Short-term Symptoms Research Articles

282 Follow-up of hospitalized COVID-19 survivors: assessment of short- and long-term cardiovascular sequelae after SARS-CoV-2 infection

AimsCardiovascular sequelae in COVID-19 survivors remain largely unclear and can potentially go unrecognized. Reports on follow-up focused on cardiovascular evaluation after hospital discharge are currently scarce. Aim of this prospective study was to assess cardiovascular sequelae in previously hospitalized COVID-19 survivors.Methods and resultsThe study was conducted at ‘Sapienza’ University of Rome—Policlinico ‘Umberto I’. After 2 months from discharge, n = 230 COVID-19 survivors underwent a follow-up visit at a dedicated ‘post-COVID Outpatient Clinic’. A cardiovascular evaluation including electrocardiogram (ECG), Troponin and echocardiography was performed. Further tests were requested when clinically indicated. Medical history, symptoms, arterial-blood gas, blood tests, chest computed tomography, and treatment of both in-hospital and follow-up evaluation were recorded. A 1-year telephone follow-up was performed. A total of 36 (16%) COVID-19 survivors showed persistence or delayed onset of cardiovascular disease at 2-months follow-up visit. Persistent condition was recorded in 62% of survivors who experienced an in-hospital cardiovascular disease. Delayed cardiovascular involvement included: myocarditis, pericarditis, ventricular disfunction, new onset of systemic hypertension and arrhythmias. At 1-year telephone follow-up, 105 (45%) survivors reported persistent symptoms, with dyspnoea and fatigue being the most frequent. 60% of survivors showed persistent chest CT abnormalities and among those 28% complained of persistent cardiopulmonary symptoms at long term follow-up.ConclusionsOur preliminary data showed persistent or delayed onset of cardiovascular involvement (16%) at short-term follow-up and persistent symptoms (45%) at long-term follow-up. These findings suggest the need for monitoring COVID-19 survivors.

S487 What Patients With Eosinophilic Esophagitis May Not Share with Their Providers: A Qualitative Assessment of Online Health Communities

Introduction: Little is known about how patients with eosinophilic esophagitis (EoE) experience and describe their symptoms, receive care, and cope with their chronic disease, which may impact adherence to treatment, disease control, and quality of life. Patients commonly seek peer support from online health communities and these virtual forums serve as unguarded data sources that provide raw insights on unmet needs and barriers to care and communication. We performed a qualitative analysis of electronic health forums to characterize patient to patient conversations about EoE symptoms and the experience of disease. Methods: We identified 3 publicly accessible electronic health forums hosting EoE communities. Conversation threads posted between July 2018 and June 2020 were coded using emergent and a priori codes based on the THRIVE conceptual framework of coping with chronic illness. Results: Of 659 threads (4,933 posts) collected over 2 years, a random sample of 240 threads (30 per 3-month quarter) were selected for analysis. Thematic saturation was reached after 172 threads. Patient experience of EoE was driven by their perspectives in 4 key domains: 1) EoE as episodic rather than chronic: symptoms often described as “flares” or self-limited “attacks” rather than a constant problem; 2) treatment choices: medications as a quick fix for short-term symptoms versus elimination diet as a tailored maintenance therapy; 3) personal success: varied definitions of positive disease outcomes; and 4) views of providers: encountering physicians who lacked knowledge about the disease and its treatment and/or were unsupportive of patient choices (Table). Conclusion: Online health communities are a valuable and unfiltered source of patient perspectives and disease-related language that can be used to understand patient needs and goals, improve education, and facilitate communication. EoE patients interpret their disease as sporadic events, polarize treatments as short-term fixes or long-term commitments, have various definitions of disease success, and lack reliable sources of knowledge, which may influence how chronic treatment is prioritized and misjudged as nonadherence. If providers are to succeed in providing high-quality EoE care, they need to equip themselves with evidence-based knowledge, engage in collaboration and shared decision making with patients, and look outside of the clinical setting to recognize barriers to disease management.Table 1.: Representative quotations from key themes.

