Functional Complaints Research Articles

Different Dimensions of Affective Processing in Patients With Irritable Bowel Syndrome: A Multi-Center Cross-Sectional Study.

Objective: Deficits in affective processing are associated with impairments in both mental and physical health. The role of affective processing in patients with functional somatic complaints such as irritable bowel syndrome (IBS) remains unclear. Most studies have focused on the capacity for emotional awareness and expression, but neglect other dimensions of affective processing. Therefore, this study aimed to systematically analyze differences in six different dimensions of affective processing between patients with IBS and healthy controls (HCs). Additionally, we exploratively investigated the impact of IBS symptom severity, psychological distress, and attachment styles on affective processing in IBS.Methods: A controlled cross-sectional multi-center study was conducted. Overall, 127 patients with IBS were compared with 127 matched HCs using multivariate analysis of variances. Affective processing was operationalized in line with the affect cascade model on six specific dimensions: emotional experience, emotional awareness, affect tolerance, affect differentiation, affect regulation, and emotional communication. They were measured using two subscales of the Mentalizing Questionnaire (MZQ) and four subscales of the Operationalized Psychodynamic Diagnosis–Structure Questionnaire (OPD-SQ). Linear regression analysis was used to investigate the influence of IBS symptom severity (IBS-Severity Scoring System, IBS-SSS), depression (Patient Health Questionnaire, PHQ-9), anxiety (General Anxiety Disorder, GAD-7), and anxious and avoidant attachment styles (Experiences in Close Relationships Scale, ECR-RD12) on the different dimensions of affective processing in IBS.Results: Patients with IBS compared to HCs showed deficits in all six dimensions of affective processing. Deficits were largest for affect tolerance (d = 0.849) and lowest for emotional experience (d = 0.222) and emotional awareness (d = 0.420). Moderate effect sizes were found for affect differentiation (d = 0.773), emotional communication (d = 0.665), and affect regulation (d = 0.552). Moreover, explorative analyses indicated that affective processing in patients with IBS was significantly influenced by levels of anxiety and insecure attachment.Conclusion: The results indicate a specific pattern of affective processing abilities in patients with IBS. The deficits in affective processing are more prominent in the area of understanding and tolerating difficult affective states than experiencing affective states. This opens interesting perspectives for the development of specific psychotherapeutic interventions.Clinical Trial Registration: DRKS00011685.

A Safe Method for Early Rehabilitation of Articular Fracture at the Base of Thumb Metacarpal Bone.

Background To evaluate the clinical and radiological results of closed reduction, distraction using an external fixator, and percutaneous fixation in patients with Bennet and Rolando fractures. Methods Patients over 18 years of age, who had isolated fracture at the base of the first metacarpal bone, had no previous functional limitations and pain complaints, were regularly followed up, and had fixation using K-wire combined with an external fixator, were included. Arthrosis was evaluated according to Eaton and Littler classification. Pain intensity was evaluated using the visual analogue scale (VAS) on a 0–10 scale. Furthermore, patients were questioned regarding limitations in their daily activities and hobbies. Pinch and grasp strengths were evaluated. Results Thirteen of the patients were male and five were female, with a mean age of 31.5 ± 12.5 years. The surgical procedure was performed on the right extremity in 12 patients and left extremity in six patients. Twelve patients were found to have Bennet fractures, whereas six patients had Rolando fractures. The mean follow-up period of the patients was found to be 29.6 ± 5.4 months. The VAS score was rated as 2 in one patient and 1 in one patient. Other patients had a pain VAS score of 0. The mean Quick-DASH score was calculated to be 1.20. No statistical difference was found in pinch strength between the two extremities (p > 0.05). No difference was observed in terms of the range of motion (p > 0.05). Conclusion Fixation using K-wire combined with an external fixator has more benefits than its disadvantages and is superior to other methods in the intra-articular fractures of the first metacarpal bone.

