Individual Clinical Symptoms Research Articles

Comprehensive Management of Polycystic Ovary Syndrome: The Role of Metformin in Addressing Metabolic and Endocrine Dysregulation

Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder that affects women of reproductive age, characterized by hormonal imbalances, insulin resistance, and a range of clinical manifestations, including infertility and metabolic disturbances. Effective management of PCOS remains a challenge due to its multifaceted nature, necessitating a comprehensive understanding of therapeutic options. Aim of the Study: This paper aims to explore the role of various treatment modalities for PCOS, with a particular emphasis on the use of metformin, an antidiabetic medication increasingly recognized for its benefits in managing insulin resistance and other associated conditions in PCOS patients. Conclusion: The findings highlight metformin's three primary mechanisms of action: enhancing insulin sensitivity, inhibiting hepatic gluconeogenesis, and influencing lipid metabolism. Metformin is effective in improving metabolic parameters and restoring ovulatory function in women with PCOS. While it is a cornerstone of therapy, the management of PCOS requires a tailored approach that considers individual clinical symptoms and phenotypes. Additional therapeutic strategies, including non-pharmacological measures and other pharmacological agents, play a vital role in a comprehensive treatment plan for PCOS.

Efficacy and safety of telitacicept therapy in systemic lupus erythematosus with hematological involvement.

To evaluate the efficacy and safety of telitacicept in SLE patients specifically with hematological involvement. A total of 22 patients with SLE and hematological involvement were included in this study. These patients received telitacicept in addition to standard therapy. We compared their demographic characteristics, clinical manifestations, and laboratory indicators before and after the administration of telitacicept. A total of 22 patients received telitacicept treatment for a median duration of 10.4months (ranging from 6 to 19months). Following telitacicept therapy, significant improvements were observed in various parameters compared to baseline. Specifically, white blood cell count increased from (3.98 ± 1.80) 109/L to (6.70 ± 2.47) 109/L, (P = 0.002), hemoglobin levels increased from (100 ± 19) g/L to (125 ± 22) g/L, (P < 0.001), and platelet count increased from (83 ± 60) 109/L to (161 ± 81) 109/L, (P = 0.004). SLE Disease Activity Index (SLEDAI) scores decreased from 12(5,15) to 0(0,4), (P < 0.001). Additionally, C3 and C4 levels showed improvement. Telitacicept treatment also resulted in a significant reduction in serum IgG levels and daily prednisone dosage. Only one adverse event (4.5%) was reported during the treatment, which was a urinary tract infection. The combination of telitacicept and standard treatment demonstrated significant improvements in anemia, as well as increased leukocyte and platelet levels in patients with SLE and hematological involvement. Importantly, the observed adverse events were manageable and controllable. Key Points • Telitacicept effectively improves anemia, clinical outcomes, and increases leukocyte and platelet counts. • Treatment with telitacicept leads to decreased levels of lgG, IgA, anti-dsDNA, and SLEDAI scores, while serum complement C3 and C4 returned to normal. • During the follow-up period there were observed changes in individual parameters, clinical symptoms, and organ involvement, all without significant adverse events.

Deciphering the neural mechanisms of miR-134 in major depressive disorder with population-based and person-specific imaging transcriptomic techniques

MiR-134 has emerged as a potential molecular biomarker for the detection and management of major depressive disorder (MDD). Nevertheless, the specific effects of miR-134 as a regulatory element on brain function and its implications for the clinical presentation of MDD are not yet fully understood. In order to investigate the potential neural mechanisms that contribute to the relationship between miR-134 and MDD, we employed a parallel two-stage cross-scale multi-omics approach. This involved utilizing the anterior cingulate cortex (ACC) functional connectivity as a means to connect microscopic molecular structures with macroscopic brain function in two separate cohorts: the MDD-I dataset (56 MDD patients and 51 healthy controls) and the MDD-II dataset (57 MDD patients and 52 healthy controls). We found a stable ACC functional dysconnectivity pattern of MDD and established the hierarchical cross-scale association from molecular organizations of miR-134 target genes to macroscopic brain functional dysconnectivity and associated behavior, as revealed by population-based analysis. Additionally, our person-specific imaging transcriptomic study revealed that individual exosomal miR-134 expression levels impact on individual clinical symptoms of MDD by modulating ACC-related functional dysconnectivity. Together, our findings provide compelling evidence of the correlation between miR-134 and depression across multi scales within the gene-brain-behavior context.

