Prolonged Fatigue Research Articles

Impact of Work Climate, Workload, and Stress on Fatigue for Improving Health and Work Outcomes

Background: Fatigue is a prevalent health issue affecting physical and mental well-being, particularly in industrial workers. Prolonged fatigue can reduce cognitive function, increase susceptibility to illness, and lower work productivity. Factors such as poor work climate, excessive workload, and stress exacerbate fatigue and negatively impact productivity. Methods: This observational cross-sectional study was conducted at PT. Makassar Tene, a sugar refinery in Makassar, Indonesia, with 118 employees. Data on work climate, workload, stress, fatigue, and productivity were collected using a Heat Stress Monitor, reaction timers, and structured interviews. Path analysis was employed to examine the direct and indirect effects of these variables on productivity. Results: The study revealed a significant direct effect of work climate on fatigue (p < 0.05) and productivity (p = 0.008). Similarly, workload directly influenced fatigue (p = 0.001) and productivity (p = 0.044). Stress was found to impact productivity indirectly through fatigue (p = 0.018). Fatigue emerged as a critical mediator, significantly reducing productivity. Conclusion: Poor work climate and excessive workload contribute to fatigue, which in turn diminishes productivity. Addressing environmental and workload factors is essential to improving employee well-being and optimizing productivity in industrial settings. Implementing effective interventions to manage work stress and fatigue is crucial for enhancing both health and work outcomes.

A Mixed Methods Analysis of Long COVID Symptoms in Black Americans: Examining Physical and Mental Health Outcomes.

While several reports confirm that long COVID is associated with poorer health, few studies explore how long COVID directly impacts the lives of Black Americans who experienced higher mortality rates early in the pandemic. Even fewer studies utilize both quantitative and qualitative methods to identify pertinent long COVID symptoms. The current study, therefore, sought to identify points of overlap and divergence when comparing qualitative vs. quantitative descriptions of long COVID experiences among Black adults in the United States. We analyzedcross-sectional surveys collected from the AmeriSpeak panel through the National Opinion Research Center (NORC) at the University of Chicago. This panel includes a probability-based sample of adults across the UnitedStates. Respondents completed online surveys between April and June 2022. We compared outcomes among participants who reported experiencing post-acute sequelae of COVID-19 (i.e., long COVID) to those who reported experiencing SARS-CoV-2 without long COVID. Nearly all qualitative responses focused on matters of physical health like prolonged coughing, cardiovascular concerns, troubled breathing, fatigue, headaches, memory loss, and bodily pains. Quantitative results, however, showed that Black adults living with long COVID reported significantly more anxiety, depressive symptoms, and hopelessness. Persons with long COVID were also significantly more likely to report experiencing psychosis, suicidal ideation, suicide plans, and suicide attempts within the last year. Black adults with long COVID experienced worse outcomes across all mental health measures. Despite the COVID-19 Public Health Emergency expiration in May 2023, urgent efforts are still required to not only treat both the physical and mental health needs of persons living with long COVID, but to effectively prevent the spread and transmission of COVID-19.

Prolonged Fatigue and Mental Health Challenges in Critical COVID-19 Survivors.

Background: The aim of this study was to investigate the development of fatigue and mental illness between 3 and 12 months after critical COVID-19 and explore risk factors for long-lasting symptoms. Study Design and Methods: A prospective, multicenter COVID-19 study in southern Sweden, including adult patients (≥18 years) with rtPCR-confirmed COVID-19 requiring intensive care. Survivors were invited to a follow-up at 3 and 12 months, where patient-reported symptoms were assessed using the Modified Fatigue Impact Scale (MFIS), the Hospital Anxiety and Depression Scale (HADS) and the Posttraumatic Stress Disorder Checklist version 5 (PCL-5). The development between 3 and 12 months was described by changes in relation to statistical significance and suggested values for a minimally important difference (MID). Potential risk factors for long-lasting symptoms were analyzed by multivariable logistic regression. Results: At the 3-month follow-up, 262 survivors (87%) participated, 215 (72%) returned at 12 months. Fatigue was reported by 50% versus 40%, with a significant improvement at 12 months (MFIS; median 38 vs. 33, P < .001, MID ≥4). There were no significant differences in symptoms of mental illness between 3 and 12 months, with anxiety present in 33% versus 28%, depression in 30% versus 22%, and posttraumatic stress disorder in 17% versus 13%. A worse functional outcome and less sleep compared to before COVID-19 were risk factors for fatigue and mental illness at 12 months. Conclusions: Fatigue improved between 3 and 12 months but was still common. Symptoms of mental illness remained unchanged with anxiety being the most reported. A worse functional outcome and less sleep compared to before COVID-19 were identified as risk factors for reporting long-lasting symptoms.