Functional electrical stimulation in the treatment of patients with type 2 diabetes mellitus complicated by diabetic angiopathy and polyneuropathy

Diabetic distal polyneuropathy (DPN) is the main cause of disability in patients with type 2 diabetes mellitus (DM2). The purpose of the research with 72 patients was to study the effect of functional electrical stimulation (FES) on reducing the degree of functional motor disorders in patients with DM2, angiopathy and DPN. Method. The patients were divided into 3 randomized groups (2 main groups, 1 control group). In addition to basic therapy, the patients of the main groups were treated with FES of the lower extremities with a frequency of 10–30 Hz in group 1 and 80–100 Hz in group 2. Results: the dynamics of quantitative assessment of the overall score on the NSS scale after treatment was significantly higher in the main groups compared to group 3 (Mann-Whitney test p 1–3 = 0,001, p 2–3 = 0,006). There was no significant difference in the overall score of the NSS between groups 1 and 2. The most pronounced positive changes in neurofunctional disorders after treatment on the NDS scale were achieved in group 1: the overall score decreased by 52% after the treatment and was significantly lower than in other groups (p 1–2 = 0,014, p 1–3 = 0,002, Mann-Whitney test). According to the treadmill test, tolerance to physical activity increased in all patients after the treatment. Significant positive dynamics of the stabilometric index of the ratio of energy consumption with closed and open eyes while standing on a balancing pillow was observed only in main group 1 (decreased by 41%, p=0,000, Wilcoxon test). Conclusions. The use of FES of the lower extremities as part of complex therapy in patients with DM2 complicated by angiopathy and DPN is safe and allowed reducing the degree of functional disorders and neuropathic complaints to a greater extent in the study group using FES with a frequency of 10–30 Hz.

Roux-en-Y duodenal diversion after Ivor Lewis esophagectomy, with video

Gastroesophageal reflux is a frequent functional complaint after Ivor Lewis esophagectomy intervention, which can affect up to 40 % of patients. Roux-en-Y duodenal bypass is a valuable option to treat gastroesophageal reflux disease in these patients when the medical treatment is ineffective because it treats both acid and biliary reflux. We only propose this operation to patients who have an impaired quality of life despite a well conducted medical treatment.After Ivor Lewis intervention, we suggest a gastrojejunostomy on the gastroplasty, on a 70 cm alimentary limb. No vagotomy needs to be performed since the vagus nerves are cut during esophagectomy.This video shows the realization of the Roux-en-Y duodenal diversion after Ivor Lewis esophagectomy.

MANAJEMEN LOW VISION PADA ANAK USIA SEKOLAH

Low vision according to the World Health Organization (WHO) is a person who has impaired visual function after treatment or standard refraction correction and has visual acuity less than 6/18 (20/60) until the light perception or field of view is less than 100 from the fixation point and is still can use residual vision to perform certain activities. Low vision cases according to WHO is 3-4 times greater than cases of blindness. The prevalence of blindness in children varies from region to region or country, ranging from 0.15 to 1.5 per 1000 children. Of the 1.4 million children who are blind, 90% are in developing countries. In addition, there are 7 million low vision children. The prevalence of low vision in children is 11 times more than blindness in children. Low vision in children can be caused by eye abnormalities both congenitally and including cataracts, glaucoma, retinitis pigmentosa, clouding of the cornea, and retinopathy of prematurity (ROP). The clinical symptoms are blurred vision, limited field of view, accompanied by functional complaints such as decreased contrast sensitivity, glare, and color vision disorders so that visual aids are needed in low vision. Low vision examination consists of anamnesis, visual acuity measurement (examination of visus distance and close range), visual field examination, contrast sensitivity test, glare examination, and color blindness test. In this paper, we report cases of low vision in children where the management uses low vision aids according to their needs. Keywords : low vision, etiology, clinical symptoms, examination, low vision aids , management

18F-FDG brain PET hypometabolism in patients with long COVID.