Resting-state functional MRI in treatment-resistant schizophrenia.

Abnormalities in brain regions involved in the pathophysiology of schizophrenia (SCZ) may present insight into individual clinical symptoms. Specifically, functional connectivity irregularities may provide potential biomarkers for treatment response or treatment resistance, as such changes can occur before any structural changes are visible. We reviewed resting-state functional magnetic resonance imaging (rs-fMRI) findings from the last decade to provide an overview of the current knowledge on brain functional connectivity abnormalities and their associations to symptoms in treatment-resistant schizophrenia (TRS) and ultra-treatment-resistant schizophrenia (UTRS) and to look for support for the dysconnection hypothesis. PubMed database was searched for articles published in the last 10 years applying rs-fMRI in TRS patients, i.e., who had not responded to at least two adequate treatment trials with different antipsychotic drugs. Eighteen articles were selected for this review involving 648 participants (TRS and control cohorts). The studies showed frontal hypoconnectivity before the initiation of treatment with CLZ or riluzole, an increase in frontal connectivity after riluzole treatment, fronto-temporal hypoconnectivity that may be specific for non-responders, widespread abnormal connectivity during mixed treatments, and ECT-induced effects on the limbic system. Probably due to the heterogeneity in the patient cohorts concerning antipsychotic treatment and other clinical variables (e.g., treatment response, lifetime antipsychotic drug exposure, duration of illness, treatment adherence), widespread abnormalities in connectivity were noted. However, irregularities in frontal brain regions, especially in the prefrontal cortex, were noted which are consistent with previous SCZ literature and the dysconnectivity hypothesis. There were major limitations, as most studies did not differentiate between TRS and UTRS (i.e., CLZ-resistant schizophrenia) and investigated heterogeneous cohorts treated with mixed treatments (with or without CLZ). This is critical as in different subtypes of the disorder an interplay between dopaminergic and glutamatergic pathways involving frontal, striatal, and hippocampal brain regions in separate ways is likely. Better definitions of TRS and UTRS are necessary in future longitudinal studies to correctly differentiate brain regions underlying the pathophysiology of SCZ, which could serve as potential functional biomarkers for treatment resistance.

КЛІНІЧНА ЕФЕКТИВНІСТЬ ТА БЕЗПЕКА АМІНОКАПРОНОВОЇ КИСЛОТИ В ЛІКУВАННІ ПАЦІЄНТІВ З ЛЕГКИМ СТУПЕНЕМ ТЯЖКОСТІ COVID-19 ТА НАЯВНІСТЮ ФАКТОРІВ РИЗИКУ ПРОГРЕСУВАННЯ ЗАХВОРЮВАННЯ

The development of rational approaches to the treatment of patients with coronavirus disease (Covid-19), especially with the presence of risk factors for the progression of the disease, remains an urgent problem of the health care system. Aim. Assessment of efficacy and safety treatment of mild forms of COVID-19 in patients with the presence of risk factors for the progression of the disease with the use of aminocaproic acid (ACA) compared to nirmatrelvir/ ritonavir and symptomatic therapy. Methods. Study was designed as prospective comparative clinical study of three groups of patients with a mild form of COVID-19, associated with the presence of risk factors for the progression of the disease, to evaluate the major clinical symptoms of the disease and the quality of life by a standardized questionnaire. Results. The evaluation of the change of individual clinical symptoms has allowed to investigate the tendencies of recovery of patients with a mild form of COVID-19, associated with the presence of risk factors for the progression of the disease, with the use of various etiotropic and symptomatic drugs. The use of ACA contributes to the disappearance of the major symptoms much faster than other treatments. The rate of the disappearance of symptoms with the use of ACA and Nirmatrelvir/ritonavir was higher than with symptomatic therapy in the first 8 days of the disease. This is explained by the antiviral action of these drugs and their effect on the early stage of the disease. Inhalation use of ACA and symptomatic drugs has the advantages over systematic use of drugs due to topical effect on the mucous membranes of the respiratory tract and the absence of systemic adverse reactions. Conclusion. A multidimensional evaluation of the clinical efficacy of the use of ACA, Nirmatrelvir/ritonavir, or symptomatic treatment alone demonstrated the rationality of inhaled ACA compared to other treatments in patients with mild COVID-19, associated with the presence of factors of risk for progression. Key words: COVID-19, aminocaproic acid, clinical efficacy.

