Symptoms In Patients Research Articles

Ecopsychosocial strategies for the self-exploration of professional family caregivers to manage the behavioural and psychological symptoms of Alzheimer patients in Iran: a qualitative study

ObjectiveThe aim of the present study was to explore the experiences and viewpoints of professional family caregivers in the management of behavioural and psychological symptoms of dementia (BPSDs) to identify...

Sensory Symptoms as an Early Manifestation of Active Vitiligo: A Case-Control Clinical and Molecular Study.

Vitiligo pathogenesis is complex. There is some evidence in support of the neurohormonal pathways involved. Although considered a nonpruritic condition, some patients may experience itching, which can occur ahead of the appearance of the patches. We aimed to assess sensory symptoms in active and stable vitiligo patients and to measure 3 neuropeptide expressions in their lesional skin (neuropeptide Y [NPY], calcitonin gene-related peptide [CGRP], and nerve growth factors [NGF]) to correlate neuropeptide levels and sensory symptoms, with vitiligo activity. This case-control study included 85 patients, aged 18 years and older, analyzed into active or stable vitiligo groups. Patients were screened for itching or other abnormal neurological sensations such as paresthesia and numbness. The Vitiligo Disease Activity Score, Vitiligo Signs of Activity Score, and dermoscopic score were performed to assess disease activity. Three neuropeptides were quantified by enzyme-linked immunosorbent assay in skin biopsies from the edge of vitiligo lesions. A normal control group was also included. Results showed that 24.7% of patients had sensory symptoms: itching (18.8%), paresthesia (2.4%), and numbness (3.5%). The NGF, CGRP, and NPY levels were significantly higher in skin of normal controls compared to stable and active vitiligo patients. They were lowest in active vitiligo skin (p = 0.001, 0.016, and 0.01, respectively). NGF was the most relevant neuropeptide to vitiligo activity and sensory manifestations. In conclusion, almost one-third of the patients with active vitiligo reported sensory symptoms, predominantly itching, thus sensory manifestations may suggest a prodroma of activity and could be included in the screening tools for vitiligo activity. Trial Registration: www.clinicaltrials.gov (NCT05390164).

Defining the Critical Requisites for Accurate Simulation of SARS-CoV-2 Viral Dynamics: Patient Characteristics and Data Collection Protocol.

Mathematical models of viral dynamics are crucial in understanding infection trajectories. However, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load data often includes limited sparse observations with significant heterogeneity. This study aims to: (1) understand the impact of patient characteristics in shaping the temporal viral load trajectory and (2) establish a data collection protocol (DCP) to reliably reconstruct individual viral load trajectories. We collected longitudinal viral load data for SARS-CoV-2 Delta and Omicron variants from 243 patients in Singapore (2021-2022). A viral dynamics model was calibrated using patients' age, symptom presence, and vaccination status. We accessed associations between these patient characteristics and aspects of viral dynamics using linear regression models. We evaluated the accuracy of viral load trajectory estimation under different simulated DCPs by varying patient numbers, test frequencies, and test intervals. Older unvaccinated individuals had a longer viral shedding duration due to lower infection and cell death rates. Higher peak viral loads were found in older, symptomatic, and vaccinated individuals, with earlier peaks in younger vaccinated individuals. Symptom presence and vaccination resulted in a shorter time from infection to diagnosis. To accurately estimate viral dynamics, more frequent tests, longer test intervals, and larger patient samples are required. For 500 patients, a 21-day follow-up with measurements every 3 days and an 8-day follow-up with daily measurements was optimal for the Delta and Omicron variants, respectively. Patient characteristics significantly impacted viral dynamics. Our analytic approach and recommended DCPs can enhance preparedness and response to emerging pathogens beyond SARS-CoV-2.

Lights and Shadows of Cytokines in Age-Related Eye Diseases: A Narrative Literature Review.

