Effects Of Symptoms Research Articles

Efficacy of Sailuotong in vascular dementia: an exploratory analysis of possible disease modifying activity

AbstractBackgroundMulti‐component, multi‐target approaches may be needed for treatment of Vascular Dementia (VaD). SaiLuoTong (SLT) consists of active ingredients derived from Ginkgo Biloba, Panax Ginseng and Crocus Sativus. A phase II, randomized, controlled, double‐blind study (NCT01978730) demonstrated the symptomatic efficacy of SLT in VaD, however, the slowing of disease progression remains unexplored. This exploratory analysis is to compare the Vascular Dementia Assessment Scale‐cognitive subscale (VaDAS‐cog) between early‐ and delayed‐starters over a 52‐week period so as to assess the disease‐modification effect of SLT.MethodSubjects with probable mild to moderate VaD were randomized to SLT 360 or 240 mg (early‐starters), or placebo (delayed‐starters). Whilst maintaining blinding, all early‐starters received SLT for 52 weeks and delayed‐starters switched to SLT 360 or 240 mg from placebo at week‐26. Using a modified intention‐to‐treat population of 325 subjects, comparison of change in VaDAS‐cog from baseline between early‐starters and delayed‐starters was performed using linear mixed‐effects models for repeated measurements, with fixed effect of intervention (early‐starters vs. delayed‐starters), time, time and intervention interaction, baseline VaDAS‐cog and randomization stratification factors. An unstructured variance‐covariance structure was employed.ResultEarly‐starters compared to delayed‐starters showed statistically significant improvement in adjusted mean change from baseline in VaDAS‐cog score at all timepoints: (Adjusted mean difference (AMD) [95% CI]: ‐1.53 [‐2.35, ‐0.71]; P<0.001) at week‐13, (AMD [95% CI]: ‐2.69 [‐3.69, ‐1.69]; P<0.001) at week‐26, (AMD [95% CI]: ‐2.15 [‐3.31, ‐0.98]; P<0.001) at week‐39 and (AMD [95% CI]: ‐1.94 [‐3.38, ‐0.51]; P = 0.008) at week‐52. The largest difference (early‐starters vs delayed‐starters) was observed at week‐26.ConclusionIn this analysis, the effect of SLT was observed at week‐13 in early‐starters and sustained until week‐52. Delayed‐starters did not catch up with early‐starters on mean change in VaDAS‐cog from baseline at week‐52, suggesting not only a symptomatic effect of SLT but also a possible disease‐modifying effect.

Identification of Potential Multitarget Compounds against Alzheimer's Disease through Pharmacophore-Based Virtual Screening.

Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive loss of cognitive functions, and it is the most prevalent type of dementia worldwide, accounting for 60 to 70% of cases. The pathogenesis of AD seems to involve three main factors: deficiency in cholinergic transmission, formation of extracellular deposits of β-amyloid peptide, and accumulation of deposits of a phosphorylated form of the TAU protein. The currently available drugs are prescribed for symptomatic treatment and present adverse effects such as hepatotoxicity, hypertension, and weight loss. There is urgency in finding new drugs capable of preventing the progress of the disease, controlling the symptoms, and increasing the survival of patients with AD. This study aims to present new multipurpose compounds capable of simultaneously inhibiting acetylcholinesterase (AChE), butyrylcholinesterase (BChE)-responsible for recycling acetylcholine in the synaptic cleft-and beta-secretase 1 (BACE-1)-responsible for the generation of amyloid-β plaques. AChE, BChE, and BACE-1 are currently considered the best targets for the treatment of patients with AD. Virtual hierarchical screening based on a pharmacophoric model for BACE-1 inhibitors and a dual pharmacophoric model for AChE and BChE inhibitors were used to filter 214,446 molecules by QFITBACE > 0 and QFITDUAL > 56.34. The molecules selected in this first round were subjected to molecular docking studies with the three targets and further evaluated for their physicochemical and toxicological properties. Three structures: ZINC45068352, ZINC03873986, and ZINC71787288 were selected as good fits for the pharmacophore models, with ZINC03873986 being ultimately prioritized for validation through activity testing and synthesis of derivatives for SAR studies.