Age- and Severity-Associated Humoral Immunity Response in COVID-19 Patients: A Cohort Study from Wuhan, China.

Age has been found to be the single most significant factor in COVID-19 severity and outcome. However, the age-related severity factors of COVID-19 have not been definitively established. In this study, we detected SARS-CoV-2-specific antibody responses and infectious disease-related blood indicators in 2360 sera from 783 COVID-19 patients, with an age range of 1–92 years. In addition, we recorded the individual information and clinical symptoms of the patients. We found that the IgG responses for S1, N, and ORF3a and the IgM for NSP7 were associated with severe COVID-19 at different ages. The IgM responses for the S-protein peptides S1-113 (aa 673–684) and S2-97 (aa 1262–1273) were associated with severe COVID-19 in patients aged <60. Furthermore, we found that the IgM for S1-113 and NSP7 may play a protective role in patients aged <60 and >80, respectively. Regarding clinical parameters, we analyzed the diagnostic ability of five clinical parameters for severe COVID-19 in six age groups and identified three-target panel, glucose, IL-6, myoglobin, IL-6, and NT proBNP as the appropriate diagnostic markers for severe COVID-19 in patients aged <41, 41–50, 51–60, 61–70, 71–80, and >80, respectively. The age-associated severity factors revealed here will facilitate our understanding of COVID-19 immunity and diagnosis, and eventually provide meaningful information for combating the pandemic.

Machine learning-assisted prediction of pneumonia based on non-invasive measures.

BackgroundPneumonia is an infection of the lungs that is characterized by high morbidity and mortality. The use of machine learning systems to detect respiratory diseases via non-invasive measures such as physical and laboratory parameters is gaining momentum and has been proposed to decrease diagnostic uncertainty associated with bacterial pneumonia. Herein, this study conducted several experiments using eight machine learning models to predict pneumonia based on biomarkers, laboratory parameters, and physical features.MethodsWe perform machine-learning analysis on 535 different patients, each with 45 features. Data normalization to rescale all real-valued features was performed. Since it is a binary problem, we categorized each patient into one class at a time. We designed three experiments to evaluate the models: (1) feature selection techniques to select appropriate features for the models, (2) experiments on the imbalanced original dataset, and (3) experiments on the SMOTE data. We then compared eight machine learning models to evaluate their effectiveness in predicting pneumoniaResultsBiomarkers such as C-reactive protein and procalcitonin demonstrated the most significant discriminating power. Ensemble machine learning models such as RF (accuracy = 92.0%, precision = 91.3%, recall = 96.0%, f1-Score = 93.6%) and XGBoost (accuracy = 90.8%, precision = 92.6%, recall = 92.3%, f1-score = 92.4%) achieved the highest performance accuracy on the original dataset with AUCs of 0.96 and 0.97, respectively. On the SMOTE dataset, RF and XGBoost achieved the highest prediction results with f1-scores of 92.0 and 91.2%, respectively. Also, AUC of 0.97 was achieved for both RF and XGBoost models.ConclusionsOur models showed that in the diagnosis of pneumonia, individual clinical history, laboratory indicators, and symptoms do not have adequate discriminatory power. We can also conclude that the ensemble ML models performed better in this study.

