Overall Severity Of Symptoms Research Articles

Efficacy of Streptococcus salivarius Blis K12 in the Prevention of Upper Respiratory Tract Infections in Physically Active Individuals: A Randomized Controlled Trial

This study investigates the efficacy of Streptococcus salivarius K12 in preventing upper respiratory tract infections (URTIs) in healthy adults. URTIs are a common issue, particularly in physically active individuals, leading to significant disruptions in daily life. Probiotics, such as S. salivarius K12, have emerged as a potential preventive strategy for these infections. This research was conducted as a randomized, double-blind, placebo-controlled trial involving 112 participants aged between 19 and 25. Participants were randomly divided into two groups: one group received a daily dose of S. salivarius K12, marketed as Bactoblis®, while the other received a placebo. The trial lasted for four months, during which adherence to the treatment protocol was closely monitored. The primary goal was to measure the incidence of URTIs using the Jackson Scale and the Wisconsin Upper Respiratory Symptom Survey (WURSS-11). The results indicated that higher adherence to the S. salivarius K12 treatment was associated with an increased number of days without URTI symptoms. Although the overall severity of symptoms did not differ significantly between the treatment and control groups, those with high adherence to S. salivarius K12 (greater than 90%) reported more days free from illness. In conclusion, S. salivarius K12 demonstrated potential as a preventive measure against URTIs, especially in individuals who adhered strictly to the treatment regimen. However, further research involving larger populations and longer follow-up periods is needed to fully confirm these findings and better understand the role of S. salivarius K12 in preventing respiratory infections.

Antihistamine and COVID-19 outcomes in outpatients.

The World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic on March 11, 2020. Since then, researchers have been investigating the efficacy and side effects of its medication, up until now. From the viewpoint of Persian medicine, some medications such as antihistamines may cause retention of secretions and lead to exacerbation and spread of the disease in the body. There are studies with conflicting results regarding the effectiveness of antihistamines in COVID-19. Systematic reviews found a lack of data on beneficial effect of antihistamine-decongestant-analgesic combinations for the common cold and a limited short-term effect of antihistamines on severity of overall symptoms. This prospective cohort study was designed to investigate the relationship between the use of antihistamines and the severity of COVID-19 symptoms. Three hundred patients with a diagnosis of COVID-19 participated in the study in Shiraz, Iran from December 4, 2021 until January 24, 2022. The interviews were conducted via phone call by a single interviewer. Patients were followed weekly for 4 weeks. We collected information by using a data collection form, containing demographic information, underlying disease, COVID-19 symptoms, treatment methods, medications, and a list of antihistamines and herbs that might have been used. Generalized estimating equations were applied to assess the relationship between the severity of COVID-19 and the use of antihistamines, taking into account potential confounding factors such as time and herbal consumption. The difference in the severity of COVID-19 disease in antihistamine users compared to nonusers was not significant in 4 weeks despite the higher baseline severity in nonusers. The comparison of two groups of antihistamine users and nonusers showed that there was a significant difference (p = 0.001) regarding the use of herbal medicines.

OXTR polymorphisms associated with severity and treatment responses of schizophrenia

The mechanisms generating specific symptoms of schizophrenia remain unclear and genetic research makes it possible to explore these issues at a fundamental level. Taking into account the associations between the oxytocin system and social functions, which are apparently impaired in schizophrenia patients, we hypothesized that the oxytocin receptor gene (OXTR) might be associated with schizophrenia symptoms in both severity and responses to antipsychotics and did this exploratory positional study. A total of 2363 patients with schizophrenia (1181 males and 1182 females) included in our study were randomly allocated to seven antipsychotic treatment groups and received antipsychotic monotherapy for 6 weeks. Their blood DNA was genotyped for OXTR polymorphisms. Their symptom severity was assessed by Positive and Negative Syndrome Scale (PANSS), and the scores were transformed into seven factors (positive, disorganized, negative symptoms apathy/avolition, negative symptoms deficit of expression, hostility, anxiety and depression). Percentage changes in PANSS scores from baseline to week 6 were calculated to quantify antipsychotic responses. We found that OXTR polymorphisms were nominally associated with the severity of overall symptoms (rs237899, β = 1.669, p = 0.019), hostility symptoms (rs237899, β = 0.427, p = 0.044) and anxiety symptoms (rs13316193, β = −0.197, p = 0.038). As for treatment responses, OXTR polymorphisms were nominally associated with the improvement in negative symptoms apathy/avolition (rs2268490, β = 2.235, p = 0.0499). No association between severity or response to treatment and OXTR polymorphisms was found with statistical correction for multiplicity. Overall, our results highlighted the possibility of nominally significant associations of the OXTR gene with the severity and improvement in schizophrenia symptoms. Given the exploratory nature of this study, these associations are indicative of the role of the OXTR gene in the pathology of schizophrenia and may contribute to further elucidate the mechanism of specific symptoms of schizophrenia and to exploit antipsychotics more effective to specific symptoms.