“I can't be dealing with this brain fog”: A workplace focus group study investigating factors underpinning the menopausal experience for NHS staff

ObjectivesMultiple studies highlight that individuals undergoing menopause are not receiving sufficient support at work. An improved menopausal experience in the workplace has been found to be associated with increased job satisfaction, increased economic participation and reduced absenteeism. This work was undertaken to explore the impact of menopause on the working lives of NHS staff working in Wales, with specific emphasis on their experience of menopausal symptoms and management strategies in the workplace. Study designThis was a qualitative study using semi-structured focus groups and thematic analysis. 14 women working in the NHS in Wales attended four focus groups, lasting up to 1.5 h. Stem questions focused on participants' positive and negative experiences in the workplace, and their receipt of support. Transcripts were analysed using the framework approach. ResultsThree major themes were identified: experiences of menopausal symptoms and symptom management, the impact of menopause on work and the impact of work on the menopause. Menopause symptom experience in the workplace was multifaceted and varied, depending on factors such as ongoing or past symptom experience, expectations, social support and effectiveness of management strategies. Inconsistent information was highlighted as a reason why some participants felt confused both about the symptoms that they could attribute to the menopause and the management strategies available to them. A variety of symptom management strategies had been used by participants, including hormone replacement therapy, flexible working hours, working from home, changes to uniform, peer support and lifestyle changes, with varying levels of success. Some women were reticent to ask for support at work even though they felt the workplace response was likely to be supportive. Almost all the women felt that they had to persuade their GP to prescribe HRT and felt that their doctors were too reticent in prescribing this treatment. ConclusionsEmployers have a key role in supporting their staff experiencing menopausal symptoms, and such support has the potential to reduce sickness absence and boost retention. Based on the findings we recommend creating an open culture to break down taboos; protected time for peer support around shared experiences and effective symptom management techniques; and maximising the impact of non-menopause-specific policies such as flexible working to help all staff manage fatigue and become more productive in their roles.

Study on the Therapeutic Effect of shRNA Injected into Tail Vein on Parkinson’s Disease in Mice Based on SNCA Gene Mutation of α-Synuclein

Aim: This research aims to investigate the therapeutic effect of shRNA injected into the tail vein on Parkinson’s disease in mice based on SNCA gene mutation of α-synuclein and explore the migration mechanism of α-synuclein. Methods: SCNA +/+ mice are used to induce α-synuclein by tuberculin pff and then establish the model of Parkinson’s disease in mice. Besides, AAV-shRNA is used to set the control group and the experimental group at different times. Open-field test, tail suspension test, and immunofluorescence are adopted to explore the therapeutic effect of shRNA and the migration mechanism of α-synuclein. Results: shRNA inhibits P-α-syn in the brain of mice afflicted with Parkinson’s disease, which has obvious behavioral therapy. The whole brain invasion of α-synuclein in OB of the olfactory bulb occurs, while the invasion of α-synuclein in CPu of the dorsal striatum only exists in the downstream brain region. Conclusion: Intravenous injection of shRNA into the tail vein can effectively inhibit α-synuclein with symptomatic therapeutic effect on mice with Parkinson’s disease, and the earlier injection enables better therapeutic effect.

The Effect of asymptomatic versus mild symptomatic COVID-19 infection on male athletic performance: A cross-sectional clinical research

Objective: Novel Coronavirus Disease 2019 (COVID-19) pandemic has affected the whole world and still host many obscurities. Researches involving athletes investigated the lifestyle, athletic performance and psychological alterations compared to pre-pandemics and returning-to-sports process. But, knowledge about the past symptomatic COVID-19 effects on athletic performance is immature. Athletes are prone to asymptomatic or mild symptomatic COVID-19 rather than severe form; so this study aimed to compare the muscular athletic performance, cardiorespiratory function and psychological condition after COVID-19 between asymptomatic and mild symptomatic athletes. Materials and Methods: This case-control designed study recruited a total of 40 young adult male long-distance runners who survived COVID-19 asymptomatically (n=20), and with mild symptoms (n=20). All of the subjects had completed the isolation period and been approved to return-to-sports. The age, anthropometric properties, athletic license term and dominant hand and foot sides of the subjects were recorded. The muscular strength of upper limb, isokinetic and isometric muscular strengths of lower limb flexor and extensors, and VO2max were measured. The self-reported depression, anxiety and COVID-19-related fear were evaluated. Results: The values of all muscular strength parameters, VO2max and anxiety level were similar between the groups (p>0.05). However, the levels of depression (p=0.048) and COVID-19-related fear (p=0.012) were significantly higher in mild symptomatic group in comparison with asymptomatic (p<0.05). Conclusions: Mild symptomatic COVID-19 did not affect muscular athletic performance and cardiorespiratory fitness, but caused psychological disorder in comparison with asymptomatic infection. In case of COVID-19, the psychological state of the athlete should be paid close attention. We suggest the supply of adequate and quick psychological support while targeting the previous level of physical fitness and athletic performance in the returning-to-sports process.