G-CSF zur Prophylaxe der Neutropenie und der febrilen Neutropenie, Anämie bei Krebserkrankung

Infektionen bei neutropenischen Patienten nach Chemotherapie manifestieren sich meistens durch Fieber (febrile Neutropenie, FN). Zu den wichtigsten Determinanten des FN-Risikos gehören der Chemotherapietyp, die Dosisintensität und patientenspezifische Faktoren. Bei einem FN-Risiko von 20 % oder höher wird die Granulopoese nach der Therapie prophylaktisch mit G‑CSF („granulocyte colony-stimulating factor“) stimuliert. Eine Anämie sollte immer abgeklärt und falls erforderlich entsprechend ihrer Ursache bei Anämiebeschwerden behandelt werden. Wenn ein absoluter oder funktioneller Eisenmangel vorliegt, dann ist meistens eine intravenöse (i.v.) Eisensubstitution erforderlich. Erythropoesestimulierende Substanzen können nach Chemotherapie bei Hämoglobin(Hb)-Werten unter 10 g/dl (6,2 mmol/l) verwendet werden. Bei chronischer Anämie und Hb-Werten unter 8–7 g/dl (< 5,0–4,3 mmol/l) sollte die Indikation für die Transfusion von Erythrozytenkonzentraten primär anhand der individuellen klinischen Symptomatik gestellt werden.

Research Progress in the Early Warning of Chicken Diseases by Monitoring Clinical Symptoms

Global animal protein consumption has been steadily increasing as a result of population growth and the increasing demand for nutritious diets. The poultry industry provides a large portion of meat and eggs for human consumption. The early detection and warning of poultry infectious diseases play a critical role in the poultry breeding and production systems, improving animal welfare and reducing losses. However, inadequate methods for the early detection and prevention of infectious diseases in poultry farms sometimes fail to prevent decreased productivity and even widespread mortality. The health status of poultry is often reflected by its individual physiological, physical and behavioral clinical symptoms, such as higher body temperature resulting from fever, abnormal vocalization caused by respiratory disease and abnormal behaviors due to pathogenic infection. Therefore, the use of technologies for symptom detection can monitor the health status of broilers and laying hens in a continuous, noninvasive and automated way, and potentially assist in the early warning decision-making process. This review summarized recent literature on poultry disease detection and highlighted clinical symptom-monitoring technologies for sick poultry. The review concluded that current technologies are already showing their superiority to manual inspection, but the clinical symptom-based monitoring systems have not been fully utilized for on-farm early detection.

G-CSF for prophylaxis of neutropenia and febrile neutropenia, anemia in cancer : Guidelines on supportive treatment part1

Infektionen bei neutropenischen Patienten nach Chemotherapie manifestieren sich meistens durch Fieber (febrile Neutropenie, FN). Zu den wichtigsten Determinanten des FN-Risikos gehören der Chemotherapietyp, die Dosisintensität und patientenspezifische Faktoren. Bei einem FN-Risiko von 20 % oder höher wird die Granulopoese nach der Therapie prophylaktisch mit G‑CSF („granulocyte colony-stimulating factor“) stimuliert. Eine Anämie sollte immer abgeklärt und falls erforderlich entsprechend ihrer Ursache bei Anämiebeschwerden behandelt werden. Wenn ein absoluter oder funktioneller Eisenmangel vorliegt, dann ist meistens eine intravenöse (i.v.) Eisensubstitution erforderlich. Erythropoesestimulierende Substanzen können nach Chemotherapie bei Hämoglobin(Hb)-Werten unter 10 g/dl (6,2 mmol/l) verwendet werden. Bei chronischer Anämie und Hb-Werten unter 8–7 g/dl (< 5,0–4,3 mmol/l) sollte die Indikation für die Transfusion von Erythrozytenkonzentraten primär anhand der individuellen klinischen Symptomatik gestellt werden.

No correlation between acetylcholine receptor antibody concentration and individual clinical symptoms of myasthenia gravis: A systematic retrospective study involving 67 patients.