Application of High Intensity Interval Training in Treating Post Concussion Syndrome

<h3>Research Objectives</h3> To investigate the symptomatic impact and applicability of High Intensity Interval Training as a novel approach during fMRI-guided treatment in patients with Post-Concussion Syndrome. <h3>Design</h3> Post Concussion Symptom Scale data from patients who participated in multimodal fMRI-guided PCS therapy was evaluated to compare patients who had not participated in HIIT during treatment versus patients who had participated in aerobic exercise but not HIIT during their treatment. <h3>Setting</h3> Patients whose data was analyzed participated in fMRI-based therapy, as pushlished in Wing et al., 2017, at the concussion treatment center Cognitive FX in Provo UT. <h3>Participants</h3> Patients who had not participated in HIIT activity during their treatment (F = 193, M = 140, Age = 8-79 years). Patients who had participated in HIIT during their treatment (F = 189, M = 108, Age = 8-72 years). Patient data was eliminated from analysis if the patient's file was incomplete. One Way ANOVA, including Tukey HSD, was performed. P < 0.05 was considered significant. <h3>Interventions</h3> The non-HIIT arobic exercise group participated in sustain aerobic exercise. The HIIT group participated in HIIT exercise as discussed in Lucas et al., 2015 and Cassidy et al., 2017. <h3>Main Outcome Measures</h3> Main outcome measures included Total Post-Concussion Symtpom Scale Score. <h3>Results</h3> Pairwise comparisons revealed no difference between non-HIIT-RC (n = 294) and HIIT-RC group (n = 293) data for pre-treatment PCSS scoring nor for post-treatment. Comparisons did show significant improvement of PCSS scoring after treatment in both non-HIIT groups and HIIT. <h3>Conclusions</h3> Despite the introduction of HIIT protocols to an already strenuous modality of PCS treatment, no significant increases in PCSS reporting were detected despite the patient population evaluated being prone to exacerbation of symptoms during or after periods of intense physical exertion, also called exercise intolerance. As application of HIIT does not correlate with reduced short-term symptom outcomes, further research will include evaluating HIIT's effect on longitudinal PCSS and fMRI data. <h3>Author(s) Disclosures</h3> Drs. Fong and Allen are co-founders of Cognitive FX. Dr. Loewen, Mr. Benson, and Ms. Ward are employed by Cognitive FX.

Shift in Social Media App Usage During COVID-19 Lockdown and Clinical Anxiety Symptoms: Machine Learning-Based Ecological Momentary Assessment Study.

BackgroundAnxiety symptoms during public health crises are associated with adverse psychiatric outcomes and impaired health decision-making. The interaction between real-time social media use patterns and clinical anxiety during infectious disease outbreaks is underexplored.ObjectiveWe aimed to evaluate the usage pattern of 2 types of social media apps (communication and social networking) among patients in outpatient psychiatric treatment during the COVID-19 surge and lockdown in Madrid, Spain and their short-term anxiety symptoms (7-item General Anxiety Disorder scale) at clinical follow-up.MethodsThe individual-level shifts in median social media usage behavior from February 1 through May 3, 2020 were summarized using repeated measures analysis of variance that accounted for the fixed effects of the lockdown (prelockdown versus postlockdown), group (clinical anxiety group versus nonclinical anxiety group), the interaction of lockdown and group, and random effects of users. A machine learning–based approach that combined a hidden Markov model and logistic regression was applied to predict clinical anxiety (n=44) and nonclinical anxiety (n=51), based on longitudinal time-series data that comprised communication and social networking app usage (in seconds) as well as anxiety-associated clinical survey variables, including the presence of an essential worker in the household, worries about life instability, changes in social interaction frequency during the lockdown, cohabitation status, and health status.ResultsIndividual-level analysis of daily social media usage showed that the increase in communication app usage from prelockdown to lockdown period was significantly smaller in the clinical anxiety group than that in the nonclinical anxiety group (F1,72=3.84, P=.05). The machine learning model achieved a mean accuracy of 62.30% (SD 16%) and area under the receiver operating curve 0.70 (SD 0.19) in 10-fold cross-validation in identifying the clinical anxiety group.ConclusionsPatients who reported severe anxiety symptoms were less active in communication apps after the mandated lockdown and more engaged in social networking apps in the overall period, which suggested that there was a different pattern of digital social behavior for adapting to the crisis. Predictive modeling using digital biomarkers—passive-sensing of shifts in category-based social media app usage during the lockdown—can identify individuals at risk for psychiatric sequelae.

