Predominant Symptoms Research Articles

Psychosocial Effects of Infertility among Infertile Women Attending the Outpatient Consultation Unit of Chracerh Yaoundé Cameroon; a CrossSectional Study

Introduction: Infertility is a public health problem that has severe psychosocial repercussions on affected persons though it is not a life-threatening condition. The psychosocial consequences of infertility include depression, anxiety, problems with sexual relations, marital issues, violence, a decline in self-confidence, jealousy, and a poor quality of life. In Cameroon, little is known about the effects of infertility on women’s mental health and social lives. Objective: The present study aimed to evaluate the sociodemographic characteristics and psychosocial effects of infertility among infertile women attending the outpatient consultation unit of the Hospital Center for Research in Endoscopic Surgery and Human Reproduction (CHRACERH) Yaoundé, Cameroon. Materials and Methods: This was a descriptive hospital-based cross-sectional study with a quantitative data collection method from the 14th of March to the 6th of April 2023 at the outpatient consultation unit of CHRACERH Yaoundé. Sociodemographic, psychological status using the GHQ-28, and social effects of infertility data were collected with a pretested questionnaire. Descriptive statistics, thematic analysis and Chi-square test was used for statistical analysis using the SPSS software. Statistical significance was set at P<0.05. Results: The mean age of participants was 39.52±7.64 years, the mean duration of infertility was 10.27±7.9 years and secondary infertility was higher 53.2%. The prevalence of psychological disorder was 40%. The overall mental score was 23.2±11.85, highest subscale score was anxiety 7.92±5.39 (14.7%) and the lowest was depression 2.74±3.77 (1.6%). The social effects identified include 1) Mood changes; frustration (35.8%), joy impaired (55.8%) and envious of pregnant woman (97.9%). 2) Relationship changes; Sexual life is conditioned by need for a child (33.2%), problems with partner (29.5%), fear of divorce (36.8%), husband having children out of marriage (51.1%); 3) Stigma; sense of guilt (74.2%), and suicidal ideation (5.3%). Conclusion: Most of the study participants were in the late thirties. Anxiety was the predominant symptom and depression was the least. Over one-third participants feared losing their partner.

Benign Neural Tumors: A Clinicopathologic Analysis

Background: Benign neural tumors, including schwannomas, neurofibromas, and meningiomas, are non-malignant growths originating from nerve tissues. Despite their benign nature, these tumors can cause significant morbidity due to their location and potential for recurrence, posing challenges in clinical management. Understanding the clinico-pathologic characteristics of these tumors is essential to optimize treatment strategies and improve patient outcomes. Aim: This study aims to analyze the clinical presentations, histopathological features, and surgical outcomes of benign neural tumors, focusing on factors influencing recurrence and complications. Methods: A descriptive observational study was conducted. A total of 57 participants diagnosed with benign neural tumors were included based on specific inclusion criteria. Data on demographics, tumor characteristics, clinical presentations, histopathological findings, and surgical outcomes were collected and analyzed using SPSS version 23.0. Statistical tests included descriptive analysis, Chi-square, and t-tests, with a p-value <0.05 considered significant. Results: The study population consisted of 29 males and 28 females, with a mean age of 42.5 years. Schwannomas were the most common tumor type (56.1%), followed by neurofibromas (31.6%) and meningiomas (12.3%). Localized pain (66.7%) and neurological deficits (45.6%) were the predominant clinical symptoms. Complete resection was achieved in 86% of cases, with a recurrence rate of 5.3%, mainly seen in neurofibromas. The overall complication rate was 10.5%, including cerebrospinal fluid leakage and wound infections. A statistically significant correlation (p=0.023) was observed between neurofibromas and higher recurrence rates. Conclusion: Benign neural tumors present diverse clinical challenges due to their location and histopathological variations. Surgical resection is effective, with low recurrence and complication rates, though neurofibromas exhibit a higher tendency for recurrence. Accurate diagnosis, tailored surgical planning, and vigilant postoperative monitoring are crucial for optimizing outcomes. Recommendations: Future studies should focus on exploring adjunctive therapies, particularly for neurofibromas, to reduce recurrence rates. Additionally, incorporating genetic and molecular profiling could further enhance personalized treatment approaches for patients with benign neural tumors. Keywords: Benign neural tumors, schwannoma, neurofibroma, recurrence, clinico-pathologic analysis