Pulmonary vein thrombosis in COVID-19 patient with chronic obstructive pulmonary disease: a case report

BackgroundPulmonary vein thrombosis is a rare condition with a non-specific presentation with multiple underlying etiologies such as malignancy or lung surgery. In rare instances, no etiology could be encountered. Instead, it has a broad spectrum of clinical manifestations, from dyspnea to lung infarction with a compromise to hemodynamics.Case presentationA 71 years old male with a history of shortness of breath. The patient tested positive for COVID-19; the prolonged exertional fatigue led to undergoing CTPA (CT pulmonary angiography), which revealed pulmonary vein thrombosis. This case emphasizes the importance of maintaining a high index of clinical suspicion in the absence of other possible diagnoses. Furthermore, diagnostic work-up and treatment strategies depend highly on the patient’s presentation and risk factors.ConclusionsPulmonary vein thrombosis is an infrequent entity reported in the medical literature and underdiagnosed because of its ambiguous presentation. Early diagnosis is paramount to prevent complications.

An uncertain recovery: The physical toll of COVID-19 infection on liberal arts and sciences students in the Netherlands

ABSTRACT This study examines the recovery experiences of students at a university college in the Netherlands during an outbreak of COVID-19 in the spring of 2022. University policy was based on the conception of COVID-19 as short-term, with a defined recovery timeline. Despite perceptions that young people face lower risks for prolonged recovery, our study reveals a different reality. Among 36 students with COVID-19, twelve experienced symptoms for over one month. Ten semi-structured interviews revealed heterogenous recovery experiences: good, mild, moderate, and difficult. We also explored how diverse recoveries interacted with academic work. Lingering symptoms ranged from smell loss to brain fog and prolonged fatigue. The unpredictability of recovery made it difficult to attribute symptoms to COVID-19 or academic work pressure. In the context of expectations to resume academic work, some students failed to recognise their ongoing struggles. An absence of conversation regarding recovery in a demanding academic environment renders diverse recovery experiences invisible. Our findings emphasise the need for a broader conceptualisation of COVID-19 recovery amongst young people and call for further research exploring the interaction between students’ illness experiences and the fast-paced academic environment.

Risk factors for burnout in the preparation of student final projects

Introduction: Burnout is a condition when someone feels exhausted from doing something. An individual who is at risk of burnout feels stress as the onset and prolonged fatigue. Objective: The research aimed to find out the risk of burnout in writing the thesis of the students. Method: the research employs the correlational quantitative design and the cross-sectional approach. The population was 274 students who had been writing the thesis. The sample was selected by using the quota sampling technique and as many as 162 students were chosen to be included as the samples. The independent variables of the research were stress, family support, and peer support system and the dependent variable was burnout. The data were gathered by using 4 questionnaires that were filled by the respondents. The analysis was conducted by using chi-square (Pearson Chi-Square) and the significance level was = 0.05. Result: The result shows that stress stated significance correlation with burnout incidence in writing a thesis, where the value of p (0,000). Meanwhile, the family support confirmed its relationship by obtaining the value of p (0,003), and the peer support system also showed the value of p (0,003) that established the correlation between burnout and the thesis writing of the students. Conclusion: The study shows the correlation of stress, family support, and peer support systems related to burnout risk. Further studies should include other variables such as workload, rewards, community, fairness, value ambiguity, and role conflict.

Prevalences and Interrelationships of Post COVID-19 Fatigue, Sleep Disturbances, and Depression in Healthy Young and Middle-Aged Adults.