Prevention of the Seasonal Spread of Arvi Among Early Children

Acute respiratory viral infections (ARVI) are widespread infectious diseases, cause significant economic damage and therefore are not only a serious medical, but also the most important socio-economic problem for humanity. This group of diseases accounts for up to 90% of all infectious morbidity. Mostly children and people over 60 years of age fall ill - the so-called risk groups for the incidence of ARVI. Every adult suffers from influenza or other acute respiratory viral infections on average 2-4 times a year, a schoolchild - 4-5 times, a preschool child - 6 times, a child of the first year of life has from 2 to 12 episodes of acute respiratory viral infections. The polyetiology of ARVI pathogens and the variability of viruses involved in the epidemic process, complications after an illness, necessitate the search for new diagnostic methods and optimization of treatment and preventive measures. Modern approaches to the treatment of influenza and acute respiratory viral infections of other etiologies are reduced to the use of complex drugs that combine antiviral, immunomodulatory, symptomatic and pathogenetic effects.

Preparing for Death While Investing in Life: A Narrative Inquiry and Case Report of Home-Based Paediatric Palliative, End-of-Life, and After-Death Care.

Paediatric palliative care is pivotal for addressing the complex needs of children with incurable diseases and their families. While home-based care offers a familiar and supportive environment, delivering comprehensive services in this context is challenging. The existing literature on home-based palliative care lacks detailed guidance for its organization and implementation. This qualitative narrative inquiry explores the organization and provision of home-based paediatric palliative care. Data were collected from healthcare practitioners using conversations, storytelling, and reflective journaling. Schwind's Narrative Reflective Process was applied to synthesize the data, resulting in an in-depth case description. The narrative approach illuminates the complexities of home-based paediatric palliative, end-of-life, and after-death care. Key findings encompass the importance of early-care coordination, interprofessional collaboration, effective symptom management, emotional and psychosocial support, and comprehensive end-of-life planning. Through the case study of the child patient, the challenges and strategies for providing holistic, family-centred care within the home environment are described. Practical insights gained from this report can inform the development and improvement of home-based palliative care programs, benefiting researchers, practitioners, and policymakers seeking to optimize care for children and families in similar contexts.