Follow-up of telemedicine mental health interventions amid COVID-19 pandemic

The initiation of the program Mental Health Support Program for Coronavirus Infection addressed the increased demand for mental health services in the province of Salamanca, resulting from the COVID-19 pandemic. The psychiatry service provided care for COVID-19 patients, their families, and healthcare workers who treated them, as these groups were identified as being at risk. This study aims to describe the assistance provided, including personnel and resources utilized, types of interventions carried out, and to assess the demand for mental health care and predominant symptoms and emotions experienced by patients. Billboards and the complex’s intranet publicized the program. Specific clinical approach using telemedicine were provide from March 2020 to December 2021 to COVID-19 patients, their relatives, and healthcare workers. 216 patients were included with a mean age of 53.2 years, with women comprising 77.3% of this group. All the groups received treatment in similar proportions. Over a period of 730 h, a total of 1376 interventions were performed, with an average duration of 31.8 min per intervention. The program could treat 79.6% of these patients without requiring referrals to other services. When the program concluded, only 21 participants (9.7%) were discharged to the local mental health network to continue their mental health treatment. The program effectively reduced the burden on regular mental health services due to its ability to treat most patients without requiring referrals. The program was able to attend to most mental health requests with minimal involvement of the regular mental health service.

Nutritional aspects in patients with gastroparesis.

The purpose of this review was to highlight most recent updates on nutritional aspects in gastroparesis (GP) focusing on dietary recommendations, utilization of enteral and parenteral nutrition, endoscopic and surgical interventions. Recent data addressed eating patterns, nutritional interventions, and clarifications on the role of endoscopic and surgical interventions underlying an impact on nutritional management of GP patients. They support the importance of gastroparesis-specific diet in addition to drug therapy, and confirm the benefits of a modified low-fat, low-fiber diet. Current guidelines suggest a new approach to GP management based on predominant symptoms. Gastric peroral endoscopic pyloromyotomy (G-POEM) and surgical gastric electrical stimulator (GES) placement may be considered in individuals with nausea and vomiting before the need for jejunostomy tube placement for enteral feeding or parenteral nutrition. Current literature supports the importance of dietary interventions, focusing on low-fat and low-fiber diets, in addition to drug therapies. Severely fiber-restrictive diets may not be necessary. There is enhanced understanding when jejunal feeding should be incorporated for refractory cases with consideration of G-POEM or/and GES even before jejunal tube placement. This approach will require patient evaluation in specialized motility centers.

Obtainment of prescribed analgesics among patients with Lyme neuroborreliosis; a nationwide, population-based matched cohort study

BackgroundRadicular pain is the most predominant symptom among adults with Lyme neuroborreliosis (LNB) but the duration preceding and following diagnosis remains unknown. We aimed to investigate whether patients with LNB have increased obtainment of analgesics before and after diagnosis and for how long. MethodsWe performed a nationwide, population-based, matched cohort study (2009–2021). all Danish residents with LNB (positive Borrelia burgdorferi intrathecal antibody index test and cerebrospinal fluid pleocytosis) were included. To form a comparison cohort, individuals from the general population were randomly extracted and matched 10:1 to patients with LNB on age and sex. Outcomes were obtainment of simple analgesics, antiepileptics, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors, tramadol, and other opioids. We calculated monthly and six-monthly proportions of individuals with obtainment of analgesics and absolute risk differences. Results1,056 patients with LNB and 10,560 comparison cohort members were included. An increased proportion of patients with LNB obtained analgesics from 3 months before study inclusion, especially simple analgesics, tramadol, and other opioids. Within the 0–1-month period after study inclusion, patients with LNB most frequently obtained simple analgesics (15 %), antiepileptics (11 %), and tramadol (10 %). Thereafter, obtainment of analgesics declined within a few months. A slightly larger proportion of patients with LNB obtained antiepileptics up to 2.5 years after diagnosis. ConclusionsUp to 3 months preceding diagnosis, LNB was preceded by increased obtainment of analgesics, which suggests diagnostic delay. Importantly, most patients with LNB did not obtain analgesics after the immediate disease course, although obtainment remained more frequent up to 2.5 years after.

Serum C-reactive protein to albumin ratio as a potential risk indicator of pneumonia caused by Chlamydia psittaci: a multicenter retrospective study.

