Shorter Duration Of Illness Research Articles

Clinical Characteristics, and Antibiotic Effectiveness in the First 48 Hours in Children Under 5 Years of Age with Bacterial Dysentery

Background: Bacterial dysentery is diarrhea with blood (plus or minus mucus), indicating an invasive infection. With effective antibiotic treatment, clinical improvement occurs within 48 hours, which leads to a reduction in the risk of serious complications and death, a shorter duration of illness, and a reduction in transmission. This study was conducted to investigate the clinical features, risk factors, and effectiveness of antibiotics in the first 48 hours in children under 5 years old with bacterial dysentery. Method: In this cross-sectional descriptive-analytical study, children less than 5 years old with bacterial dysentery were hospitalized in Ali Ibn Abitaleb and Ali Asghar Hospital in Zahedan, Iran. After obtaining the necessary permits from the ethics committee, the researcher extracted the information on 85 cases of patients diagnosed with bacterial dysentery, taking into account the entry and exit criteria in an accessible way. The information was entered into the questionnaire. Results: The mean age of the patients was 31.17±16.04 months. 52.9% of patients were girls (n=45). Fever was observed in 100% of patients(n=85). The severity of mild, moderate, and severe dehydration was observed in 36.47%, 40%, and 25.53% of the patients, respectively. The most injected antibiotic was ceftriaxone. White blood cell (WBC) levels decreased significantly after receiving treatment (antibiotic). (before treatment: 13.22±9.91 and after treatment: 8.57±2.71 cells/microliter, P-value=0.001). Conclusion: Our study showed that antibiotic treatment in bacterial dysentery effectively reduces the serum level of WBC. It is suggested that educational programs for mothers in the field of child nutrition be provided and that the effectiveness of different types of antibiotics be compared in future studies.

Efficacy of Horticultural Therapy on Positive, Negative, and Affective Symptoms in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background/Objectives: Positive symptoms, negative symptoms, and emotional disturbances are core features of schizophrenia. Although horticultural therapy (HT) has shown promise as an adjunctive treatment, evidence supporting its effectiveness remains limited. This systematic review and meta-analysis aimed to assess the impact of HT on total symptoms, positive symptoms, negative symptoms, and emotional disturbances in individuals with schizophrenia. Methods: We conducted a search for randomized controlled trials (RCTs) published up to March 2024 across multiple databases, including PubMed, Embase, Cochrane Library, CINAHL, CEPS, CNKI, Wanfang, and Yiigle. A random-effects model was employed to calculate the standardized mean difference (SMD). Results: A total of 35 studies enrolling 2899 participants were included. Our results indicated that, in the short term (≦3 months), HT has moderate to large effect sizes on total symptoms (SMD = 0.690, 95% CI 0.463 to 0.916), positive symptoms (SMD = 0.695, 95% CI 0.038 to 1.351), negative symptoms (SMD = 0.681, 95% CI 0.395 to 0.967), depression (SMD = 0.646, 95% CI 0.334 to 0.959), and anxiety (SMD = 0.627, 95% CI 0.364 to 0.890), with more pronounced benefits for anxiety symptoms in patients with a shorter duration of illness. In the long term (>3 months), HT shows large effect sizes for total symptoms (SMD = 1.393, 95% CI 0.858 to 1.928), negative symptoms (SMD = 1.389, 95% CI 0.935 to 1.842), anxiety (SMD = 1.541, 95% CI 1.042 to 2.040), and moderate to large effect sizes for positive symptoms (SMD = 0.667, 95% CI 0.077 to 1.258) and depression (SMD = 0.707, 95% CI 0.198 to 1.217). Additionally, longer weekly treatment durations are associated with better outcomes for total symptoms and negative symptoms. Schizophrenia patients with more severe initial symptoms may be potential responders to HT. Conclusions: These findings support the efficacy of HT in improving symptoms and emotional well-being in schizophrenia patients. Further trials with more rigorous designs are warranted to confirm these benefits.

Comparative study on sexual dysfunction in alopecia areata: prevalence and associated factors.