Background: An evaluation of the persistence of symptoms following COVID-19 in economically active young and middle-aged adults is crucial due to its significant socioeconomic impact resulting from compromised work performance. Methods: A prospective, multicenter study at 12 South Korean hospitals from January to December 2022 involved telephone interviews along with validated questionnaires. Results: Among 696 participants with a median age of 32 and no prior diagnoses, 30% of participants experienced persistent fatigue, while 21.4% suffered from sleep disturbance at 6 months following infection. Additionally, approximately 25% of the participants exhibited depression that endured for up to 6 months. Symptomatic individuals at 3 months exhibited a significantly higher prevalence of persistent fatigue, sleep disturbances, and depression at 6 months compared to those who remained asymptomatic. Notably, sleep disturbance and persistent fatigue at 3 months emerged as significant independent predictors of the presence of depression at 6 months. Conclusions: Even among young and middle-aged healthy adults, prolonged fatigue, sleep disturbance, and depression exhibit a significant prevalence and persisted for up to 6 months. Therefore, implementing a workplace management protocol for these symptoms is essential to mitigate the socioeconomic burden caused by the impairment of work efficiency.

Very high cycle fatigue assessment of thermoplastic-based hybrid fiber metal laminate by using a high-frequency resonant testing system

The prolonged fatigue lifetime of fiber metal laminates (FML) compared to monolithic metals is a key aspect for safety-relevant components, where detailed knowledge about the fatigue properties up to the very high cycle fatigue (VHCF) regime is necessary. For thermoplastic-based FMLs, offering formability, recyclability, and mass production due to short consolidation cycle times, this knowledge needs to be established.In this study, FML containing AA6082 sheets and unidirectional glass and carbon fiber-reinforced polyamide 6 was investigated. Fatigue tests up to max. 109 cycles were conducted on a servo-hydraulic and a high-frequency resonant fatigue testing system with frequencies of 10 Hz and 1,000 Hz. Frequency-induced self-heating was evaluated and limited using air-cooling to maintain the matrix properties. Fatigue progress was monitored through high-speed optical deformation analysis.Compared to HCF loads, VHCF loads lead to reduced crack and delamination occurrence. Changes in microstructure are dominated by singular crack initiation and propagation within the aluminum. The FML’s S-N curve shows a significant flattening from the HCF to the VHCF regime, simplifying the predictability of the fatigue life. By using post-stretching, the VHCF strength can be increased by over 60 %, making this thermoplastic-based FML a considerable competitor in the field of FML.

EFEKTIVITAS EDUKASI ANTENATAL TERHADAP KETAKUTAN DAN EFIKASI DIRI PERSALINAN PADA PRIMIPARA: SYSTEMATIC REVIEW

Fear of giving birth due to lack of knowledge causes a decrease in primigravida mothers' confidence in their ability to undergo childbirth. Decreased self-efficacy in childbirth can cause birth complications such as prolonged labor, fatigue and weakness in the mother, which results in the mother's failure to undergo a natural birth. Antenatal education is an appropriate alternative to increase mothers' knowledge of the birth process. The aim of the research was to examine the effectiveness of antenatal education in reducing fear of childbirth and increasing childbirth self-efficacy in primiparous mothers. The structure of this research is a detailed analysis using the PRISMA flow diagram. Researchers applied the PICO method and searched for articles in English published between 2018 and 2023. Some of the databases used included Proquest, PUBMED, Sage Journal, Springer Link, Science Direct, EBSCO, Plos One and Taylor &amp; Francis. Article quality assessment using JBI Critical Appraisal Tools for RCT. Seven articles were identified and analyzed, all articles used a Randomized Controlled Trial design. The research sample numbered 56 to 182, consisting of primiparas in the age range 18-32 years with a gestational age of &lt;34 weeks and was conducted in Saudi Arabia, Turkey, Iran and China. From the literature search, in general it can be concluded that antenatal education provided to primiparous mothers is effective in reducing fear of childbirth and increasing self-efficacy in childbirth.