Abstract 192: Throwing The Kitchen Sink At Tandem Occlusions: A Safety Analysis

Introduction The risk of tandem occlusion treatment in the setting of intravenous thrombolysis is unclear. Angioplasty and stenting typically require the administration of glycoprotein IIb/IIIa inhibitors and/or dual‐antiplatelets which may increase the risk of hemorrhage in the setting of recent thrombolysis administration. Methods We conducted a retrospective analysis of a prospectively maintained patient registry at a comprehensive stroke center. Patients who received thrombolysis and subsequently underwent endovascular therapy for acute ischemic stroke between 2012 and 2022 were included. Patients were separated into two groups depending on whether or not rescue angioplasty or stenting was performed. Per local practice patterns, patients who underwent angioplasty or stenting were immediately started on dual antiplatelets with or without a glycoprotein IIb/IIIa inhibitor bridge. Baseline demographics and clinical characteristics were compared. Outcomes of interest included symptomatic intracerebral hemorrhage (ICH), asymptomatic ICH, hemorrhagic transformation, mass effect and death. Analysis was completed using Chi Square and Fisher’s exact test for categorical variables and Mann‐Whitney U for continuous variables. Results Baseline demographics and clinical characteristics were compared between groups. Patients who underwent treatment of a tandem occlusion were on average younger (67 vs 73, p=0.08) and male (70.1% vs 55%, p=0.03). Median LDL was higher (94 vs 67, p=0.01) and there was a higher rate of diabetes (55.2% vs 40%, p=0.03) and lower rate of atrial fibrillation (12.1% vs 26.6%, p=0.01). Median NIHSS on admission was lower in the tandem occlusion group (15 vs 18, 0.02). Otherwise groups did not significantly differ in level of hemoglobin a1c or rates of hypertension, coronary artery disease, congestive heart failure, smoking status or prior stroke or transient ischemic attack. There was no significant different in hemorrhagic transformation (OR 1.02, 95% CI 0.49, 2.13), mass effect (OR 1.73, 95% CI 0.79, 3.79), symptomatic intracranial hemorrhage (OR 1.27, 95% CI (0.54, 2.99), asymptomatic intracerebral hemorrhage (OR 0.53, 95% CI 0.12, 2.43) or death (OR 0.55, 95% CI 0.24, 1.22) between groups. Limitations include a single center study and the retrospective nature of this analysis. Conclusion We did not find significant risk associated with the treatment of tandem occlusions in the setting of intravenous thrombolysis. Future prospective, multi‐center studies would be beneficial.

Analyzing the challenges faced by recently qualified nurses in radiation therapy nursing at Japan’s National University Hospitals: Uncovering the determinants of difficulty

ObjectiveNewly graduated nurses embarking on careers in radiation therapy nursing at Japan’s National University Hospitals face a spectrum of challenges, many of which have received limited attention in existing literature. This study aimed to uncover the primary difficulties encountered by these nurses, with a specific focus on their implications for training and systematic education. MethodsEmploying a survey involving nurses from five prestigious medical institutions in Japan, we explored the real-time experiences and challenges within radiation therapy nursing. Our investigation concentrated on adverse events and the requisite knowledge for effective symptom management. The results illuminated a notable divergence in experiences among nurses, with particular challenges emerging in the treatment of head and neck cancers, especially when combined with chemotherapy. The data emphasized the pivotal role of certified nurses in offering support and knowledge transfer in complex cases, underscoring the importance of peer support and consultations. ResultsThe findings underscored a significant variance in experiences among nurses, with specific difficulties encountered in the management of head and neck cancers, particularly in conjunction with chemotherapy. The data highlighted the essential role of certified nurses in providing support and knowledge dissemination in challenging scenarios, underscoring the significance of peer support and consultations. ConclusionsThis study provides an overview of the landscape, highlighting the critical role of peer consultation and the need for advancements in the educational framework for radiation therapy nurses.

A Case of Postherpetic Neuralgia Treated with Korean Medicine, including Soeumin <italic>Bojungikgitang-gagambang</italic>

Objectives: This study reports on the effect of Korean medicine treatment, including Soeumin <i>Bojungikgitang-gagambang</i>, on a patient with postherpetic neuralgia.Methods: The patient received Korean herbal medicine, pharmacopuncture treatment, and acupuncture treatment for 22 days. We assessed changes in symptoms due to the treatment using the Numeric Rating Scale (NRS), the McGill Pain Questionnaire-Short Form (SF-MPQ), and the European Quality of Life-5 Dimensions (EQ-5D) scale. We also measured the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) to distinguish neuropathic pain.Results: After treatment, the patient showed decreased NRS, SF-MPQ, and EQ-5D scores.Conclusion: The results indicate that Korean medicine treatment, including Soeumin <i>Bojungikgitang-gagambang</i>, is an effective management of symptoms in patients with postherpetic neuralgia.