PurposeIn the context of the worldwide outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), some patients report functional complaints after apparent recovery from COVID-19. This clinical presentation has been referred as “long COVID.” We here present a retrospective analysis of 18F-FDG brain PET of long COVID patients from the same center with a biologically confirmed diagnosis of SARS-CoV-2 infection and persistent functional complaints at least 3 weeks after the initial infection.MethodsPET scans of 35 patients with long COVID were compared using whole-brain voxel-based analysis to a local database of 44 healthy subjects controlled for age and sex to characterize cerebral hypometabolism. The individual relevance of this metabolic profile was evaluated to classify patients and healthy subjects. Finally, the PET abnormalities were exploratory compared with the patients’ characteristics and functional complaints.ResultsIn comparison to healthy subjects, patients with long COVID exhibited bilateral hypometabolism in the bilateral rectal/orbital gyrus, including the olfactory gyrus; the right temporal lobe, including the amygdala and the hippocampus, extending to the right thalamus; the bilateral pons/medulla brainstem; the bilateral cerebellum (p-voxel < 0.001 uncorrected, p-cluster < 0.05 FWE-corrected). These metabolic clusters were highly discriminant to distinguish patients and healthy subjects (100% correct classification). These clusters of hypometabolism were significantly associated with more numerous functional complaints (brainstem and cerebellar clusters), and all associated with the occurrence of certain symptoms (hyposmia/anosmia, memory/cognitive impairment, pain and insomnia) (p < 0.05). In a more preliminary analysis, the metabolism of the frontal cluster which included the olfactory gyrus was worse in the 7 patients treated by ACE drugs for high blood pressure (p = 0.032), and better in the 3 patients that had used nasal decongestant spray at the infectious stage (p < 0.001).ConclusionThis study demonstrates a profile of brain PET hypometabolism in long COVID patients with biologically confirmed SARS-CoV-2 and persistent functional complaints more than 3 weeks after the initial infection symptoms, involving the olfactory gyrus and connected limbic/paralimbic regions, extended to the brainstem and the cerebellum. These hypometabolisms are associated with patients’ symptoms, with a biomarker value to identify and potentially follow these patients. The hypometabolism of the frontal cluster, which included the olfactory gyrus, seems to be linked to ACE drugs in patients with high blood pressure, with also a better metabolism of this olfactory region in patients using nasal decongestant spray, suggesting a possible role of ACE receptors as an olfactory gateway for this neurotropism.

The association between changes of gustatory function and changes of salivary parameters: A pilot study.

The aim of the pilot study was to explore which of the salivary parameters best reflects improvement or deterioration of taste function. A total of 14 patients were included. Taste ability was measured using taste strips and patients rated their symptom strength using visual analogue scales. Salivary parameters (flow rate, total proteins, proteolysis, catalase, total anti-oxidative capacity [TAC], carbonic anhydrase VI [caVI], and pH) were determined and the Beck Depression Inventory (BDI) was administered. All these parameters were measured twice with a one-year interval to acquire the changes of data. Patients with decreased taste function exhibited a decrease in salivary proteolysis and caVI, and an increase in salivary total protein. Patients with increased taste function also showed an increase in salivary total protein. Δ Salivary flow rate was negatively correlated with Δ taste strip scores. Δ Salivary pH was significantly lower in patients with increased taste function compared to patients with decreased taste function. Δ BDI was positively correlated with both Δ symptoms ratings. Across all patients, symptom ratings decreased while salivary total protein increased; salivary flow rate, proteolysis and caVI decreased significantly compared with baseline. The present longitudinal results suggest that changes of both taste function and taste complaints were accompanied by changes in salivary parameters, indicating that salivary parameters have the potential to be useful in the diagnosis of patients with qualitative taste disorders.

A journey through psychiatry - A personal perspective.

A journey through psychiatry - A personal perspective.

