Occasional Symptoms Research Articles

Prevalence and patterns of anxiety, depressive, hyperactivity, and inattention symptoms among secondary and high school students: A cross-sectional study

This study aimed to examine the prevalence of anxiety, depression, hyperactivity, and inattention symptoms among secondary school and high school students. The research specifically focused on understanding the status of these mental health symptoms in the adolescent population. This cross-sectional study involved 529 students (40.5% males, 59.5% females) aged 12--18 years who were selected via a convenience sampling method from various secondary and high schools. Four separate questionnaires were developed to measure anxiety, depression, hyperactivity, and inattention symptoms via a 4-point Likert scale. Descriptive statistics were applied to analyze the data. The findings indicated that anxiety, depression, hyperactivity, and inattention symptoms were generally low, with overall mean scores falling at the "Never" level for most symptoms. However, some symptoms, particularly inattention, were present at the "sometimes" level, suggesting occasional challenges in focus and concentration. Anxiety symptoms, such as difficulty concentrating and persistent worry, were also notable. Depressive symptoms, such as self-criticism and sadness, although less common, were observed. While severe mental health symptoms are not consistently observed, the presence of certain anxiety, depression, and inattention symptoms suggests the need for early intervention. Schools should implement mental health support programs to address these occasional symptoms, which can affect academic performance and overall well-being.

Chilaiditi Syndrome: An Incidental Finding on a Chest Radiograph in a Long-Term Ventilated Patient

Background: Chilaiditi syndrome is a situation with a structural impingement of the colon on the liver, leading to an elevated hemidiaphragm in the X-ray along with a gas-like ap-pearance in the right hemithorax. It is generally a benign disease that is managed conservatively upon diagnosis. Rarely, it can be a cause of intestinal obstruction. Chilaiditi syndrome was origi-nally named after Demetrius Chilaiditi, the Greek radiologist who first described the case in 1910 while working in Vienna. Case Presentation: Here, we have described the case of a 76-year-old male who was admitted to our long-term care facility for chronic respiratory failure, and he was connected to mechanical ventilation via tracheostomy. He was having occasional bouts of constipation, and was on regular laxatives. In a CT chest film done because of very thick respiratory secretions and desaturation, an incidental finding of Chilaiditi syndrome was noted. : The patient has been managed conservatively with laxatives and per-need enemas. : Chilaiditi syndrome is a rare condition in which the colon interposes between the liver, right hemidiaphragm, and the abdominal wall, causing occasional clinical symptoms. Conversely, radiographic findings without clinical symptoms are known to exhibit the Chilaiditi sign. The disease's prevalence is estimated to be somewhere between 0.025 and 0.28%. Conclusion: Chilaiditi syndrome is a syndrome that refers to the interposition of the colon upon the hepatic flexure. It is a very rare but a serious cause of constipation, resulting in severe symptoms to the extent that they may warrant surgical intervention.

Granulomatous mastitis and other inflammatory mastitis simulating breast neoplasms – A retrospective study in the fine needle aspiration cytology clinic of a tertiary care center in eastern India

Background: Fine needle aspiration cytology (FNAC) is an important diagnostic modality in palpable breast lesions. This together with imaging modality is important in distinguishing benign from malignant lesions of the breast. Granulomatous/inflammatory mastitis forms a small subset of breast lesions that may present as a breast lump. Clinical and radiological features in these cases may mimic malignant breast pathology. Aims and Objectives: The aim of this study was to study the frequency of granulomatous mastitis and other inflammatory mastitis with respect to other neoplastic lesions of the breast, presented in FNAC clinics and to correlate the cytological findings with the clinical presentation of granulomatous and other inflammatory mastitis. Materials and Methods: A retrospective study was conducted in the Department of Pathology in a tertiary care center in Eastern India for duration of 4 years 5 months. Details of all patients who underwent FNAC for breast lesions during the study period were recorded in terms of their clinical presentation, cytological findings, imaging, and ancillary investigations. The findings were then tabulated in a master sheet and analysis done by descriptive statistics using SPSS 25. Results: A total of 154 cases were included with 5 cases (3.2%) of granulomatous and 12 cases (7.8%) of inflammatory mastitis. Age range for granulomatous/inflammatory mastitis was 20–70 years. Lump and pain were the most common complaints followed by inflammatory skin changes and nipple discharge. Very few cases also showed nipple retractions and very occasional systemic symptoms like fever. History of lactation was seen among five cases. Three cases showed positive acid-fast bacilli in Ziehl–Neelsen stain. Radiology was discordant with cytological findings in three cases, where the former suggested a breast neoplastic process. Conclusion: Granulomatous/inflammatory mastitis is a rarely diagnosed entity in breast cytopathology with no standard guidelines for management. Antibiotics antitubercular therapy and corticosteroids are some proposed lines of medical management. In treatment-resistant cases, wide local excision may be done depending on available resources and surveillance opportunities.

