Symptom Criteria Research Articles

Prevalence of Posttraumatic Stress Disorder and Depression Among Internally Displaced Persons in Mogadishu-Somalia.

Nearly 2.6 million people have been forced into displacement camps in Somalia as a result of frequent conflicts exacerbated by climate change disasters. Although the psychological impact of war and natural disasters is well documented elsewhere, little is known about the unseen scars of psychological trauma among internally displaced persons (IDPs) in Somalia. This study was carried out between January and February 2021 and sought to determine the prevalence of post-traumatic stress disorder (PTSD) and depression among IDPs and examine the association between displacement and these psychiatric conditions. A cross-sectional quantitative study was conducted among 401 IDPs in Mogadishu. The Harvard Trauma Questionnaire was used to determine the levels of trauma exposure and PTSD, and Hopkins Symptom Checklist-25 was used to estimate the prevalence of depression. Multivariate and bivariate analyses were performed to analyze the association between demographic and displacement variables and the outcomes of PTSD and depression. More than half (59%) of participants met the symptom criteria of depression, and nearly a third (32%) of respondents met the symptom criteria for PTSD. The most prevalent traumatic event was a lack of food or water (80.2%). Important predictive factors for the development of psychiatric morbidity were unemployment, cumulative traumatic exposure, and frequency and duration of displacement. The study revealed high levels of depressive disorder and PTSD among IDPs in Mogadishu. Furthermore, this study provided evidence of IDPs' susceptibility to trauma exposure and lack of essential services and goods. The study highlighted the importance of the provision of Mental Health and Psychosocial Support (MHPSS) services in IDP camps.

Non-Cardiac Chest Pain as a Persistent Physical Symptom: Psychological Distress and Workability.

Non-Cardiac Chest Pain (NCCP) is persistent chest pain in the absence of identifiable cardiac pathology. Some NCCP cases meet criteria for Persistent Physical Symptoms (PPS), where the symptoms are both persistent and distressing/disabling. This study aimed to identify patients that might need specialist treatment for PPS by examining cases of NCCP that meet PPS criteria. We analysed data from 285 chest pain patients that had received an NCCP diagnosis after attending an emergency cardiac department. We compared NCCP patients who did and did not meet the additional criteria for heart-related PPS and hypothesised that the groups would differ in terms of psychological variables and workability. We determined that NCCP patients who meet PPS criteria were more likely than other NCCP patients to be inactive or unable to work, reported more general anxiety and anxiety about their health, were more depressed, ruminated more, and, importantly, had a higher number of other PPS. A high proportion of NCCP patients meet PPS criteria, and they are similar to other PPS patients in terms of comorbidity and disability. This highlights the importance of focusing psychological interventions for this subgroup on the interplay between the range of physical and psychological symptoms present.

Testing the Arabic-Saudi Arabia version of the Rome IV Diagnostic Questionnaire for functional gastrointestinal disorders for Children living in Saudi Arabia.

Functional gastrointestinal disorders (FGID) are a worldwide phenomenon described by painful, recurrent or chronic gastrointestinal (GI) symptoms. Variable types of FGID exist in a significant portion of children in Saudi Arabia (SA). While the studies and reports on child FGID are limited, the available ones show a notable significance of FGID in children in SA. The self-report Rome IV Diagnostic Questionnaire (DQ) globally recognizes the selection of symptom criteria and incidence thresholds. Using such a questionnaire would help clinicians provide a provisional diagnosis, serve as a case definition for epidemiological surveys, and identify inclusion criteria for clinical trials. This research aimed to pilot test the collective FGIDs prevalence among preschool children in Jeddah city and its countryside of Saudi Arabia, using Rome IV DQ in Arabic-SA. Of the 59 responses, 11.8% (n = 7), 5% (n = 3), 1 (1.6%), and 1 (1.6%) participants have functional dyspepsia, functional constipation, functional irritable bowel syndrome, and functional aerophagia, respectively according to the Rome IV criteria. The tested translated DQ in this study was the first translated version available in Arabic- SA, which could provide researchers and clinicians in SA with a diagnostic tool for FGIDs. However, because this study is a pilot study in a new field, the conclusions cannot be extrapolated to the demographic of the targeted population of children. The same researchers plan a larger study to use the current results and a larger calculated sample to assess FGIDs prevalence in children 4+ years old in Jeddah and its countryside, Saudi Arabia.