Identifying central symptom clusters and correlates in children with acute leukemia undergoing chemotherapy: a network analysis.

Previous studies have examined symptom clusters in children with acute leukemia, yet a knowledge gap persists regarding central symptom clusters and their influencing factors. By identifying these central clusters and associated factors, healthcare providers can enhance their understanding and effective management of symptoms. Our study seeks to address this gap by identifying symptom clusters, exploring central clusters, and investigating the demographic and health-related factors associated with these clusters in children with acute leukemia undergoing chemotherapy. A total of 586 children with acute leukemia from January 2021 to April 2023 were recruited from China. They were investigated using Memorial Symptom Assessment Scale 10-18 during chemotherapy. The principal component analysis was used to identify the symptom clusters. An association network was conducted to describe the relationships among symptoms and clusters. A multiple linear model was used to investigate the associated factors for the severity of overall symptoms and each symptom cluster. Five clusters were identified, including oral and skin cluster, somatic cluster, self-image disorder cluster, gastrointestinal cluster and psychological cluster. Gastrointestinal cluster was the most central symptom cluster. Age, sex, clinical classification, number of having chemotherapy and education degree and marital status of the primary caregiver are associated with the severity of these five symptom clusters. Our study highlights the importance of evaluating symptom clusters in children with acute leukemia during chemotherapy. Specifically, addressing gastrointestinal symptoms is crucial for effective symptom management and overall care.

Efficacy of Dupilumab in severe Atopic Dermatitis (AD) using the AD Control Tool (ADCT) Score in the population of Qatar.

Atopic Dermatitis (AD) is a high-burden disease that affects approximately 2-5% of adults. AD patients experience intense pruritus and often report sleep and mental health disturbances accompanied by a diminished quality of life. The patients' perceptions of their treatment benefits are becoming increasingly important in the benefit/risk assessment of therapeutics such as the gold standard in AD therapy, Dupilumab. A survey questionnaire (ADCT) has been recently developed to assess the control of AD symptoms using subjective patient-based reporting only. This study aimed to investigate the self-reported efficacy of Dupilumab in Qatari patients with severe AD using the new ADCT evaluation tool. Methods: 30 patients completed a baseline survey before starting Dupilumab, and ADCT was assessed at four weeks post-therapy initiation. ADCT evaluates six AD symptoms in a severity grading from 0 to 3 (max. 24 points). The impact is assessed over the past week, including overall severity of symptoms, days with intense episodes of itching, the intensity of bother, problems with sleep, impact on daily activities, and impact on mood or emotions. In addition, itch severity was also assessed using a numeric rating scale (NRS11) ranging from 0 to 10. Results: The overall mean ADCT score at baseline was 17.6, and at week 4, it was reduced to 4.1. Patients reported a dramatic change in the overall symptoms already in this early phase. The parried t-test showed a significant difference in ADCT Score before and after therapy. There was a substantial decline in experiencing the associated AD symptoms: overall severity of symptoms (mean baseline =3.1, Dupilumab week 4 =0.9 (3.1/0.9), days with intense episodes of itching (3.2/0.7), the intensity of bother (3.2/0.8), the problem with sleep (2.7/0.4), impact on daily activities (2.5/0.6), and impact on mood or emotions (2.9/0.6). The itch score also reduced from 8/10 at baseline to 0-3 at week 4. Conclusion: Treatment of adult Asian/Arabic patients with severe AD treated with Dupilumab with or without topical steroids was highly effective and significantly improved overall well-being and pruritus as early as after 4 weeks of treatment.