Emergence of Different Autoimmune Diseases Including a Behçet's disease in a Sibling After tick bites. Remarkable cure of Behcet's disease by a Combination of Antibiotics and Hydroxychloroquine

We report therein the onset of three chronic diseases: Behcet's disease, fibromyalgia and rheumatoid arthritis in three sisters after tick bites. Only Behcet's disease was treated in our department. After failure of the initial treatment including colchicine and corticoids, the patient recovered within a prolonged antibiotic therapy time period of 18 months. A 23-year-old female patient was admitted to hospital in the Infectious Diseases Department as she presented with headache, diffuse inflammatory arthromyalgia, abdominal pain and cutaneous folliculitis, and for the umpteenth time for several past years, meningeal syndrome recurrence. The physical examination was unremarkable. The biological test assessment was normal, as were the ophthalmological and cerebral MRI examinations. The patient’s HLA B5 test was negative. The upper digestive fibroscopy shown digestive ulcerations. The diagnosis of Behcet's disease was made on the following: inflammatory arthralgias, digestive ulcerations, folliculitis lesions; recurrent bipolar aphthosis was found at patient’s interview. The patient was given prednisone 0.5 mg/kg/day and colchicine 1 mg/day. The evolution was characterized by an initial improvement of clinical symptoms followed by further iterative recurrence as soon as the corticosteroid doses were reduced. Upon resuming the interview with the patient’ s mother, clinical symptoms began at the age of 9 years old by the occurrence of a voluminous cutaneous erythema following multiple tick bites. One month later the patient presented with subacute lymphocytic meningitis, which was treated as tuberculosis meningitis without relevant bacteriological evidence. On the same day, the patient's two sisters were also bitten by ticks. A few weeks later on, one of them developed osteomyelitis of the tibia, which was operated on. The bacteriological examination result was negative, the histological examination showed non-specific osteomyelitis. Subsequently, she developed various multiple functional complaints that led to the diagnosis of fibromyalgia. Her other sister concomitantly developed seronegative rheumatoid arthritis. The diagnosis of chronic post-tick bite syndrome was suspected despite the negativity of the Lyme serology. The patient significantly improved thanks to high-dose of intravenous penicillin G, despite an initial exacerbation during the first month of treatment, which could be interpreted as confirmation of an infectious process (Jarisch-Herxheimer reaction). Corticosteroids and colchicine were discontinued ; the patient was given doxycycline for a total duration of 18 months. Antibiotic therapy was associated with hydroxychloroquine, the same way as reported for therapy of chronic Q fever and some types of Lyme disease [1]. In 2004, the patient was in complete remission of Behcet's disease. Ten years later, no recurrence has been observed.

Iris reconstruction: A perspective on the modern surgical armamentarium.

The surgical reconstruction of eyes with iris defects is almost invariably complex and challenging. A number of prosthetic iris devices are available including large-incision, rigid diaphragm, aniridic intraocular lens style devices, small-incision devices incorporating a capsular ring, and flexible, customized, small-incision iris prostheses. The surgical techniques for rehabilitation are dictated by the configuration of the iris defect, the presence of concurrent ocular pathology, and the functional complaint of the patient. Successful rehabilitation requires careful surgical planning and appropriate patient selection. Nonetheless, endowed with the modern surgical armamentarium, the reconstructive surgeon may achieve significant functional and cosmetic improvement.

Relevance of Methane and Carbon Dioxide Evaluation in Breath Tests for Carbohydrate Malabsorption in a Paediatric Cohort.