Enzalutamide Maintenance Following Docetaxel in Metastatic Castration-Naive Prostate Cancer: A Pilot Feasibility Study

Purpose: To assess the feasibility and short-term efficacy of maintenance enzalutamide following first-line docetaxel plus androgen deprivation therapy (ADT) in patients with high-volume, metastatic castration-naive prostate cancer (mCNPC).Materials and Methods: The present study included 38 consecutive patients with mCNPC who did not have disease progression with ADT plus docetaxel between October 2022 and October 2023. Patients received a switch maintenance therapy with enzalutamide until progression, unacceptable toxicity, or patient withdrawal. Endpoints included time to prostate-specific antigen (PSA) progression and safety.Results: Among the 38 patients, the median age was 68 years, and the most frequently observed metastatic site was bone (n=36), followed by lymph nodes (n=28), lung (n=8), and liver (n=1). The median duration of firstline docetaxel was 2.8 months (range, 2.7–5.0 months). At the time of commencing maintenance enzalutamide, the median PSA was 3.2 ng/mL (range, 0.01–258 ng/mL). Maintenance enzalutamide was generally welltolerated. A total of 11 patients (28%) discontinued enzalutamide, and the main reasons included adverse events (prolonged fatigue of grade 1 or 2, n=6), disease progression (n=3) and financial burdens (n=2). Median time to PSA progression was not reached, and 93% were PSA progression-free at 12 months.Conclusions: Maintenance enzalutamide is a feasible treatment option with potential clinical benefit for patients with high-volume mCNPC who were progression-free after first-line ADT+docetaxel.

Very high cycle fatigue of laser powder bed fused Al-Cu-Mg-Ag-TiB2 (A20X) Alloy: Stress relief and aging treatments

This study presents a comprehensive exploration of the fatigue response in the very high cycle fatigue (VHCF) regime for an additively manufactured (i.e., laser powder bed fused) A20X aluminum alloy. Although the need for high-performance materials with exceptional fatigue qualities has increased dramatically, the VHCF behavior of Al-Cu-Mg-Ag-TiB2 (A20X) structures remains largely unknown. A series of ultrasonic fatigue tests were performed to assess the prolonged fatigue life of the A20X alloy (in the VHCF domain where the number of cycles to failure is beyond 10 million cycles). The VHCF response, assessed through ultrasonic fatigue testing, was investigated by examining the stress-life (S-N) curves in a statistical framework, the fatigue crack initiation and propagation behavior, and the fracture surfaces. An asymptotic trend was experimentally found at 109 cycles, with a stress amplitude of 110 MPa for stress-relieved (SR) and 125 MPa for artificially aged (T7) materials, indicating the presence of an endurance limit. Furthermore, fracture surfaces showed the typical fisheye morphology, with a fine granular area (FGA) containing an internal crack-initiating site. The findings of this paper can assist in optimizing fatigue and durability design allowable for applications for extended fatigue life in the VHCF domains.

The validation of Chinese version of workplace PERMA-profiler and the association between workplace well-being and fatigue

BackgroundWell-being is an important issue in workplace. One of these assessment tools of well-being, Workplace PERMA Profiler, is based on Seligman’s five dimensions well-being. Prolonged fatigue may last for a long time, leading a great impact on both employees and enterprises. However, rare studies about the association between well-being and fatigue had been investigated. Our aim is to establish the Chinese version Profiler, and to discovery the association between workplace well-being and fatigue.MethodsThe Chinese version was established according to International Society of Pharmacoeconomics and Outcomes Research (ISPOR) task force guidelines. In the study, researchers employed simple random sampling by approaching individuals undergoing health checkups or receiving workplace health services, inviting them to participate in a questionnaire-based interview. Prolonged Fatigue was evaluated by Checklist Individual Strength (CIS). The reliability was evaluated by Cronbach’s alphas, Intra-class Correlation Coefficients (ICCs), and measurement errors. Moreover, confirmatory factor analysis and correlational analyses were assessed for the validity.ResultsThe analyses included 312 Chinese workers. Cronbach’s alphas of the Chinese version ranged from 0.69 to 0.93, while the ICC ranged from 0.70 to 0.92. The 5-factor model of confirmatory factor analysis revealed a nearly appropriate fit (χ2 (82) = 346.560, Comparative Fit Index [CFI] = 0.887, Tucker-Lewis Index [TLI] = 0.855, Root Mean Square Error of Approximation [RMSEA] = 0.114, Standardized Root Mean Square Residual [SRMR] = 0.060). Moreover, the CIS and its four dimensions were significantly and negatively associated with the Positive Emotion, while they are positively associated with Engagement dimension except CIS-Motivation dimension.ConclusionThe Chinese version Workplace PERMA-Profiler indicate nice reliability and validity. Furthermore, all CIS dimensions were negatively influenced by Positive Emotion, while commonly positively associated with Engagement.