Variations in the Evaluation and Management of Vascular Rings: A Survey of American Clinicians.

Vascular rings are arterial malformations that lead to the compression of the trachea and/or esophagus. While "tight" rings often produce symptoms and require surgery, "loose" rings rarely produce symptoms. Given advances in fetal echocardiography, this diagnosis is now more often made prenatally. This poses a new conundrum in the management of asymptomatic patients, leading to practice variation and creating a target for clinical system improvement. Hence, we conducted this survey aiming to demonstrate the practice variation existing in current evaluation and management of these patients. An anonymous web-based survey was distributed to several listservs for pediatric cardiologists and pediatric cardiothoracic surgeons. Survey questions targeted respondent practice characteristics, testing obtained, and indications for testing or surgical referral. In total 61 responses were received, predominantly from pediatric cardiologists (95%) in the United States (97%). About 60% of clinicians reported frequently diagnosing patients with vascular rings by fetal echocardiogram, with only about 20% diagnosing them frequently on evaluation of symptoms. Computed tomography angiography and echocardiogram were the most common imaging modalities employed. Most clinicians obtained cross-sectional imaging at the time of diagnosis and referred to surgery once patients had at least occasional symptoms. Respondents demonstrated a low degree of agreement (Krippendorf's alpha 0.48). Few statistically significant patterns were identified between respondents based on their practice characteristics. This study identified significant variation between clinicians regarding the evaluation and management of vascular rings. Further research or expert opinions may help to standardize practice, saving costs and improving the quality of care for affected patients.

A tale of noisy airways: Asthma or not?

A young female in her early twenties presented with complaints of sneezing, nocturnal dry cough, chest tightness and occasional nocturnal wheeze. She reported occasional reflux symptoms. She denied loss of weight, loss of appetite or fever.

Celiac disease symptom profiles and their relationship to gluten-free diet adherence, mental health, and quality of life

BackgroundA subgroup of adults with celiac disease experience persistent gastrointestinal and extraintestinal symptoms, which vary between individuals and the cause(s) for which are often unclear.MethodsThe present observational study sought to elucidate patterns of persistent symptoms and the relationship between those patterns and gluten-free diet adherence, psychiatric symptoms, and various aspects of quality of life (QOL) in an online sample of adults with celiac disease. U.S. adults with self-reported, biopsy-confirmed celiac disease (N = 523; Mage = 40.3 years; 88% women; 93.5% White) voluntarily completed questionnaires as part of the iCureCeliac® research network: (a) Celiac Symptoms Index (CSI) for physical symptoms and subjective health; (b) Celiac Dietary Adherence Test for gluten-free diet adherence; (c) PROMIS-29, SF-36, and Celiac Disease Quality of Life Survey for psychiatric symptoms and QOL. Symptom profiles were derived using latent profile analysis and profile differences were examined using auxiliary analyses.ResultsLatent profile analysis of CSI items determined a four-profile solution fit best. Profiles were characterized by: (1) little to no symptoms and excellent subjective health (37% of sample); (2) infrequent symptoms and good subjective health (33%); (3) occasional symptoms and fair to poor subjective health (24%); (4) frequent to constant symptoms and fair to poor subjective health (6%). Profiles 2 and 3 reported moderate overall symptomology though Profile 2 reported relatively greater extraintestinal symptoms and Profile 3 reported relatively greater gastrointestinal symptoms, physical pain, and worse subjective health. Profiles differed on anxiety and depression symptoms, limitations due to physical and emotional health, social functioning, and sleep, but not clinical characteristics, gluten-free diet adherence, or QOL. Despite Profile 3’s moderate symptom burden and low subjective health as reported on the CSI, Profile 3 reported the lowest psychiatric symptoms and highest quality of life on standardized measures.ConclusionsAdults with celiac disease reported variable patterns of persistent symptoms, symptom severity, and subjective health. Lack of profile differences in gluten-free diet adherence suggests that adjunctive dietary or medical assessment and intervention may be warranted. Lower persistent symptom burden did not necessarily translate to better mental health and QOL, suggesting that behavioral intervention may be helpful even for those with lower celiac symptom burden.