The eye is considered to be an immune-privileged region. However, several parts of the eye have distinct mechanisms for delivering immune cells to the injury sites or even in response to aging. Although these immune responses are intended to be protective, the visual acuity can be compromised by the release of pro-inflammatory cytokines by immune cells, which induce chronic inflammation and fibrosis. Age-related eye diseases (AREDs) are the primary cause of vision impairment (VI) in the elderly, with a poor comprehension of their pathophysiology. Age-related eye diseases affect both the anterior and posterior segments, resulting in diminished quality of life and risk of irreversible blindness. Immune system dysregulation and the upregulation of pro-inflammatory cytokines have been linked to AREDs, underscoring the need to comprehend inflammation's impact on ocular disorders to enhance patient symptom management. In this framework, the PubMed database was searched using the medical subject headings (MeSH) terms "Age-related eye diseases," "dry eye syndrome," "glaucoma," "cataract," "diabetic retinopathy," "inflammation," "interleukin," and "cytokine" with the aim of overview the role of cytokines in AREDs and discuss their potential therapeutic approaches.

The problem of pain in systemic lupus erythematosus: A comprehensive analysis of pain distribution using the CHOIR body map and PROMIS measures.

Our study investigates the associations between pain distribution, biopsychosocial factors, and Patient-Reported Outcomes Measurement Information System (PROMIS) measures in patients with systemic lupus erythematosus (SLE). Employing self-reported pain body maps, we aim to characterize the distribution of pain and its impact on biopsychosocial measures. We retrospectively analyzed the electronic health records (EHR) of 332 adult patients with SLE attending pain clinics at an academic medical center. The study included demographics, pain distribution assessed via self-reported body maps, and PROMIS assessments of biopsychosocial experiences. We used linear regression models adjusted for age and sex to investigate associations between pain distribution and PROMIS outcomes. Men, on average, indicated pain in 3.2 regions, whereas women reported pain in 5.6 regions. Women predominantly highlighted the hip, buttock, and leg region, whereas men primarily emphasized the shoulder and arm region. We found a positive correlation between pain widespreadness and worse PROMIS measures, including pain interference, behavior, fatigue, depression, anxiety, sleep disturbance, and social isolation. Additionally, widespread pain was associated with lower physical function, emotional support, and satisfaction in roles and activities. Female patients reported higher levels of pain and PROMIS measures compared to males. Our findings highlight the multidimensional impact of pain on SLE patients' lives underscoring the need for holistic pain management approaches. The intricate associations between pain distribution and biopsychosocial factors emphasize the importance of considering spatial dimensions of pain in clinical interventions. Further research is warranted to explore effective interventions addressing psychosocial aspects of pain in SLE, aiming to enhance patient symptom management and quality of life.

Pharyngeal perforations after anterior cervical spinal procedures: A systematic review.

Digestive system perforations after anterior cervical spine surgery (ACSS), if left untreated, are life-threatening. These injuries are often categorized as pharyngoesophageal. Although the pharynx and esophagus are continuations of each other, they are two distinct anatomical structures. There is limited experience in managing patients with pharyngeal injuries after ACSS. Using PRISMA guidelines, a PubMed search was conducted on the iatrogenic pharyngeal perforations after ACSS for the treatment of disc herniation and degenerative cervical myeloradiculopathy. A total of 12 patients met our inclusion criteria. Eleven were from published studies, and one was our patient (2 female and 10 male, mean age=56.25 years, range: 31-82 years). Clinical symptoms of patients with iatrogenic pharyngeal perforation after ACSS varied depending on whether the cases present early or late after surgery. Although clinical symptoms suggested a pharynx or esophageal injury, definitive diagnosis was challenging. All cases diagnosed either early or late after ACSS underwent surgical repair treatment, except for one case managed conservatively with antibiotics and nasogastric feeding. The overall outcome was favorable for all patients. However, the postoperative follow-up duration was not specified in two cases. In the remaining 10 cases, postoperative follow-up durations were generally short and varied significantly (mean=4.87 months, median=1.75 months, range:1 week-24 months). Iatrogenic pharyngeal injuries resulting from ACSS are extremely rare. They are relatively straightforward to diagnose and can be managed with a multidisciplinary approach. However, their long-term prognosis remains unknown.

