Intensity Of Symptoms Research Articles

The use of autologous platelet-rich plasma in the treatment of chronic pharyngitis

To evaluate the clinical efficacy of autologous PRP in the treatment of chronic pharyngitis. Autologous PRP was injected into the posterior pharyngeal wall as a course of endopharyngeal blockages as part of the complex therapy of chronic pharyngitis. Patients in the control group received standard therapy, without the use of autologous PRP. The effectiveness of the studied technique was evaluated by statistical analysis of the intensity of symptoms of the disease, determined by patients throughout the entire period of treatment in the patient's diary, as well as by analyzing data from mass spectrometry of microbial markers and bacteriological examination of the pharyngeal mucosa, collected at the beginning of the study and 14 days after completion of the course of therapy. The use of a course of endopharyngeal blockades with autologous platelet-rich plasma as part of the complex therapy of chronic pharyngitis, according to our estimates, provides a significant effect in the form of higher rates of reduction in the severity of symptoms of the disease, a significant reduction in the number of microorganisms deviating from the reference values (by 2 times or more), a decrease in the duration of the disease compared with the control group.

New scientific findings on the mucokinetic effect of ambroxol

The use of ambroxol is recommended by the German Society for Pneumology and Respiratory Medicine [1] to reduce symptom intensity and accelerate the recovery from acute and subacute cough. As mucoactive, it stands out by its mucokinetic effects, increasing cilia beating in the airways to remove the mucus. A new study [2] has now shed light on further details of the signalling pathway responsible for the mucokinetic action of ambroxol.

СТАНДАРТИ ЛІКУВАННЯ ПАЦІЄНТІВ НА ХРОНІЧНЕ ОБСТРУКТИВНЕ ЗАХВОРЮВАННЯ ЛЕГЕНЬ, 2024 РІК: МІСЦЕ ТІОТРОПІУМА БРОМІДУ

Updated GOLD 2024 guidelines emphasized the problem of insufficient or inaccurate diagnosis of COPD, leading to inappropriate therapy of these patients. This trend is also widespread in Ukraine, despite the significant improvement in diagnosis and available treatment options. The aim of the study was to determine the effectiveness of tiotropium bromide (Spiriva® HandiHaler® "Boehringer Ingelheim Pharma GmbH", Germany) for the initial and follow-up treatment of patients. We evaluated the effect of the drug on the clinical and functional status of patients and adherence to therapy. Materials and methods. We enrolled 20 patients with newly diagnosed COPD (group 1) and 10 patients already receiving treatment with previously diagnosed COPD (group 2). In all group 2 patients the diagnosis was established in 2022-2023. In this study the diagnosis and initiation of treatment has been done according to GOLD 2024 recommendations. In 1 month of treatment the effectiveness of treatment based on the change of symptoms (mMRC dyspnea scale and CAT score) and treatment compliance were assessed. Results. Standard clinical examination was performed to confirm or revise of COPD diagnosis. In group 1 GOLD 2 airflow limitation were observed in 75 % (n = 15) of patients, GOLD 3 — in 25 % (n = 5); 25 % (n = 5) patients were classified as group A, and 75 % (n = 15) of patients — as group В. In group 2 there were prevalent the patients with more severe airflow limitation: GOLD 2 — 40 % (n = 4), GOLD 3 — 60 % (n = 6). All patients from this group were allocated to group B due to symptoms intensity. The analysis of CAT responses structure has demonstrated that the questions 1 to 4 evaluating such symptoms as cough and dyspnea collected more points. All patients received inhalation therapy with tiotropium bromide DPI once daily and Berodual H MDI as needed. In group 1 post-treatment CAT score demonstrated a significant change in comparison with visit 1 score (13,5 (SD 1,4) vs 11 (SD 1,0), р = 0,001). Conclusion. Overall, during the study period we observed a significant improvement in compliance, which was reflected in the decrease in the frequency of use of short-acting bronchodilators. The use of tiotropium bromide as an initial or follow-up therapy right after 1 month of treatment significantly reduced the clinical manifestations of the disease. Key words: chronic obstructive pulmonary disease, GOLD 2024, tiotropium bromide.

Integrated care program for patients with dementia and behavioural disorders in the home setting.