Health-related quality of life and patient-reported symptoms after postoperative proton beam radiotherapy of cervical and endometrial cancer: 2-year results of the prospective phase II APROVE-trial

IntroductionThe APROVE-trial investigated the tolerability of postoperative proton beam therapy in women with cervical or endometrial cancer. The present analysis evaluated the secondary endpoints of health-related quality of life (HRQOL) and patient-reported symptoms.Methods25 patients were included in this prospective phase-II-trial and treated with postoperative radiotherapy using protons alone or in combination with chemotherapy. To attain general and gynecologic-specific HRQOL measures, the EORTC-QLQ-C30 questionnaires combined with -QLQ-CX24 for cervical and -QLQ-EN24 for endometrial cancer were assessed at baseline, at the end of RT and up to 2 years after radiotherapy. The results were compared to an age-matched norm reference population. Symptoms were assessed using Common Terminology Criteria for Adverse Events (CTCAE) and institutional patient-reported symptoms grading.ResultsScores regarding global health status were markedly impaired at baseline (mean: 58.0 ± 20.1) compared to reference population data, but significantly (p = 0.036) improved and evened out to comparable norm values 2 years after proton therapy (mean: 69.9 ± 19.3). Treatment caused acute and long-term worsening of pain (p = 0.048) and gastrointestinal symptoms (p = 0.016) for women with endometrial cancer, but no higher-grade CTCAE ≥ 3° toxicity was observed. Dosimetric evaluation of rectum, sigmoid, large and small bowel showed no correlation with the reported gastrointestinal symptoms. After 2 years, fatigue had significantly improved (p = 0.030), whereas patients with cervical cancer experienced more often lymphedema (p = 0.017). Scores for endometrial cancer pertaining to sexual activity (p = 0.048) and body image (p = 0.022) had improved post treatment; in the latter this effect persisted after 2 years.ConclusionProton beam therapy in the adjuvant setting was well tolerated with only low-grade side effects concerning gastrointestinal symptoms, lymphedema and pain. Overall quality of life was impaired at baseline, but patients were able to recover to values comparable to norm population 2 years after proton therapy. Larger studies are needed to confirm whether the benefit of proton therapy translates into a clinical effect. Sexual dysfunction remains an important issue.Trial registration: The trial was registered at https://clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT03184350, 09th June 2017).

Mental health symptoms and coping strategies among Ukrainians during the Russia-Ukraine war in March 2022.

The Russian attack on Ukraine has been ongoing since February 24, 2022. Nevertheless, no research has documented the mental health of Ukrainians during the biggest land war in Europe after the Second World War, or how Ukrainians cope with the impact of the war. To provide the prevalence rates of symptoms of psychological distress, anxiety, depression, and insomnia; and to link them with Ukrainians' productive coping strategies during the war. Online survey conducted in Ukraine during the initial period of the Russian invasion (March 19-31, 2022), using a quota sampling method, of 1,400 Ukrainians aged 18 years or older, with a total of 801 valid responses for a response rate of 57.2%. Psychological distress assessed by the Kessler Psychological Distress scale (K6); anxiety assessed by Generalized Anxiety Disorder-2 (GAD-2) scale; depression assessed by Patient Health Questionnaire-2 (PHQ-2); insomnia assessed by Insomnia Severity Index-4 (ISI-4); modes of coping assessed by Brief COPE. Of 801 Ukrainian adults, 52.7% had symptoms of psychological distress (mean = 13.3 [SD = 4.9]); 54.1% of them reported symptoms of anxiety (mean = 2.9 [SD = 1.7]); 46.8% reported symptoms of depression (mean = 2.6 [SD = 1.6]). Symptom criteria for insomnia were met by 97 respondents (12.1%) (mean = 10.4 [SD = 4.2]). Demographic variables (including gender, living in an urban area, having children or elderly persons in the household, living in an area occupied by Russian forces) were associated with symptoms of distress, anxiety, depression, and insomnia. The productive coping strategies of using instrumental support, behavioral disengagement, self-distraction, and planning were significantly associated with mental health symptoms. Prevalence rates of symptoms of psychological distress, anxiety, depression, and insomnia were high. These findings underscore the need for healthcare and productive coping strategies for Ukrainians during the war.