Characterizing post-SSRI sexual dysfunction and its impact on quality of life through an international online survey.

Post-SSRI sexual dysfunction (PSSD) is an underrecognized and poorly understood medical condition characterized by sexual dysfunction that persists despite SSRI discontinuation. We conducted a survey of individuals with PSSD to better characterize this condition and its impact on various quality of life concerns. Surveys were distributed to an online support group for individuals with PSSD. Surveys assessed medications suspected of causing PSSD and symptoms experienced during and after treatment. Respondents reported the trajectory of their condition, the efficacy of different treatments, and the impact of PSSD on their quality of life. 239 survey responses were included in this study. A majority of respondents had a history of SSRI use (92%) compared to only SNRI or atypical antidepressant use (8%). The overall severity of symptoms improved for 45% and worsened or remained the same for 37% of respondents after discontinuing treatment with serotonin reuptake inhibitors. Only 12% of respondents reported being counseled regarding potential sexual dysfunction while taking antidepressants. The majority rated the effect of PSSD on their quality of life as extremely negative (59%) or very negative (23%). PSSD can have an overwhelmingly negative impact on quality of life. Currently, it is unclear why certain individuals develop PSSD and there are no definitive treatments for this condition. Further research of PSSD and greater awareness of this condition is needed among prescribers of serotonin reuptake inhibitors to improve patient care.

Nonadherence after hospital discharge in patients with schizophrenia or schizoaffective disorder: A six-month naturalistic follow-up study

BackgroundDespite a wealth of studies seeking to identify factors associated with nonadherence few consistent predictors have been determined, and several gaps still exist in the literature. MethodWe assessed 110 consecutively admitted patients diagnosed with schizophrenia or schizoaffective disorder according to ICD-10 criteria. Assessments were performed during hospitalization and at six-months follow-up. Evaluation included sociodemographic, clinical, psychopathologic and treatment-related variables. Prevalence of nonadherence, associated variables, reasons for nonadherence and possible subtypes were explored. Adherence was defined as the concurrence of adherence to antipsychotic treatment and adherence to outpatient follow-up, during the six-month period. ResultsNonadherence was detected in 58.2% of patients. An identifiable profile was found in nonadherent patients. After multivariate logistic regression analysis, low socio-economic level (OR = 3.68; 95% CI = 1.42–9.53), current cannabis use or abuse (OR = 2.79; 95% CI = 1.07–7.28), nonadherence as a reason for relapse and admission (OR = 5.46; 95% CI = 2.00–14.90), and greater overall severity of symptoms at six months follow-up (OR = 2.00; 95% CI = 1.02–3.95) remained independently associated with nonadherence. Believing that medication is unnecessary was the most reported reason for nonadherence. For nonadherent patients (N = 64), two distinguishable subtypes were found: intentional nonadherence (N = 32; 50%), and unintentional nonadherence (N = 32; 50%). ConclusionsA large percentage of patients with schizophrenia or schizoaffective disorder did not adhere to their treatment in the post-discharge follow-up period. The profile identified may enable better prevention of this problem. Specific reasons for nonadherence should also be explored to provide individualized strategies.

Reexamining the effect of emotional freedom techniques on stress biochemistry: A randomized controlled trial.

In a direct replication of Church, Yount, and Brooks (2012), this study examined changes in stress biochemistry and psychological distress symptoms in 53 participants randomly allocated to one of three 60-min group interventions: Emotional Freedom Techniques (EFT), psychoeducation (PE), and no treatment (NT). The Symptom Assessment-45 (SA-45) was used to assess psychological distress symptoms. Salivary cortisol assays were administered 30 min pre- and postintervention to test cortisol levels. The original study by Church et al. indicated the EFT group showed statistically significant improvements in anxiety (-58.34%, p < .05), depression (-49.33%, p < .002), overall severity of symptoms (-50.5%, p < .001), and symptom breadth (-41.93%, p < .001). The group also experienced a significant decrease in cortisol (-24.39%) compared to the PE group (-14.25%) and NT group (-14.44%). The present results indicated the EFT group experienced a significant decrease in cortisol greater than the original study (-43.24%, p < .05), but these results were not mirrored by subjective reports of psychological distress. The EFT group reduction in cortisol was significantly different from that of the PE group (-19.67%), and as expected, the posttreatment cortisol level detected among the EFT group was lower than that of the NT group (2.02%); however, there was not a statistically significant difference between the 2 groups. Additionally, there were no significant improvements in cortisol reduction among the NT and PE groups. Findings support the original study indicating EFT to be an efficient and effective brief treatment for reducing biological markers of stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Validation of the Atopic Dermatitis Control Tool (ADCT\xa9) using a longitudinal survey of biologic-treated patients with atopic dermatitis