The relevance of methane measurement in breath tests for the detection of carbohydrate malabsorption in children is controversial. The need for correction for poor sample collection is disputed. We evaluated the relevance of methane/CO2 measurements for the diagnosis of paediatric carbohydrate malabsorption. A total of 132 breath tests (fructose: n = 54; lactose: n = 78) were performed in 91 children/adolescents with functional abdominal complaints. Breath samples were collected and analysed for hydrogen, methane, and CO2. Malabsorption was defined by a net increase over baseline of ≥20 parts per million (ppm) for hydrogen, ≥5 to ≥12 ppm for methane, and ≥10 to ≥15 ppm for hydrogen-plus-methane. The diagnosis was made before and after the use of a CO2-based correction factor (5.5% as the numerator). Hydrogen-based test results were compared with results obtained with other cut-off values. Fifty-eight positive tests were obtained by hydrogen measurement (without CO2 correction). The addition of methane measurements did not significantly influence the test results (P > 0.05). Only under the use of extraordinary cut-offs (combined hydrogen-plus-methane smaller than ≥18 ppm) did the rate of malabsorbers increase significantly (P < 0.05). After CO2 correction, hydrogen ≥20 ppm was detected in 4 additional patients, but 1 patient lost the hydrogen-based diagnosis of malabsorption (Cohen kappa = 0.92). Methane measurement did not significantly affect the detection rate of carbohydrate malabsorbers in children/adolescents with functional abdominal complaints when established cut-offs are used. The use of CO2 correction altered the diagnosis of malabsorption in a minority of patients but did not significantly alter overall test results.

Diagnosis clinical criteria of sport related concussion: Toward an operational criteria definition in France

ObjectiveAn expert working group was set up at the initiative of the French Ministry of Sports with the objective of harmonising the management of sport related concussion (SRC) in France, starting with its definition and diagnosis criteria. ResultsDefinition: A clinical definition in 4 points have been established as follows: Concussion is a brain injury: 1) caused by a direct or indirect transmission of kinetic energy to the head; 2) resulting in an immediate and transient dysfunction of the brain characterised by at least one of the following disorders: a) Loss of consciousness, b) loss of memory, c) altered mental status, d) neurological signs; 3) possibly followed by one or more functional complaints (concussion syndrome); 4) the signs and symptoms are not explained by another cause. Diagnosis criteria: In the context of the direct or indirect transmission of kinetic energy to the head, the diagnosis of concussion may be asserted if at least one of the following signs or symptoms, observed or reported, is present within the first 24hours and not explained by another cause: 1) loss of consciousness; 2) convulsions, tonic posturing; 3) ataxia; 4) visual trouble; 5) neurological deficit; 6) confusion; 7) disorientation; 8) unusual behaviour; 9) amnesia; 10) headaches; 11) dizziness; 12) fatigue, low energy; 13) feeling slowed down, drowsiness; 14) nausea; 15) sensitivity to light/noise; 16) not feeling right, in a fog; 17) difficulty concentrating. ConclusionSharing the same definition and the same clinical diagnostic criteria for concussion is the prerequisite for common rules of management for all sports and should allow the pooling of results to improve our knowledge of this pathology.

P063 Manometric Study and the Role of the Perianal Disease and the Clinical Activity in Anorectal Dysfunction in Crohn's Disease.