Generation of an isogenic control from an induced pluripotent stem cell line of a patient with dominant optic atrophy harbouring the genetic variant C.1024 A > G (P.K342E) in the OPA1 gene

Aims/Purpose: Dominant Optic Atrophy (DOA) is an inherited optic neuropathy commonly caused by OPA1 gene mutations, affecting mitochondrial function. The main symptom of patients is vision loss, but the syndromic form of DOA, DOA‐plus, presents with additional manifestations such as deafness and myopathy, among others. The visual impairment occurring in DOA is caused by the degeneration of Retina Ganglion Cells (RGCs), specialized neurons that convey visual information from the retina to the brain. Currently, there is a lack of an effective treatment for DOA patients, which highlights the importance of developing a proper experimental model. Induced Pluripotent Stem Cells (iPSCs) technology could be a promising approach to generate a model of DOA, useful not only for studying mechanisms of disease and therapeutic strategies, but also to confirm if a genetic variant is pathogenic. Our final aim is to determine if a genetic variant in OPA1 gene is pathogenic in a patient with DOA‐plus by the generation of an isogenic human RGC model.Methods: An iPSC line, OPA1.15, carrying the variant NM_015560.3: c.1024 A > G (p.K342E) in OPA1 gene, obtained from a patient with DOA‐plus was created. Subsequently, a battery of assays was performed to confirm the pluripotency and good quality of the OPA1.15 iPSC line. In this work, as a first step for the creation of the RGC model, the generation of an isogenic control from OPA1.15 with the CRISPR/Cas9 system has been developed.Results: A bona fide iPSC line from a patient with DOA‐plus has been created. Using this line, an isogenic control was generated with the genome editing tool CRISPR/Cas9.Conclusions: The iPSC line OPA1.15 and its matched isogenic control will be very useful to generate a RGC model to delve into the pathogenicity of this variant.

Effect of individual physiotherapy and telerehabilitation on back pain and quality of life in people with multiple sclerosis with mild and moderate disability.

Back pain is a common but often underestimated symptom of patients with MS that can negatively influence their quality of life. However there are only limited number of studies comparing the effect of different types of exercise and use of telerehabilitation on back pain in MS. Therefore, the aim of the study is to compare whether telerehabilitation alone is as effective as conventional outpatient physiotherapy followed by online exercise. This single-centre intervention study compared the impact of different individual outpatient physiotherapy treatments (Group 1 - individual Pilates exercise or Group 2 - strength training) and telerehabilitation alone (individual Pilates exercise with a physiotherapist online). The primary objective was to compare the effect of interventions on back pain (assessed using the Visual Analogue Scale and McGill Pain Questionnaire) and quality of life (Multiple Sclerosis Quality of Life-54). Secondary aims were to compare effect of interventions on spine and thorax mobility, functional mobility (assessed using the Timed 25 foot walk test, Six Spot Step test), respiratory muscle strenght and patient reported outcomes (assessed using he Hospital Anxiety and Depression Scale, Fatigue Severity Scale). 45 people with MS were enrolled in the study (3 men, age:48.4± SD 11,5, Expanded Disability Status Scale (EDSS): 3.3±SD 1,1) and 36 people completed the entire exercise program. All types of exercise intervention showed a positive effect on the reduction of back pain, quality of life and fatigue. The interventions also increased respiratory muscle strength and increased thorax mobility, but we did not find any effect of interventions on gait tests. There were no difference in effect on outcome measures between different types of exercise interventions. Telerehabilitation, involving individual exercise sessions with a physiotherapist, has a comparable effect on reducing back pain, improving quality of life, and enhancing respiratory muscle strength in people with MS as individual Pilates or strength training.