Safety and efficacy of a modified WALANT technique using undiluted adrenaline during open surgical carpal tunnel release: a prospective report of 308 procedures

PurposeThe current study aimed to report on the safety and efficacy of utilizing a modified WALANT (mWALANT) technique during open surgical carpal tunnel release (CTR), where we used undiluted epinephrine compared to the originally described WALANT technique.MethodsFrom January 2015 till the end of June 2021, 200 patients (175 (87.5%) were females) who presented with carpal tunnel syndrome, either bilateral (108 (54%) patients) or unilateral (92 (46%)) were included, formulating a total of 308 procedures. Open surgical CTR was performed as a daycare procedure by the same surgeon. The mWALANT injectable mixture was prepared by mixing 8 CC of 2% lidocaine HCl + 1 CC of 0.25 mg/1 ml epinephrine without dilution (2.5 times the concentration used in the original WALANT technique). The injection was performed before draping.ResultsThe patients’ average age at surgery was 42.88 ± 13.03 years old; they were followed up for an average of 31 ± 17.17 months. The average operative time was 9.5 ± 1.87 min. None (0.0%) of the patients needed top-up of local anesthesia or shift into general anesthesia, and no (0.0%) patients needed postoperative hospital stay. The average VAS during the surgical procedure was 2.5 ± 2.1, mainly reported during infiltration of the local anesthesia; no patients reported discomfort during the surgical procedure itself. 180 (90%) patients reported a full return to their usual preoperative ADL after an average of 4.7 ± 1.2 weeks. No (0.0%) postoperative fingers ischemic or temperature changes. Two (1%) patients experienced an adrenaline rush in the form of tachycardia that needed sedation and close monitoring by the anesthesiologist; they were discharged on the same day. One (0.5%) patient (who had uncontrolled diabetes mellitus) showed a superficial wound infection which resolved after conservative management.ConclusionsUsing undiluted epinephrine during the mWALANT technique is safe and effective. There is no need to wait until the drugs fully function, and no epinephrine-related complications were encountered apart from occasional adrenaline rush symptoms.

A First-Person Account of Developmental Language Disorder.

The aim of this study is to share the lived experiences of an adult with developmental language disorder (DLD) and relate her experience to the evidence base and issues in clinical practice. We co-wrote a first-person account grounded in the research literature. We organized the account into six main sections: (a) the early signs of DLD; (b) diagnosis; (c) treatment; (d) the impact of DLD on family relationships, social-emotional health, and academic performance; and (e) considerations for practicing speech-language pathologists. We close with (f) the first author's current perspective on life with DLD. The first author was diagnosed with moderate-to-severe DLD in early childhood, and she continues to exhibit subtle and occasional symptoms of DLD as an adult. At specific points in development, her family relationships were disrupted and her social, emotional, and academic functions were disabled, particularly in the school context. Supportive adults, especially her mother and her speech-language pathologist, helped lessen these impacts. DLD and its consequences also positively influenced her worldview and professional choices. The precise nature of her DLD and her experiences around the disorder will not be true of everyone with DLD. Nevertheless, the broad themes that emerge from her narrative are reflected in the evidence base and thus are likely applicable to many individuals with DLD or other neurodevelopmental conditions.