ObjectiveTo investigate the correlation between acetylcholine receptor antibodies (AChR‐Ab) concentration levels and individualized clinical symptoms in patients with AChR myasthenia gravis (AChR‐MG) in China.MethodsELISA was used to determine the concentration of AChR‐Ab in patients with MG. The Myasthenia Gravis Foundation of America (MGFA) Clinical Classification, Quantitative Myasthenia Gravis (QMG) score, and MG‐specific activities of daily living (MG‐ADL) scoring systems were used to evaluate the clinical status of patients. Spearman correlation analysis was used to determine the correlation between the AChR‐Ab concentration and clinical score. The changes in the antibody concentration and clinical score are shown in MGFA‐antibody concentration–treatment plots.ResultsAutoantibody detection tests were performed in 67 patients, and their clinical scores were recorded. Forty‐nine patients received immunosuppressive therapy, 17 patients received pyridostigmine only, and 1 patient under thymectomy without any medication. The AChR‐Ab concentration correlated with the MGFA Classification in 5 (29.4%) patients in the pyridostigmine‐only group and 15 (30.6%) patients in the immunosuppressive drug group. The changes in the MGFA Classification preceded the changes in the AChR‐Ab concentration in 4 (23.5%) patients treated with pyridostigmine and 10 (20.4%) patients on immunosuppressive drugs. In patients on oral non‐steroidal immunosuppressants, the AChR‐Ab concentration changed by more than 50%, whereas the MGFA Classification did not increase. The AChR‐Ab concentration decreased in 17/32 (53.1%) patients after thymectomy, and then increased, whereas the AChR‐Ab concentration increased in 15/32 (46.9%) patients and the MGFA Classification decreased in 27/32 (81.8%) patients after thymectomy. The AChR‐Ab concentration presented a slight correlation with the corresponding MGFA, QMG, and MG‐ADL in patients with thymoma.DiscussionIn the Chinese AChR‐MG population, the Changes in the AChR‐Ab concentration in individuals with AChR‐MG did not consistently correlate with the severity of clinical symptoms.

Symptom-specific assessment of treatment efficacy: The potential of network estimation techniques

Abstract BodyIntroduction: Most studies on the efficacy of psychiatric treatments consider overall scale scores as outcome measures. A focus on individual symptoms would, however, result in a more precise assessment of treatment efficacy and has potential in improving our understanding of the working mechanisms of treatment. Such an approach may also help in improving the identification of patients who are -based on their pretreatment symptomatology- the most likely to benefit from a particular treatment. Objectives: To show the potential of network estimation techniques in a) unraveling the diverse symptom-specific responses to various depression treatments and b) improving the identification of patients who are the most likely to benefit from these treatments. Methods: First, we combined patient-level data of multiple trials considering various depression treatments, such as antidepressant medication and (internet-based) cognitive-behavioral therapy. Network estimation techniques were used to determine the complex patterns in which symptom-specific responses to treatment were related. Results: Individual clinical symptoms differed substantially in their responses to treatment and these symptom-specific responses were related in a complex manner. Patients suffering from symptoms that were directly affected by a particular treatment were -by definition- the most likely to benefit from that treatment. Conclusions: Network estimation techniques were able to unravel the diverse symptom-specific responses to treatment and could help in improving our understanding of the chain of events leading to a clinical response. Information from the networks could also help in improving the identification of patients who were the most likely to benefit from a particular treatment.DisclosureNo significant relationships.

Emergent creativity in frontotemporal dementia

Numerous papers report on connections between creative work and dementing illness, particularly in frontotemporal dementia (FTD), which may combine with motor neuron disease (FTD-MND). However, the emergence of FTD(-MND) patients' de novo artistic activities is rarely reported and underappreciated. Therefore, the present review summarizes relevant case studies' outcomes, capturing creativity's multifaceted nature. Here, we systematically searched for case reports by paying particular attention to the chronological development of individual patients' clinical symptoms, signs, and life events. We synoptically compared the various art domains to the pattern of brain atrophy, the clinical and pathological FTD subtypes. 22 FTD(-MND) patients were identified with creativity occurring either at the same time (41%) or starting after the disease onset (59%); the median lag between the first manifestation of disease and the beginning of creativity was two years. In another five patients, novel artistic activity was developed by a median of 8years before the start of dementia symptoms. Artistic activity usually evolved over time with a peak in performance, followed by a decline that was further hampered by physical impairment during disease progression. Early on, the themes and objects depicted were often concrete and realistic, but they could become more abstract or symbolic at later stages. Emergent artistic processes may occur early on in the disease process. They appear to be a communication of inner life and may also reflect an attempt of compensation or "self-healing". The relative preservation of primary neocortical areas such as the visual, auditory, or motor cortex may enable the development of artistic activity in the face of degeneration of association cortical areas and subcortical, deeper central nervous system structures. It is crucial to understand the differential loss of function and an individual's creative abilities to implement caregiver-guided, personalized therapeutic strategies such as art therapy.