BACKGROUND: Although Crohn's disease frequently affects the perianal region and its function, studies evaluating anorectal function in these patients are rare and with controversial results. The impact of perianal disease on anorectal function complaints is not clear, other factors such as disease activity, stool consistency and decreased rectal capacity may have a more important role in its pathogenesis. Athanasios et al. found no association between the values of resting and squeeze pressure and fecal incontinence in Crohn's disease (CD) patients. According to the authors, this result could be explained by the difference in the pathophysiology of fecal incontinence among patients with inflammatory bowel disease (IBD). The aim of this study is to determine associated manometric factors, the role of perianal disease, disease activity and fecal consistency in anorectal dysfunction in CD patients. METHODS: This is an observational, cross-sectional study. Fifty-six Crohn's disease patient under outpatient follow-up, completed a questionnaire and were submitted to a medical record review, and anorectal manometry. Manometric variables studied: resting and squeeze pressure, anismus, rectoanal inhibitory reflex (RAIR), rectal sensitivity and capacity and proof of balloon expulsion. Functional disorders studied: fecal incontinence and urgency, incomplete/obstructed evacuation and tenesmus. Software R for Windows, version 4.0.2 was used for the statistical analyses. Pearson's χ2 test, Fisher's exact test and T-Student Test for independence was used to study the association between manometric and clinical variables and functional disorders, with P < 0,05. RESULTS: Of the 56 patients evaluated, 53.6% are male, with a mean age of 41.4 years (SD: 12.4). According to the Montreal Classification, most patients have non-penetrating/non-stenosing disease (61.5%). Perianal disease, was present in 44.2% of the patients. Most patients were in remission, according to the Harvey-Bradshaw Index. Among the functional complaints, the most common is fecal incontinence (38%), followed by a sensation of obstructed/incomplete evacuation (36%) and fecal urgency (29%). When patients with anorectal functional complaints (fecal incontinence, incomplete/obstructed evacuation, fecal urgency and tenesmus) were compared with patients without anorectal functional complaints, no statistically significant difference was found in relation to perianal disease. On the other hand, a statistically significant difference was found when we compared the patients with any anorectal functional complaint (fecal incontinence, incomplete/obstructed evacuation, fecal urgency and tenesmus) with the patient without any complaints in relation to activity index of the disease and fecal consistency. CONCLUSION: Our results suggest that functional complaints in patients with Crohn's disease are more related to disease activity and fecal consistency, among other factors, than structural and functional ano-rectal-perineal abnormality, including those caused by perianal involvement of the disease. Therefore, the control of the disease activity probably is critical for the management of this function symptoms.

Burn-out of the Medical Oncology Health Care Professionals and Associated Factors in Tunisia

Introduction: Burn-out is defined as a syndrome of emotional exhaustion, depersonalization and diminished self-achievement that affects individuals exposed to chronic occupational stress. Physicians and caregivers faced with the death of their patients, such as oncology, are particularly vulnerable to this syndrome.Objectives: To evaluate the burn-out of medical professionals in medical oncology, to research the predisposing factors and to analyze the functional complaints and the behavior of the staff associated with this syndrome.Methods: A descriptive and analytical cross-sectional study among medical oncology professionals practicing in public hospitals in the Tunisian territory who exercise more than two years in oncology; with the Maslach Burnout Inventory (MBI).Results: Our study population was predominantly female (81%). 53% are doctors and 47% are paramedical health care professionals. A high degree of emotional exhaustion, depersonalization and personal achievement were found in 63%, 53% and 59% in our population, respectively. With 21% global high burn-out. The female sex was associated with high emotional exhaustion and low personal accomplishment as well as global burn-out. This burn-out was attributed to factors associated with working conditions and professional climate, mainly: overwork, poor organization of service, lack of resources and time, lack of recognition, lack of communication, lack of respect, conflicts with colleagues, report unsatisfactory salary effort and aggressions by patients and their families. Functional complaints and health care professional’s behavior associated with burn-out were: feelings of sadness, blockage, and irritability, sleep disorders, unexplained pain, epigastralgia, addictive behaviors, psychotropic consumption, suicidal thoughts, decreased performance and desire for a job transfer.Conclusions: By its impact on professionals, burn-out in medical oncology represents a major threat to the quality of health care. Its etiologies, although complex and intricate, are well known. Its prevention and its support are possible, but involve mobilization at all levels.

WITHDRAWN: HORNER’S SYNDROME DURING HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION FOR A BENIGN THYROID NODULE.