Полиэтиология низкочастотной сенсоневральной тугоухости

Despite the successes of modern medical science, a powerful arsenal of diagnostic techniques (including neurophysiological methods and neuroimaging), the diagnosis for cochleovestibular disorders usually depends on the personal experience of the doctor and is based on the results of a clinical examination and symptomatic criteria. Given the complexity of identifying idiopathic Meniere’s disease, this paper discusses a number of comorbid and conjugate conditions accompanied by low-frequency sensorineural hearing loss. Due to the variety of causes of the development of this type of hearing loss, emphasis is placed on the expediency of expanding the examination of patients in this category.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Social cognition deficits are associated with lower quality of life in cervical dystonia: A single centre study

Background and objectivesPatients with cervical dystonia (CD) demonstrate significant non-motor symptoms including sensory, psychiatric and cognitive features. It has been shown that the non-motor symptoms have a major influence on quality of life. Social cognition, particularly deficits in Theory of Mind (ToM), can affect the development of interpersonal relationships, understanding of social situations and can affect patient outcomes.We used the “Faux Pas” measure of social cognition to assess ToM in patients with CD and compared this with quality of life, disease severity and psychiatric symptoms. MethodsPatients with adult-onset idiopathic isolated cervical dystonia were assessed using the “Faux Pas” questionnaire. Validated questionnaires were used to assess mood symptoms (BAI/BDI and HADS) and quality of life (CDIP-58). Disease-specific disability, motor severity and psychosocial symptoms were measured using TWSTRS2. Faux pas results were compared with published healthy control values. Results32 participants (19 female) were included with a mean age of 57.7 years. 20 participants met criteria for excess mood symptoms (anxiety and/or depression). Mean CDIP-58 was 31.9. There was no relationship between faux pas outcomes and motor severity. However, correlation analyses showed that participants who performed worse on the faux pas questionnaire had lower quality of life. ConclusionThe non-motor symptoms, including social cognition, are often neglected. We have demonstrated that low quality of life in CD is associated with to abnormal social cognition. Clinicians should be mindful of these symptoms, particularly in patients reporting low treatment satisfaction.

Yoga Plus Mantram Repetition to Reduce Chronic Pain in Veterans With Post-Traumatic Stress Disorder: A Feasibility Trial.

Veterans with post-traumatic stress disorder (PTSD) are more likely to report chronic pain than veterans without PTSD. Yoga has been shown to reduce both chronic pain and PTSD symptoms in clinical trials. The goal of our study was to assess the feasibility and acceptability of conducting a randomized controlled trial (RCT) that combined yoga and mantram repetition (Yoga + MR) into one program for military veterans with both chronic pain and PTSD. In this feasibility RCT, 27 veterans were randomized to either Yoga + MR or a relaxation intervention. Due to the COVID-19 pandemic, in-person recruitment, assessments, and intervention attendance were re-evaluated. Although remote delivery of aspects of the study were utilized, interventions were delivered in-person. Feasibility benchmarks met included full recruitment in 12months or less, 75%+ retention at initial follow-up assessment, 50%+ attendance rate, and 75%+ of participants satisfied with the interventions. The sample was racially and ethnically diverse, and 15% of participants were women. Participant recruitment lasted approximately 11months. Out of 32 participants initially randomized, two participants asked to be dropped from the study and three did not meet PTSD symptom criteria. For the remaining 27 participants, retention rates were 85% at 12 weeks and 81% at 18weeks. Participants attended 66% of in-person yoga and 55% of in-person relaxation sessions. Satisfaction was high, with 100% of yoga participants and 75%/88% of relaxation participants agreeing or strongly agreeing they were satisfied with the intervention/instructors. After 12weeks (end of intervention), Yoga + MR participants reported reduced back-pain related disability (primary outcome), reduced alcohol use, reduced fatigue, and increased quality of life, while relaxation group participants reported reductions in pain severity, PTSD symptoms, and fatigue. Amidst many research challenges during the pandemic, recruitment, retention, and efficacy results from this feasibility trial support advancement to a larger RCT to study Yoga + MR for chronic pain and PTSD.