Classification of patients referred under suspicion of tick-borne diseases, Copenhagen, Denmark

To provide better care for patients suspected of having a tick-transmitted infection, the Clinic for Tick-borne Diseases at Rigshospitalet, Copenhagen, Denmark was established. The aim of this prospective cohort study was to evaluate diagnostic outcome and to characterize demographics and clinical presentations of patients referred between the 1st of September 2017 to 31st of August 2019.A diagnosis of Lyme borreliosis was based on medical history, symptoms, serology and cerebrospinal fluid analysis. The patients were classified as definite Lyme borreliosis, possible Lyme borreliosis or post-treatment Lyme disease syndrome. Antibiotic treatment of Lyme borreliosis manifestations was initiated in accordance with the national guidelines. Patients not fulfilling the criteria of Lyme borreliosis were further investigated and discussed with an interdisciplinary team consisting of specialists from relevant specialties, according to individual clinical presentation and symptoms. Clinical information and demographics were registered and managed in a database.A total of 215 patients were included in the study period. Median age was 51 years (range 17–83 years), and 56 % were female. Definite Lyme borreliosis was diagnosed in 45 patients, of which 20 patients had erythema migrans, 14 patients had definite Lyme neuroborreliosis, six had acrodermatitis chronica atrophicans, four had multiple erythema migrans and one had Lyme carditis. Furthermore, 12 patients were classified as possible Lyme borreliosis and 12 patients as post-treatment Lyme disease syndrome. A total of 146 patients (68 %) did not fulfil the diagnostic criteria of Lyme borreliosis. Half of these patients (73 patients, 34 %) were diagnosed with an alternative diagnosis including inflammatory diseases, cancer diseases and two patients with a tick-associated disease other than Lyme borreliosis. A total of 73 patients (34 %) were discharged without sign of somatic disease. Lyme borreliosis patients had a shorter duration of symptoms prior to the first hospital encounter compared to patients discharged without a specific diagnosis (p<0.001). When comparing symptoms at presentation, patients discharged without a specific diagnosis suffered more often from general fatigue and cognitive dysfunction.In conclusion, 66 % of all referred patients were given a specific diagnosis after ended outpatient course. A total of 32 % was diagnosed with either definite Lyme borreliosis, possible Lyme borreliosis or post-treatment Lyme disease syndrome; 34 % was diagnosed with a non-tick-associated diagnosis. Our findings underscore the complexity in diagnosing Lyme borreliosis and the importance of ruling out other diseases through careful examination.

The prevalence of symptoms and risk factors associated with obstructive sleep apnea among patients attending primary health centers in Erbil, Iraq

Background and objective: Although snoring and day time tiredness and are a common finding in persons with obstructed sleep apnea; however, most of them are unaware of their diseases. This study aimed to find the prevalence of sleep apnea and symptoms at the primary care level. Methods: A cross-sectional study was conducted among randomly selected 500 patients aged ≥ 18 years attending two primary care centers in Erbil city, from the 1st of April 2018 to the end of February 2019. A Berlin modified questionnaire was used to address an individual's characteristics, risk factors, and clinical symptoms. Results: The mean age + SD of 500 individuals was 41.06 + 14.79 years. Nearly all (97.2%) of the participants were living in urban areas. Around three quarters (72.2%) of the sample were married, 27.8% were smokers, 45.8% were overweight, and 18.6% were obese. The overall prevalence of obstructed sleep apnea was 23.2%, the prevalence of low-risk OSA was 22.4%, and the prevalence increased with age. Obstructed sleep apnea was more among females (26%) than males (20.8%), although the difference was not significant. A high percentage was observed among those with raised blood pressure and obese persons (87.9% and 86%, respectively). No significant association was detected between obstructed sleep apnea and smoking. Conclusion: High risk of obstructive sleep apnea was common among patients attending primary care. Awareness and education of physicians and patients about the disease is essential. Those at high risk should be referred to sleep centers for further evaluation.