Temporally non-regular patterns of deep brain stimulation (DBS) enhance assessment of evoked potentials while maintaining motor symptom management in Parkinson's disease (PD)

BackgroundTraditional deep brain stimulation (DBS) at fixed regular frequencies (>100 Hz) is effective in treating motor symptoms of Parkinson's disease (PD). Temporally non-regular patterns of DBS are a new parameter space that may help increase efficacy and efficiency. ObjectiveTo compare the effects of temporally non-regular patterns of DBS to traditional regularly-spaced pulses. MethodsWe simultaneously recorded local field potentials (LFP) and monitored motor symptoms (tremor and bradykinesia) in persons with PD during DBS in subthalamic nucleus (STN). We quantified both oscillatory activity and DBS local evoked potentials (DLEPs) from the LFP. ResultsTemporally non-regular patterns were as effective as traditional pulse patterns in modulating motor symptoms, oscillatory activity, and DLEPs. Moreover, one of our novel patterns enabled recording of longer duration DLEPs during clinically effective stimulation. ConclusionsStimulation gaps of 50 ms can be used to increase efficiency and to enable regular assessment of long-duration DLEPs while maintaining effective symptom management. This may be a promising paradigm for closed-loop DBS with biomarker assessment during the gaps.

Virtual Reality Meditation for Fatigue in Persons With Rheumatoid Arthritis: Mixed Methods Pilot Study.

Effective symptom management is crucial to enhancing the quality of life for individuals with chronic diseases. Health care has changed markedly over the past decade as immersive, stand-alone, and wearable technologies including virtual reality have become available. One chronic pain population that could benefit from such an intervention is individuals with rheumatoid arthritis (RA). Recent pharmacologic advances in the management of RA have led to a decrease in inflammatory symptoms (eg, chronic pain) or even disease remission, yet up to 70% of patients with RA still suffer from fatigue. While VR-delivered behavior, meditation, and biofeedback programs show promise for pain and anxiety management, there is little information on the use of virtual reality meditation (VRM) for fatigue management among individuals with RA. This study aims to (1) examine the feasibility of implementing a study protocol that uses VRM, (2) determine the acceptability of using VRM for fatigue management in an outpatient population, and (3) identify barriers and contextual factors that might impact VRM use for fatigue management in outpatients with RA. We used a convergent, mixed methods design and enrolled adults aged 18 years or older with a clinical diagnosis of RA. Patient-Reported Outcome Measure Information System (PROMIS) measures of fatigue, depression, anxiety, pain behavior, and physical function were assessed alongside the brief mood introspection scale at baseline and weekly for 4 weeks. VRM use across the 4-week study period was automatically stored on headsets and later extracted for analysis. Semistructured interview questions focused on feedback regarding the participant's experience with RA, previous experience of fatigue, strategies participants use for fatigue management, and the participant's experience using VRM and recommendations for future use. A total of 13 participants completed this study. Most participants completed all study surveys and measures (11/13, 84% and 13/13, 100%, respectively) and were active participants in interviews at the beginning and end of the program. Participants used VRM an average of 8.9 (SD 8.5) times over the course of the 4-week program. Most participants enjoyed VRM, found it relaxing, or recommended its use (12/13, 92%), but 8 (62%) noted barriers and conceptual factors that impacted VRM use. On average, participants saw decreases in PROMIS fatigue (-6.4, SD 5.1), depression (-5.6, SD 5.7), anxiety (-4.5, SD 6), and pain behavior (-3.9, SD 5.3), and improvements in PROMIS physical function (1.5, SD 2.7) and Brief Mood Introspection Scale mood (5.3, SD 6.7) over the course of this 4-week study. While this study's implementation was feasible, VRM's acceptability as an adjunctive modality for symptom management in RA is contingent on effectively overcoming barriers to use and thoughtfully addressing the contextual factors of those with RA to ensure successful intervention deployment. ClinicalTrials.gov NCT04804462; https://classic.clinicaltrials.gov/ct2/show/NCT04804462.

Allogenic stem cells for Crohn's anal fistulas: Treating early improves the deep remission rate.

The aim of this study was to evaluate the real-life clinical and radiological efficacy of darvadstrocel injection into complex perianal fistulas in Crohn's disease. Secondary endpoints were to assess symptomatic efficacy, adverse effects and factors associated with complete combined clinical-radiological response (deep remission). After marketing the product in France, all first patients treated consecutively were included. A complete clinical response was defined by a complete closure of all external openings with no discharge on pressure. A complete radiological response (MRI), evaluated at least after six months of follow-up, was defined by a completely fibrotic sequela without abscess. A deep remission was defined as the association of a complete clinical response with a complete radiological response. A total of 43 patients were included (M/F: 22/21, median age 37 [26-45] years). The fistulas were already drained with seton(s) and were on biologic treatment. After a median follow-up of 383 (359-505) days, 28 (65%) patients showed a clinical response (22 complete and 6 partial) and 16 (37%) achieved a deep remission. The Perineal Disease Activity Index decreased significantly after treatment: 39 (91%) patients reported symptomatic improvement in terms of discharge, pain, and induration, and 28 (65%) no longer had any perineal symptoms. No severe adverse events were reported. A short history of Crohn's disease <3 years was significantly associated with deep remission (OD 4.5 [1.0-19.1], p = 0.04). Darvadstrocel injection resulted in a clinical response for two thirds of patients and deep remission for one third. A shorter duration of Crohn's disease was associated with deep remission.