Alopecia areata (AA) impairs quality of life. However, there is no evidence on the impact of this disease in terms of sexual dysfunction (SD). The aim of the present study was to assess the prevalence of SD and possible associated factors in a cohort of patients with AA. A cross-sectional study was conducted in a cohort of AA patients matched with healthy controls. Sexual function was assessed using a numerical scale and gender-specific questionnaires. A total of 60 patients with AA and 60 healthy controls were included. The prevalence of SD was higher in women with AA than in healthy controls and in men with AA (p<0.05). Female SD was associated with younger age, shorter duration of illness and higher rates of anxiety and depression (p<0.05). Male SD was associated with older age and greater severity of AA (p<0.05). Women with AA appear to have higher rates of SD than healthy controls and men with AA. Similarly, the factors associated with SD differ between men and women, with mood disturbance being of greater relevance in women, whereas disease severity seems to play a key role in men.

Cognitive assessment of a sample of Egyptian patients with amyotrophic lateral sclerosis

BackgroundCognitive and behavioral changes in ALS are featured as an integral part of the disease. A noticeable proportion of ALS patients present with a full-blown picture of frontotemporal dementia, which is considered the most common form of cognitive impairment in ALS.ResultsA total of 30 ALS cases and 30 sex, age and education matched healthy controls were enrolled; their sociodemographic data were statistically insignificant as regards (age, sex, education). Regarding cognitive and behavioral assessment using the ECAS-EG, both ECAS mean total score and subdomains mean scores were significantly lower in ALS patients compared to controls (p-value < 0.001), with statistically significant relation between ALS clinical staging and ECAS total scores (p-value < 0.001). Furthermore, it was found that mean scores of nearly all ECAS domains are lower in early-onset group with longer duration of illness than late onset with short duration of illness but with a non-statistically significant difference.ConclusionALS causes significant cognitive impairment, with relation between functional status and clinical staging of the disease with the severity of cognitive and behavioral dysfunctions and although early-onset cases had lower score on ECAS compared to those with late onset, but it was non-significant.

Underreporting of Cases in the COVID-19 Outbreak of Borriana (Spain) during Mass Gathering Events in March 2020: A Cross-Sectional Study.

Determining the number of cases of an epidemic is the first function of epidemiological surveillance. An important underreporting of cases was observed in many locations during the first wave of the COVID-19 pandemic. To estimate this underreporting in the COVID-19 outbreak of Borriana (Valencia Community, Spain) in March 2020, a cross-sectional study was performed in June 2020 querying the public health register. Logistic regression models were used. Of a total of 468 symptomatic COVID-19 cases diagnosed in the outbreak through anti-SARS-CoV-2 serology, 36 cases were reported (7.7%), resulting in an underreporting proportion of 92.3% (95% confidence interval [CI], 89.5-94.6%), with 13 unreported cases for every reported case. Only positive SARS-CoV-2 polymerase chain reaction cases were predominantly reported due to a limited testing capacity and following a national protocol. Significant factors associated with underreporting included no medical assistance for COVID-19 disease, with an adjusted odds ratio [aOR] of 10.83 (95% CI 2.49-47.11); no chronic illness, aOR = 2.81 (95% CI 1.28-6.17); middle and lower social classes, aOR = 3.12 (95% CI 1.42-6.85); younger age, aOR = 0.97 (95% CI 0.94-0.99); and a shorter duration of illness, aOR = 0.98 (95% CI 0.97-0.99). To improve the surveillance of future epidemics, new approaches are recommended.

Exploring the ‘Rare’: A Comprehensive Analysis of the Rare Malignant Cervical Tumors in a Tertiary Cancer Care Institute of Northeast India