Safety and humoral responses to BNT162b2 mRNA vaccination of SARS-CoV-2 previously infected and naive populations

Since COVID-19 risk of reinfection is of great concern, the safety and efficacy of the mRNA-based vaccines in previously infected populations should be assessed. We studied 78 individuals previously infected with SARS-CoV-19, who received a single dose of BNT162b2 mRNA COVID-19 vaccine, and 1:2 ratio matched infection-naïve cohort who received two injections. The evaluation procedure included symptom monitoring, and serological tests. Among the post-infected population, the median IgG-S response after the first vaccine dose was 3.35 AU, compared to 2.38 AU after the second vaccine injection in the infection naive group. A strong correlation was demonstrated between IgG-S level before vaccination, and the corresponding responses after a single vaccine dose (r = 0.8, p < 0.001) in the post infected population. Short-term severe symptoms that required medical attention were found in 6.8% among the post-infected individuals, while none were found in the infection naïve population. Our data suggest that a single vaccine dose is sufficient to induce an intense immune response in post-infected population regardless of seropositivity. Although some short-term safety issues were observed compared to the infection naïve population, a single dose regimen can be considered safe in post-infected populations.

Short-term insomnia symptoms are associated with level and not type of physical activity in a sample of Indian college students.

SummaryObjectiveThere is diverse results on the association between physical activity and sleep. So this study investigated association of level and type of physical activity with short term insomnia among college students.MethodsA cross sectional study was conducted among college students in India. The sample was 662 students with 359 males and 303 females. The predictor variables were type and level of physical activity and predicted variables were sleep complaints.Physical activity components were aseesesed through international physical activity questionnaire and sleep complaints using Pitsburg sleep questionnaire. The binary logistic regression models were used for data analysis. Level of significance was set at p ≤ 0.05 for all the analysis.ResultsThe age (mean + SD) of the participants were 23.2 ± 3.5 years. The self reported symptoms of short trem insomnia such as global sleep quality (adjusted odds ratio(AOR) = 15.58), subjective sleep quality (AOR = 6.01), sleep latency (AOR = 5.09), sleep duration (AOR = 0.13), sleep disturbances (AOR = 4.88), day time sleep dysfunction (AOR = 5.59) had shown association with level of physical activity. There was no association of type of physical activity with any other predicted variables.ConclusionsThe findings of the present study supports that level of physical activity is a key predictor of short term insomnia symptoms among college students. There should be Interventions to maintain and improve the level of physical activity among students.

Relation of the Number of Cardiovascular Conditions and Short-term Symptom Improvement After Percutaneous Coronary Intervention for Stable Angina Pectoris

With aging of the population, cardiovascular conditions (CC) are increasingly common in individuals undergoing PCI for stable angina pectoris (AP). It is unknown if the overall burden of CCs associates with diminished symptom improvement after PCI for stable AP. We prospectively administered validated surveys assessing AP, dyspnea, and depression to patients undergoing PCI for stable AP at our institution, 2016-2018. The association of CC burden and symptoms at 30-days post-PCI was assessed via linear mixed effects models. Included individuals (N=121; mean age 68 ± 10 years; response rate=42%) were similar to non-included individuals. At baseline, greater CC burden was associated with worse dyspnea, depression, and physical limitations due to AP, but not AP frequency or quality of life. PCI was associated with small improvements in AP and dyspnea (p ≤ 0.001 for both), but not depression (p=0.15). After multivariable adjustment, including for baseline symptoms, CC burden was associated with a greater improvement in AP physical limitations (p=0.01) and depression (p=0.002), albeit small, but not other symptom domains (all p ≥ 0.05). In patients undergoing PCI for stable AP, increasing CC burden was associated with worse dyspnea, depression, and AP physical limitations at baseline. An increasing number of CCs was associated with greater improvements, though small, in AP physical limitations and depression. In conclusion, the overall number of cardiovascular conditions should not be used to exclude patients from PCI for stable AP on the basis of an expectation of less symptom improvement.

