Severity Of Symptomology Research Articles

Corneal Neuropathic Pain: A Patient and Physician Perspective.

Corneal neuropathic pain (CNP) is a debilitating condition characterized by pain in the absence of a noxious stimulus. Symptoms such as ocular stinging, burning, photophobia, irritation, and a deep aching pain can be severe despite a seemingly normal ocular surface on examination. CNP may develop due to either peripheral or central sensitization. Peripheral sensitization develops due to aberrant regeneration of corneal nociceptors and nerve fibers as a result of corneal injury or disease of peripheral corneal nerves. Whereas, central sensitization develops due to upregulation of excitatory neurotransmitters as a result of chronic inflammation, which leads to amplification of neuronal response to stimuli. Unfortunately, due to the disparity in severity of symptomology and the observable signs on examination, patients' symptoms are commonly thought to be "psychological" or "functional", and patients report feeling ignored and neglected. Additionally, diagnosis is often delayed which adversely affects patient outcomes. Research to date has focused on the scientific aspects of corneal neuropathic pain: its pathophysiology, epidemiology, investigations, and management. Research into the patient personal experience and the challenges faced by individual patients and their clinicians is lacking. We present the patient and physician perspective on the journey of both patients in order to provide insights into the challenges faced by patients and physicians in the diagnosis, assessment, and management of corneal neuropathic pain.

Concussion risk and symptomology severity in adolescents are associated with pre-season drowsiness and emotional complaints.

Concussions are an ever present risk for many sports. Underlying emotional disturbances and drowsiness are associated with worse post-concussion symptom scores. Yet, not study has examined associations of both emotional disturbances and drowsiness on concussion severity and symptomology. Examine the associations between baseline sleepiness, emotional complaints, and concussion risk and symptom severity in adolescent athletes. A cohort of 626 adolescent athletes underwent baseline/pre-season concussion screening. Those who experienced a physician diagnosed concussion underwent follow up concussion symptomology assessment. Over 90% of players were seen within two weeks of the concussion incident. Linear regression examined for associations between concussion symptom scores and baseline drowsiness and baseline emotional symptoms. Logistic regression examined for association between each symptom and baseline drowsiness and baseline emotional symptoms. Of the 626 athletes that underwent baseline testing, 292 experienced a concussion. Of those 292 athletes, 174 (59.6%) reported baseline drowsiness and 183 (62.7%) baseline emotional symptoms. Baseline drowsiness and emotional complaints were associated with a 2.6 (95% confidence interval = 1.9 to 3.6) and 2.8 (95% confidence interval = 2.0 to 3.9) times greater odds of sustaining a concussion respectively. Increased symptomology after concussion was associated with both baseline drowsiness (unstandardised b = 4.6, p < 0.01) and baseline emotional complaints (unstandardised b = 6.0, p < 0.01). Preseason drowsiness and emotional complaints in adolescent athletes are associated with higher risk of adverse clinical outcomes following concussion. Therefore, clinicians and coaches should be aware, and properly screen, for sleep and emotional problems as part of pre-season/baseline health screening.

Association of urinary polycyclic aromatic hydrocarbon metabolites with symptoms among autistic children: A case-control study in Tianjin, China.