The heterogeneity of attenuated and brief limited psychotic symptoms: association of contents with age, sex, country, religion, comorbidities, and functioning.

The Attenuated Psychosis Symptoms (APS) syndrome mostly represents the ultra-high-risk state of psychosis but, as does the Brief Intermittent Psychotic Symptoms (BIPS) syndrome, shows a large variance in conversion rates. This may be due to the heterogeneity of APS/BIPS that may be related to the effects of culture, sex, age, and other psychiatric morbidities. Thus, we investigated the different thematic contents of APS and their association with sex, age, country, religion, comorbidity, and functioning to gain a better understanding of the psychosis-risk syndrome. A sample of 232 clinical high-risk subjects according to the ultra-high risk and basic symptom criteria was recruited as part of a European study conducted in Germany, Italy, Switzerland, and Finland. Case vignettes, originally used for supervision of inclusion criteria, were investigated for APS/BIPS contents, which were compared for sex, age, country, religion, functioning, and comorbidities using chi-squared tests and regression analyses. We extracted 109 different contents, mainly of APS (96.8%): 63 delusional, 29 hallucinatory, and 17 speech-disorganized contents. Only 20 contents (18.3%) were present in at least 5% of the sample, with paranoid and referential ideas being the most frequent. Thirty-one (28.5%) contents, in particular, bizarre ideas and perceptual abnormalities, demonstrated an association with age, country, comorbidity, or functioning, with regression models of country and obsessive-compulsive disorders explaining most of the variance: 55.8 and 38.3%, respectively. Contents did not differ between religious groups. Psychosis-risk patients report a wide range of different contents of APS/BIPS, underlining the psychopathological heterogeneity of this group but also revealing a potential core set of contents. Compared to earlier reports on North-American samples, our maximum prevalence rates of contents were considerably lower; this likely being related to a stricter rating of APS/BIPS and cultural influences, in particular, higher schizotypy reported in North-America. The various associations of some APS/BIPS contents with country, age, comorbidities, and functioning might moderate their clinical severity and, consequently, the related risk for psychosis and/or persistent functional disability.

Borderline personality disorder in ICD-11 and DSM-5 – the relational nature of the criteria for the disorder

The paper illustrates the relational nature of the psychiatric category of borderline personality disorders based on the analysis of symptomatic criteria set out in the International Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) issued by the World Health Organization (WHO), as well as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) developed by the American Psychiatric Association (APA). We point to the appreciation of the relational nature of the phenomenon, which is noticeable already in a very cursory analysis, in the latest WHO and APA classification systems. The clinical manifestations of these criteria seem not only to be interconnected, but also to result from one another, suggesting a fundamentally structural nature of the phenomenon. All the described difficulties relate to interpersonal relationships – both in terms of the direct causes of disfunctions and long-term family and social consequences. This particularly applies to the borderlinetype emotionally unstable personality disorder, which is inseparably linked to emotional volatility and instability, and which is difficult to define using criteria in a way that does not give rise to diagnostic challenges. Therefore, we draw attention to difficulties with relationships, which are an important diagnostic criterion. Both ICD-11 and DSM-5 contain separate diagnostic categories for relationship problems, which, as it turns out, not necessarily coexist with other disorders. Linking relationship pathology with personality disorders may be of great importance for establishing the correct diagnosis and therefore choosing an appropriate treatment strategy.