Clinical predictors of treatment response towards exposure therapy in virtuo in spider phobia: A machine learning and external cross-validation approach

While being highly effective on average, exposure-based treatments are not equally effective in all patients. The a priori identification of patients with a poor prognosis may enable the application of more personalized psychotherapeutic interventions. We aimed at identifying sociodemographic and clinical pre-treatment predictors for treatment response in spider phobia (SP).N = 174 patients with SP underwent a highly standardized virtual reality exposure therapy (VRET) at two independent sites. Analyses on group-level were used to test the efficacy. We applied a state-of-the-art machine learning protocol (Random Forests) to evaluate the predictive utility of clinical and sociodemographic predictors for a priori identification of individual treatment response assessed directly after treatment and at 6-month follow-up. The reliability and generalizability of predictive models was tested via external cross-validation.Our study shows that one session of VRET is highly effective on a group-level and is among the first to reveal long-term stability of this treatment effect. Individual short-term symptom reductions could be predicted above chance, but accuracies dropped to non-significance in our between-site prediction and for predictions of long-term outcomes. With performance metrics hardly exceeding chance level and the lack of generalizability in the employed between-site replication approach, our study suggests limited clinical utility of clinical and sociodemographic predictors. Predictive models including multimodal predictors may be more promising.

The Relationship of Comorbid Overweight-Obesity With Cold Executive Functions, Verbal Short-Term Memory, and Learning in Attention Deficit Hyperactivity Disorder.

The aim of this study was to investigate the relationship between comorbid obesity/overweight and cold executive functions, verbal short-term memory, and learning in children with attention deficit and hyperactivity disorder (ADHD). Our study was conducted on 100 drug-naive participants, including 70 patients with ADHD and 30 healthy controls. In our study, patients diagnosed with ADHD were divided into two groups according to body mass index as above the 85th percentile and at or below the 85th percentile. Cold executive functions were evaluated by the Stroop Test (ST) and Cancellation Test (CT). Serial Digit Learning Test (SDLT) was administered to measure verbal short-term memory and learning capacity. To evaluate the severity of ADHD objectively, the parents completed the Conners' Parents Rating Scale-Revised Short Version (CPRS-RS). There was no statistically significant difference in ST, SDLT, CT scores, and CPRS-RS subscale scores between the two groups with ADHD. This study show that overweight/obesity comorbid with ADHD may not be associated with cold executive functions, verbal short-term memory, learning, or ADHD symptom severity.

Neonatal Outcomes in Pregnant Women Infected with COVID-19 in Babol, North of Iran: A Retrospective Study with Short-Term Follow-Up.

During the coronavirus disease 2019 (COVID-19) pandemic, the number of pregnant women and neonates suffering from COVID-19 increased. However, there is a lack of evidence on clinical characteristics and neonatal outcomes in pregnant women with COVID-19. We evaluated short-term outcomes (4 weeks postdischarge) and symptoms in neonates born to mothers infected with COVID-19. In this retrospective cohort study, we included all neonates born to pregnant women with COVID-19 admitted to Ayatollah Rohani Hospital, Babol, Iran, from February 10 to May 20, 2020. Clinical features, treatments, and neonatal outcomes were measured. Eight neonates were included in the current study. The mean gestational age and birth weight of newborns were 37 ± 3.19 weeks (30₊6-40) and 3077.50 ± 697.64 gr (1720-3900), respectively. Apgar score of the first and fifth minutes in all neonates was ≥8 and ≥9 out of 10, respectively. The most clinical presentations in symptomatic neonates were respiratory distress, tachypnea, vomiting, and feeding intolerance. This manifestation and high levels of serum C-reactive protein (CRP) in three infants are common in neonatal sepsis. The blood culture in all of them was negative. They have been successfully treated with our standard treatment. Our pregnant women showed a pattern of clinical characteristics and laboratory results similar to those described for nonpregnant COVID-19 infection. This study found no evidence of intrauterine or peripartum transmission of COVID-19 from mother to her child. Furthermore, the long-term outcomes of neonates need more study.

Examining the effect of firm-specific factors on the automotive industry in Indonesia

This study aims to examine the factors that affect the value of manufacturing companies in the Automotive Industry Sub-Sector Listed on the Indonesia Stock Exchange in 2015 - 2019. These factors are firm size and financial performance. The financial performance consists of liquidity, profitability, and solvency. The number of manufacturing companies in the Automotive Industry sub-sector which was made into the population was 13. Sampling was using the purposive sampling technique. Based on the predetermined criteria, there were 10 companies that met the criteria so that there were 50 observations. Data collection techniques use documentation from financial reports published on the official website of the Indonesia Stock Exchange. The model used in this research is panel data regression using the Eviews application. The findings of this study indicate that of the four independent variables tested, only the solvency variable affects firm value, but the simultaneously firm size and financial performance have a significant effect on firm value. The results of this study indicate that in general, stock investors view the importance of all financial ratios, but can ignore short-term financial symptoms that are reflected in company size, profitability, and liquidity, but should pay more attention to the security of long-term investments which can be seen insolvency.