The aim of the study was to describe psittacosis pneumonia and to assess the predictive value of the C-reactive protein/albumin ratio in psittacosis pneumonia for severity. Data on psittacosis pneumonia cases diagnosed using metagenomic sequencing were collected from three hospitals in Shanghai, China from Oct. 2019 to Oct. 2022. Serum levels of C-reactive protein and albumin were measured and the C-reactive protein to albumin ratio (CAR) was calculated. Spearman's correlation analysis, ordered logistic regression analysis, and receiver operating characteristic curve analysis were conducted to examine the correlation and predictive ability of the three indicators on the severity of the disease. A total of 27 patients with psittacosis pneumonia were enrolled, with an average age of 62 years and 70.4% being male. 44.4% of patients had a clear history of contact with poultry or birds. The predominant symptom was fever (100%). Patients treated in the respiratory intensive care unit (RICU) had a higher likelihood of experiencing wheezing (88.9% versus 33.3%, P=0.013) and chest tightness (88.9% vs. 33.3%, P=0.013) than those in the general ward (Non-RICU). The proportion of patients with pleural effusion was significantly higher in the RICU compared to the Non-RICU (88.9% vs. 38.9%, P=0.019). The RICU group had a significantly higher CAR than the Non-RICU group (9.41 vs. 4.05, P=0.017). This result was accompanied by higher intubation and ventilator support (33.3% vs. 0.0%, P=0.029), higher PCT and CRP levels and lower albumin and PaCO2 levels in the RICU than in the Non-RICU. Logistic regression analysis indicated that CAR (OR 1.49; 95% CI 1.07-2.06, P=0.017) was risk factor for prolonged hospitalization (> 14 days). Elevated serum CAR levels were found to be associated with a greater risk of severe psittacosis pneumonia. Consequently, it may serve as an uncomplicated and useful diagnostic tool for clinicians to promptly and precisely ascertain the severity of psittacosis pneumonia, ultimately aiding them in devising the most optimal therapeutic plan.

Non-invasive brain stimulation for treatment-resistant schizophrenia: protocol of a systematic review and network meta-analysis

BackgroundNon-invasive brain stimulation (NIBS) is a promising intervention for treatment-resistant schizophrenia. However, there are multiple available techniques and a comprehensive synthesis of evidence is lacking. Thus, we will conduct a systematic review and network meta-analysis to investigate the comparative efficacy and safety of NIBS techniques as an add-on to antipsychotics for treatment-resistant schizophrenia.MethodsWe will include single- and double-blind randomized-controlled trials (RCT) comparing any NIBS technique with each other or with a control intervention as an add-on to antipsychotics in adult patients with treatment-resistant schizophrenia. We will exclude studies focusing on predominant negative symptoms, maintenance treatment, and single sessions. The primary outcome will be a change in overall symptoms, and secondary outcomes will be a change in symptom domains, cognitive performance, quality of life, functioning, response, dropouts, and side effects. We will search for eligible studies in previous reviews, multiple electronic databases and clinical trial registries from inception onwards. At least two independent reviewers will perform the study selection, data extraction, and risk of bias assessment. We will measure the treatment differences using standardized mean difference (SMD) and odds ratio (OR) for continuous and dichotomous outcomes, respectively. We will conduct pairwise and network meta-analysis within a frequentist framework using a random-effects model, except for rare event outcomes where we will use a fixed-effects Mantel–Haenszel method. We will investigate potential sources of heterogeneity in subgroup analyses. Reporting bias will be assessed with funnel plots and the Risk of Bias due to Missing Evidence in Network meta-analysis (ROB-MEN) tool. The certainty in the evidence will be evaluated using the Confidence in Network Meta-analysis (CINeMA) approach.DiscussionOur network meta-analysis would provide an up-to-date synthesis of the evidence from all available RCTs on the comparative efficacy and safety of NIBS for treatment-resistant schizophrenia. This information could guide evidence-based clinical practice and improve the outcomes of patients.Systematic review registrationPROSPERO-ID CRD42023410645.