Akram’s lifestyle: An effective remedy for the management of gastroesophageal reflux disease

Abstract: INTRODUCTION: The prevalence of gastroesophageal reflux disease (GERD) has generally increased worldwide. Irregular pattern of intake of meals are known to be the most prevalent cause of GERD. The intake of food on top of another meal may cause gastroesophageal reflux either by generating transient lower-esophageal sphincter relaxations (TLESRs) subsequent to distention of the upper part of the stomach or/and delayed gastric emptying due to inhibition of migrating motor complexes (MMCs) in the distal part of the stomach. Present study evaluated the effect of authors suggested regimen “Akram’s lifestyle”, taking meals twice-a-day with the liberty to consume only liquids in the intervening periods on the outcome of patients presenting with mild to moderate GERD. MATERIALS AND METHODS: Study included 60 patients with symptoms of GERD who agreed to follow “Akram’s lifestyle”, took two meals a day about 10-12 hours apart, consuming liquids in between meals for a period of two weeks. Typical GERD symptoms of heartburn, acid reflux, nausea, vomiting and dyspepsia as reported by the patients were scored on visual analog scale (VAS). Gastrointestinal and associated complaints were also evaluated by “Yes/No” response. Data obtained before and after two weeks of intervention was analyzed using SPSS version 28.0. RESULTS: Final data after 2 weeks were available for 45 patients. There was a highly significant improvement in GERD symptoms (heartburn, reflux, nausea, vomiting, and dyspepsia) within 2 weeks of dietary intervention (P < 0.000). Improvement was also reflected in the significant reduction (>69%) in the gastrointestinal complaints as evaluated by “Yes/No” responses after the dietary intervention. CONCLUSIONS: Adherence to “Akram’s lifestyle” for GERD for 2 weeks resulted in a significant improvement or complete relief of symptoms of patients with GERD. Reduced gastric acid secretion, TLESRs and enhanced gastric emptying could be the potential contributing factors in causing this improvement. Further investigations with larger samples are needed to confirm the findings.

Relationships between clinical symptoms, cognitive functioning, and TMS-evoked potential features in patients with major depressive disorder.

Cognitive impairment is a common clinical symptom of patients with major depressive disorder (MDD). Transcranial magnetic stimulation-evoked potentials (TEPs) detect cortical excitability and connectivity and provide potential biomarkers for MDD patients and their cognitive impairment. This study aimed to investigate the interrelationships between clinical symptoms, cognitive function, and electrophysiological marker TEPs in patients with MDD. A total of 117 participants were recruited, including 59 MDD patients and 58 healthy controls. Clinical symptoms were assessed by the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, and cognitive functioning was assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). TEPs were recorded by transcranial magnetic stimulation combined with electroencephalography (TMS-EEG). MDD patients exhibited lower RBANS total (P<0.001), immediate memory (P=0.001), language (P=0.003), attention (P<0.001), and delayed memory (P=0.008) scores than HCs. Patients with MDD had larger amplitudes for N100 (P=0.040) and N280 (P=0.037), compared to HCs. Correlation analysis indicated significant correlations between the following RBANS scores and TEPs: language and N45 amplitude (r=0.222, P=0.024), language and P60 amplitude (r=0.278, P=0.004), attention and P180 amplitude (r=0.213, P=0.030), RBANS total score and P30 amplitude (r=0.198, P=0.044), visuospatial/constructional index and N100 amplitude (r=-0.272, P=0.005). The results of this study indicate that cortical dysfunction and cognitive impairment are present in patients with MDD and that there is a strong correlation between them, suggesting that TEPs detected by the TMS-EEG may be used as a biomarker for MDD patients and their cognitive impairment.

Symptom Network and Subgroup Analysis in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study.