Postsurgical oral symptoms after insertion of one or two implants for mandibular overdentures: short-term results of a randomized clinical trial

ObjectiveThis randomized clinical trial aimed to compare the short-term postsurgical symptoms after insertion of one or two implants for retention of a mandibular overdenture. This study investigated whether the less invasive single-implant approach results in lower postoperative symptoms compared to the conventional two-implant overdenture.Materials and methodsPatients received new complete dentures and were randomly assigned to groups receiving one or two single-stage, early-loaded hydrophilic implants, inserted in the midline (n = 23), or the lateral incisor-canine area bilaterally (n = 24). Patient-reported postoperative symptoms were measured in a 0–100 visual analogue scale concerning pain in the surgical area, pain when chewing, bleeding, swelling, and unpleasantness. Data collection occurred 24 h and 7 and 21 days after surgery. Demographic and clinical features (smoking habit, classification of the residual ridges, and mucosal width and thickness at the implant sites), osteotomy for alveolar bone reduction, and surgery time were tested as predictors of symptom levels.ResultsOverall reported symptoms were mild and self-limited, with high rates of complete remission after the early loading period of 3 weeks. Progressive improvement of symptoms occurred from the 24-h to the 7-day and 21-day follow-ups (p < 0.001), similarly in both groups. None of the clinical predictors was significantly associated with the changes in symptoms.ConclusionsFindings suggest that the insertion of one or two implants may result in similar postoperative outcomes.Clinical relevanceThe severity of short-term postoperative symptoms may not be a critical factor for the decision between overdenture treatment with one or two implants.

Environmental and individual exposure to secondhand aerosol of electronic cigarettes in confined spaces: Results from the TackSHS Project†.

Secondhand electronic cigarette (e-cigarette) aerosol (SHA) might impair indoor air quality and expose bystanders. This study aims to investigate exposure to SHA in controlled conditions of enclosed settings simulating real-world scenario. An experiment was performed in a car and in a room, in which SHA was generated during a 30-minute ad libitum use of an e-cigarette. The experiment was replicated on five consecutive days in each setting. We measured PM2.5 , airborne nicotine concentrations, and biomarkers of exposure to SHA, such as nicotine metabolites, tobacco-specific nitrosamines, propylene glycol, and glycerol in bystanders' saliva samples before, during, and after the exposure period. Self-reported health symptoms related to exposure to SHA were also recorded. The results showed that the highest median PM2.5 concentration was recorded during the exposure period, being 21µg/m3 in the room setting and 16µg/m3 in the car setting-about twofold increase compared to the baseline. Most concentrations of the airborne nicotine and all biomarkers were below the limit of quantification in both settings. Bystanders in both settings experienced some short-term irritation symptoms, expressed as dry throat, nose, eyes, and phlegm. In conclusion, short-term use of an e-cigarette in confined spaces increased indoor PM2.5 level and caused some irritation symptoms in bystanders.

The efficacy of Personalized Normative Feedback interventions across addictions: A systematic review and meta-analysis.

Personalized Normative Feedback (PNF) may help address addictive disorders. PNF highlights discrepancies between perceived and actual peer norms, juxtaposed against self-reported behavior. PNF can be self-directed and cost-efficient. Our study estimates the efficacy of PNF alone, and in combination with other self-directed interventions, to address frequency and symptom severity of hazardous alcohol use, problem gambling, illicit drug and tobacco use. We searched electronic databases, grey literature, and reference lists of included articles, for randomized controlled trials published in English (January 2000-August 2019). We assessed study quality using the Cochrane Risk of Bias tool. Thirty-four studies met inclusion criteria (k = 28 alcohol, k = 3 gambling, k = 3 cannabis, k = 0 tobacco). Thirty studies provided suitable data for meta-analyses. PNF alone, and with additional interventions, reduced short-term alcohol frequency and symptom severity. PNF with additional interventions reduced short-term gambling symptom severity. Effect sizes were small. PNF did not alter illicit drug use. Findings highlight the efficacy of PNF to address alcohol frequency and symptom severity. The limited number of studies suggest further research is needed to ascertain the efficacy of PNF for gambling and illicit drug use. Cost-effectiveness analyses are required to determine the scale of PNF needed to justify its use in various settings.