Clinical characteristics, endovascular choices, and surgical outcomes of intracranial vertebral artery dissecting aneurysms: a consecutive series of 196 patients.

The authors aimed to evaluate the clinical features, endovascular strategy selection, and outcomes of vertebral artery (VA) dissecting aneurysms (VADAs) near the origin of the posterior inferior cerebellar artery (PICA). Clinical data were obtained from 196 patients with 202 VADAs who had been surgically treated at the authors' hospital between 2005 and 2021. The patients' medical records, imaging data, and follow-up outcomes were retrospectively analyzed. All 196 patients (148 male, 48 female; mean age 53 years) underwent endovascular therapy for VADA. The most common chief complaints were headache (56.6%), dizziness (40.8%), and other occasional symptoms (18.4%). Twenty-six patients experienced posterior circulation ischemia, and 25 patients experienced subarachnoid hemorrhage (SAH). On DSA images, 37 aneurysms were found in the dominant VA, and 165 aneurysms were found on the nondominant side. Eighty-eight VADAs had stenosis. Regarding the VADA location, there were 59 distal, 51 proximal, 23 ventral, 64 PICA, and 5 obliteration types. Single-stent implantation (10.9%), overlapping stent implantation (23.8%), flow diverter (FD) implantation (11.9%), single stent-assisted coil (SAC) embolization (31.7%), overlapping SAC embolization (12.9%), parent artery occlusion (PAO) (8.4%), and FD-assisted coil embolization (0.5%) were chosen. The follow-up rate was 82.7%. The modified Rankin Scale (mRS) score was 0.5 ± 1.1. Ninety-six patients underwent DSA. The complete occlusion rates were 100%, 81.4%, 56.7%, and 76.5% in the PAO group, SAC reconstruction group, stent implantation group, and FD implantation group, respectively. Young patients showed a higher probability of SAH, and elderly patients showed a higher probability of posterior circulation infarction. The surgical plan selection should be based on the SAH history, VA dominant side, and PICA origin location.

Development of a new quantification method of Sarcocystis cruzi through detection of the acetyl-CoA synthetase gene.

Sarcocystis cruzi is a member of the genus Sarcocystis, infecting bovine animals such as cattle and bison as intermediate hosts, and canids such as dogs and raccoon dogs as definitive hosts. Acute sarcocystosis of S. cruzi causes occasional symptoms in cattle, including weight loss, reduced milk production, abortions, and death, and similar to other Sarcocystis species can potentially cause food poisoning in humans when raw or undercooked infected cattle meat is consumed. Despite these issues, genetic information on S. cruzi is scarce, and there is no specific quantitative method for the detection and quantification of the parasite in infected cattle. In this study, we aimed to develop a method based on high-throughput sequencing of S. cruzi genome and transcriptome that specifically and quantitatively detects the S. cruzi acetyl-CoA synthetase gene (ScACS). Cardiac muscles were collected from slaughterhouses in Saitama Prefecture to obtain sarcocysts from which DNA and RNA were extracted for the high-throughput sequencing. Using the sequences, we developed a specific quantitative PCR assay which could distinguish S. cruzi ACS from that of Toxoplasma gondii by taking advantage of the differences in their exon/intron organizations and validated the assay with the microscopic counting of the S. cruzi bradyzoites. Thus, this assay will be useful for future studies of S. cruzi pathogenesis in cattle and for the surveillance of infected animals, thereby easing public health concerns.

DLKN-MLC: A Disease Prediction Model via Multi-Label Learning.