BackgroundThe Atopic Dermatitis Control Tool (ADCT©) is a brief patient self-administered instrument designed and validated to assess atopic dermatitis (AD) control; six AD symptoms and impacts are evaluated over the past week, including overall severity of symptoms, days with intense episodes of itching, intensity of bother, problem with sleep, impact on daily activities, and impact on mood or emotions. This study assessed the reliability, validity, and responsiveness of the ADCT in a longitudinal context, and provided thresholds to identify meaningful within-person change.MethodsData were from a prospective, longitudinal patient survey study of real-world effectiveness of dupilumab in patients with AD. Eligible patients completed a baseline survey before starting dupilumab and were followed at Months 1, 2, 3, and 6 post-initiation as they became eligible.ResultsPsychometric analyses confirmed internal consistency; Cronbach’s α coefficients were consistently above the threshold of 0.70 across each follow-up; item-to-total correlations were above the threshold of r ≥ 0.50. High correlations between the ADCT and the Dermatology Life Quality Index (DLQI) and skin pain supported construct validity, while known-group validity was shown on Patient Global Assessment of Disease (PGAD) overall well-being subgroups with worse AD-related overall well-being having higher mean ADCT total scores at all time points. The ability of the ADCT to detect change was confirmed; the threshold for meaningful within-person change was estimated to be 5 points. Finally, test–retest reliability was confirmed in subgroups of patients with stable PGAD responses.ConclusionsOur findings confirm that the ADCT is a valid and reliable tool for assessing AD control.

Identifying Symptom Clusters Among People Living With HIV on Antiretroviral Therapy in China: A Network Analysis

ContextThere exists a research interest shift from separate symptoms to symptom clusters among people living with HIV (PLWH), which may provide a better understanding of symptom management in HIV/AIDS care. However, the symptom clusters among Chinese PLWH are still unknown. ObjectivesThe aim of our study was to identify symptom clusters and to examine demographic and health-related factors associated with these symptom clusters among PLWH prescribing antiretroviral therapy (ART) in China. MethodsFrom April to September 2017, we recruited 1116 participants through a convenience sampling in five HIV/AIDS designated facilities in the eastern, middle, and southwest regions of China. The principal component analysis was used to identify the symptom clusters. Association network was adopted to describe the relationships among symptoms and clusters. A multiple linear model was used to investigate the associated factors for the severity of overall symptoms and the prevalence of each symptom clusters. ResultsFive symptom clusters were identified, including cognitive dysfunction, mood disturbance, wasting syndrome, dizziness/headache, and skin-muscle-joint disorder. Cognitive dysfunction was the most central symptom cluster. Variables including primary caregiver during ART treatment, years of HIV diagnosis and ART use, having comorbidity, self-rated health, and quality of life were associated with the prevalence of these five symptom clusters. ConclusionOur study suggests that there is a need to evaluate symptom clusters for the improvement of symptom management among PLWH. It is particularly important to include assessment and treatment of cognitive symptoms as an essential component of the HIV care.