Prediction of drop-out and functional impairment in recent-onset schizophrenia spectrum disorders

Persistent negative symptoms are associated with worse outcome in both first-episode and chronic subjects with schizophrenia. The identification of these symptoms in recent-onset subjects is still controversial as retrospective data are often unavailable. The prospective assessment of persistence of negative symptoms might represent a valid alternative but the length of the persistence is still to be established. The present study investigated the prevalence of negative symptoms of moderate severity, unconfounded by depression and extrapyramidal symptoms at baseline in a large cohort of patients in the early stage of a schizophrenia-spectrum disorder, recruited to the OPTiMiSE trial. Persistent unconfounded negative symptoms were assessed at 4, 10 and 22 weeks of treatment. Symptomatic remission, attrition rate and psychosocial functioning was evaluated in subjects with short-term (4 weeks) persistent negative symptoms (PNS) and in those with negative symptoms that did not persist at follow-up and/or were confounded at baseline (N-PNS). Negative symptoms of moderate severity were observed in 59% of subjects at baseline and were associated to worse global functioning. PNS were observed in 7.9% of the cohort, unconfounded at both baseline and end of 4-week treatment. PNS subjects showed lower remission and higher attrition rates at the end of all treatment phases. Fifty-six percent of subjects completing phase 3 (clozapine treatment) had PNS, and 60% of them were non-remitters at the end of this phase. The presence of short-term PNS during the first phases of psychosis was associated with poor clinical outcome and resistance to antipsychotic treatment, including clozapine.DisclosureProf Mucci has been a consultant and/or advisor to or has received honoraria from Gedeon Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer and Pierre Fabre.

Opioid withdrawal behavior in spiny mice: A novel preclinical model of neonatal opioid withdrawal syndrome (NOWS)

As the opioid epidemic continues to grow, opioid use among pregnant women is increasing significantly. This has led to a steady rise in the number of infants born with neonatal opioid withdrawal syndrome (NOWS). Although short-term withdrawal symptoms associated with NOWS are well characterized, there are many gaps in our understanding of the short and long-term effects of prenatal opioid exposure. Current animal models of NOWS are limited by shortened gestational periods, large litter sizes, and primary organogenesis occurring after birth. This often leads to postnatal treatment to mimic drug exposure during third-trimester development. Using the unique rodent species Acomys cahirinus, more commonly known as spiny mice, which have an extended 40-day gestation period, small litter sizes, and increased in utero organogenesis we aim to study the short-term effects of prenatal morphine exposure by assessing withdrawal behavior. To model maternal opioid use, dams were treated daily with morphine (10 and 30 mg/kg S.C.) beginning on gestation day 19 until the day of birth; this resulted in a cumulative exposure of 19–21 days. Withdrawal behaviors for each pup were recorded daily between postnatal days 0–7 (PND 0–7). Our study found that prenatal morphine exposure in spiny mice led to an increase in withdrawal behavior throughout the early postnatal period and validated the use of this species as a novel pre-clinical model of NOWS. We are hopeful this rodent model will further our understanding of the short and long-term consequences of prenatal opioid exposure on neurodevelopment and behavior.

Psychotherapies for neurocognitive disorder due to alzheimer’s disease- the current level of evidence

IntroductionPsychosocial interventions for Alzheimer’s dementia (AD) may increase patients quality of life and overall functioning, while it decreases caregivers burden. Therefore psychotherapies represent an important component of the case management, beside pharmacological approaches.ObjectivesTo review the current psychotherapeutic options available for patients diagnosed with AD, that may be added to their ongoing pharmacological treatment.MethodsA literature review was conducted through main electronic databases, and papers published between January 2000 and August 2020 were included in the analysis.ResultsCognitive stimulation therapy is based on general cognitive abilities training, with an accent over the social interaction, and it has been associated with significant improvement when compared to wait list or standard care. Reminiscence therapy, usually administered in a group format, focuses on past experinces, triggered by photos, newspaper fragments, music tunes etc., and according to a meta-analysis it may increase communicational, cognitive, and affective abilities. Validation therapy is based on a very empathic communication and tries to acknowledge patients perspective over the world, but the data to support its efficacy is limited for AD. Multisensorial stimulation is based on the assumption that stimuli deprivation is involved in the onset of anxiety, restlessness, insomnia etc, and may lead to short-term non-cognitive symptoms. Music therapy, art therapy, and animal-assisted therapy are also indicated, but more trials are needed to confirm their efficacy.ConclusionsA large number of psychotherapeutic interventions are explored for AD patients, but most of them have low levels of evidence.