Differences in intestinal bacteria in traumatic injury survivors with and without probable posttraumatic stress disorder

BackgroundPosttraumatic stress disorder (PTSD) is a common consequence of traumatic injury, yet certain biological factors contributing to PTSD are poorly understood. The gut microbiome may influence mental health outcomes, but its role in heterogeneous PTSD presentations requires elucidation. MethodsBacterial composition was examined in adults 2–4 years post-trauma with probable PTSD (n = 24) versus trauma-exposed controls without probable PTSD (n = 24). 16S rRNA sequencing and bioinformatic tools assessed microbial diversity and abundance. Relationships between taxa and PTSD symptom clusters were evaluated. ResultsNo differences were found in overall microbial community structure between groups. The probable PTSD group exhibited significantly reduced Actinobacteriota and increased Verrucomicrobiota phylum abundance compared to controls. Specific taxa showed notable inverse associations with negative mood/cognition versus hyperarousal symptoms. Prevotella and Ruminococcaceae were negatively associated with negative mood but positively associated with hyperarousal. ConclusionsResults demonstrate microbial signatures of probable PTSD subtypes, highlighting the microbiome as a potential mediator of heterogeneous trauma psychopathology. Definition of PTSD microbial correlates provides a foundation for personalized psychobiotic interventions targeting predominant symptom profiles.

MDB-95. MEDULLOBLASTOMA IN INDONESIA: CLINICAL PROFILES AND OUTCOMES

Abstract BACKGROUND Medulloblastoma is the most frequent malignant brain tumor in children and adolescents, accounting for 20–25% of all brain tumors. Epidemiological data is fundamental to optimising pediatric brain tumor (PBT) health services and reducing overall morbidity and mortality. To bridge this gap, we aimed to present comprehensive pediatric medulloblastoma data, focusing on clinical profiles and outcomes within one of the national general hospitals in the country. METHODS A retrospective observational longitudinal study was conducted at Cipto Mangunkusumo National General Hospital, focusing on children registered under the PBT service from January 2021 to December 2023. The study analyzed patients’ profiles, medulloblastoma characteristics, factors related to diagnosis delay, and vital status follow-up. RESULTS All 16 patients underwent tumor removal surgery with a mean age of 7.13 ± 5.39 years, with an equal distribution of both sexes (50%). Histological confirmation of medulloblastoma was observed in all patients, with 2/16 (12.5%) classified as WNT, 9/16 (56.3%) as Non-WNT, and 5/16 (31.3%) lacking additional information. Regarding risk stratification, 13/16 (81.3%) of patients were classified as high-risk by age <3, residual tumor >1.5 cm2, and presence of metastasis. Vomiting 6/16 (37.5%), disequilibrium 5/16 (31.3%), and headache 3/16 (18.8%) were the predominant symptoms, with mean duration delay from symptom onset to first medical consultation of 2.5, 1.8, and 6.7 weeks, respectively. In the last follow-up, 5/16 (31.3%) of patients were deceased (4/11 in high-risk and 1/2 in low-risk groups), and 3/16 (18.8%) were lost to follow-up. CONCLUSION This study underscores the importance of early diagnosis and intervention for pediatric medulloblastoma, particularly in high-risk cases, which need heightened awareness among the community and healthcare providers. Additionally, addressing the issue of patients lost to follow-up is crucial for optimizing outcomes. Further research is warranted to enhance diagnostic methods and healthcare services for pediatric brain tumor patients nationwide.

GLP-1 Receptor Agonist Exposures Are Increasingly Common and Generally Associated with Mild Symptoms: A Single Poison Center Experience

IntroductionGlucagon-like peptide-1 receptor agonist use has increased over the last decade for glycemic control in type 2 diabetes mellitus, cardiovascular risk reduction, and weight loss. Clinical trials indicate that gastrointestinal adverse effects are commonly experienced and severe hypoglycemia is rare; however, there is little data regarding glucagon-like peptide-1 receptor agonist in overdose.MethodsWe performed a retrospective chart review evaluating and characterizing glucagon-like peptide-1 receptor agonist exposures reported to a single poison center between 2006 and 2023. Patient demographics, circumstances of exposure, clinical effects, and outcomes were abstracted from charts. Descriptive statistics were utilized to summarize demographic information and clinical factor data.ResultsA total of 152 charts met inclusion criteria. Therapeutic errors accounted for 91% of exposures. Most patients (67%) reported no symptoms, although not all patients were followed to a definitive outcome. Nausea, vomiting, generalized weakness, and abdominal pain were the predominant symptoms reported. Most patients (62%) were monitored and closely followed in the home setting. Hypoglycemia was rare but occurred in the setting of a single agent glucagon-like peptide-1 receptor agonist exposure in two patients. Two additional patients who developed hypoglycemia involved co-administration of insulin. 21% of the exposures were related to errors on initial use of the pen.ConclusionExposures to glucagon-like peptide-1 receptor agonist have increased substantially over the years. Effects from an exposure tended to be mild and primarily involve gastrointestinal symptoms. Hypoglycemia was rare. Therapeutic and administration errors were common. Education on pen administration may help to reduce errors.