Abstract Objective Horner’s syndrome (HS) is a rare complication of high-intensity focused ultrasound (HIFU) and radiofrequency ablation for thyroid nodules. We present such a case and discuss how to avoid this complication in the future. Methods This case occurred during HIFU treatment of a benign thyroid nodule (BTN). Ultrasound and fine-needle aspiration cytology (FNAC) were performed before the procedure. Volume reduction was evaluated at 6 weeks, 3, 6, and 12 months. Technical success was ≥50% reduction at 6 months. Results A 30-year-old woman presented with a solitary symptomatic thyroid nodule. Her thyroid stimulating hormone was 1.16 (ref 0.4-3.6) μUI/mL), ultrasound found a 13 mL right-thyroid EU-TIRADS 4 nodule. Two FNACs were read as Bethesda II. The subsequent HIFU procedure was conducted with local 2% lidocaine anesthesia. The procedure was painful (visual analogic scale 10/10) and ipsilateral partial ptosis occurred during the procedure. Volume reduction at 12 months was 34.6% of the initial volume with persisting functional and cosmetic complaints, discomfort, and partial ptosis. As the volume reduction was ≤50%, the procedure was a technical failure. A new FNAC was read as Bethesda IV. A right lobectomy was performed without postoperative outcomes and without requiring hormonal replacement therapy. Pathological evaluation found no malignant cells. Conclusion HS is a rare complication of HIFU for management of BTNs. It may be symptomatic and have sequalae that persist for months. Severe neck pain may by associated, but further investigation is needed.

Genetic Risk, Vascular Function, and Subjective Cognitive Complaints Predict Objective Cognitive Function in Healthy Older Adults: Results From the Brain in Motion Study.

Aging is associated with subjective memory complaints. Approximately half of those with subjective memory complaints have objective cognitive impairment. Previous studies have provided evidence of an association between genetic risk for Alzheimer’s disease (AD) and dementia progression. Also, aging is a significant risk factor for vascular pathology that may underlie at least some of the cognitive changes. This study investigates the relative contribution of subjective cognitive complaints (SCC), vascular function, and genetic risk for dementia in predicting objective cognitive performance. Multiple regression and relative importance analysis were used to investigate the relative contribution of vascular function, self-reported SCC, and dementia genetic risk, in predicting objective cognition in a sample of 238 healthy community-dwelling older adults. Age, sex, premorbid cognitive abilities, subjective verbal memory complaints, higher cerebrovascular blood flow during submaximal exercise, and certain dementia risk alleles were significant predictors of worse objective verbal memory performance (p < 0.001, R2 = 35.2–36.4%). Using relative importance analysis, subjective verbal memory complaints, and certain dementia risk alleles contributed more variance than cerebrovascular measures. These results suggest that age-related changes in memory in healthy older adults can be predicted by subjective memory complaints, genetic risk, and to a lesser extent, cerebrovascular function.

Intentıonal reımplantatıon of hopeless teeth: Cases serıes

Intentional replantation is an alternative for the treatment of advanced periodontal destruction of the anterior teeth. Systemically healthy three female patient was referred to our clinic with functional complaints. Diagnosis were chronic periodontitis and class III mobility was noted at the mandibular incisors with complete periodontal attachment loss. After phase I periodontal treatment periodontally involved teeth were extracted, endodontic treatment accomplished, the teeth were replanted and fixed to its place with fiber reinforced composite splint. At the end of 2 years tooth was in function with alveolar bone gain. Intentional replantation provided long-term maintenance of patient’s own teeth.

Emotional Regulation Following Acquired Brain Injury: Associations With Executive Functioning in Daily Life and Symptoms of Anxiety and Depression.

Objective: To examine whether a questionnaire measuring emotional regulation after acquired brain injury adds clinical information beyond what can be obtained with a comprehensive executive function questionnaire and an anxiety and depression measure.Method: Seventy adult persons (age 19–66 years, Mage = 43, SDage = 13) with acquired brain injury in the chronic phase and executive function complaints. All were recruited to participate in a randomized controlled trial (NCT02692352) evaluating the effects of cognitive rehabilitation. Traumatic brain injury was the dominant cause of injury (64%), and mean time since injury was 8 years. Emotional regulation was assessed with the Brain Injury Trust Regulation of Emotions Questionnaire (BREQ). Executive function was assessed with the Behavior Rating Inventory of Executive Function Adult Version (BRIEF-A). The Hopkins Symptom Checklist 25 (HCSL-25) was employed to measure anxiety and depression symptoms.Results: Overall, significant correlations were found between reports of emotional regulation (BREQ) and executive function in daily life (BRIEF-A). Furthermore, our analyses revealed a significant relationship between self-reported scores of emotional regulation (BREQ) and symptoms of anxiety and depression (HSCL-25).Conclusion: The significant associations between the BREQ and most of the other clinical measures indicate that, for patients with acquired brain injury, the BREQ does not add substantial information beyond what can be assessed with the BRIEF-A and the HSCL-25.