"A glimmer of hope" - Perceptions, barriers, and drivers for medicinal cannabis use amongst Australian and New Zealand people with endometriosis.

Previous quantitative research has shown that cannabis use, mostly illicit, is used for symptom management amongst those with endometriosis living in Australia or New Zealand, but the drivers and barriers for use of legal, medicinal cannabis in this population are currently unclear. This study sought to investigate, via online focus-groups, the perceptions, barriers, drivers, and experiences associated with cannabis use, whether legal or illicit, amongst 37 Australians and New Zealanders, aged 18-55, with a medical diagnosis of endometriosis. Previous cannabis usage was not required to participate. Discussion topics included strategies employed to manage symptoms, exploration of current medications, previous use of cannabis for pain management, and interest in using medicinal cannabis as a management strategy. Participants with moderate to severe symptoms of medically diagnosed endometriosis reported inadequacies with their current medical and self-management strategies and were inclined to try medicinal cannabis, both as part of their medical management and as part of a clinical trial. Barriers to medicinal cannabis adoption identified in this cohort included high costs of legal cannabis products, lack of clarity and fairness in current roadside drug testing laws and workplace drug testing policies, concern over the impact of stigma affecting familial, social and workplace life domains, and subsequent judgement and the lack of education/engagement from their medical providers regarding cannabis use. Given the interest in medicinal cannabis and the reported lack of effective symptom management, clinical trials are urgently required to determine the potential role that medicinal cannabis may play in reducing the symptoms of endometriosis.

Intensity Modulated Radiotherapy For Recurrent Spine Aneurysmal Bone Cyst In Adolescence-Case Report And Review of Literature

Aneurysmal bone cysts are rarely diagnosed aggressive benign bone tumors that require CT and MRI imaging and strict histopathological analysis. This clinically and histologically benign tumor is mainly diagnosed in children and adolescents in the long bones of the limbs, but in 12%-30% it is localized in the spine. Since the value of external beam radiotherapy (EBRT) for aneurysmal bone cyst (ABC) has not been well defined, we present our observations and treatment outcome after the realization of intensity modulated radiotherapy (IMRT) up to total dose 30 Gy for recurrent spine aneurysmal bone cyst in adolescent age. In this article, for the first time in the world medical literature, an MRI imaging finding after performed IMRT in recurrent ABC is presented. Our observations lead to the conclusion, that radiation therapy is an effective treatment method for relapsed or inoperable disease, achieving not only a symptomatic pain-relieving effect, but also a significant tumor reduction and restoration of the bone structure.

FRI476 Asymptomatic Thyrotropin-secreting Pituitary Microadenoma With Biochemical Secondary Hyperthyroidism: A Diagnostic Conundrum