Introduction: Behavioural symptoms involve suffering and functional worsening of people with dementia, overburden their caregivers and increase emergency department visits, hospitalizations and early institutionalizations.
 Objectives And Who It Is For: To evaluate the results of an interdisciplinary intervention to improve the control of behavioural symptoms in elderly people with dementia receiving chronic care at home.
 Who We Involved And Engaged With: Representatives of general practitioners, home care specialists, geriatricians, psychiatrists, healthcare managers, and patients and families voice through claims and suggestions. The first pilot was adapted considering patients’ needs and acceptance.
 Materials And Methods (What We Did): before-after quasi-experimental study with own individual as control. Inclusion criteria: admission to the Home Medicine section between 06/01/2021 and 09/30/2022, age older than 64 years; and major cognitive impairment with behavioural disorders of complex management for the attending physician; or need for adequacy of psychotropic drugs during the transition of care for having suffered an acute confusional syndrome during hospitalisation. Exclusion criteria: history of psychosis or life expectancy of less than six months.
 Intervention: Provision of care by a health care team coordinated by a geriatrician via telemedicine, the home follow-up physician and a health and social care counsellor (comprehensive gerontological assessment). The geriatrician agreed on tailored interventions together with the patient's relatives or caregivers.
 The main outcome variable was changes in the score of the behavioural disorders subscale of the NPIq questionnaire administered by the geriatrician. The consumption of psychotropic drugs, standardised by defined daily doses (DDD) according to WHO, was also analysed.
 Results: 81 persons were included (72% women), mean age 89.5 years. Seventy percent lived in a private home and the remainder in care homes. At baseline, they had the following mean (SD) symptom intensity scores of: delirium 1.1 (2.7), hallucinations 1.3 (2.6), agitation-aggression 2.6 (4.3), depression 0.9 (2.9), anxiety 1.1 (3.0), euphoria-denial 0.1 (1.0), apathy 0.6 (2.3), disinhibition 0.3 (1.7), irritability 1.0 (2.7), motor disturbances 0.9 (2.7), nocturnal behaviours 2.2 (3.8), appetite-ingestion 0.3 (1.6), total intensity 12.5 (13.7). At baseline, 42.0% were taking benzodiazepines, mean DDD 19.9/100 patients. 
 After the intervention there was an average decrease of -7.6 points in the total NPIq scale (95%CI -10.0 to -5.1; p<0.001) and 50% of those taking benzodiazepines had discontinuation or dose decrease. without significant changes in other psychotropic drugs (only an increase in donepezil and memantine).
 Learnings: The integrated management program of elderly with dementia and behavioural disorders improved behavioural symptoms with decreased doses of BZD after the intervention.
 Next Steps: For scientific purposes, to perform a randomised controlled clinical trial. For local managerial purposes, to scale up the initiative to all eligible persons.

UNVEILING THE COMPLEX REALITIES: UNDERSTANDING SLEEP AND FATIGUE CHARACTERISTICS OF END-OF-LIFE CAREGIVERS

Abstract This mixed methods multi-case study explores sleep and fatigue characteristics among end-of-life caregivers. The research sample encompasses cases aiding individuals with advanced (n=4) and chronic illnesses (n=1), including various caregiver demographics such as gender, age groups (19-64 and 65+), and health conditions. Data collection involves comprehensive surveys capturing demographics, care recipient symptom intensity, caregiver depressive symptoms, caregiving stress, caregiver sleep quality, and caregiver fatigue level. The study integrates data from a 30-day Personal Sleep Monitoring Device (PSMD) and a 14-day sleep journal, enriched by insights from semi-structured interviews and field notes. The outcomes indicate a PSQI (Pittsburgh Sleep Quality Index) score of 6.1, accompanied by 7.44 hours of sleep recorded by the PSMD. There were approximately 20.5 nocturnal awakenings within 30 days, with average fatigue at 55.28 and daily fatigue at 49.66. Objective sleep outcomes were consistent among caregivers, while their own sleep ratings ranged from “Fairly Bad” to “Very Good.” Themes for each case were formulated to delve into the context of these sleep and fatigue characteristics. These themes encompass adaptive leadership, linchpin roles, emotional labor management, self-reliance, and vigilance. A prevailing overarching theme is the perception of “Not having control.” A significant finding underscores the dynamic influence of care recipients’ daily statuses on caregivers’ sleep quality and fatigue levels, leading to unpredictable outcomes. This study offers profound insights into end-of-life caregivers’ intricate journeys, highlighting individual differences and the dynamic nature of caregiving roles, while recognizing the importance of tailored interventions for enhancing caregiver’s well-being and caregiving effectiveness.