IntroductionThe WHO 2020 classification of tumors of the female genital tract has adopted the dualistic classification of cervical squamous and adenocarcinoma into HPV–HPV-associated and HPV–HPV-independent types. However, the separate discussion on 'rare' varieties of cervical cancer is significant as it allows us to delve into their risk factors and natural course of disease and define any alternative treatment strategies to improve outcomes.ObjectivesTo estimate the factors associated with histologically proven rare malignant tumors of the cervix and the overall survival of rare malignant cervical tumors in a tertiary care institute of Northeast India (NEI).MethodsOur tertiary care institute in Northeast India, a region with unique healthcare challenges, including a high incidence of cervical cancers, conducted this retrospective study from 01/01/2018 to 31/12/2022. It excluded patients with incomplete records, squamous and adenocarcinoma histology, and metastatic cancer to the cervix. We collected demographic and survival data and performed survival analysis using SPSS 29.0.ResultsOut of 2367 diagnosed cervical cancer patients, 45 patients (1.9%) were diagnosed with rare cancer. Adenosquamous (0.7%) was the leading histology, followed by small cell NET (0.59%) and clear cell carcinoma (0.33%) in rare cervical cancer. Bleeding per vaginum was the presenting symptom in 91%. More than 80% of patients had a short duration of illness (< 6 months). Stage III (42%), followed by Stage II (27%), Stage IV (21%), and Stage I (10%) were presenting stages. A final diagnosis in 72% of histology required immunohistochemistry (IHC). Most of the patient (65%) did not complete their treatment.ConclusionThis study's findings underscore the need for collective efforts in studying rare cancers, which can significantly enhance treatment strategies and improve the overall prognosis and quality of life for individuals affected.

Pediatric Respiratory Infections ‎After the COVID-19 Pandemic: A Single-Center Experience.

Background Pediatric respiratory infections, mainly bronchiolitis, are a substantial clinical burden. The most common etiology is respiratory syncytial virus (RSV). Other viruses include human rhinovirus, human metapneumovirus, influenza, adenovirus, coronavirus, and parainfluenza viruses. Objective We aimed to study the epidemiology and clinical characteristics of children with confirmed viral bronchiolitis and flu after the COVID-19 pandemic season and compare the behavior of each virus. Methods This retrospective observation study was done over seven months, from October 2022 to April 2023. All children (0-14) were included in the study if they met the clinical diagnosis of bronchiolitis or flu. Viral etiology is confirmed by PCR, using the respiratory panel available in our center which included the detection of four viruses: COVID-19, RSV, influenza A, and B. Clinical data, lab results, and X-rays were collected and correlated with each viral infection for all admitted patients. Results We recruited 237 children with bronchiolitis and flu symptoms from October 2022 to April 2023. The peak of infections (41%) was in November. Seasonal variations for each virus showed distinct patterns across the year. RSV peaked at the beginning of the season, gradually declining after that. In contrast, influenza A and B maintained a relatively consistent presence throughout the season. Meanwhile, COVID-19 reached its peak during March and April. One hundred forty-four (60%) of the patients were under two years of age. RSV was predominant in 150 patients (63.3%). COVID-19 was only detected in 25 patients (10%), whereas influenza A and B were equally isolated in 31 (13%) patients each. Fifty-one children (21%) were initially sick and required pediatric intensive care unit (PICU) admission, with no deaths reported. Notably, COVID-19 had a milder disease course, a shorter length of stay (LOS) in the hospital (two days) and a shorter duration of illness (five days) compared to other viruses. RSV infection was linked to more profound hypoxia and more sick children with more extended hospital stays. Conclusion Our study showed that, following the pandemic and the release of lockdown measures, there was another peak of upper respiratory tract infections (URTI) and flu, which was more aggressive, primarily due to other viruses, especially RSV. This resurgence was associated with more severe respiratory symptoms and an increased need for hospitalization. Notably, children with COVID-19 were in better condition compared to those with RSV.

Creutzfeldt-Jakob Disease and Fatal Familial Insomnia: Demographics and In-Hospital Mortality in Spain.

Background: Creutzfeldt-Jakob disease (CJD) and fatal familial insomnia (FFI) are prion diseases characterized by severe neurodegenerative conditions and a short duration of illness. Methods: This study explores the characteristics of hospitalizations for CJD and FFI in Spain from 2016 to 2022 using the Spanish National Hospital Discharge Database (SNHDD). Results: We identified a total of 1063 hospital discharges, including 1020 for CJD and 43 for FFI. Notably, the number of hospitalized patients with FFI showed a significant peak in 2017. The average length of hospital stay (LOHS) was 13 days for CJD and 6 days for FFI, with in-hospital mortality rates (IHM) of 36.37% for CJD and 32.56% for FFI. Among CJD patients, the average LOHS was 14 days, with a significantly longer duration for those who experienced IHM. Conclusions: The presence of sepsis or pneumonia and older age were associated with a higher IHM rate among CJD patients. The total estimated cost for managing CJD and FFI patients over the study period was EUR 6,346,868. This study offers new insights into the epidemiology and healthcare resource utilization of CJD and FFI patients, which may inform future research directions and public health strategies.