Abstract Disclosure: G. Al-Naqeeb: None. R. Ghosh: None. P. Veeraraghavan: None. C. Cochran: None. J. Klubo-Gwiezdzinska: None. S. Gubbi: None. Background: Thyrotropin (TSH)-secreting pituitary adenomas (TSHAs) are often macroadenomas (&amp;gt;1 cm), and clinically present with secondary hyperthyroidism (SH), but clinically silent microTSHAs (&amp;lt;1 cm) with only biochemical SH pose a diagnostic challenge. Clinical Case: A 49-year-old, healthy male was referred to our center for evaluation of abnormal thyroid function tests (TFTs). Immunoassay (IA) measurements at an outside hospital had identified elevated free T4 (FT4), and an inappropriately normal TSH, and a pituitary magnetic resonance imaging (MRI) had noted an 8mm x 7mm non-invasive adenoma. The patient denied hyperthyroidism symptoms, medication/herbal supplement intake, radiation exposure, headaches, vision changes, and thyroid/pituitary disorders, or abnormal TFTs in relatives. Physical exam revealed no signs and symptoms of hyperthyroidism. No thyromegaly or cervical lymphadenopathy was felt. IA profile at our institute was consistent with an SH pattern [TSH: 3.32 mIU/L (NL: 0.4 - 4.7); FT4: 3 ng/dL (NL: 0.9 - 1.7); total T4: 14.5 mcg/dL (NL: 4.5 - 11.7); triiodothyronine: 266.6 ng/dL (NL: 80 - 200)], with similar values on repeat measurement. Equilibrium dialysis technique also yielded an elevated FT4 value. TSH-receptor, anti-thyroid peroxidase, and anti-thyroglobulin (Tg) antibody (Ab) titers, serum Tg, and thyroid binding globulin levels were normal. Dilution studies ruled out heterophile Ab interference. Familial dysalbuminemic hyperthyroxinemia was unlikely given the elevated FT4 values. Genetic testing revealed a normal THRB gene, thereby ruling out thyroid hormone resistance. THRA gene was not tested due to absence of behavioral or hearing issues. Markers of hyperthyroidism, including angiotensin converting enzyme, carotene, apolipoproteins, and osteocalcin levels were normal, except for an elevated sex hormone binding globulin of 104 nmol/L (NL: 11 - 78). Biochemical evaluation of other pituitary axes was normal. However, an elevated alpha sub-unit fraction (ASF) was noted on two separate measurements. Sonogram revealed a heterogeneous, hypervascular thyroid. Bone densitometry, echocardiogram, and Holter monitor studies were normal. The combination of biochemical SH, elevated ASF, pituitary adenoma, and exclusion of other etiologies causing SH pattern established the diagnosis of TSHA. An active surveillance approach was implemented. A pituitary MRI done 18 months later showed minimal (2mm in one axis) increase in the adenoma size, and the patient continued to demonstrate biochemical SH but remained asymptomatic. Conclusion: MicroTSHAs can present with asymptomatic SH. In this situation, excluding other biochemical SH etiologies is crucial to prevent unnecessary invasive procedures. But once TSHA diagnosis is established, due to the risk of tumor growth leading to symptomatic SH or mass effects, active surveillance is warranted. Presentation: Friday, June 16, 2023

Translation and psychometric testing of Indonesian Version of Chronic Kidney Disease– Symptom Burden Index

Introduction: Chronic Kidney Disease Symptom Burden Index (CKD-SBI) is an instrument measuring symptom burden developed by Almutary and colleagues in 2015 to refine the identification of symptom burden in chronic kidney disease population. This instrument has not been tested for Indonesian language, thus, the aim of study was to translate and psychometrically testing the Indonesian version of CKD-SBI. Methods: This study design was cross-sectional study. The study methods were divided into translation and psychometric testing. The translation was conducted by adapting Guillemin and Beaton's guidelines. The psychometric properties determined 320 hemodialysis patients with several inclusion criteria such as above 18 years old, regularly receiving hemodialysis for more than 3 months. Patients with cognitive impairment, psychiatric patients, and in critical condition were excluded. Results: The item content validity index of the Indonesian version was 0.92, and the subscale content validity was 0.78. The instrument demonstrated convergent validity with the Kidney Disease Quality of Life. Excellent internal consistency was demonstrated based on a Cronbach’s alpha coefficient of .91 and a subscale ranging from 0.86 to 0.92. The confirmatory factor analysis showed that the five factors of English Version did not fit the Indonesian version. Conclusions: Translated Indonesian versions of CKD-SBI can be used as instruments to assess symptom burden among patients with hemodialysis. By assessing symptom burden, we hope nurses in the hospital are able to decide effective symptom management to increase the health-related quality of life among these populations.