Ventilation causing an average CO2 concentration of 1,000 ppm negatively affects sleep: A field-lab study on healthy young people

Poor bedroom ventilation, leading to poor indoor air quality (IAQ), has been shown to reduce sleep quality. Ventilation causing a carbon dioxide (CO2) concentration of 1,000 ppm is assumed to permit optimal sleep quality. The effects of three ventilation levels causing average indoor CO2 concentrations of 750 ppm, 1,000 ppm and 1,300 ppm, on sleep quality, physiological response and next-day work performance were examined. After a first night for adaptation, thirty-six young and healthy participants slept alone in simulated bedrooms for two nights at each of the three ventilation levels in balanced order. Sleep quality was recorded by a wrist-worn sleep tracker. Physiological parameters were measured before sleep and after waking. The participants’ ratings of the bedroom environment, the intensity of the health symptoms they experienced, and cognitive performance were obtained using questionnaires and tests.Compared with ventilation causing an average CO2 concentration of 750 ppm, sleep quality was significantly reduced at the ventilation rates causing CO2 concentrations of 1,000 ppm and 1,300 ppm: Sleep efficiency was reduced by 1.3 % and 1.8 % and time awake increased by 5.0 min and 7.8 min, respectively. Deep sleep duration decreased at the ventilation rate causing CO2 concentration of 1,300 ppm as compared to 750 ppm along with a significant increase in salivary cortisol after waking, which suggests increased stress and sympathetic activity. Ventilation causing an average CO2 concentration of 1,000 ppm or above in bedrooms should therefore be avoided. Participants whose sleep quality was poorer performed worse on tests of cognitive performance the next day.

Self-reported characteristics of people seeking primary care physiotherapy in Denmark: A cross-sectional study.

Limited knowledge exists on the self-reported characteristics of patients seeking primary care physiotherapy in Denmark. To describe primary symptom site, co-occurrent pain sites, pain intensity, symptom duration, and number of symptom episodes in patients seeking primary care physiotherapy using patient-reported data. Cross-sectional study of patients seeking primary care physiotherapy within a nationwide network of clinics in Denmark (FysioDanmark® ). Data from the FysioDanmark® clinical database with patient-reported information obtained from questionnaires distributed to patients prior to their first consultation were used. This included primary symptom site, co-occurrent pain sites, pain intensity (0-10 numeric rating scale), symptom duration, and number of symptom episodes. Data from 61,097 patients (57% female) aged 42years (interquartile range 29-53) and 63,566 first visits were included. The most common reasons for seeking care were back- (22.9%), non-specific- (19.8%) and shoulder symptoms (15.9%). The majority of patients (89.4%) reported symptoms lasting longer than 7days, and many experienced recurrent episodes. Median pain intensity ranged from 3 to 5 across primary symptom sites and age groups. In general, females reported higher pain intensity than males. Danish patients seeking primary care physiotherapy most commonly presented with back, non-specific, and shoulder symptoms, with mild-to-moderate pain lasting longer than 7days, and many with recurrent episodes.

Application of trichoderma and aspergillus as biofertilizers in eco-friendly ratoon rice cultivation

The study’s goal is to find the best native fungus from rice husk waste so that a solid biofertilizer can be made with high-husk flour as a carrier material and an inert agent. This study was conducted on agricultural land in Seloliman Village, Trawas District, and Mojokerto Regency. Biofertilization and biological agent formulation activities carried out at Muhammadiyah University of Sidoarjo’s Microbiology Laboratory aided the research. The experiment was conducted using a factorial randomized block design. The first factor consisted of three treatments: no fungi, Trichoderma sp., and Aspergillus sp. The second factor consists of soil treatment and apical treatment. The six treatment combinations were repeated four times (24 samples). The variables measured comprised plant height, number of panicles, weight of grain per plant, weight of 100 grams of grain, and the efficacy of biological agents in improving plant growth and productivity. All data underwent analysis of variety and then an HSD test at the 5% significance level to identify disparities among treatments. The study reveals that isolates Tc-013 and As-022 were identified as Trichoderma esperellum and Aspergillus flavus or A. oryzae, respectively. The application of Trichoderma and Aspergillus caused a decrease in the intensity of disease symptoms, reaching 64.7% and 37.3%, an increase in plant height and number of panicles, and an increase in the weight of 100 grains of 59.89 and 49.35%, respectively, as compared to the control treatment where the fungus was not applied.