Outcome of Guillain-Barré syndrome with bulbar palsy

BackgroundElective intubation is advocated in Guillain-Barré syndrome (GBS) with bulbar palsy to prevent aspiration pneumonia and lung collapse. We evaluate the outcome of GBS patients with bulbar palsy, and also compare the risks and benefits of intubation and MV in them. Methods187 GBS patients with bulbar palsy from a cohort of 547 GBS registry were analyzed. Detailed clinical records and peak disability on a 0-6 GBS Disability Scale (GBSDS) were noted. The patients were intubated if arterial blood gas (ABG) analysis revealed hypoxia, hypercarbia or acidosis. The patients with normal ABG parameters were fed by nasogastric tube, and nursed in lateral position. Occurrence of pneumonia, in-hospital death and outcomes at 6-months were classified as complete (GBSDS <2), partial (GBSDS 2-3) and poor (GBSDS >3). Results76/187(40.6%) patients required MV, and they had a shorter duration of illness (p = 0.007), higher peak disability (p < 0.001), autonomic dysfunction (p < 0.001) and more frequently received IVIg (p = 0.02). Pneumonia (63% vs 10.8%; p < 0.001) and in-hospital deaths (7.9% vs 1.8%; p = 0.06) were more frequent in MV group compared to nasogastric fed group. At 6-months,104 (55.6%) patients recovered completely. On multivariate analysis, the independent predictors of poor outcome were peak disability [Adjusted Odds Ratio (AOR) 9.84, 95% Confidence Interval (CI) 3.15-30.74, p < 0.0001], day of hospitalization from disease onset (AOR 1.09, 95% Cl 1.01-1.01; p=0.009) and requirement of MV (AOR 0.10; 95% 0.02-0.50; p = 0.005). ConclusionGBS patients with bulbar palsy may be managed by nasogastric feeding and nursing in lateral position without increasing the risk of pneumonia. Mechanical ventilation based on ABG does not worsen outcomes of GBS with bulbar palsy.

A novel model of ambulatory teaching of residents in general practice in China: a cross-sectional study

BackgroundThis study aims to determine the satisfaction and future training needs of general practice residents participating in a novel model of ambulatory teaching aligned with the specifications for standardized residency training in outpatient management issued by the Chinese Medical Doctor Association (CMDA).MethodsA cross-sectional survey of the satisfaction and training needs was conducted among general practice residents at West China Hospital, Sichuan University. Patient characteristics and preceptors’ feedback on the residents’ performance were also analyzed.ResultsThe study involved 109 residents (30.28% men) and 161 patients (34.78% men; age: 52.63 ± 15.87 years). Residents reported an overall satisfaction score of 4.28 ± 0.62 with the ambulatory teaching program. Notably, residents scored lower in the Subjective-Objective-Assessment-Plan (SOAP) evaluation when encountering patients with the greater the number of medical problems (P < 0.001). Residents encountering patients with a shorter duration of illness (< 3 months) achieved higher scores than those with longer illness durations (≥ 3 months, P = 0.044). Residency general practitioners (GPs) were most challenged by applying appropriate and effective patient referrals (43/109; 39.45%). GPs expressed a strong desire to learn how to make decisions when facing challenging patient situations (4.51 ± 0.63).ConclusionThis study suggests selecting patients with multiple comorbidities for ambulatory teaching and enhancing training on practical problem-solving abilities for GPs. The findings provide insights for the development of future ambulatory teaching programs.