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous pollutants that are associated with altered neurodevelopment and various neurodevelopmental disorders. However, studies evaluating internal biomarkers of PAH exposure in reference to the severity of autism spectrum disorder (ASD) symptomology and autistic behaviors are scarce. Hence, we conducted a case-control study evaluating 12 urinary hydroxylated PAH metabolites (i.e., hydroxy-PAHs) in 101 children with autism and 101 neurotypical children, matching according to sex and age in a 1:1 ratio. In children with ASD, the severity of symptomology and autistic behaviors were assessed using the child autism rating scale (CARS) and the autism behavior checklist (ABC). We found that urinary levels of nine of the hydroxy-PAHs were statistically significantly higher in the ASD group, with the exception of 2-hydroxynaphthalene (2-OHNap) and 4-hydroxyphenanthrene (4-OHPhe). Moreover, urinary hydroxy-PAH levels were associated with ASD risk, with odds ratios ranging from 1.86 to 17.19. Exposures to 1-hydroxynaphthalene (1-OHNap, β=3.32), hydroxyphenanthrenes (1/2/3 + 9-OHPhes, β=3.41-5.12), 1-hydroxypyrene (1-OH-Pyr; β=3.91), 2-hydroxybenzofuran (2-OHDBF; β=3.93), and ∑OH-PAHs (β=4.67) were positively associated with CARS scores after adjusting for covariates (all p &lt; 0.05). When applying the ABC scale, 1-OHPyr levels were positively associated with ABC total scores (β=18.54), with the strongest associations evidenced in regard to the social relatedness (β=6.51) and language domains (β=6.51) (all p &lt; 0.05). Bayesian kernel machine regression (BKMR) showed consistent positive exposure responses for 1-OHNap, 1-OHPhe, and 3 + 9-OHPhe levels in regard to CARS scores, and for 1-OHPyr levels in regard to ABC total scores. Our findings suggest that children with ASD may have higher urinary levels of hydroxy-PAHs, and that these biomarker levels are associated with an increased odds of ASD, an increased severity of autism symptomology, and increased autistic behaviors in children with autism. LAY SUMMARY: We conducted an epidemiologic study evaluating the associations of urinary hydroxy-PAH levels with autism spectrum disorder (ASD), autism symptomology, and autistic behaviors. We found that urinary hydroxy-PAHs were statistically significantly associated with ASD. We note strong statistically significant associations between 1-OHNap, 1-OHPhe, and 3 + 9-OHPhe levels and increased severity of autism symptomology, as well as a strong statistically significant association between 1-OHPyr levels and behavioral characteristics within the social and linguistic domains. This work, if confirmed, will contribute to the future development of diagnostics for children with mild autism, as well as to environmental measures to promote the health and wellbeing of children with autism spectrum disorders.

Ambulatory Assessment in Concussion Clinical Care and Rehabilitation.

Concussion is a mild traumatic brain injury that is characterized by a wide range of physical, emotional, and cognitive symptoms as well as neurocognitive, vestibular, and ocular impairments that can negatively affect daily functioning and quality of life. Clinical consensus statements recommend a targeted, clinical profile-based approach for management and treatment. This approach requires that clinicians utilize information obtained via a clinical interview and a multi-domain assessment battery to identify clinical profile(s) (e.g., vestibular, mood/anxiety, ocular, migraine, cognitive fatigue) and prescribe a corresponding treatment/rehabilitation program. Despite this comprehensive approach, the clinical picture can be limited by the accuracy and specificity of patient reports (which often conflate timing and severity of symptomology), as well as frequency and duration of exposure to symptom exacerbating environments (e.g., busy hallways, sitting in the back seat of a car). Given that modern rehabilitation programs leverage the natural environment as a tool to promote recovery (e.g., expose-recover approach), accurate characterization of the patient clinical profile is essential to improving recovery outcomes. Ambulatory assessment methodology could greatly benefit concussion clinical care by providing a window into the symptoms and impairments experienced by patients over the course of their daily lives. Moreover, by evaluating the timing, onset, and severity of symptoms and impairments in response to changes in a patient's natural environment, ambulatory assessments can provide clinicians with a tool to confirm clinical profiles and gauge effectiveness of the rehabilitation program. In this perspective report, we review the motivations for utilizing ambulatory assessment methodology in concussion clinical care and report on data from a pilot project utilizing smart phone-based, ambulatory assessments to capture patient reports of symptom severity, environmental exposures, and performance-based assessments of cognition for 7 days following their initial evaluation.