EEG spectral and microstate analysis originating residual inhibition of tinnitus induced by tailor-made notched music training.

Tailor-made notched music training (TMNMT) is a promising therapy for tinnitus. Residual inhibition (RI) is one of the few interventions that can temporarily inhibit tinnitus, which is a useful technique that can be applied to tinnitus research and explore tinnitus mechanisms. In this study, RI effect of TMNMT in tinnitus was investigated mainly using behavioral tests, EEG spectral and microstate analysis. To our knowledge, this study is the first to investigate RI effect of TMNMT. A total of 44 participants with tinnitus were divided into TMNMT group (22 participants; ECnm, NMnm, RInm represent that EEG recordings with eyes closed stimuli-pre, stimuli-ing, stimuli-post by TMNMT music, respectively) and Placebo control group (22 participants; ECpb, PBpb, RIpb represent that EEG recordings with eyes closed stimuli-pre, stimuli-ing, stimuli-post by Placebo music, respectively) in a single-blind manner. Behavioral tests, EEG spectral analysis (covering delta, theta, alpha, beta, gamma frequency bands) and microstate analysis (involving four microstate classes, A to D) were employed to evaluate RI effect of TMNMT. The results of the study showed that TMNMT had a stronger inhibition ability and longer inhibition time according to the behavioral tests compared to Placebo. Spectral analysis showed that RI effect of TMNMT increased significantly the power spectral density (PSD) of delta, theta bands and decreased significantly the PSD of alpha2 band, and microstate analysis showed that RI effect of TMNMT had shorter duration (microstate B, microstate C), higher Occurrence (microstate A, microstate C, microstate D), Coverage (microstate A) and transition probabilities (microstate A to microstate B, microstate A to microstate D and microstate D to microstate A). Meanwhile, RI effect of Placebo decreased significantly the PSD of alpha2 band, and microstate analysis showed that RI effect of Placebo had shorter duration (microstate C, microstate D), higher occurrence (microstate B, microstate C), lower coverage (microstate C, microstate D), higher transition probabilities (microstate A to microstate B, microstate B to microstate A). It was also found that the intensity of tinnitus symptoms was significant positively correlated with the duration of microstate B in five subgroups (ECnm, NMnm, RInm, ECpb, PBpb). Our study provided valuable experimental evidence and practical applications for the effectiveness of TMNMT as a novel music therapy for tinnitus. The observed stronger residual inhibition (RI) ability of TMNMT supported its potential applications in tinnitus treatment. Furthermore, the temporal dynamics of EEG microstates serve as novel functional and trait markers of synchronous brain activity that contribute to a deep understanding of the neural mechanism underlying TMNMT treatment for tinnitus.

Development and Initial Validation of the Pain Progress Measure

Introduction. Current numerical rating scales for pain mostly measure symptom intensity. There is a need to develop outcome measures reflecting the multifaceted nature of pain. The purpose of this study is to describe the development and validation of the Pain Progress Measure (PPM), which is an outcome measure intended to capture the holistic nature of pain. Methods. The author developed 15 pain assessment items related to the biopsychosocial theory of pain. For content validity, 14 expert panelists were purposely selected to assess items as either essential, or useful but not essential, and not essential. The number of essential items was then taken to get the content validity ratio (CVR). Internal consistency reliability was established through Cronbach's alpha. Results. The mean content validity ratio (CVR= 0.69) was above the critical value of 0.57 and therefore showed that the PPM has good content validity. There were 10 items shown with good CVR, but 5 items did not reach the critical values. Cronbach's alpha shows a coefficient of 0.883, demonstrating good reliability. Pearson-R correlation of 0.94 demonstrates excellent inter-rater reliability. Discussion. Pain Progress Measure (PPM) items below CVR critical value were removed to create the shortened version of the PPM. The shortened version without items below CVR critical value showed a higher mean CVR. Initial validation and reliability testing of the Pain Progress Measure has shown its capabilities to holistically quantify the pain of patients undergoing physical rehabilitation interventions. However, further research is recommended to expand on other psychometric properties such as concurrent validity, confirmatory factor analysis, and test-retest reliability.

Neck pain, disability and mobile phone usage among physiotherapy students - a cross-sectional study.