The mastery lifestyle intervention to reduce biopsychosocial risks for pregnant Latinas and African Americans and their infants: protocol for a randomized controlled trial

BackgroundPregnant Mexican Americans (hereafter called Latinas) and Black/African American women are at increased risk for psychological distress, contributing to preterm birth and low birthweight; acculturative stress combined with perceived stress elevates depressive symptoms in Latinas. Based on our prior research using a psychoneuroimmunology framework, we identified psychological and neuroendocrine risk factors as predictors of preterm birth in Latina women that are also identified as risk factors for Black/African American women.Methods/designIn this prospective, randomized controlled trial with parallel group design we will explore psychosocial, neuroendocrine, and birth outcome effects of the Mastery Lifestyle Intervention (MLI). The MLI is a culturally relevant, manualized, psychosocial, group intervention integrating two cognitive behavioral therapies for both pregnant Latinas and Black/African American women (total n = 221). Study inclusion criteria are: women with current pregnancy at 14–20 weeks gestation, ability to read and speak English or Spanish, self-identify as Latina of Mexican heritage or Black/African American, 18–45 years old, born in the US or Mexico, and currently living in the US. Participants must receive Medicaid or other government-supported insurance, and meet screening criteria for anxiety, depressive symptoms, or stress. Participants are randomly assigned to either the intervention (MLI) or usual care group (UCG) in groups of 6–8 participants that occur over 6 consecutive weeks. Data are collected at 3 time points: enrollment (14–20 weeks gestation), following treatment (20–26 weeks), and 6 weeks after treatment (32–36 weeks gestation). Additional outcome, mediating, and moderating data are collected from the electronic health record during pregnancy and at birth. Analyses will primarily use generalized linear mixed modeling (GLMM) to evaluate the relationships between predictors and outcomes.DiscussionThis RCT will test the efficacy of two combined third generation cognitive behavioral therapies (the MLI), given in a group format over 6 sessions, as compared to a usual prenatal care group, for both Latina and African American pregnant women. If efficacious, it may be provided as an adjunct to routine prenatal care and improve mental health, as well as babies being born too small and too soon.Trial registrationThe trial was retrospectively registered at ClinicalTrials.gov. Bethesda (MD): National Library of Medicine. Identifier NCT05012072, Reducing Pregnancy Risks: The Mastery Lifestyle Intervention (MLI); August 19, 2021. The trial is currently recruiting participants.

Acute suicidal affective disturbance and borderline personality disorder symptoms: Distinct yet correlated constructs

ObjectiveAcute Suicidal Affective Disturbance (ASAD) has been proposed to address the need for a suicide-specific diagnostic entity that better accounts for the psychological symptoms that may emerge during an acute suicidal crisis and that may precede imminent suicidal behaviors. However, additional research is needed to establish ASAD's delimitation from preexisting psychological disorders, especially disorders that include suicidal thoughts and behaviors in their diagnostic criteria such as borderline personality disorder (BPD). MethodsWe estimated two Gaussian graphical models (GGMs), exploratory factor analysis (EFA) models, and confirmatory factor analysis models in a sample of psychiatric outpatients (N = 460) to examine the structure of ASAD and BPD symptoms. ResultsOur estimated models showed while most ASAD and BPD symptoms largely shared associations with other symptoms belonging to their respective disorder construct, strong associations connected some ASAD symptoms with BPD symptoms, which, in a network model, emerged in the form of nonzero edges among those symptoms, and in EFA models, as factors that featured both ASAD and BPD symptoms as indicators. ConclusionsOur findings suggest the network structure of the proposed criteria of ASAD features symptoms that are largely distinct to ASAD but do include symptoms that share meaningful correlations with BPD symptoms that suggest ASAD and BPD are correlated constructs.