ALGORITHM OF PSYCHOLOGICAL AND PSYCHOTHERAPEUTIC SUPPORT OF PATIENTS WITH CHRONIC CEREBRAL ISCHEMIA

Introduction. Nowadays, it is important to study the mechanisms of psychological adaptation in patients with early stage of chronic cerebral ischemia (ES CCI) from the standpoint of biopsychosocial approach. The objective of the study was to develop the algorithm for identifying psychosocial characteristics of patients with ES CCI and providing them with psychotherapeutic care. Material and methods. 280 patients with ES CCI developed against a background of arterial hypertension and/or cerebral atherosclerosis (middle age 53.9±8.1 years (from 30 to 72 years) gender index 1:1) were selected for the study. The control group included healthy individuals comparable to those in the main group according to gender and age characteristics (n=32, middle age 52.4±6.5 years (31–65 years), gender index 1:1, p&gt;0.05 ). The panel of psychological methods was used to identify the individual psychological and socio-environmental factors in patients with ES CCI.Results and conclusions. A three-stage algorithm of psychological and psychotherapeutic support of patients with early stage of chronic cerebral ischemia (ES CCI) was developed and tested by the multidisciplinary team of specialists. At the stage of opportunistic screening, the neurologist used express methods for diagnosing cognitive (Mini-test of mental state), emotional (Hospital scale of anxiety and depression), vegetative disorders (the Wayne test) among the studied persons. At the stage of selective screening, the medical psychologist performed systemic psychodiagnostics of the ES CCI. At the stage of treatment, a correction was made: psychovegetative disorders by progressive muscular relaxation; anxiety-depressive manifestations – cognitive re-attribution according to A. Beck; obsessive-phobic disorders – direct motivated suggestion in reality with elements of clarification and persuasion. The indicators of the effectiveness of psychological and psychotherapeutic correction in patients with ES CCI were: positive dynamics of the Scale of quality of life SF-36 and regression of integrative indicators of the Scale of psychopathological manifestations of SCL-90-R – «Index of overall severity of symptoms» and «Total number of affirmative answers». Thus, the algorithm described above is suitable for use in practical healthcare for optimizing individual therapeutic strategies.

Do antihistamines relieve the symptoms of upper respiratory infections?

EVIDENCE-BASED ANSWER Not appreciably. In adults, antihistamines provide improvement in severity of overall symptoms only during the first 1 to 2 days and have no clinically significant effect on nasal obstruction, rhinorrhea, or sneezing. In children, antihistamines do not hasten recovery or decrease nasal discharge (SOR: A, systematic review of RCTs). Currently, the FDA recommends against the use of antihistamines in children younger than 2 years for symptomatic treatment of the common cold (SOR: C, expert opinion).

The intra-day dynamics of affect, self-esteem, tiredness, and suicidality in Major Depression

Despite growing interest in the temporal dynamics of Major Depressive Disorder (MDD), we know little about the intra-day fluctuations of key symptom constructs. In a study of momentary experience, the Experience Sampling Method captured the within-day dynamics of negative affect, positive affect, self-esteem, passive suicidality, and tiredness across clinical MDD (N= 31) and healthy control groups (N= 33). Ten symptom measures were taken per day over 6 days (N= 2231 observations). Daily dynamics were modeled via intra-day time-trends, variability, and instability in symptoms. MDD participants showed significantly increased variability and instability in negative affect, positive affect, self-esteem, and suicidality. Significantly different time-trends were found in positive affect (increased diurnal variation and an inverted U-shaped pattern in MDD, compared to a positive linear trend in controls) and tiredness (decreased diurnal variation in MDD). In the MDD group only, passive suicidality displayed a negative linear trend and self-esteem displayed a quadratic inverted U trend. MDD and control participants thus showed distinct dynamic profiles in all symptoms measured. As well as the overall severity of symptoms, intra-day dynamics appear to define the experience of MDD symptoms.

Cross-Domain Symptom Development Typologies and Their Antecedents: Results From the UK Millennium Cohort Study

Typologies of symptom development have been used to identify individuals with different symptom development in the externalizing and internalizing domains of child psychopathology separately despite the domains' high comorbidity and shared common etiologic risk. This study identified typologies of development jointly across the 2 symptom domains in childhood and investigated their associated antecedents with a specific focus on the comparisons between overall severity of symptoms and symptom expression in one or the other domain. Latent class analysis identified groups based on emotional and behavioral symptoms assessed at 3, 5, 7, and 11 years in the UK Millennium Cohort Study (N= 15,439). Different sociodemographic, family structure and environment, birth, infancy, and early childhood antecedents were examined. Five groups were identified: 1. low symptoms (57%), 2. moderate behavioral (21%), 3. moderate emotional (12.5%), 4. high emotional and moderate behavioral (5.5%), and 5. high behavioral and moderate emotional (4%). Higher symptoms were predicted by larger numbers of antecedents and risk factors compared with the low symptom group and compared with moderate and high levels of symptoms in either domain (groups 5 versus 2 and 4 versus 3). Comparisons of groups with similar overall symptom levels but different dominant symptom domain (groups 2 versus 3 and 4 versus 5) indicated that apart from gender and ethnicity, there were few unique antecedents of whether children mainly internalize or externalize their symptoms. It is possible and useful to define groupings or typologies jointly across externalizing and internalizing symptom development in childhood. Although numerous antecedents predict the experience of symptoms, there arefew unique antecedents that differentiate individuals withsimilarly high levels of psychopathology expressed mainly as internalizing or externalizing symptoms. Identification of at-risk children and delivery of early intervention might benefit from a decreased focus on symptom domain with possible downstream effects through the life course for most common psychiatric disorders.