Impacts of COVID-19 vaccine boosters on clinical outcomes associated with the Omicron variant in China: A cross-sectional survey

ObjectiveTo investigate the real-world effectiveness of COVID-19 vaccine boosters during China’s Omicron wave. MethodsIn January 2023, we surveyed Shenzhen, China residents via online questionnaires to investigate their COVID-19 symptoms and vaccination history. The outcomes of interest included fever, other COVID-19-related symptoms, severity of symptoms, whether early onset (before December 23, 2022) and duration. Respondents were categorized as no booster, one booster 6mo ago, one booster within 6mo, or two boosters based on dose count and vaccination timing. We used multivariable logistic regressions and Tobit models to assess COVID-19 vaccine booster impacts. ResultsCompared to the no booster group, two booster recipients had a lower fever risk (OR = 0.35, 95 %CI = 0.16–0.76) but not lower risks of COVID-19-related symptoms (OR = 0.74, 95 %CI = 0.26–2.06) and self-reported severe symptoms (OR = 0.47, 95 %CI = 0.19–1.15). Nor did the two booster recipients had a shorter illness duration (marginal effect = -0.79 days, 95 %CI = -1.65–0.07) and a lower risk of symptom onset delay (OR = 0.48, 95 %CI = 0.19–1.23). Compared to the no booster group, both one booster within six months (OR = 2.17, 95 %CI = 1.34–3.52) and one booster six months ago (OR = 1.30, 95 %CI = 0.92–1.82) did not reduce the risks of fever and symptoms (one booster within six months: OR = 1.57, 95 %CI = 0.84–2.90; one booster six months ago: OR = 1.23, 95 %CI = 0.79–1.93). Regardless of timing, one booster did not reduce illness duration (within six months: marginal effect = 0.25 days, 95 %CI = -0.20–0.70; six months ago: marginal effect = 0.27 days, 95 %CI = -0.08–0.62). However, receiving one booster within six months delayed symptom onset (OR = 0.54, 95 %CI = 0.34–0.86), while one booster six months ago did not (OR = 1.03, 95 %CI = 0.74–1.44). ConclusionsReceiving two booster doses reduced the onset of fever during the Omicron outbreak in mainland China.

Role of parental educational level as psychosocial factor in a sample of inpatients with anorexia nervosa and bulimia nervosa.

Evidence on parental educational level (PEL) as a risk factor for Eating Disorders (EDs) is mixed, and no study has assessed its role in relation to the compliance and outcomes of treatments in EDs. Further, no study differentiated from the educational level of mothers and fathers, nor considered the possible mediation of perfectionism in fostering EDs. A clinical sample of 242 first-ever admitted inpatients with EDs provided information on PEL and completed the following questionnaires: the Eating Disorder Examination Questionnaire (EDE-Q) and the Frost Multidimensional Perfectionism Scale (F-MPS). Clinicians also provided information on the Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D) for each participant. Individuals with high PEL (whether mothers, fathers, or both parents) showed significantly higher scores on depressive symptoms and lower on parental criticism, were younger, had an earlier age of onset, had fewer years of illness, more were students and employed, and fewer had offspring. Individuals with fathers or both parents with high educational levels suffered more from Anorexia Nervosa rather than Bulimia Nervosa, had a longer length of stay during the current hospitalization, had less dietary restraint, and had higher personal standards. Individuals with mothers with high educational levels showed a lower rate of previous substance or alcohol addiction. Personal standards partially mediated the relationship between higher PEL and lower dietary restraint. PEL emerged to be a twofold psychosocial risk factor, being associated with higher depressive symptoms and a longer length of stay, but also with a shorter duration of illness and better scholar and working involvement. Higher PEL was related to higher personal standards but not to global perfectionism. Patterns of eating psychopathology emerged based on the high PEL of mothers or fathers.

Predicting cerebral infarction in tuberculous meningitis and its prognostic significance.

Aim: Tuberculous meningitis (TBM) often causes cerebral infarction, but its predictive factors are not well understood. Methods: Patients aged ≥13years admitted with TBM were enrolled prospectively. Cerebral infarction was diagnosed using magnetic resonance imaging. Results: Of 186 patients, 80 (43%) had infarction. Most infarctions were multiple and located in the cortical areas, basal ganglia and subcortical regions. Independent predictors of infarction at admission included high blood pressure, short illness duration, low Glasgow coma scale and hydrocephalus. Neuroimaging inflammation signs, cerebrospinal fluid analysis abnormalitiesand pre-existing cardiovascular risks did not predict infarction. In-hospital mortality was higher in TBM with infarction, particularly in those with advanced TBM (stage 3). Conclusion: Baseline parameters of raised intracranial pressure predict cerebral infarction in TBM.