With the increasingly available electronic health records (EHR), disease prediction has recently gained immense research attention, where an accurate classifier needs to be trained to map the input prediction signals (e.g., symptoms, auxiliary examination results, etc.) to the estimated diseases for each patient. However, most of the current disease prediction models focus on the prediction of a single disease; in the medical field, a patient often suffers from multiple diseases (especially multiple chronic diseases) at the same time. Therefore, multi-disease prediction is of greater significance for patients’ early intervention and treatment, but there is no doubt that multi-disease prediction has higher requirements for data extraction ability and greater complexity of classification. In this paper, we propose a novel disease prediction model DLKN-MLC. The model extracts the information in EHR through deep learning combined with a disease knowledge network, quantifies the correlation between diseases through NodeRank, and completes multi-disease prediction. in addition, we distinguished the importance of common disease symptoms, occasional disease symptoms and auxiliary examination results in the process of disease diagnosis. In empirical and comparative experiments on real EHR datasets, the Hamming loss, one-error rate, ranking loss, average precision, and micro-F1 values of the DLKN-MLC model were 0.2624, 0.2136, 0.2190, 88.21%, and 87.86%, respectively, which were better compared with those from previous methods. Extensive experiments on a real-world EHR dataset have demonstrated the state-of-the-art performance of our proposed model.

Epidemiology of Insomnia: Prevalence, Course, Risk Factors, and Public Health Burden.

This article summarizes epidemiologic evidence on insomnia, including the prevalence, incidence, and risk factors, as well as its course and consequences. Approximately 10% of the adult population suffers from an insomnia disorder and another 20% experiences occasional insomnia symptoms. Women, older adults, and people with socioeconomic hardship are more vulnerable to insomnia. Insomnia is often a chronic condition, with a 40% persistence rate over a 5-year period. Insomnia is a significant public health problem that should be addressed at the individual level with appropriate clinical care and at the population level with large-scale sleep health interventions.

Microscopic colitis: an update.

Microscopic colitis (MC) is an inflammatory pathology of the bowel diagnosed predominantly in older patients. MC is a cause of chronic watery, non-bloody diarrhea, that affects the older patients, mostly women, and leads to impaired health-related quality of life. The diagnosis and treatment can be often difficult. There are three main histological subtypes: collagenous colitis, lymphocytic colitis and incomplete microscopic colitis. Because of the variable nature of this pathology, the therapeutic options should be individualized for every patient. MC has a variable course, varying from occasional symptoms to recurrent or progressive symptoms. A literature search was performed on the main databases. Data on microscopic colitis was collected and presented. This comprehensive review aims to raise awareness of this pathology while providing the latest data regarding current recommendations. General practitioners and gastroenterologists should always take microscopic colitis into consideration when diagnosing a patient with chronic diarrhea.

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Influence of Ocular Therapies on Spherical and Cylindrical Power of the Eye: A Case Report

A 28-year-old female reported with diminution of vision for distant objects in both the eyes since 12 years associated with occasional symptoms of eye strain and headache while working on the computers since five years. The subject was a diagnosed case of Compound Myopic Astigmatism and the treatment was planned on the understanding of the same as Prathama Patalagatha Timira. External ocular therapies mentioned in the classics like Virechana Nasya Tarpana Pindi and eye exercises for refractive errors were administered for the subject. Oral medication Mahatriphaladi Ghrita was started after the course of Pindi. Autorefraction was done at various stages of the treatment and during follow up. A change in spherical and cylindrical power was noted and hence an effort was made to understand the relation between the ocular therapies and power of the eye.nbsp

Inverse effect and receptor dynamics – Coffee, Opium and Wine's secondary pharmacology

A homeopathic widespread belief is that the inversion of effect of the drugs in homeopathic medical practice is due to dilution or very low doses, but there are many homeopathic incoherencies. For example the first conception of the similia principle was obtained through planned, small sample, clinical experiments with ponderal/pharmacological doses in healthy and diseased subjects1. Furthermore the classical foundations of the similia principle in Organon2, the primary and secondary actions of drugs, were thought to be connected with opposite, time-dependent reactions of the body to high doses and the inversion of effect was seen in temporal sequence after a strong dose and not after changes of doses, so the idea that dilutions are responsible for inversion of effects is not suitable to the classical theory. And lastly homeopathic provings or pathogenetic trials have frequently mixed, unregarded to the doses, occasional toxicological symptoms and symptoms obtained through diluted substances3, reinforcing the idea that, on healthy subjects, in several cases many substances produce the same symptoms in pharmacological or infinitesimal doses. So at least the dose-dependent inversion of effect is not generalized in a great part of the collected symptoms. Biological foundations to similia principle have to be searched in other directions4, as in different sensitivity to drugs between health and disease, or in different time-dependent effect of drugs on specific, but different, cell sensitivity set point. In the vision described here both these possibilities represent the same phenomenon of altered cell sensitivity. It is aim of this article to show that the original hahnemannian idea to explain homeopathic similia principle starting from a pharmacological and biological point of view with ponderal doses, seems correct, rationally comprehensible and based on modern knowledges. The three pharmacologic examples that best illustrate this reasoning, coffe, opium and wine, will be discussed.