Analysis of the Cochrane Review: Antihistamines for the Common Cold. Cochrane Database Syst Rev. 2015;11:CD009345

The common cold is an acute, self-limiting inflammation of the mucosa of the upper airways, which may involve one or all the sinuses, nasopharynx, oropharynx and larynx. It is common to have at least one episode per year. Common cold symptoms, which may include sore throat, sneezing, nasal congestion, runny nose, headache, malaise and mild fever usually disappear within a few days without treatment. The causative agent of most colds is rhinovirus. Although not associated with mortality, common cold is associated with significant morbidity. There is no vaccine or cure for common cold and, therefore, their treatment is centered on relieving the symptoms. This Cochrane review aimed to synthesize the existing evidence about the clinical benefit of antihistamines, used as monotherapy, compared with placebo or no treatment in children and adult patients with common cold. A total of 18 randomized clinical trials with 4342 participants were included. Main results were: 1) Antihistamines have a small (days one and two) beneficial effect in the short term on the severity of overall symptoms in adult patients, although this effect is not present in the medium to long term; 2) antihistamines were not associated with a clinically significant beneficial effect on the individual symptoms (nasal congestion, rhinorrhea, and sneezing); 3) Antihistamines are not associated with an increased risk of adverse effects; 4) No conclusion can be made about the effectiveness of antihistamines in pediatric populations. Our interpretation of the results is that the available evidence is insufficient to support the prescription or buying OTC antihistamines to relieve the symptoms of common cold without allergic component.

The effect of sex and irritable bowel syndrome on HPA axis response and peripheral glucocorticoid receptor expression

Background and aimsDysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been reported in irritable bowel syndrome (IBS). Enhanced HPA axis response has been associated with reduced glucocorticoid receptor (GR) mediated negative feedback inhibition. We aimed to study the effects of IBS status, sex, or presence of early adverse life events (EAL) on the cortisol response to corticotropin-releasing factor (CRF) and adrenocorticotropic hormone (ACTH), and on GR mRNA expression in peripheral blood mononuclear cells (PBMCs). MethodsRome III+ IBS patients and healthy controls underwent CRF (1μg/kg ovine) and ACTH (250μg) stimulation tests with serial plasma ACTH and cortisol levels measured (n=116). GR mRNA levels were measured using quantitative PCR (n=143). Area under the curve (AUC) and linear mixed effects models were used to compare ACTH and cortisol response measured across time between groups. ResultsThere were divergent effects of IBS on the cortisol response to ACTH by sex. In men, IBS was associated with an increased AUC (p=0.009), but in women AUC was blunted in IBS (p=0.006). Men also had reduced GR mRNA expression (p=0.007). Cumulative exposure to EALs was associated with an increased HPA response. Lower GR mRNA was associated with increased pituitary HPA response and increased severity of overall symptoms and abdominal pain in IBS. ConclusionThis study highlights the importance of considering sex in studies of IBS and the stress response in general. Our findings also provide support for PBMC GR mRNA expression as a peripheral marker of central HPA response.

Antihistamines for the common cold.