THE RELATIONSHIP OF BIG FIVE PERSONALITY WITH BURNOUT IN MTsN HONORARY TEACHER

Jobs that are vulnerable to burnout are jobs that provide services directly to people. One of the jobs in the field of community service is teacher. Burnout is a state of tiredness and frustration caused by the pressure of work and hampered desires which results in a decline in physical condition, emotional exhaustion and prolonged mental fatigue. Research was conducted to determine the relationship between personality types, especially using the big five personality theory, with burnout in MTsN honorary teachers. The approach in this research uses a quantitative approach with two scales, namely the mask burnout inventory (MBI) scale and the big five inventory (BFI) scale. The sample in the research was 127 honorary teachers with a sampling technique using total sampling. Data was collected using questionnaires directly and online (Google from). This research was analyzed using multiple linear regression analysis. The results of this research are that there is a joint relationship between the big five personalities and burnout in honorary teachers based on the results of the F test with a significance level of &lt;0.05, namely 0.000 with a fairly strong correlation of 0.570.

THE RELATIONSHIP OF BIG FIVE PERSONALITY WITH BURNOUT IN MTsN HONORARY TEACHER

Jobs that are vulnerable to burnout are jobs that provide services directly to people. One of the jobs in the field of community service is teacher. Burnout is a state of tiredness and frustration caused by the pressure of work and hampered desires which results in a decline in physical condition, emotional exhaustion and prolonged mental fatigue. Research was conducted to determine the relationship between personality types, especially using the big five personality theory, with burnout in MTsN honorary teachers. The approach in this research uses a quantitative approach with two scales, namely the mask burnout inventory (MBI) scale and the big five inventory (BFI) scale. The sample in the research was 127 honorary teachers with a sampling technique using total sampling. Data was collected using questionnaires directly and online (Google from). This research was analyzed using multiple linear regression analysis. The results of this research are that there is a joint relationship between the big five personalities and burnout in honorary teachers based on the results of the F test with a significance level of &lt;0.05, namely 0.000 with a fairly strong correlation of 0.570.

Development of porous asphalt mixture based on the synthesis of PTEMG and MDI polyurethane asphalt

Polyurethane-modified asphalt (PA) stands out as an environmentally sustainable road material, renowned for its exceptional performance that significantly extends road surface lifespans while reducing maintenance costs. This study focuses on the preparation of PA using a single-component blending method that incorporates polyether polyol PTEMG (Poly-(tetra methylene ether glycol)) and isocyanate MDI (4,4′-diphenylmethane diisocyanate) as primary raw materials. Various analytical techniques, including Fluorescence Microscopy, Fourier-transform Infrared Spectroscopy (FTIR), Thermogravimetric analysis (TG), Differential Scanning Calorimetry (DSC), Viscosity Testing, Tensile Testing, and Bending Beam Rheometer (BBR), were employed to investigate PA's microstructure, modification mechanism, thermal properties, viscosity characteristics, curing properties, and low-temperature stability. A porous polyurethane-modified asphalt mixture, targeting a void content of 20%, was designed and compared to a high-viscosity modified asphalt mixture with the same void content in terms of performance. The results indicate a combination of chemical and physical processes in PA modification. Through TG and DSC experiments, it was ascertained that polyurethane-modified asphalt commences decomposition at 252 °C, exhibiting an exothermic peak within the temperature range of − 19.98–2.73 °C. The introduction of polyurethane substantially enhances the thermal performance and cryogenic stability of the asphalt binder. Viscosity tests and tensile experiments indicate that the curing reaction of polyurethane-modified asphalt is protracted and irreversible. Consequently, it is recommended to prepare polyurethane-modified asphalt mixtures employing a compaction temperature of 175 °C and a maximum resting time of 100 min. Additionally, specimens should rest at room temperature for at least 3 days. Comparatively, the porous asphalt incorporating polyurethane exhibits notable advantages over the high-viscosity modified asphalt mixture. It demonstrates superior high-temperature stability, excellent resistance to low-temperature cracking, reduced sensitivity to strains, prolonged fatigue life, and improved flexibility. However, its fatigue resistance and resistance to dynamic loads are slightly inferior. This study offers valuable insights into the use of polyurethane in porous asphalt mixtures, making it a promising option for sustainable road construction.