Sudden Sensorineural Hearing Loss in Patients Aged from 15 to 40 Years.

Objectives: The purpose of this study was to investigate the hearing characteristics and causes of sudden sensorineural hearing loss (SSNHL) in patients aged from 15 to 40 years, focusing on audiological outcomes one year after the diagnosis. Methods: The medical records of individuals with SSNHL who were referred to our tertiary-level audiologic center were reviewed. All patients had undergone comprehensive diagnostic evaluations, including high-resolution 3D-FLAIR delayed magnetic resonance imaging (MRI), cone beam computed tomography (CBCT), and screening for coagulation, infectious, and autoimmune diseases. Results: Overall, 56 patients (mean age 28.1 ± 7.6 years) were included in the study. The hearing threshold in the affected ear improved significantly from 56.0 ± 18.0 dB at the diagnosis to 46.9 ± 22.3 dB after one year (p = 0.02). The degree of hearing loss, audiometric configurations, hearing improvements, and adherence to hearing treatments showed considerable variability among patients. Aural fullness, tinnitus, and hyperacusis were the predominant symptoms associated with SSNHL, and their prevalence decreased significantly over time. The diagnostic protocol led to the identification of the specific cause of SSNHL in 75% (42/56) of patients. The known etiology was found to be otological (39.3%), infectious (21.4%), autoimmune (7.1%), vascular (5.4%), or neoplastic (1.8%). In particular, Menière's disease (n = 12), isolated cochlear endolymphatic hydrops (n = 6), HSV-1 (n = 5), and EBV (n = 4) infections were the most frequent causes of SSNHL. Conclusions: The identification of the specific etiology of SSNHL may facilitate a more personalized approach to management and treatment.

Mitochondrial membrane protein-associated neurodegeneration presenting with pure motor neuropathy: A rare case report and review of the literature

Abstract Neurodegeneration with brain iron accumulation is a collective term for neurodegenerative disorders characterized by excessive deposition of iron in the brain, especially in the globus pallidus and substantia nigra. Mitochondrial membrane protein-associated neurodegeneration mainly affects the pyramidal and extrapyramidal systems, and patients can present with various manifestations during disease progression, including gait disorder, dystonia, ataxia, swallowing dysfunction, neuropsychiatric abnormalities, cognitive disabilities, optic atrophy, and, sometimes, peripheral neuropathy. We report a patient of mitochondrial membrane protein-associated neurodegeneration with peripheral neuropathy as the predominant symptom.

Clinical Characteristics and Patterns of Immune Responses in COVID-19 Patients From a Rural Community Hospital.