The common cold is an upper respiratory tract infection, most commonly caused by a rhinovirus. It affects people of all age groups and although in most cases it is self limiting, the common cold still causes significant morbidity. Antihistamines are commonly offered over the counter to relieve symptoms for patients affected by the common cold, however there is not much evidence of their efficacy. To assess the effects of antihistamines on the common cold. We searched CENTRAL (2015, Issue 6), MEDLINE (1948 to July week 4, 2015), EMBASE (2010 to August 2015), CINAHL (1981 to August 2015), LILACS (1982 to August 2015) and Biosis Previews (1985 to August 2015). We selected randomised controlled trials (RCTs) using antihistamines as monotherapy for the common cold. We excluded any studies with combination therapy or using antihistamines in patients with an allergic component in their illness. Two authors independently assessed trial quality and extracted data. We collected adverse effects information from the included trials. We included 18 RCTs, which were reported in 17 publications (one publication reports on two trials) with 4342 participants (of which 212 were children) suffering from the common cold, both naturally occurring and experimentally induced. The interventions consisted of an antihistamine as monotherapy compared with placebo. In adults there was a short-term beneficial effect of antihistamines on severity of overall symptoms: on day one or two of treatment 45% had a beneficial effect with antihistamines versus 38% with placebo (odds ratio (OR) 0.74, 95% confidence interval (CI) 0.60 to 0.92). However, there was no difference between antihistamines and placebo in the mid term (three to four days) to long term (six to 10 days). When evaluating individual symptoms such as nasal congestion, rhinorrhoea and sneezing, there was some beneficial effect of the sedating antihistamines compared to placebo (e.g. rhinorrhoea on day three: mean difference (MD) -0.23, 95% CI -0.39 to -0.06 on a four- or five-point severity scale; sneezing on day three: MD -0.35, 95% CI -0.49 to -0.20 on a four-point severity scale), but this effect is clinically non-significant. Adverse events such as sedation were more commonly reported with sedating antihistamines although the differences were not statistically significant. Only two trials included children and the results were conflicting. The majority of the trials had a low risk of bias although some lacked sufficient trial quality information. Antihistamines have a limited short-term (days one and two of treatment) beneficial effect on severity of overall symptoms but not in the mid to long term. There is no clinically significant effect on nasal obstruction, rhinorrhoea or sneezing. Although side effects are more common with sedating antihistamines, the difference is not statistically significant. There is no evidence of effectiveness of antihistamines in children.

Internet screening for anxiety disorders: Treatment-seeking outcomes in a three-month follow-up study

Although many people use the internet to diagnose mental health problems, little is known about the relationship between internet self-diagnosis and treatment-seeking. The MACSCREEN (a validated, self-report screening tool for anxiety and depression) was posted on our clinic homepage and respondents were invited to take an anxiety test. Three months after completing the MACSREEN and a variety of symptom severity scales, respondents were emailed a follow up questionnaire asking about treatment-seeking behaviours. Of the 770 MACSCREEN respondents, 103 completed the follow-up questionnaire. Of these, 100% met criteria for at least one anxiety or mood disorder diagnosis and 51% sought treatment after completing the MACSCREEN. In the 49% who did not seek treatment, fear of medication (57%), discomfort talking to their doctor about anxiety (28%) and the belief that symptoms were not severe enough (28%) were cited as barriers. Compared to non-seekers, treatment-seekers were significantly more likely to meet screening criteria for Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Posttraumatic Stress Disorder and Depression. Higher Sheehan Disability Scale scores and being married (versus single) significantly increased the odds of treatment-seeking, suggesting that functional impairment and disease burden on the family may be stronger predictors of treatment seeking than overall severity of symptoms.

Issue Highlights

Issue Highlights

Restless legs syndrome in pregnancy is connected with iron deficiency

ObjectiveAlmost one-third of pregnant women develop symptoms of restless legs syndrome (RLS), which could have a negative impact on quality of life and the course of pregnancy and/or labor. The aim of our study was to determine possible risk factors for developing RLS in pregnant women. MethodsA total of 300 random women in the third trimester of gravidity filled out a simple questionnaire based on the official diagnostic criteria for RLS. Respondents positive for RLS were interviewed to further characterize their symptoms. The parameters of iron metabolism were examined based on blood samples. All data were statistically analyzed. ResultsWe detected significantly lower hemoglobin levels with signs of hypochromic anemia typical of iron deficiency in RLS-positive respondents, although oral iron supplementation was significantly higher in this group. The overall severity of symptoms correlated inversely with hemoglobin level. ConclusionAccording to our results, it appears that serum iron level disturbances play a crucial role in the pathophysiology of secondary RLS in pregnant women.