Exploring starter typologies in a Turkish homicide offender sample with psychotic illness

ABSTRACT In this cross-sectional retrospective study comprising 124 Turkish homicide offenders with psychotic illness, we aimed to identify subgroups utilizing an age-at-onset framework and comparing these subgroups based on offender and offending characteristics. The sample was categorized into early starters (ES) and late starters (LS), and various variables were examined. Nearly one-third of the sample consisted of ES. According to univariate and multivariate analyses, ES exhibited a higher likelihood of prior offending and a shorter duration of illness until the index homicide compared to LS. Univariate analyses also indicated associations between being in the ES subgroup and lower education, presence of a personality disorder, a younger age at the first offense, and involving co-offenders during the index homicide. Moreover, late first offenders (LFO), constituting 13% of the entire sample, were identified within the LS subgroup and were associated with lower rates of personality disorders. Our results align with existing research, confirming conventional criminogenic needs specific to ES. Novel findings, along with some study results that did not reach statistical significance, may be unique to homicide offenders with psychosis. Further exploration of the applicability of age-at-onset typology in this specific group is warranted.

Physical activity and treatment adherence in patients with mental disorders: a randomized controlled trial

IntroductionLack of adherence to pharmacological treatment is considered a multifactorial phenomenon, remarkably frequent in clinical practice. Non-adherence is associated with increased number of relapses, poor clinical and functional outcomes, and worsening of patient health status, with a resulting increase in healthcare costs, particularly in people with severe mental disorders (SMD). Treatment adherence rates remain extremely low, highlighting the need to develop innovative and integrated strategies; one of these is represented by the promotion of healthy lifestyle behaviours, including regular physical activity.ObjectivesThe aim of this study is to assess how the rates of treatment adherence vary in patients with SMD after receiving a psychosocial intervention, focusing on the positive relationship between treatment adherence and physical activity.MethodsLIFESTYLE is a randomized controlled trial comparing the efficacy of a structured psychosocial lifestyle intervention involving moderate physical activity exercises over a brief psychoeducational intervention. Levels of physical activity was assessed thorough the IPAQ scale, while treatment adherence was evaluated by the Morisky Medication Adherence Scale (MMAS).ResultsThe sample includes 401 patients, with a mean duration of illness was 16.3 (±17.8) years. All patients were receiving a pharmacological drug treatment; in particular, 59.6% (N=239) were treated with a second-generation antipsychotic and 54.9% (N=220) with a mood stabilizer. Our results show that moderate physical activity improves rates of treatment adherence. After 6 months, adherence to treatment increased from 35.8% at baseline to 47.6% at baseline in the experimental group, along with improvement in clinical health parameters (reduction in BMI, weight, and metabolic parameters). Another significant inverse correlation was found between adherence and quality of life (Rho di Person: -.140, p&lt;.005). Furthermore, this study indicates that having a diagnosis of major depression, a better cognitive functioning, a shorter duration of illness and contact time with the local mental health centre are factors that positively influence treatment adherence. Remarkably, treatment adherence was not influenced by symptom severity and type of pharmacological treatment.ConclusionsModerate physical activity can represent a valid strategy to increase treatment adherence in patients with SMD. Therefore, promoting physical activity exercises in our clinical practice may be associated with better outcomes. However, further studies that evaluate patients with acute mental disorders are needed.Disclosure of InterestNone Declared

Which patients do we need to consider augmentation of muscle active potentials regarding transcranial electrical stimulation motor-evoked potentials monitoring before spine surgery?