Fractionated Radiosurgery in Large Volume Relapsed Glioblastoma Multiforme

Relapse is part of the natural history in glioblastoma (GBM) and there are limited advances in surgical, alternating electric field therapy (TTF), chemotherapy (CTX), immunotherapy or radiotherapeutic treatments. Radiosurgery (SRS) and Fractionated Stereotactic Radiosurgery (FSRS) may be an option, but remains controversial. We performed a review of our patients with recurrent large volume glioblastoma treated with FSRS over the last 5 years. Since January 2017 to December 2021, we reviewed our experience with large volume FSRS for the treatment of selected patients with large volume GBM recurrence. Indications and treatment planning were done according RANO criteria MR images. Overall survival (OS) and progression-free survival (PFS) after salvage FSRS were the primary endpoints evaluated. Response to FSRS was assessed with clinical evaluation and using brain MR. A total of 15 patients with GBM recurrence were treated in our institution after surgery plus adjuvant radio-chemotherapy treatment with Stupp regimen. Median age was 58 (53-74) years old. Prescription dose was 24 Gy in 4 fractions in consecutive days. Selected patients for FSRS had a good PS with large volume relapse and edema. The target volume (CTV) was the enhanced volume in MR T2 classically known has edema and the relapsed T1 volume with gadolinium uptake. The median PTV was 118.5 cc (50-244cc). 33% of the patients received concurrent chemotherapy or biological therapy with or after FSRS. No patient developed G3 symptomatic adverse radiation effect. Median follow-up was 28.6 (10-82) months from diagnosis. PFS after salvage FSRS was 11 (4-55) months. Median overall survival was 12.4 months after FSRS. Our experience and results suggest that reirradiation provides encouraging disease control and survival rates in GBM relapsed patients. The large volume FSRS associated or not with systemic treatment had good tolerance and can improve survival of patients with relapsed large volume GBM. Randomized controlled trials are needed to establish the optimal management strategy for recurrent GBM.

Understanding Sickle cell disease: Causes, symptoms, and treatment options.

Sickle cell disease (SCD) is a hereditary blood disorder characterized by the production of abnormal hemoglobin molecules that cause red blood cells to take on a crescent or sickle shape. This condition affects millions of people worldwide, particularly those of African, Mediterranean, Middle Eastern, and South Asian descent. This paper aims to provide an overview of SCD by exploring its causes, symptoms, and available treatment options. The primary cause of SCD is a mutation in the gene responsible for producing hemoglobin, the protein that carries oxygen in red blood cells. This mutation has abnormal hemoglobin called hemoglobin S, which causes red blood cells to become stiff and sticky, leading to various health complications. Patients with SCD may experience recurrent pain, fatigue, anemia, and increased infection susceptibility. Treatment options for SCD focus on managing symptoms and preventing complications. This includes pain management with analgesics, hydration, and blood transfusions to improve oxygen delivery. Hydroxyurea, a medication that increases the production of fetal hemoglobin, is commonly used to reduce the frequency and severity of pain crises. Additionally, bone marrow or stem cell transplants can cure select individuals with severe SCD. Finally, understanding the causes, symptoms, and treatment options for SCD is crucial for healthcare professionals, patients, and their families. It enables early diagnosis, effective symptom management, and improved quality of life for individuals with this chronic condition.

A population-based study on the common androgenic symptoms in PCOS and its management

The aim of this population-based study is to comprehensively investigate the prevalence, severity, and management of common androgenic symptoms in individuals with Polycystic Ovary Syndrome (PCOS). By analyzing a diverse population sample, this study aims to provide valuable insights into the understanding and effective management of androgenic symptoms associated with PCOS. In the endocrine disorder known a PCOS, the ovaries produce an excessive number of androgens, which are male sex hormones that are typically present in women in modest amounts. The disorder known as polycystic ovarian syndrome is characterized by an abundance of small cysts (fluid-filled sacs) produced by the ovaries. Google forms-based survey data was gathered to better understand recent trends among female patients. In order to understand the pattern of androgenic symptoms in PCOS patients, the obtained replies were examined and analyzed. According to this study, hirsutism, alopecia, and acne are the most typical androgenic symptoms experienced by women. Common treatments for these symptoms include taking biotin supplements, applying minoxidil topically for alopecia, and utilizing over-the-counter acne drugs such benzoyl peroxide and salicylic acid. Additionally, drugs that reduce testosterone are used to treat hirsutism. These results underline how crucial it is to identify and treat androgenic symptoms in women because they can significantly affect both physical appearance and general wellbeing.