Differential responses of soybean genotypes to off‐target dicamba damage

AbstractSince the commercialization and widespread adoption of dicamba‐tolerant (DT) soybean cultivars across the United States, numerous cases of off‐target damage to non‐DT soybean have been reported. Soybean is naturally highly sensitive to dicamba, a synthetic auxin herbicide. Previous studies have focused on understanding the impact of growth stage, dosage, frequency, and duration of dicamba exposure on the severity of symptomology and yield loss. To date, little research has investigated the effect of genetic components in the observed responses. Therefore, this study was conducted to estimate yield losses caused by prolonged off‐target dicamba exposure and to identify genotypes with varying responses to off‐target damage. A total of 553 soybean genotypes derived from 239 unique biparental populations were evaluated in nine environments over 3 yr. A yield penalty of 8.8% was observed for every increment in damage score on a 1–4 scale with losses as high as 40%. Although the interaction between damage and maturity group (MG) significantly affected yield, genotypes showing the most tolerance had similar yields independent of their MG. This indicated that natural tolerance to off‐target dicamba may be conferred by physiological mechanisms other than the length of the recovery window. Given the widespread adoption of DT systems and potential yield losses in non‐DT soybean genotypes, identification of non‐DT soybean genotypes with higher tolerance to off‐target dicamba may sustain and improve the production of other non‐DT herbicide soybean production systems, including the niche markets of organic and conventional soybean.

Accommodative Insufficiency Is the Primary Source of Symptoms in Children Diagnosed With Convergence Insufficiency

Accommodative insufficiency (AI) and convergence insufficiency (CI) have been associated with similar symptomology and frequently present at the same time. The severity of symptomology in CI has been linked to the severity of the CI, suggesting a dose-dependent relationship. However, with increasing severity of CI also comes increased comorbidity of AI. AI alone has been shown to cause significant symptomology. We hypothesize that AI drives the symptoms in CI with a comorbid AI condition (CIwAI) and that it is the increased coincidence of AI, rather than increased severity of CI, which causes additional symptomology. Elementary school children (n = 299) participated in a vision screening that included tests for CI and AI and the CISS-V15 symptom survey. They were categorized into four groups:1) normal binocular vision (NBV); 2) AI-only; 3) CI-only; and 4) CIwAI. One hundred seventy elementary school children fell into the categories of interest. Pairwise comparison of the group means on the symptom survey showed: 1) children with AI-only (mean = 19.7, p = 0.006) and children with CIwAI (mean = 22.8, p = 0.001) had significantly higher symptom scores than children with NBV (mean = 10.3); and 2) children with CI-only (mean = 12.9, p = 0.54) had a similar symptom score to children with NBV. Using a two-factor analysis of variance (AI and CI), the AI effect was significant (AI mean = 21.56; no AI mean = 11.56, p < 0.001), whereas neither the CI effect (p = 0.16) nor the CI by AI interaction effect (p = 0.66) were significant. CI is a separate and unique clinical condition and can occur without a comorbid AI condition, our CI-only group. Past reports of high symptom scores for children with CI are the result of the presence of AI, a common comorbid condition. When AI is factored out, and children with CI only are evaluated, they are not significantly more symptomatic than children with NBV.

Comparing Outcomes of Voice Therapy: A Benchmarking Study Using the Therapy Outcome Measure

The quality cycle requires clinicians to assess the outcomes of interventions. Benchmarking is an approach that has been advocated to compare current performance across different services to identify commonalities and significant differences. This article gives the results of a study of outcomes in speech and language therapy (SLT) using the therapy outcome measure (TOM) for patients with voice disorder (dysphonia) comparing outcomes of seven separate speech and language therapy services. The study aimed to identify the similarities and differences in outcomes of care provided by different services. Two hundred and forty patients with dysphonia (age range 3-87.5 years, average 51.9 years) were treated. The results indicated that although there was no significant difference in the profile of the severity of symptomology of patients referred to speech and language therapy in different geographical areas, there was a significant difference in the treatment outcomes across the services and in the stated reason for discharge from treatment. Nevertheless, most patients with dysphonia had a good outcome and this was associated with completion of the course of treatment. There were significant differences in the number of treatment contacts provided by the different services and in the duration (between admission and discharge) of treatment across the services. Benchmarking can provide useful information through use of routinely collected clinical data.