This study aims to construct a contemporaneous symptom network of inpatients with Exacerbation of Chronic Obstructive Pulmonary Disease (ECOPD) based on the symptom cluster, identify core and bridge symptoms, and patient subgroups with different symptom clusters based on individual differences in the intensity of patient symptom experiences. This study used convenience sampling to collect demographic, symptom, auxiliary examination, and prognosis information of 208 inpatients with ECOPD from April 2022 to October 2023. The data underwent exploratory factor analysis (EFA), symptom network analysis, latent class analysis (LCA), Spearman correlation analysis, Wilcoxon signed-rank test, single-factor regression and multiple-factor stepwise regression. In hospitalized patients with ECOPD, symptom network analysis revealed that loss of appetite was the core symptom, while chest distress was the bridge symptom. Through LCA analysis, two symptom subgroups were identified: a high-symptom group (53.8%) and a low-symptom group (46.2%). This suggests that there is significant heterogeneity in symptom experience among ECOPD individuals. Patients in the high-symptom group had a higher probability of experiencing symptom clusters related to nutrition-sleep. The combination of symptom network analysis and LCA comprehensively captures the symptom/symptom cluster characteristics and accounts for the heterogeneity of ECOPD patients from both individual and group perspectives. This study identifies core symptoms, bridge symptoms, and symptom subgroups, offering valuable insights for precision symptom management in ECOPD.

Persistent COVID-19 symptoms and associated factors in a tertiary hospital in Thailand.

Coronavirus disease 2019 (COVID-19) is associated with long-term symptoms, but the spectrum of these symptoms remains unclear. We aimed to identify the prevalence and factors associated with persistent symptoms in patients at the post-COVID-19 outpatient clinic. This cross-sectional, observational study included hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients followed-up at a post-COVID-19 clinic between September 2021 and January 2022. Persistent symptoms, defined as lasting > 4 weeks after infection, were analyzed alongside symptom timing (28-90, 91-120, and > 120 days) and associated factors using multivariate analysis. Among 277 patients, mean (SD) age was 56 (16.6) years, and 58.5% were male. Of these, 80.9% reported at least one persistent symptom. Common symptoms included dyspnea (48.2%), insomnia (42.4%), and myalgia (42.1%). In multivariate analysis, being female [odds ratio (OR) 3.41; 95% confidence interval (CI) 1.5-7.76], and oxygen therapy (OR 3.39; 95% CI 1.3-8.81) were independently associated factors with persistent symptoms. High-sensitivity C-reactive protein (HsCRP) (> 75 mg/dL) was an independent risk factor for dyspnea (adjusted OR 2.29; 95% CI 1.28-4.12), and fatigue (adjusted OR 2.24; 95% CI 1.25-4). Oxygen therapy was an independent risk factor for neurologic symptoms, i.e. insomnia (adjusted OR 2.05; 95% CI 1.15-3.65), and brain fog (adjusted OR 2.02; 95% CI 1.14-3.58). There was a high prevalence of persistent COVID-19 symptoms. The most common symptom was dyspnea. Female gender and oxygen supplementation were independent associated factors. Continuous follow-up of these patients is still required.

Efficacy and safety of reslizumab in severe eosinophilic asthma: a systematic review

Introduction. Severe eosinophilic asthma is one of the phenotypes of asthma which is characterised by elevated eosinophil count in blood and sputum, and inadequate control of symptoms even on treatment with bronchodilators and inhaled corticosteroids. Interleutin-5 is the main inflammatory mediator involved in eosinophilic inflammation in the airways. Reslizumab is an anti-IL-5 monoclonal antibody which worls by down regulating the IL-5 signalling pathway, thus reducing the eosinophilic associated inflammation in severe asthma. The aim of this systematic review was to evaluate the efficacy and safety of reslizumab in improving lung function and providing symptomatic control in patients with severe eosinophilic asthma. Material and method. The literature search was performed using two electronic databases: PubMed and Science Direct. Randomised, double blind, controlled studies comparing the efficacy and safety of Reslizumab versus placebo in patients diagnosed with severe eosinophilic asthma were included in the systematic review. The primary outcome of the review was ‘change in the FEV1 from baseline to end of therapy. The secondary outcomes were changes from baseline in the Asthma Control questionnaire (ACQ), sputum and blood eosinophil counts. Safety outcomes included the incidence of most common adverse events and events that led to treatment discontinuation. Results. The systematic review included 4 research reports with five trials with a total of 1766 patients randomised to reslizumab (1034) and placebo (732). The results from overall analysis suggest that Reslizumab is more effective in improving the FEV1 value when compared to placebo [0.235 vs 0.05 L/s respectively]. Better reductions in ACQ score [-0.834 vs -0.556], sputum and blood eosinophil count [0.404 × 103 vs 0.05 × 103 cells/µL] were found in Reslizumab group when compared to placebo. In terms of safety analyses, no major differences were observed between both the groups. Conclusion. Reslizumab is safe and effective in improving the lung function and reducing the symptoms in patients with severe eosinophilic asthma.