Background Although demographic and clinical factors such as age, certain comorbidities, and sex have been associated with COVID-19 outcomes, these studies were largely conducted in urban populations affiliated with large academic medical centers. There have been very few studies focusing on rural populations that also characterize broader changes in inflammatory cytokines and chemokines. Methodology A single-center study was conducted between June 2020 and March 2021 in Abilene, Texas, USA.Patients were included if they presented to the hospital for treatment of COVID-19, had extra biological materials from routine care available, and were between the ages of 0 to 110 years. There were no exclusion criteria. Patient characteristics, symptom presentation, and clinical laboratory results were extracted from electronic health records. Blood specimens were analyzed by protein microarray to quantitate 40 immunological biomarkers. Results A total of 122 patients were enrolled, of whom 81 (66%) were admitted to the general non-critical inpatient unit, 37 (30%) were admitted to the intensive or critical care units, and four (3.2%) were treated outpatient. Most hospitalized COVID-19 patients in this rural population were elderly, male, obese, and retired individuals. Predominant symptoms for non-critical patients were shortness of breath, fever, and fatigue. Ferritin levels for outpatient patients were lower on average than those in an inpatient setting and lactate dehydrogenase (LDH) levels were noted to be lower in non-critical and outpatient than those in the intensive care unit setting. Inflammatory biomarkers were positively correlated and consistent with inflammatory cascade. Interleukin (IL)-10 was positively correlated while platelet-derived growth factor was negatively correlated with inflammatory biomarkers. Patients ≥65 years had significantly higher levels of LDH and seven cytokines/chemokines (granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin IL-1b, IL-6, IL-10, IL-11, macrophage inflammatory protein (MIP)-1d, and IL-8) while levels of five other immune molecules (intercellular adhesion molecule 1 (ICAM-1), monocyte chemoattractant protein 1 (MCP-1), tissue inhibitor of metalloproteinase 2 (TIMP-2), IL-2, and IL-4) were significantly lower compared to those <65 years. Females had significantly higher levels of LDH and 10 cytokines/chemokines (GM-CSF, IL-1b, IL-6, IL-10, IL-11, IL-15, IL-16, MIP-1a, MIP-1d, and IL-8) while levels of TIMP-2 and IL-4 were significantly lower than male patients. Conclusions The clinical characteristics of this rural cohort of hospitalized patients differed somewhat from nationally reported data. The contributions of social, environmental, and healthcare access factors should be investigated. We identified age and sex-associated differences in immunological response markers that warrant further investigation to identify the underlying molecular mechanisms and impact on COVID-19 pathogenesis.

The Frequency of Hypoglycemia and Its Symptoms in Preterm Neonates in the First 24 Hours.

Introduction Hypoglycemia is a critical concern in neonatal care, particularly among preterm infants. This study aims to investigate the frequency of hypoglycemia within the first 24 hours of life in preterm neonates, considering factors such as gestational age (GA), birth weight, and gender. Materials and methods A cross-sectional study was conductedfrom February to August 2021. The sample comprised 186 preterm infants selected through consecutive sampling. Data collection involved demographic information, glucose level monitoring, and symptom assessment. Results Of the 186 preterm neonates, 31.7% (n=59) experienced hypoglycemia within the first 24 hours, with feeding refusal being the predominant symptom. There was a significant difference in hypoglycemia occurrence between infants born before and after 32 weeks of gestation (p<0.05). Males were slightly more affected than females, although not statistically significant. Infants weighing less than 2 kg showed a higher susceptibility to hypoglycemia. Conclusion The early detection and management of hypoglycemia are crucial in preterm neonatal care. Close monitoring, especially in the initial four hours, is essential to prevent complications. Larger studies are warranted to confirm these findings and improve understanding and management strategies for hypoglycemia in preterm neonates, particularly within the first 24 hours of life.

Spectrum of Central Nervous System Involvement in Childhood-Onset Sjögren's Syndrome: A Case-Based Review.

Sjögren's syndrome (SS) is less frequently diagnosed in childhood than in adults, and central nervous system (CNS) disease is among the rarest systemic involvements. Thus, the clinical spectrum of CNS diseases and their management strategies have not been fully defined. In this article, we present the case of a 16-year-old girl who was referred for severe headache and diagnosed with SS with CNS involvement. Several immunosuppressive treatments failed to improve her neurological symptoms until the rituximab treatment. When we systematically reviewed the literature on cases of CNS involvement in childhood-onset SS, we found that CNS involvement was the presenting feature at the diagnosis of SS in the majority of published cases. While headache and fever were the most frequent complaints at presentation, most of the children displayed features of neuromyelitis optica spectrum disorder. CNS disease showed a variable response to immunosuppressives, and residual neurological deficits were not rare. Additionally, a significant number of cases required treatment with rituximab due to the treatment failures or subsequent flares. Sjögren's syndrome should be considered in children presenting with predominant neurological symptoms, and careful evaluation of glandular features might help in the prompt diagnosis of childhood-onset SS in children with CNS disease.