BACKGROUND CONTEXTTranscranial electrical stimulation motor-evoked potentials (Tc-MEPs) are the current trend and are important in preventing intraoperative neurological deficits. Posttetanic Tc-MEPs (p-MEP) can augment the amplitudes of compound muscle active potentials (CMAPs), especially in the case of insufficient conventional Tc-MEPs (c-MEP). PURPOSETo retrospectively investigate pre- and intraoperative factors necessitating p-MEP monitoring and to examine changes in the success rates of baseline Tc-MEP monitoring before and after tetanic stimulation in patients with such factors. STUDY DESIGNRetrospective observational study. PATIENT SAMPLEPatients (n=184) who underwent spinal surgery with Tc-MEP monitoring in our department between August 2020 and July 2022. OUTCOME MEASURESManual muscle testing (MMT) scores were calculated to identify patients with preoperative motor deficits. c-MEP and p-MEP amplitudes were recorded from the defined muscles. METHODSWe compared preoperative and intraoperative factors between the c-MEP and p-MEP groups (study 1). In cases where the factors were identified, we investigated the success rate of the baseline MEP measurement of each muscle before and after tetanic stimulation (study 2). RESULTSOne hundred fifty-seven patients were included. Of those, 87 showed sufficient CMAPs with c-MEP. Meanwhile, 70 needed p-MEP because of insufficient CMAPs. In univariate analysis, cervical/thoracic surgery (p<.001), preoperative MMT 3 or below (p=.009), shorter duration of illness (p=.037), previous cerebrovascular disease (p=.014), and dialysis (p=.031) were significantly associated with p-MEP group. Preoperative MMT 3 or below was the only factor requiring p-MEP (odds ratio, 3.34; 95% confidence interval, 1.28-8.73, p=.014) in multivariate analysis. In the p-MEP group, 24 patients had preoperative motor deficits; 16 patients with complete data were included in the analysis (study 2). The success rates of MEP monitoring before and after tetanic stimulation of the entire lower-extremity muscles were 42.7 and 57.3%, respectively (p<.001). The success rates for each muscle before and after tetanic stimulation were abductor pollicis brevis: 81.3% and 96.9%, tibialis anterior: 34.4% and 50.0%, gastrocnemius: 25% and 40.6%, and abductor hallucis: 68.8% and 81.3%, respectively. No significant differences were observed in success rates for any of the muscles. CONCLUSIONSPatients with preoperative MMT 3 or below highly needed p-MEP. The success rate of baseline MEP monitoring increased with tetanic stimulation, even in patients with preoperative motor deficits. We believe that p-MEP monitoring can result in reliable CMAP recording, especially in cases of preoperative motor deficits with MMT scores of 3 or below.

Impact of Benzodiazepines and Illness Duration on Obsessive-Compulsive Disorder during COVID-19 in Italy: Exploring Symptoms' Evolutionary Benefits.

Obsessive-compulsive disorder (OCD) is believed to follow a waxing and waning course, often according to environmental stressors. During the COVID-19 pandemic, pre-existing OCD symptoms were reported to increase and to change from checking to washing behaviors, while new-onset symptoms were predominantly of the hoarding type. In the present study, we followed the evolution of OCD symptoms, anxiety, depression, and insights of illness in forty-six OCD patients throughout the pandemic. Clinical measures were collected at four different time points before and during the COVID-19 pandemic in Italy. Within-subject comparisons were used to compare clinical scale scores across time, and correlations were examined between patients' baseline characteristics and changes in clinical scores. We found that all clinical measures increased during the first Italian lockdown with respect to the pre-pandemic values. Anxiety decreased during the temporary elimination of restriction provisions, whereas the severity of OCD symptoms and insight returned to pre-pandemic values during the second mandatory lockdown. These results were observed only in two sub-groups of patients: those taking benzodiazepines and those with shorter illness duration. Our findings suggest the need for additional clinical attention to these specific sub-groups of OCD patients in case of particularly distressing circumstances while pointing to a possible adaptive role of their OCD symptoms when the environment requires a higher care of hygiene and an extraordinary supply of essential resources.

Immune and behavioral correlates of protection against symptomatic post-vaccination SARS-CoV-2 infection.

We sought to determine pre-infection correlates of protection against SARS-CoV-2 post-vaccine inzfections (PVI) acquired during the first Omicron wave in the United States. Serum and saliva samples from 176 vaccinated adults were collected from October to December of 2021, immediately before the Omicron wave, and assessed for SARS-CoV-2 Spike-specific IgG and IgA binding antibodies (bAb). Sera were also assessed for bAb using commercial assays, and for neutralization activity against several SARS-CoV-2 variants. PVI duration and severity, as well as risk and precautionary behaviors, were assessed by questionnaires. Serum anti-Spike IgG levels assessed by research assay, neutralization titers against Omicron subvariants, and low home risk scores correlated with protection against PVIs after multivariable regression analysis. Commercial assays did not perform as well as research assay, likely due to their lower dynamic range. In the 32 participants that developed PVI, anti-Spike IgG bAbs correlated with lower disease severity and shorter duration of illness.