Modern mobile devices have become tools used for educational, research, business or recreational purposes. Incorrect position during excessive use of a smartphone can lead to biomechanical changes, the most visible of which is the position of the head in protraction, characterized by the protrusion of the head and neck forward in relation to the shoulder girdle and trunk. The aim of the study was to analyze the relationship between disability, neck pain (NP), use of phones before bedtime, and hours of using smartphones. The study involved 146 physiotherapy students aged 18-26. Students were asked to complete pain surveys (VAS pain scale), and Neck Disability Index (NDI). Participants were also asked if their pain lasted longer than 3 months, how long they used their smartphone during the day, and whether they used it before bedtime. Statistically significant differences were found between groups with and without neck pain regarding NDI score (p<0.001). Participants who suffered from neck pain longer than 3 months had greater NDI scores (p=0.03), greater intensity of symptoms (p=0.04), greater problems with reading (p<0.01) and driving (p=0.04) than participants who experienced pain for less than 3 months. Using phones before bedtime was related to problems with focusing (p<0.01). There were statistically significant correlations between the time of phone use and disability in terms of reading (p=0.04), focusing (p<0.001), work (p<0.001) and sleeping (p=0.02). Dysfunctions associated with pain in the cervical section may affect the learning abilities of students and thus the acquisition of professional competencies. Not using a smartphone before bedtime is recommended, as it causes poorer concentration. The longer the time spent using the phone, the more significant the disability.

"It's Incapacitated Me in so Many Ways": Older Adults' Lived Experience With Postoperative Symptoms at Home After Major Elective Surgery.

This qualitative study aimed to explore the challenges faced by older adults regarding the postoperative symptom experience after major elective surgery. Although extensively studied in oncology settings, the impact of postoperative symptom burden remains largely underexplored in elective major surgery among older adults. We employed convenience sampling to recruit adults aged 65 years or above undergoing major elective surgery at the University of California, San Francisco. Semistructured interviews regarding the surgical experience were conducted at 1 and 3 months postoperatively. An inductive qualitative approach was used to identify emerging themes. Symptoms revealed by participants during interviews were also captured. Nineteen participants completed a 1-month postoperative interview, and 17 additionally completed a 3-month interview. Three themes emerged: (1) postoperative symptoms significantly impacted valued life activities and psychosocial well-being, (2) participants felt "caught off guard" by the intensity and duration of postoperative symptoms, and (3) participants expressed the need for additional support, resources, and education on symptom management. The most frequently mentioned symptoms were postoperative pain (n=12, 63.1%), gastrointestinal discomfort (n=8, 42.1%), and anxiety/stress (n=8, 42.1%) at 1-month postsurgery compared with pain and depression (both n=6, 35.3%) at 3 months. Study participants were surprised by the negative impact of postoperative symptoms on their psychosocial well-being and ability to engage in valued life activities. Symptom burden is an important patient-reported outcome that should be assessed postoperatively. Interventions to minimize postoperative symptom burden in older adults could optimize quality of life and participation in meaningful activities during surgical recovery.

Subjective and physiological reactivity to emotional stressors in somatic symptom disorder

ObjectiveWe examined whether autonomic flexibility to experimentally presented stressors is reduced in somatic symptom disorder (SSD) as this would point to reduced vagal control as a proposed indicator of emotion regulation deficits. MethodIn this experimental study, the influence of health-related and social stressors on subjective and physiological reactivity was investigated in 29 subjects with SSD without any medical condition SSD(mc−), 33 subjects with SSD with medical condition SSD(mc+) and 32 healthy controls at the age from 18 to 70 years. Self-report and physiological variables were measured before and after/during stressor exposure, using state ratings of symptom intensity, disability, tension and mood, heart rate (HR), and heart rate variability (HRV). ResultsOverall, the tension increased and the mood worsened after exposure to stressors compared to pre-exposure. Compared to HC, the two SSD groups showed higher symptom intensity, disability, tension and worse mood. The SSD(mc−) group revealed higher HR than HC (p = .012, d = −0.77). Compared to pre-exposure, symptom impairment increased after social stressor exposure in SSD(mc−) (p < .001, d = 1.36). HRV-root mean square of successive differences (RMSSD) only decreased in HC during exposure (p = .003, d = −1.09), not in the SSD groups. The two SSD groups did not differ in their reactivity to stressors. ConclusionHRV in SSD, seems to respond less flexibly to stressors, potentially reflecting overall physiological disturbance through reduced parasympathetic influence on HR. Stress reactivity in SSD(mc−) and SSD(mc+) do not seem to differ.