High Discovery Rate of Duodenal and Gastric Eosinophilia in Patients With Unexplained Moderate–Severe Abdominal Symptoms: A Prospective US Multisite Study

High Discovery Rate of Duodenal and Gastric Eosinophilia in Patients With Unexplained Moderate–Severe Abdominal Symptoms: A Prospective US Multisite Study

Association of Gulf War Illness with Characteristics in Deployed vs. Non-Deployed Gulf War Era Veterans in the Cooperative Studies Program 2006/Million Veteran Program 029 Cohort: A Cross-Sectional Analysis.

Gulf War Illness (GWI), a chronic multisymptom illness with a complex and uncertain etiology and pathophysiology, is highly prevalent among veterans deployed to the 1990-1991 GW. We examined how GWI phenotypes varied by demographic and military characteristics among GW-era veterans. Data were from the VA's Cooperative Studies Program 2006/Million Veteran Program (MVP) 029 cohort, Genomics of GWI. From June 2018 to March 2019, 109,976 MVP enrollees (out of a total of over 676,000) were contacted to participate in the 1990-1991 GW-era Survey. Of 109,976 eligible participants, 45,169 (41.1%) responded to the 2018-2019 survey, 35,902 respondents met study inclusion criteria, 13,107 deployed to the GW theater. GWI phenotypes were derived from Kansas (KS) and Centers for Disease Control and Prevention (CDC) GWI definitions: (a) KS Symptoms (KS Sym+), (b) KS GWI (met symptom criteria and without exclusionary health conditions) [KS GWI: Sym+/Dx-], (c) CDC GWI and (d) CDC GWI Severe. The prevalence of each phenotype was 67.1% KS Sym+, 21.5% KS Sym+/Dx-, 81.1% CDC GWI, and 18.6% CDC GWI severe. These findings affirm the persistent presence of GWI among GW veterans providing a foundation for further exploration of biological and environmental underpinnings of this condition.

Stress and Depression in Ohio Social Workers during the COVID-19 Pandemic: The Buffering Role of Social Connectedness.

Although social workers have an elevated risk of infection with COVID-19, no previous studies have investigated the virus's impact on practitioners. Using survey data (N = 441), this study identified associations between stress, depression, and COVID-related factors and explored the role of social connectedness as a moderator for mental health among Ohio social workers. The results of the study showed that among social workers with a positive COVID-19 diagnosis, 70 percent experienced moderate/high levels of stress, and 37 percent met the criteria for clinical depressive symptoms. Results from the multiple regression analyses showed that perceived stress was positively associated with a positive COVID-19 diagnosis for social workers, and depression was positively associated with working with a client with a positive COVID-19 diagnosis. An interaction effect was also identified between social connectedness and social workers' mental health. These findings suggest that the provision of individual or organizational interventions that emphasize social connectedness can help to protect social workers' mental health.

Emotions and Cognition of Dhildren with Autism Spectrum Disorders During the Covid-19 Pandemic

Children with autism spectrum disorder (ASD) often have difficulty controlling emotions, difficulty maintaining attention, relatively poor memory, and difficulty in speaking. Attention, memory, and speech are parts of cognition. During the covid-19 pandemic, individuals with autism feel more stressed because they have lost their routine. This type of research is quantitative descriptive with a cross sectional approach. The sampling technique is purposive sampling. The number of samples used were 59 ASD children aged 5-11 years. Emotional data was collected using the Positive and Negative Affect Schedule for Children, Short Form/PANAS-C-S scale, attention data was collected using the inattention subscale of the Swanson, Nolan, and Pelham scale, version IV (SNAP-IV), memory data was collected using the Observer questionnaire. Memory Questionnaire-Parent Form (OMQ-PF), and speech data were collected using the speech subscale of ATEC. The data obtained were analyzed descriptively. The results showed the average positive emotion (PA) of children with ASD = 18.20; negative emotional level (NA) = 12.42; emotion (PA + NA) = 5.78; inattention = 24.80; memory = 83.51; and speech = 26.71. The mean of positive emotions in ASD children is lower, negative emotions are higher, and overall good emotions are lower than normal children aged 8-11 years. The mean inattention score in children with ASD was included in the criteria for severe attention deficit symptoms. The mean memory of ASD children is lower than normal children aged 5-16 years. The average speech score of children with ASD is lower than the score normally achieved by normal children. The emotions and cognition of children with ASD during the covid-19 pandemic were lower than normal children. Efforts are needed to increase positive emotions and improve cognitive function which include: attention, memory, and speech in ASD children with various therapies that are suitable for each individual.