Patient reported outcomes among U.S. Veterans living with myeloproliferative neoplasms.

e18528 Background: Myeloproliferative Neoplasms (MPNs) profoundly affect patients' well-being, necessitating effective symptom relief. Patient-reported outcomes are pivotal for care improvement, aligning with Centers for Medicare and Medicaid Services priorities. This study aims to assess MPN symptom burden among U.S. Veterans, examining risk levels, thrombo-hemorrhagic complications, medication use, information access, care, and service-connected benefits. Methods: Conducted as a cross-sectional survey from December 1, 2023, - January 22, 2024, all Veterans in the MPN Advocacy Education &amp; International database were recruited. Symptom burden was assessed using the validated MPN Symptom Assessment Form Total Symptom Score (MPN SAF TSS), with descriptive statistics and T-tests employed for analysis. Results: Of 61 respondents, 88% were male, 92% Caucasian, 88% served during the Vietnam war. The mean age was 73±7, with MPN diagnosis at 64±9 and a mean duration of 44±10 years from service-connected exposure. Key findings included 56% Polycythemia Vera, 26% Essential Thrombocythemia, 16% Primary Myelofibrosis, 70% JAK2, 10% CALR, 3% MPL, 14% unaware of their mutation status, and 34% unaware of MPN risk status. Seventeen (28%) underwent phlebotomy, 64% used Hydroxyurea, 29% Ruxolitinib, and 3% Interferon. Fatigue and itching were the predominant and severe symptoms (Table), with 43% reporting no symptom improvement. Mean MPN SAF TSS of all respondents was higher than prior study by Emanuel et.al. which adjusted for MPN subtype (36.4 vs. 21.6, p&lt;0.0001). Twelve (20%) reported bleeding and 10% reported venous thrombosis after MPN diagnosis, while 13% reported arterial thrombosis before MPN diagnosis. Twenty-two (36%) are not seeing an MPN specialist and 61% are not seeing a hematologist at their local Veterans Affairs Medical Centers. Twenty-three (38%) did not seek a second opinion while 43% do not have a caregiver. Respondents turn to MPN organizations (75%), physician offices (74%), Google Search (49%), Webinars (41%), and Facebook (23%) for information. Five (8%) received service-connected disability benefits. Conclusions: Veterans with MPNs endure a substantial symptom burden, surpassing previous studies, signifying suboptimal management. Limited access to care persists, necessitating enhanced support. However, self-reporting bias and potential limitations in activity assessment must be acknowledged. Efforts to enhance MPN awareness, specialized care, and support mechanisms are imperative for comprehensive management. [Table: see text]

Functional Bowel Disorder Management in Routine Practice with Tips for Hot Topics: Expert Opinion Review.

Functional gastrointestinal system disorders are common problems in practice. The most common symptoms are abdominal pain, gas, bloating, diarrhea, constipation, and a mixture of these, and similar symptoms can be seen in conditions such as inflammatory bowel disease, colorectal cancer, and celiac disease depending on the age of the patient, indicating the importance of differential diagnosis. The importance of patient management is shown by making a symptom-based diagnosis and making cost-effective, that is, limited advanced examinations. The pathophysiology of irritable bowel syndrome (IBS) is multifactorial, and stress is one of the leading triggers of IBS symptoms. Therefore, terminology will change to gut-brain interaction disorders in the future, and the patient-physician relationship has a special place in the treatment of functional bowel disorder. Dietary recommendation and medical treatment in IBS should be determined according to the predominant symptom and symptom severity. In addition to diet, some lifestyle changes can also be helpful in reducing IBS symptoms. Antispasmodics and antidepressants are not fast-acting. These drugs should be used for at least 2-4 weeks to see the efficacy of treatment. Drugs should be used according to the standard recommended duration and dose in intermittent treatments.