Current measures are not sufficient: an interview-based qualitative assessment of quality of life in cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) negatively impacts quality of life (QoL), but existing QoL questionnaires may not comprehensively reflect patients' experience. To identify the aspects of QoL that are most meaningful to patients with CTCL and to evaluate existing QoL instruments in this context. Semistructured interviews were conducted between May and June 2019 using purposive sampling of patients with CTCL. Data were analysed by an inductive thematic approach using Dedoose Version 8.0.35. One-on-one interviews lasting a median of 43 min were completed by 18 patients [median age 62 years (interquartile range 52-70); 39% advanced-stage (IIB-IV)]. Itch was the most common clinical symptom reported (16 of 18 patients), followed by pain (12 of 18), skin breaks (11 of 18) and skin flaking (10 of 18). Eleven patients reported that their symptoms interfered with sleep, which impacted daily functioning. Patients also noted a lack of understanding of the disease in the community and felt uncertain (12 of 18), depressed (11 of 18), suicidal (four of 18) and hopeless (nine of 18). Nearly all patients (17 of 18) reported a sense of 'otherness' (not feeling 'normal' or 'like themselves'), and most patients (16 of 18) specifically mentioned concern about their physical appearance. Patients also noted substantial treatment burden. Salient patient concerns, including individual clinical symptoms, concern about appearance and problems with sleep, were not adequately or consistently represented in generic, skin-specific or CTCL-specific QoL measures. Incorporating the concerns and priorities that distinguish patients with CTCL from other patient populations will be of paramount importance in developing a comprehensive CTCL-specific measure of QoL that adequately captures patients' experience.

Diagnosing thyroid disorders: Comparison of logistic regression and neural network models.

Background:The main goal of this study was to diagnose the two most common thyroid disorders, namely, hyperthyroidism and hypothyroidism, based on multinomial logistic regression and neural network models. In addition, the study evaluated the predictive ability of laboratory tests against the individual clinical symptoms score.Materials and Methods:In this study, the data from patients with thyroid dysfunction who referred to Imam Khomeini Clinic and Shahid Beheshti Hospital in Hamadan were collected. The data contained 310 subjects in one of three classes—euthyroid, hyperthyroidism, and hypothyroidism. Collected variables included demographics and symptoms of hypothyroidism and hyperthyroidism, as well as laboratory tests. To compare the predictive ability of the clinical signs and laboratory tests, different multinomial logistic regression and neural network models were fitted to the data. These models were compared in terms of the mean of the accuracy and area under the curve (AUC).Results:The results showed better performance of neural network model than multinomial logistic regression in all cases. The best predictive performance for logistic regression (with a mean accuracy of 91.4%) and neural network models (with a mean accuracy of 96.3%) was when all variables were included in the model. In addition, the predictive performance of two models based on symptomatic variables was superior to laboratory variables.Conclusions:Both neural network and logistic regression models have a high predictive ability to diagnose thyroid disorder, although neural network performance is better than logistic regression. In addition, as achieving less error prediction model has always been a matter of concern for researchers in the field of disease diagnosis, predictive nonparametric techniques, such as neural networks, provide new opportunities to obtain more accurate predictions in the field of medical research.

Metabolic Evaluation of Epilepsy: A Diagnostic Algorithm With Focus on Treatable Conditions.

Although inborn errors of metabolism do not represent the most common cause of seizures, their early identification is of utmost importance, since many will require therapeutic measures beyond that of common anti-epileptic drugs, either in order to control seizures, or to decrease the risk of neurodegeneration. We translate the currently-known literature on metabolic etiologies of epilepsy (268 inborn errors of metabolism belonging to 21 categories, with 74 treatable errors), into a 2-tiered diagnostic algorithm, with the first-tier comprising accessible, affordable, and less invasive screening tests in urine and blood, with the potential to identify the majority of treatable conditions, while the second-tier tests are ordered based on individual clinical signs and symptoms. This resource aims to support the pediatrician, neurologist, biochemical, and clinical geneticists in early identification of treatable inborn errors of metabolism in a child with seizures, allowing for timely initiation of targeted therapy with the potential to improve outcomes.