An enhanced model for environmental dry eye: Exploring pathological features and underlying factors

This study aimed to develop an enhanced environmental dry eye (EDE) model that accurately reproduces the etiology of prolonged visual fatigue and investigates the underlying pathological features. A total of 40 adult SPF-grade Wistar rats were randomly assigned to control (n = 20) and model (n = 20) groups. Rats in the control group were maintained under normal conditions, while rats in the model group were exposed to a controlled frontal airflow of 2–4 m/s from a fan for 7.5 h daily while placed on a suspended cylindrical wire mesh frame. Various assessments were performed at different time points during the 14-day experiment, including blink frequency, tear secretion (phenol red thread test), tear film breakup time (BUT), fluorescein staining (FL), corneal epithelial status (light microscopy), ultrastructure of corneal epithelial cells (electron microscopy), and expression levels of inflammatory cytokines (IL-1β, TNF-α) in tears (enzyme-linked immunosorbent assay). Additionally, mRNA and protein expression levels of MMP-9, IL1β, IL6, TNF-α, IFN-γ, and caspase-3 in corneal tissues were quantified (real-time quantitative PCR and Western blotting). Compared to the control group, the model group rats exhibited significant decreases in blink frequency (P < 0.001), tear secretion (Schirmer I test) values (P < 0.001), and tear film breakup time levels (P < 0.001). There was also a significant increase in fluorescein staining scores (P < 0.001) in the model group. Histological examination revealed distinct differences of the corneal epithelium between groups. The corneal epithelium of the model group appeared thicker, with disorganized cell arrangement in the superficial and basal layers, partial defects or detachment of superficial epithelial cells, and a rough, uneven surface. Scanning electron microscopy observations showed a rough corneal epithelial surface with numerous cracks and scattered vesicular-like structures in the model group. Furthermore, the model group rats exhibited a significant increase in expression of IL-1β and TNF-α in tears (P < 0.001), and upregulated expression levels of MMP-9, TNF-α, IL-1β, caspase-3, IL-6, and IFN-γ at both the mRNA and protein levels in corneal tissues (P < 0.001). In conclusion, the modified “wire-meshing cylindrical board” model effectively overcomes the limitations of the traditional “jogging board " dry eye model and successfully simulates the etiology of prolonged visual fatigue. This innovative EDE model demonstrates a high degree of relevance to dry eye conditions resulting from prolonged visual tasks, with a high success rate of model induction. Moreover, it proves to be a simple, practical, and easily replicable model, making it highly suitable for further studies on prolonged visual fatigue and facilitating its widespread adoption in research and clinical applications.