Progressive loss of cortical gray matter in first episode psychosis patients with auditory hallucinations

BackgroundPrevious longitudinal magnetic resonance imaging studies have shown progressive gray matter (GM) reduction during the earliest phases of schizophrenia. It is unknown whether these progressive processes are homogeneous in all groups of patients. One way to obtain more valid findings is to focus on the symptoms. Auditory hallucinations (AHs) are frequent and reliable symptoms of psychosis. The present study aims to analyze whether longitudinal changes in structural abnormalities in cortical regions are related to the presence of AHs and the intensity of psychotic symptoms in a large sample. MethodsA Magnetic Resonance (MR) voxel-based morphometry analysis was applied to a group of 128 first episodes psychosis (FEP) patients (63 patients with AHs and 65 patients without AHs) and 78 matched healthy controls at baseline and at a 2-year follow-up. ResultsAt baseline, FEP patients exhibited significant GM volume reductions in the temporal, frontal and precentral regions. At follow-up, FEP patients exhibited GM volume changes in the temporal, Rolandic, frontal, precentral and insula regions. At baseline, no significant differences were found between FEP patients with and without AHs. At follow-up, while FEP patients with AHs showed less GM volume in temporal and frontal lobes, non-AH FEP patients showed reductions in the frontal, precentral and fusiform areas. PANSS scores showed statistically significant correlations with GM volume reductions at baseline and follow-up. ConclusionsBrain cortical loss in the early phases of psychosis is not associated with potentially transitory AHs; however, brain structural changes may emerge as AHs appear in chronic patients.

Physical and psychosocial burden experienced by women on maintenance hemodialysis.

The global prevalence of chronic kidney disease is growing at an alarming rate, and the number of patients progressing to kidney failure is increasing. A substantial number of patients are undergoing hemodialysis (HD), which improves health and lengthens life. However, it imposes multiple physical and psychological demands on the patients. With the intensity of symptoms being greater among women, a greater focus is needed to obtain empirical evidence regarding the health problems of females receiving HD. A descriptive qualitative design was used to explore the health problems of women undergoing maintenance HD. The sampling technique used was maximum variation purposive sampling. The data were collected through in-depth face-to-face interviews with 12 female patients attending the dialysis unit of a tertiary care hospital in northern Kerala, South India, using a semi-structured interview guide. The interview was audiotaped, and the participant content was later converted verbatim into English. The content was imported to NVivo and coded. Thematic analysis was performed using Braun and Clarke's six-step approach. During data analysis, six major themes and 20 subthemes emerged. The themes include (1) physical suffering, (2) mental agony, (3) restricted life, (4) sexual inactivity, (5) breakdown of social life, and (6) financial hardship. Females undergoing maintenance hemodialysis experience significant health-related issues in all major dimensions of health. They are physically vulnerable, psychologically defeated, and socially detached. The study highlights the need for detailed evaluation and consistently supportive and educational care.

ASSOCIATION BETWEEN CHRONIC PRIMARY HEADACHES AND CIRCLE OF WILLIS ANOMALIES IN MAGNETIC RESONANCE ANGIOGRAPHY

Primary chronic headaches affect a substantial portion of the population, being predominant contributors to headache-related disability. Magnetic Resonance Angiography has emerged as a valuable diagnostic tool in examining the visibility of posterior communicating arteries in primary chronic headaches. Study at AKFA Medline University Hospital, involved 53 patients who were subjected to comprehensive neurological evaluations, assessed headache severity and frequency, and advanced imaging procedures. Six participants were excluded due to concomitant illnesses. According to 47 patients (M:F= 20:27) reported chronic headaches: n=41 (87.2%) showed no Posterior Communicating Artery visualization and n=6 (12.8%) showed Posterior Communicating Artery visualization. The mean age of participants was 42.3 ± 13.4. Alterations in the standard structure of the Circle of Willis might influence the frequency and intensity of headache symptoms. There has been a noted correlation between irregularities in the Circle of Willis with patients experiencing headaches, and a possible genetic involvement. More research is needed to understand the mechanisms.