Hyperacusis and Tinnitus in Vestibular Migraine Patients.

To estimate the prevalence of tinnitus and hyperacusis in patients with vestibular migraine (VM), and to define the association with hearing loss, anxiety, and depression. A cross-sectional, multicenter study including 51 adult patients with definite or probable VM, defined according to the Barany Society diagnostic criteria. Audiological examinations were performed by pure tones extended to high frequencies to assess hearing thresholds. Psychoacoustic (pitch, masking level, and residual inhibition) and psychometric assessment of tinnitus was performed in all patients that reported tinnitus with the following questionnaires: Tinnitus Handicap Inventory (THI), Hypersensitivity to Sound Questionnaire and Hospital Anxiety Depression Scale. Correlation and regression analyses were used to assess the relationship between THI scores hyperacusis, anxiety, and depression in patients with VM. Forty-five of 50 VM patients (90%) were females; 38 out of 50 (75%) patients reported tinnitus. In our series, the most common frequency (pitch) for tinnitus was 8000 Hz. Tinnitus was not associated with hearing loss in patients with VM and the hearing thresholds were similar in VM patients with or without tinnitus. Hyperacusis was reported in 35 (60%) individuals, and in patients with tinnitus, the THI scores were associated with higher scores in Hypersensitivity to Sound Questionnaire, and anxiety and depression subscales of Hospital Anxiety Depression Scale. There were differences in the distribution of hearing loss in patients with hyperacusis, however both groups did not exceed the normal hearing threshold (17.18 ± 13.43 patients with hyperacusis and 11.66 ± 5.41, p = 0.023 in patients without hyperacusis). Tinnitus is a common symptom in patients with VM and it is not related to hearing loss in the standard audiogram. Hyperacusis was associated with tinnitus, anxiety, and depression, but it was not associated with hearing thresholds.

Risk Factors Associated with Post-Cholecystectomy Syndrome and Insights into Post Surgical Follow Up Retrospective Cohort Study

Post Cholecystectomy Syndrome PCS refers to a persistence of heterogenous symptoms in patients who have undergone cholecystectomy Although the term PCS remains in contention we define it as a complex of 1 varied symptoms which include right upper quadrant pain nausea/vomiting diarrhea, or dyspepsia

Treating Adolescent Depression: Exploring Neurofeedback Training, Dhikr, and Community Stigma in Complementary Therapies (A Case Study)

Adolescent depression, particularly when complicated by psychotic features, presents significant challenges in treatment due to its complex and multifaceted nature. This case study explores the integration of neurofeedback training and Dhikr, an Islamic meditative practice, as complementary therapies alongside traditional pharmacotherapy in treating a 15 years old male diagnosed with severe recurrent depression. Despite initial reluctance and skepticism influenced by community stigma surrounding mental health and spiritual practices, both therapies contributed to noticeable improvements in the patient's symptoms and overall well-being. Neurofeedback was utilized to regulate brainwave activity, while Dhikr provided a meditative and spiritual component that promoted mindfulness and inner peace. The case highlights the importance of addressing community stigma, personalized treatment plans, and holistic approaches in managing adolescent depression, ultimately leading to better engagement and therapeutic outcomes.

A Stepwise Approach to Surgical Decision-making for Lower Eyelid Ectropion: Insights from a Retrospective Study.