Asthma is a risk factor for general fatigue of long COVID in Japanese nation-wide cohort study

BackgroundMultiple prolonged symptoms are observed in patients who recover from an acute COVID-19 infection, which is defined as long COVID. General fatigue is frequently observed in patients with long COVID during acute and post-acute phases. This study aimed to identify the specific risk factors for general fatigue in long COVID. MethodsHospitalized patients with COVID-19 aged over 18 years were enrolled in a multicenter cohort study at 26 medical institutions. Clinical data during hospitalization and patient-reported outcomes after discharge were collected from medical records, paper-based questionnaires, and smartphone apps. ResultsAmong prolonged symptoms through 1-year follow-ups, general fatigue was the most interfering symptom in daily life. Patients with protracted fatigue at all follow-up periods had lower quality of life scores at the 12-month follow-up. Univariate logistic regression analysis of the presence or absence of general fatigue at the 3-month, 6-month, and 12-month follow-ups identified asthma, younger age, and female sex as risk factors for prolonged fatigue. Multivariable logistic regression analysis revealed that asthma was an independent risk factor for persistent fatigue during the 12-month follow-up period. Longitudinal changes in the symptoms of patients with or without asthma demonstrated that general fatigue, not cough and dyspnea, was significantly prolonged in patients with asthma. ConclusionsIn a Japanese population with long COVID, prolonged general fatigue was closely linked to asthma. A preventive approach against COVID-19 is necessary to avoid sustained fatigue and minimize social and economic losses in patients with asthma.

Spontaneous Intracranial Haemorrhage as Part of the Initial Manifestation of Childhood Systemic Lupus Erythematosus: An Unusual Clinical Presentation

Childhood-onset systemic lupus erythematosus is a systemic autoimmune disorder with a variety of clinical manifestations. Most children and adolescents experience the gradual onset of prolonged fever, weight loss, fatigue, and arthralgia over weeks or months. Nonetheless, isolated haematological abnormalities are unusual as an initial clinical manifestation. We report a case of spontaneous intracranial haemorrhage due to severe thrombocytopenia as part of the initial manifestation of SLE in childhood. A high index of suspicion is necessary to diagnose systemic lupus erythematosus in children who present with unexplained spontaneous intracranial haemorrhage and isolated thrombocytopenia as an initial presentation.

Aqueous Extract of Brassica rapa L.'s Impact on Modulating Exercise-Induced Fatigue via Gut-Muscle Axis.

Exercise-induced fatigue is a common physiological response to prolonged physical activity, often associated with changes in gut microbiota and metabolic responses. This study investigates the potential role of Brassica rapa L. in modulating these responses. Using an animal model subjected to chronic exercise-induced stress, we explored the effects of Brassica rapa L. on fatigue-related biomarkers, energy metabolism genes, inflammatory responses, intestinal integrity, and gut microbiota composition. Our findings revealed that Brassica rapa L. exhibits significant antioxidant activity and effectively modulates physiological responses to fatigue. It influences gene expression related to the tricarboxylic acid (TCA) cycle in muscle tissue through the AMPK/PGC-1α/TFAM signaling pathway. Furthermore, Brassica rapa L. has been found to alleviate inflammation by inhibiting lipopolysaccharide (LPS) infection and suppressing the activation of the NF-κB pathway. It also maintains intestinal integrity and controls Gram-negative bacterial growth. A correlation analysis identified several pathogenic bacteria linked with inflammation and energy metabolism, as well as beneficial probiotic bacteria associated with improved energy metabolism and reduced inflammation. These findings underscore Brassica rapa L.'s potential for managing prolonged exercise-induced fatigue, paving the way for future therapeutic applications. The results highlight its impact on gut microbiota modulation and its role in nutrition science and sports medicine.

Parathyroid adenoma in a 33 years female, manifesting as non-traumatic multiple bone fractures

A 33 years old female patient presented to OPD with chief complaints of prolonged fatigue, abnormal gait and difficulty in walking since 7 years. On further evaluation MRI pelvis revealed bilateral non-traumatic pelvic bone fractures, with high Serum parathyroid hormone level (1050 pcg/ml) and hypercalcemia. CECT Neck showed a well-defined soft tissue density lesion involving the posterior-inferior aspect of the right lobe of thyroid gland. Surgical resection was performed and histopathology revealed parathyroid adenoma. Clinical manifestations and PTH and calcium levels gradually decreased to normal after surgery. Patient’s symptoms gradually decreased over a period of 2 month after treatment of the underlying cause. In a young female presenting with bony pains and non-traumatic fractures, a differential diagnosis of parathyroid adenoma must be kept in mind.