Subjective cognitive decline and elder mistreatment in Mexican community-dwelling older adults

Background and objectivesElder mistreatment in individuals with subjective cognitive decline is an understudied public health problem that violates human rights. Design and Methods: Cross-sectional study of 386 Mexican community-dwelling older adults. Individuals with episodic memory, executive function, language, visuospatial skills or attention cognitive complaints without low cognitive performance scores in the Mini-Mental State Examination and the Isaacs Set Test that were considered positive for subjective cognitive decline (SCD). Elder mistreatment (EM) was considered positive if any of the questions on the Geriatric Mistreatment Scale were answered affirmatively. Logistic regression models were created to test the association between SCD and EM. ResultsAfter adjustments made by age, sex, education and depressive symptoms a positive association was found between SCD and EM (OR = 2.226; 95%CI = 1.296 to 3.822 ; p = 0.004). This association was observed in all subtypes of cognitive complaints except excecutive function: episodic memory (OR = 2.219 ; 95%CI = 1.321 to 3.728 ; p = 0.003), language (OR = 2.500 ; 95% CI = 1.422 to 4.396 ; p = 0.001), visuospatial (OR = 2.158 ; 95%CI = 1.162 to 4.007 ; p = 0.015), attention (OR = 2.197 ; 95%CI = 1.206 to 4.001 ; p = 0.010) and executive (OR = 1 2.062 ; 95%CI = 0.981 to 4.333 ; p = 0.056). Discussion and Implications: This study brings to light the relation between SCD and EM in a population where it has been understudied. Exploring mistreatment in older adults who experience subjective cognitive decline might help preserve their safety and create future prevention and intervention strategies.

Potential for recovery between 4 and 8 years after a severe traumatic brain injury. Data from the PariS-TBI longitudinal study.

Severe traumatic brain injury (TBI) is a leading cause of complex and persistent disability. Yet, long-term change in global functioning and determinants of this change remain unclear. This study aimed to assess change in global functioning in the long-term after severe TBI and factors associated with the change. This was a prospective observational study of an inception cohort of adults with severe TBI in the Paris area (PariS-TBI). Outcome was assessed at 1, 4 and 8 years post-injury. For the included participants (n=257), change in global outcome between 4 and 8 years was evaluated with the Glasgow Outcome Scale Extended (GOSE) score, and its association with pre-injury, injury-related and post-injury variables was tested with univariate and multivariable analyses. More than half of the 73 participants evaluated at both 4 and 8 years showed global improvement (of at least one point) in GOSE score and an improvement in mood, executive function, and subjective complaints. On univariate analysis, none of the pre-injury, injury or post-injury variables were associated with GOSE score change between 4 and 8 years, except for GOSE score at 4 years (rho=-0.24, P=0.04). On multivariable analysis, probability of increased GOSE score was associated with more years of education (odds ratio 1.18 [95% confidence interval 1.02-1.37], P=0.03). The change in GOSE score was significantly correlated with change in Hospital Anxiety Depression Scale score between 4 and 8 years (rho=-0.42, P<0.001). Most participants with severe TBI in the present sample showed a late improvement (4 to 8 years post-injury) in global functioning. Of the socio-demographic and injury-related factors, only more years of education was associated with improvement in global functioning. Decreased anxiety and depression symptoms were associated with improved global functioning. Targeting interventions to enhance resilience may be the most effective in the long-term after severe TBI.