Cicatricial lower-eyelid ectropion is a serious complication resulting from undesired lower lid blepharoplasty or impaired wound healing. Surgical treatment for ectropion is challenging for oculoplastic surgeons due to the unpredictability of surgical outcome and the difficulty of surgical design. The authors aimed to fully describe the surgical decision-making strategy for cicatricial ectropion, and to potentially enhance treatment outcomes. In this study, we conducted a retrospective review of the treatment of 26 patients (30 eyelids) with cicatricial ectropion between 2017 and 2021. We summarized the corresponding decision-making processes before and during surgery. Treatment involved scar tissue release combined with lateral canthal procedures and repair of the skin defect. During the early postoperative stage, no flap necrosis was observed, and complete surgical healing was achieved within 2 weeks. The Ectropion Grading Scale (EGS) showed a significant decrease after surgical treatment based on our approach, and most patient symptoms were alleviated. Additionally, the majority of the patients expressed high satisfaction with the aesthetic outcome of the procedure. This treatment approach significantly enhanced both the appearance and function of lower lid, which holds considerable promise as an ideal surgical design for cicatricial ectropion.

Using latent variables to improve the management of depression among hemodialysis patients

Background Screening for depression can be challenging among hemodialysis patients due to the overlap of depressive symptoms with dialysis or kidney disease related symptoms. The aim of this study was to understand these overlapping symptoms and develop a depression screening tool for better clinical assessment of depressive symptoms in dialysis patients. Methods We surveyed 1,085 dialysis patients between March 1, 2018 and February 28, 2023 at 15 dialysis facilities in Northeast Ohio with the 9-item patient health questionnaire (PHQ-9) and kidney disease quality of life (KDQOL) instrument. To evaluate overlap across questionnaire items, we used structural equation modeling (SEM). We predicted and transformed factor scores to create a hemodialysis-adjusted PHQ-9 (hdPHQ-9). In exploratory analysis (N = 173), we evaluated the performance of the hdPHQ-9 relative to the PHQ-9 that also received a Mini-International Neuropsychiatric Interview. Results Our study sample included a high percentage of Black patients (74.6%) and 157 (14.5%) survey participants screened positive for depression (PHQ-9 ≥ 10). The magnitude of overlap was small for (respectively, PHQ-9 item with KDQOLTM item) fatigue with washed out, guilt with burden on family, appetite with nausea and movement with lightheaded. The hdPHQ-9 showed reasonably high sensitivity (0.81 with 95% confidence interval [CI] 0.58, 0.95) and specificity (0.84 with 95% CI 0.77, 0.89); however, this was not a significant improvement from the PHQ-9. Conclusion There is little overlap between depressive symptoms and dialysis or kidney disease symptoms. The PHQ-9 was found to be an appropriate depression screening instrument for dialysis patients.

Case Study : Nursing Care for Schizophrenia Patients with Low Self-Esteem at RSJ Prof HB. Saanin Padang

Low self-esteem is a negative symptom in schizophrenia patients, where clients experience negative feelings toward themselves and others, leading to feelings of worthlessness and hopelessness. Without intervention, this condition can result in social isolation. This study aims to provide nursing care for schizophrenia patients with low self-esteem issues at RSJ Prof. HB. Saanin Padang in 2024. The research method used is a single case descriptive study with a case study approach. Nursing care was conducted from May 29 to June 4, involving one participant with low self-esteem issues. Data was collected through interviews, direct measurement, and observation. The assessment results indicated that the client frequently felt worthless, with a diagnosis of chronic low self-esteem. The intervention included behavior management over six days through activities such as making the bed, sweeping, and folding blankets. After implementation, there was an improvement in self-esteem, eye contact, and the ability to choose activities. Conclusion : Clients with low self-esteem benefit from social support. Recommended : The hospital is expected to maintain the existing interventions, and future researchers are encouraged to focus their implementation strategies on schizophrenia clients with low self-esteem.

ChatGPT-4.0 in oral and maxillofacial radiology: prediction of anatomical and pathological conditions from radiographic images.

ChatGPT has the ability to generate human-like text, analyze and understand medical images using natural Language processing (NLP) algorithms. It can generate real-time diagnosis and recognize patterns and learn from previous cases to improve accuracy by combining patient history, symptoms, and image characteristics. It has been used recently for learning about maxillofacial diseases, writing and translating radiology reports, and identifying anatomical landmarks, among other things.