SYSTEMATIC REVIEW OF AUTONOMIC AND RESPIRATORY IMPAIRMENTS IN CERVICAL COMPRESSIVE MYELOPATHY

Background: Cervical myelopathies are progressive conditions caused by chronic compression of the spinal cord due to degenerative changes or other structural factors. While motor impairments are the predominant symptoms, disruption of autonomic and respiratory pathways in the spinal cord can lead to dysfunction in these systems as well. This systematic review aimed to comprehensively evaluate the evidence on autonomic and pulmonary dysfunction occurring in patients with cervical compressive myelopathies. Methods: We systematically searched major electronic databases including MEDLINE, Embase, and CENTRAL for studies reporting on autonomic or pulmonary impairments in adults with degenerative cervical myelopathy, ossification of the posterior longitudinal ligament, or other cervical compressive myelopathies. Screening, data extraction and quality assessments were conducted in duplicate. Findings were synthesized narratively. Results: 28 studies (n=1,642 patients) met eligibility criteria. Autonomic dysfunctions identified included abnormal heart rate variability parameters, altered sweating/temperature regulation, neurogenic bladder, and erectile dysfunction. The pooled prevalence of neurogenic bladder among 8 studies was 48% (95% CI 33-62%). For pulmonary dysfunction, diaphragmatic paralysis and respiratory failure requiring ventilator support was relatively uncommon (&lt;10%) but sleep disordered breathing and decreased respiratory muscle strength were more prevalent (20-50% range). Both autonomic and pulmonary impairments correlated with increased myelopathy severity, particularly among patients with lesions involving the lower cervical cord. Conclusions: Autonomic and pulmonary deficits occur in a substantial subset of patients with cervical myelopathies, frequently correlating with lesion severity. Screening and management of these non-motor impairments is important for optimizing functional status and quality of life. Additional high-quality research on the epidemiology, mechanisms, and clinical implications of these complications is needed.

High-grade sinonasal adenocarcinoma as an unusual presentation: A case report

The occurrence of malignant tumors, such as adenocarcinoma, is commonplace in the nasal region, characterized by a notably low incidence. This rarity often contributes to delayed diagnosis, rendering the condition challenging to manage. Here, we present the case of a 70-year-old man who presented with chronic left nasal obstruction, accompanied by headaches and recurrent epistaxis. The diagnostic investigation revealed an extensive and aggressive nasal adenocarcinoma, necessitating a hemi-maxillectomy for tumor excision. Subsequent reconstruction of the ipsilateral cheek was accomplished using a pectoralis major flap. Despite the initial intervention, the patient experienced a recurrence 1 year later. In sinonasal adenocarcinoma, nasal obstruction stands out as the predominant symptom, complemented by potential manifestations of swelling and facial deformation. The inherently aggressive nature of this tumor underscores the imperative for early diagnosis and meticulous management to achieve optimal therapeutic outcomes. The comprehensive approach involving surgical intervention and reconstruction reflects the complexity in treating advanced nasal adenocarcinomas.

Faecal Immunochemical Test (FIT) Sensitivity; A Five Year Audit.

Introduction: Colorectal cancer has a high prevalence and mortality rate in the United Kingdom. Cancerous colorectal lesions often bleed into the gastrointestinal lumen. The faecal immunochemical test (FIT) detects haemoglobin (Hb) in the faeces of patients and is used as a first line test in the diagnosis of colorectal cancer. Materials and Methods: A retrospective audit of all FIT performed and all colorectal cancers diagnosed in the Hull and East Riding of Yorkshire counties of the United Kingdom (population approximately 609,300) between 2018 and 2022 was conducted. FIT were performed using a HM-JACKarc analyser from Kyowa medical. The predominant symptom suggestive of colorectal cancer which prompted the FIT was recorded. Colorectal cancer was diagnosed using the gold standard of histological biopsy following colonoscopy. Results: Between 2018 and 2022, 56,202 FIT were performed on symptomatic patients. Follow on testing identified 1,511 with colorectal cancer. Of these people, only 450 people with a confirmed colorectal cancer had a FIT within the 12months preceding their diagnosis. Of these 450 FIT results, 36 had a concentration of <10μg/g and may be considered to be a false negative. The sensitivity of FIT in the patients identified was 92.00%. The most common reason stated by the clinician for a FIT being performed in patients with colorectal cancer was a change in bowel habits, followed by iron deficient anaemia. The number of patients diagnosed with colorectal cancer decreased in 2020, but increased significantly in 2021. Discussion: This study shows that 8.00% of people diagnosed with colorectal cancer in the Hull and East Riding of Yorkshire regions had a negative FIT. This study also shows that the SARS-CoV-2 pandemic affected the number of people diagnosed with colorectal cancer, and therefore skews the prevalence and pre-test probability of a positive test. There are many reasons why a FIT could produce a false negative result, the most likely being biological factors affecting the stability of haemoglobin within the gastrointestinal tract, or pre-analytical factors influencing faecal sampling preventing the detection of haemoglobin. Some colorectal lesions do not protrude into the gastrointestinal lumen and are less likely to bleed. Conclusion: This is the first study showing data from outside of a structured clinical trial and provides the largest study to date showing the sensitivity of FIT in a routine clinical setting. This study also provides evidence for the impact COVID-19 had on the rate of colorectal cancer diagnosis.