Efficacy of Tuina plus Ba Duan Jin for primary dysmenorrhea due to cold-induced blood stasis

ObjectiveTo observe the effect of Ba Duan Jin (Eight-brocade Exercise) plus Tuina (Chinese therapeutic massage) in treating primary dysmenorrhea due to cold-induced blood stasis in female college students and on the score of fatigue scale-14 (FS-14).MethodsSeventy-two female college students with primary dysmenorrhea due to cold-induced blood stasis were randomized into a Tuina group and a joint group, with 36 cases in each group. The Tuina group only received Tuina manipulations. In the joint group, besides the same Tuina manipulations, patients practiced Ba Duan Jin. For both groups, the once-daily intervention was conducted from 6 d before the menstrual period until menstrual day 1 for 3 menstrual cycles. Changes in the scores of COX menstrual symptom scale (CMSS), visual analog scale (VAS), and FS-14 after the intervention were observed. Clinical efficacy was also estimated.ResultsDuring the process, 1 case dropped out in the Tuina group, and 35 cases completed the intervention; 2 cases dropped out in the joint group, and 34 cases completed the intervention. The total effective rate was 94.1% in the joint group, higher than 88.6% in the Tuina group (P<0.05). After treatment, the symptom duration and intensity scores in the scores of CMSS, VAS, and FS-14 declined in both groups (P<0.05 or P<0.01); the CMSS symptom duration score and FS-14 score were lower in the joint group than in the Tuina group (P<0.05).ConclusionTuina manipulations alone or combined with Ba Duan Jin practice can effectively treat primary dysmenorrhea due to cold-induced blood stasis in female college students; when combined with Ba Duan Jin practice, Tuina manipulations can more significantly improve pain duration and fatigue, suggesting the advantages of combining Tuina Gongfa and manipulations.

The relationship between attention deficit hyperactivity disorder (ADHD) and criminal behavior: a psychological profile of convicts serving custodial sentences. Pilot studies

Attention Deficit Hyperactivity Disorder is a disorder whose symptoms are mostly observed in childhood, however, their intensity may also persist into adulthood. What is more, research shows that the very nature of this disorder’s symptoms is such that adults experience numerous secondary consequences of the disorder. The purpose of the described pilot studies was to determine the connection between hyperactivity disorder and criminal behaviour as well as between hyperactivity disorder and mental functioning understood as the experience of trauma, maladaptive emotional schemas and mental health. Two groups of convicts participated in the research: first offenders and recidivists in prison aged from 21 to 65. Each group consists of 20 people (40 in total). Participants in the study were recruited from semi-open prisons in Poland (Detention Centre in Poznań, Iława Prison). The control group consisted of men without a criminal record aged from 21 to 65 – 20 men in total. The DIVA 5.0 questionnaire was used in order to recognise the intensity of ADHD symptoms. Other questionnaires used in the study were the Childhood Trauma Questionnaire (CTQ), the Family Adaptability and Cohesion Scale IV (FACES-IV), Young Schema Questionnaire (YSQ) and the General Health Questionnaire (GHQ-30). The results of pilot studies demonstrate that ADHD materially correlates with the experience of early childhood trauma. ADHD intensity also correlates with the evaluation of family functioning – these people evaluated relationships in their families of origin more negatively than the control group. Finally, ADHD intensity correlates with the disclosure of maladaptive emotional schemas. Research results did not demonstrate a connection between the intensity of ADHD symptoms and the tendency to get into conflicts with the law.The conducted research is innovative in nature as it attempts to provide a multifactorial approach to relationship between ADHD and criminal behavior.

Effects of Soft Tissue Massage Along with Mobilization Technique on Intensity of Symptoms and Functional Status of Carpal Tunnel Syndrome: A Randomized Controlled Trial

The median nerve in the wrist is compressed in the carpal tunnel, causing Carpal Tunnel Syndrome (CTS). The symptoms of this condition include numbness, tingling, and pain in the hand and fingers. The effectiveness of soft tissue massage along with mobilization techniques in managing CTS symptoms and improving functional status is an area to explored. Objective: To determine the effects of soft tissue massage along with mobilization technique on intensity of pain and functional status in Carpal tunnel syndrome patients. Methods: A randomized controlled trial was conducted on 60 patients with mild and moderate carpal tunnel syndrome at Sindh Institute of Physical Medicine and Rehabilitation, Karachi. In group A, soft tissue massage (Medenci hand massage technique) was combined with joint (radiocarpal and inter-carpal) and median nerve mobilization sliders, whereas in group B, only joint and median nerve mobilization sliders were used. A visual analog pain scale, the Boston scale of carpal tunnel syndrome, a dynamometer and a pinch gauge were used to evaluate participant on day 1 and the last treatment session. Results: There was no significant difference between group A and B after treatment. However, there was significant improvement (p&lt;0.05) in intragroup analysis in all outcome measures after treatment in both groups with p&lt; 0.05. Conclusions: Soft tissue massage along with joint and nerve mobilization is effective in symptoms severity and functional status. To further validate the findings of this study, similar investigations will need to be undertaken in the future to consider it before surgical intervention in CTS.