Protocol for a pilot single-centre, parallel-arm, randomised controlled trial of dietary inulin to improve gut health in solid organ transplantation: the DIGEST study

IntroductionKidney transplantation remains the best treatment for end-stage kidney disease, however the requirement for indefinite immunosuppression increases the risk of cardiovascular disease, cancer and infection, leading to a reduction in...

The relationship between comorbid overweight-obesity and cold executive functions, verbal short-term memory, and learning in attention deficit hyperactivity disorder

IntroductionAttention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. ADHD is a risk factor for the development of overweight and obesity. One neuropsychological factor that may play a prominent role in the relationship between ADHD and obesity is executive functioning.ObjectivesThe aim of this study is to investigate the relationship between comorbid obesity/overweight and cold executive functions, verbal short-term memory, and learning in children with ADHD. This is the first study to examine relationship between verbal short-term memory-learning and obesity in patients with ADHD.MethodsThis study was conducted with 70 patients with ADHD and 30 healthy controls. In this study, patients diagnosed with ADHD were divided into two groups according to body mass index (BMI) as &lt;85 percentile and ≥85 percentile. Cold executive functions were evaluated by Stroop Test (ST) and Cancellation Test (CT). Serial Digit Learning Test (SDLT) was administered to measure verbal short-term memory and learning capasity. In order to evaluate the severity of ADHD objectively, parents completed the Conners’ Parents Rating Scale-Revised Short Version (CPRS-RS).ResultsThe ST, SDLT and CT scores were significantly lower in both groups with ADHD than the control group. The CPRS-RS subscale scores were significantly higher in both groups with ADHD than the control group. There was no statistically significant difference in ST, SDLT, CT scores and CPRS-RS subscale scores between the two groups with ADHD.ConclusionsThis study show that overweight/obesity comorbid with ADHD was not associated with cold executive functions, verbal short-term memory, learning, or ADHD symptom severity.DisclosureNo significant relationships.

A case series: xiphoidectomy for xiphodynia, a rare thoracic wall disorder

BackgroundXiphodynia is a rare musculoskeletal disorder characterized by pain at the lower anterior chest or epigastric region. Treatment options include oral analgesics, local injection with analgesic or laser therapy. Yet, these often provide only short-term symptom relieve. A definite reduction in pain sensation might be achieved by performing a xiphoidectomy, though studies on its safety and efficacy are scarce. In the current single-centre study the outcomes of xiphoidectomy for xiphodynia are retrospectively assessed.MethodsAll patients undergoing xiphoidectomy for xiphodynia between April 2013 and February 2020 at Zuyderland Medical Centre, Heerlen, the Netherlands, were included in this case series. Pain scores using the Numeric Rating Scale were assessed preoperatively and postoperatively and submitted to the Wilcoxon signed rank test. A clinically significant improvement was defined as a 2-point decrease in Numeric Rating Scale score. In addition, surgical outcomes, including complications and duration of surgery were extracted from the patient records.ResultsA total of 19 patients underwent xiphoidectomy for xiphodynia. The follow-up ranged from 1 to 83 months. Seventeen out of 19 patients showed a clinically relevant improvement in Numeric Rating Scale pain scores where the overall pain scores also revealed a statistically significant decrease from 8 (interquartile range, 7–8) to 0 (interquartile range, 0–0; P<0.001) after surgery. Median procedure time was 29 minutes (interquartile range, 24–38 minutes) and no postoperative complications occurred.ConclusionsXiphoidectomy for xiphodynia is a safe and effective surgical procedure with good outcomes on pain relief. Though, future comparative studies are urged to elucidate its value among other treatment options.