Early diagnosis of dehydration in hospitalized geriatric patients using clinical and laboratory criteria.

Dehydration is a common yet underdiagnosed condition, which is associated with poor prognosis in older patients. The clinical and laboratory criteria for assessing dehydration are of variable or poor diagnostic value in this population and require further validation. To test different clinical and laboratory criteria for the early diagnosis of dehydration in hospitalized older patients as compared to the standard diagnosis based on a body weight gain ≥ 3% during the first week of admission. Prospective study using clinical and laboratory criteria for dehydration selected by an expert panel. Acute geriatric unit. Geriatric patients (n = 112; aged 83 ± 6years) admitted to the unit. Using selected criteria (skin fold, dry mouth, calf muscle consistency, systolic blood pressure < 90mmHg, orthostatic blood pressure drop, postural dizziness, thirst, apathy or delirium, urea, creatinine, uric acid, proteins, hemoglobin), expert clinicians prospectively assessed the patients to make a clinical diagnosis of dehydration upon admission. Clinicians were asked to provide a yes/no answer for each criterion and a global yes/no answer for dehydration, along with its estimated probability. Body weight was measured at admission and at Day 7. Laboratory parameters were assessed at baseline and at Day 7. The clinical diagnosis made at admission was retrospectively compared to the standard diagnosis made at Day 7 (> 3% weight gain) to test the values of each criterion separately, the global diagnosis, and its estimated probability. In total, 100 patients with complete data (mean age 83 ± 6years) were considered for analysis. Dehydration was the principal reason for admission in three patients only but was clinically diagnosed as part of the study in 39 patients, whereas the standard diagnosis of dehydration was ascertained in 20. Inter-rater agreement (kappa) was fair for the clinical criteria and clinical diagnosis, moderate to near perfect for the laboratory criteria, and substantial for the estimated probability of dehydration. When matched with the standard diagnosis, the final clinical diagnosis of dehydration had 70% sensitivity and 69% specificity, with a 90% negative predictive value. Individually, both clinical and laboratory criteria had good specificity (65-90%), but poor sensitivity (< 55%). Compared with the standard diagnosis, dehydration was overdiagnosed by systematic clinical assessment upon admission in this frail population. However, clinicians performed better at excluding dehydration. Clinical acumen seems better than any individual clinical symptom or sign.

Determinants of clinical leptospirosis in Nepal.

Leptospirosis is an important zoonotic disease in Nepal; however, there is a lack of information on sources of leptospirosis infection for people and associated risk factors. We implemented a case-control study nested within a cross-sectional survey to investigate zoonotic risks of human leptospirosis among adult, febrile patients seeking treatment in healthcare centres in Kaski District, Nepal, from April to October 2013. The study population was 239 febrile patients; the data consisted of paired blood samples; questionnaires on clinical symptoms; occupational, environmental and animal exposures; and a blood sample from animals in the household. In total, 63 cattle, 92 buffalo, 181 goats, 20 dogs and 14 rodents from 119 households were blood sampled. Serology was performed on the samples using the microscopic agglutination test (MAT) for a panel of 20 serovars with a starting dilution of 1:50. Clinical leptospirosis was defined as a titre of 1:400 or stronger, or a 4-fold or greater rise between acute and convalescent titres, or evidence of seroconversion for one or more serovars represented by a titre of <1:50 in the acute sample and a titre of ≥1:100 in the convalescent sample. The prevalence of clinical leptospirosis was 5.4% (95% CI 2.6%-8.3%). The most common symptoms among recruited participants were loss of appetite and lethargy followed by chills, profuse sweating and backache. No individual clinical symptom nor combination of any two symptoms was significantly associated with clinical leptospirosis. However, owning goats (OR 1.3, CI 95% 1.05-1.66), working in rice fields (OR 1.3, CI 95% 1.11-1.72) and male gender (OR 4, CI 95% 1.12-17.26) significantly increased the risk of clinical leptospirosis in humans. Findings suggest that leptospirosis should be considered in the clinical differential diagnosis among febrile adult patients in Nepal, especially for men, goat owners and/or those who work in rice fields.