Eating disorders and COVID-19 - different or just more?

BackgroundCOVID-19 saw an increase in child mental health presentations internationally. Clinicians analogised the exponential increase in anorexia nervosa to a ‘tsunami’ or ‘outbreak’, raising parallel concerns regarding medical and psychological risks (Marsh in The Guardian, 2021; Leask in NZ Herald, 2021; Monteleone et al. in Eat Weight Disord 26(8):2443–2452, 2021) . It is unclear whether Ireland emulated this picture of increased referrals with increased medical compromise.AimsThis paper examines both rates and clinical profiles of child eating disorder presentations in the Republic of Ireland (ROI), across different clinical settings.MethodsFollowing ethical approval, retrospective chart reviews were conducted in a community eating disorder service and in two paediatric hospital settings. The time frame of the different studies ranged from January 2016 to December 2022.ResultsCommunity eating disorder services saw significantly higher referral rates post COVID-19 (3.78/month vs. 2.31/month, p = 0.02), with a shorter duration of illness (4.8 months vs. 7.4 months, p = 0.001), but no significant difference in ideal body weight % (IBW%) at referral (85.32% vs. 83.7%, p = 0.1). Both paediatric hospitals witnessed significantly increased referrals post-COVID-19 (hospital 1; 4.38/month vs. 1.93/month, p = 0.0001; hospital 2; 2.8/month vs. 0.92/month, p < 0.0001), but no significant difference in IBW% at assessment (hospital 1; 82.7% vs. 81.39%, p = 0.673; hospital 2; 81.5% vs. 83%, p = 0.563). There was no significant difference in clinical profile, management, or duration of hospital stay.ConclusionsThis study supports the growing consensus of a pandemic specific increase in eating disorder referrals to both medical and psychiatry services. However, there was little to indicate a change in clinical profile or severity. Ongoing monitoring of referrals is necessary to ensure adequate service availability and expertise.

Illness duration and treatment outcome of intensive cognitive-behavioral therapy in adolescents with anorexia nervosa.

This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive-behavioral therapy (CBT-E) in patients aged between 12 and 18 years with anorexia nervosa with a duration of illness <3 versus ≥3 years. One hundred and fifty-nine consecutively treated patients (n = 122 with illness duration <3 years and n = 37 ≥ 3 years) were enrolled in a 20-week intensive CBT-E program. All patients underwent assessment at admission, end of treatment (EOT), and 20-week follow-up. The following measures were used: body mass index (BMI)-for-age percentile and percentage of expected body weight (EBW), Eating Disorder Examination Questionnaire, Brief Symptom Inventory, and Clinical Impairment Assessment. Approximately 81% of eligible patients began the program, with over 80% successfully completing it. Patients with a longer or shorter duration of illness did not show significantly different treatment outcomes. In detail, BMI-for-age percentile and percentage of EBW outcomes were significantly improved from baseline to EOT, remaining stable until 20-week follow-up in both groups. Similarly, in both groups, scores for eating disorder psychopathology, general psychopathology, and clinical impairment decreased significantly at EOT and remained stable from EOT to follow-up. Furthermore, a substantial percentage of adolescents in both groups achieved a good BMI outcome at EOT and 20-week follow-up, with approximately 60% maintaining a full response at the latter time point. These findings suggest that intensive CBT-E appears to be an effective treatment for severely ill adolescent patients with anorexia nervosa, regardless of whether the duration of illness is shorter or longer than 3 years. Existing treatment outcome studies in adolescents, whether randomized controlled trials or longitudinal investigations, typically involve patients with less than 3 years of illness, while data on the treatment outcomes for adolescents with anorexia nervosa with an illness duration of 3 years or over is very limited. Our findings suggest that adolescents with anorexia nervosa, irrespective of the duration of their illness, can derive similar benefits from intensively CBT-E.