Symptomatic improvement following resection of cystic pineal lesions

Introduction: Pineal cysts have proven to be a challenging pathology for neurosurgeons. Due to occasional nonspecific symptoms, as well as a wide range of possible morphology and diagnoses, literature is scarce, and little evidence-based management guidelines exist. Methods: We present a retrospective review of 38 patients who underwent a surgical resection of a pineal lesion in a single center by a single surgeon between 2012 and 2018. Symptoms, imaging characteristics of the lesion, pathology report, and postoperative radiographic and clinical outcomes were collected. Results: Thirty-eight patients were selected. The most common preoperative symptoms included headaches (97%), visual disturbances (89%), cognitive disturbances (58%), and nausea/vomiting (53%). Preoperative radiographic measures showed no relationship to the pathological diagnosis of pineal cyst or pineocytoma (P > 0.05) except for mass effect on the tectal plate that was associated with pineocytoma (P < 0.05). Lesion pathology breakdown: 23 (60%) – World Health Organization Grade I pineocytoma, 14 (37%) – simple pineal cysts, and 1 (3%) – pineal parenchymal tumor of intermediate differentiation. The mean follow-up was 24 months. Headaches and visual disturbances were relieved in 78% and 58% of patients, respectively. Cognitive disturbances were found to be correlated with pineal cyst (P < 0.01). Patients with hyperintense fluid-attenuated inversion recovery signal and enhancement on preoperative magnetic resonance imaging were found to be at higher risk of not experiencing full symptom resolution (P < 0.05). Finally, if no symptom resolution occurred, then higher chance of patients not returning to work was seen (P < 0.05). Conclusion: Albeit challenging to treat, careful examination of presurgical imaging findings and surgical resection of appropriately selected pineal lesions can lead to significant relief of preoperative symptoms and overall meaningful improvement.

Anxiety, OCD, delusions, and religiosity among the general public during the COVID-19 pandemic.

The COVID‐19 outbreak has not only affected the physical health of the public but also resulted in severe psychological outcomes. This study aims to investigate the psychological effects of the COVID‐19 outbreak on Pakistan's general public. In order to identify the main psychological factors that have emerged due to the current pandemic, extensive literature and opinion pieces of psychologists were reviewed. After a thorough study of the existing scholarship, four main psychological factors were investigated: stress and anxiety, obsessive compulsive disorder (OCD), delusions of getting infected from the disease, and religiosity. A research survey was circulated among the sample population online. A total 356 valid responses were received in the period of two to three weeks. Findings showed that the respondents reported a moderate level of anxiety, occasional symptoms of OCD, and delusions. However, respondents showed a high inclination toward religion during the current pandemic situation. Furthermore, respondents highlighted a few other psychological factors, such as financial strain and loneliness, in the survey. The primary sources of COVID‐19‐related information were social media and television among the general public of Pakistan. Finally, guidelines and tips from the reviewed psychologists and psychiatrists on overcoming the highlighted psychological problems that have arisen due to the COVID‐19 outbreak were summarised.

Early Intervention and Resolution of Pediatric Intestinal Pseudo-Obstruction in Systemic Lupus Erythematosus: A Pediatric Case Report

Early Intervention and Resolution of Pediatric Intestinal Pseudo-Obstruction in Systemic Lupus Erythematosus: A Pediatric Case Report

Isolated Gastrointestinal Alpha-gal Meat Allergy Is a Cause for Gastrointestinal Distress Without Anaphylaxis

Isolated Gastrointestinal Alpha-gal Meat Allergy Is a Cause for Gastrointestinal Distress Without Anaphylaxis