Secondary Polycythemia Associated with COVID-19 Is Associated with Higher Mortality but Does Not Seem to Affect Thrombotic Risk

Introduction Reactive polycythemia (without presence of a chronic myeloproliferative neoplasm (MPN)) is commonly observed among patients with chronic pulmonary disease, whereas its significance in the context of COVID-19 is less well known. We aimed to investigate to what extent might polycythemia at the time of hospital admission affect outcomes of acutely ill COVID-19 patients. Methods We retrospectively evaluated a total of 5872 consecutive hospitalized COVID-19 patients treated in a tertiary referral center, UH Dubrava Zagreb, Croatia, in period 3/2020-6/2021. All patients were of white race and adults. All patients were tested positive for SARS-CoV-2 with either PCR or antigen test in the presence of compatible clinical symptoms. Patients with missing laboratory or clinical information or with prior or subsequently proven MPN were excluded from analysis. Hemoglobin threshold levels defined by the World health organization (WHO) criteria for diagnosis of anemia and the 2008 and 2016 WHO criteria for diagnosis of polycythemia vera (PV) were used to stratify patients into four subgroups (anemia, normal hemoglobin values, 2016 but not 2008 WHO polycythemia vera (PV), and 2008 WHO PV hemoglobin criteria fulfilling patients). Patients were evaluated in regard to baseline clinical characteristics, in hospital mortality, venous (VTE), arterial thrombosis and major bleeding. Due to non-normal distribution, numerical variables were presented as median and interquartile range (IQR). The Kruskal Wallis ANOVA, the chi squared test and the logistic regression were used. P values &amp;lt;0.05 were considered statistically significant. All analyses were performed using the MedCalc statistical software version 22.007 (MedCalc Software Ltd, Ostend, Belgium). Results A total of 5872 COVID-19 patients were analyzed. There were 2575 (43.9%) female and 3297 (56.1%) male patients. Median age was 72 years, median Charlson comorbidity index was 4 points. A total of 4166 (70.9%) patients presented with severe and 897 (15.3%) with critical intensity of COVID-19 symptoms. Median hemoglobin level at the time of admission was 128 g/L, IQR (114-141). A total of 3082 (52.5%) patients presented with normal hemoglobin levels, 2607 (44.4%) with anemia, 158 (2.7%) fulfilled 2016 but not 2008 WHO PV hemoglobin criteria and 25 (0.4%) fulfilled 2008 WHO PV hemoglobin criteria. Patients presenting with polycythemia in comparison to those with normal hemoglobin values were significantly older, were more likely to be of male sex, had higher Charlson comorbidity index, higher leukocytes, lower platelets, higher intensity of COVID-19 symptoms, required higher intensity of oxygen supplementation both at the admission and later during hospitalization (P&amp;lt;0.05 for all analyses). Figure 1 depicts the relationship of belonging to different hemoglobin categories with clinical outcomes. Patients presenting with anemia (OR 1.42, P&amp;lt;0.001), WHO 2016 grade (OR 1.63, P=0.003) and WHO 2008 grade polycythemia (OR 4.98, P&amp;lt;0.001) had increased risk of mortality in comparison to patients presenting with normal hemoglobin values. Anemia was associated with higher VTE (OR 1.34, P&amp;lt;0.006) and major bleeding risk (OR 2.27, P&amp;lt;0.001) in comparison to normal hemoglobin values, whereas no significant association of polycythemia with venous or arterial thrombotic or major bleeding risk was observed. Relationship of anemia, WHO 2016 and WHO 2008 grade polycythemia with increased mortality remained significant after adjusting analyses for age, sex, Charlson comorbidity index, COVID-19 severity and need for mechanical ventilation, all independently predicting inferior outcome (P&amp;lt;0.05 for all analyses). Conclusion Secondary polycythemia in non-MPN COVID-19 patients is associated with high mortality, increasing with higher degree of polycythemia, but does not seem to affect thrombotic or major bleeding risk in comparison to normal hemoglobin values. These observations might help in understanding risks associated with polycythemia and increased blood viscosity in the context of other respiratory diseases. These findings might also translate into the context of MPN and COVID-19, suggesting that blood cells other than erythrocytes might play a more important role regarding thrombotic risk. Future studies are warranted.