development of a personalised machine learning-driven mobile intervention.