A clinical study to evaluate the efficacy of Dahaprashamana Gana in the management of Vasomotor Symptoms in Perimenopause and Menopause

Background: Menopause is a transitional phase marking the finale of the reproductive life of a woman. It’s associated with complex physical and psychological changes. The vasomotor symptoms are the hallmark of menopause, affecting 75% of women and among this 25% are severely affected and are the most common and long-lasting symptoms according to many studies. In Ayurvedic literature “Rajonivrutti” has very little references available. The age of Rajonivruthi is said to be around 50 years as per the classics and it is considered as a premonitory sign of Jara in women. The vasomotor symptoms like hot flushes, night sweats, irritability clearly indicate the involvement of dominant Pitta Dosha associated with Vata. Hence a drug that pacifies Pitta along with Vata, without disturbing Kapha will be ideal for treatment. Dahaprashamana Gana explained in Charaka Samhitha Sutrasthana, denotes a group of medicinal plants, which has been indicated as useful in removing Daha which is a direct manifestation of Pitta. Aim: To analyse the effect of Dahaprashamana Churna in the management of vasomotor symptoms in perimenopause and menopause. Method: A simple randomized open label controlled clinical study thirty subjects fulfilling the diagnostic criteria of Vasomotor symptoms were selected and randomly categorized to Group A and Group B by using lottery method. Result: Dahaprashamana Churna found to be effective in all subjective and objective parameters. Conclusion: Dahaprashamana Churna is more effective than Vitamin E in the management of Vasomotor symptoms in Perimenopause and Menopause

Analysis of wound healing time and wound-free period in patients with chronic limb-threatening ischemia treated with and without revascularization.

The traditionally reported outcomes for patients with ischemic wounds have centered on amputation-free survival. However, that discounts the importance of other patient-centered outcomes such as the wound healing time (WHT) and wound-free period (WFP). We evaluated the long-term wound outcomes of patients treated for chronic limb-threatening ischemia at our institution. From 2014 to 2017, we identified all patients with chronic limb-threatening ischemia and ischemic wounds using symptomatic and hemodynamic criteria. The primary data included the wound size, wound location, WIfI (wound, ischemia, foot infection) grade, WHT, WFP, minor and major amputation, and death. Wounds were not considered healed if the patient had required a major amputation or had died before wound healing. The WHT was calculated as the interval in days between the diagnosis and determination of a healed wound. The WFP was calculated as the interval in days between a healed wound and wound recurrence, major amputation, death, or the end of the study period. A comparison of the wound healing parameters stratified by revascularization status was performed using the Student t test. A generalized linear model adjusted for age, sex, initial wound size, and WIfI grade was used to evaluate the risk of wound healing with and without revascularization. A total of 256 patients had presented with 372 wounds. Of the 256 patients, 48% had undergone revascularization. During the study period, 97 minor amputations and 100 major amputations had been required, and 132 patients had died. The average wound size was 13.9± 52.0cm2; however, for the 155 wounds that had healed, the average size was only 4.0± 9.6cm2(P= .002). No differences were found in the wound size when stratified by revascularization status (P= .727). Adjusted for the initial wound size, the risk of wound healing was not different when stratified by revascularization (risk ratio, 1.22; 95% confidence interval, 0.80-1.87; P= .354). For those whose wounds had healed, the average WHT and WFP were 173± 169days and 775± 317days, respectively. The WHT was not faster for the revascularized group (155days vs 188days; P= .221). When stratified by revascularization status, the rate of wound recurrence was 4.6 vs 8.9 wounds per 100 person-years for the revascularized and nonrevascularized groups, respectively (P= .125). In our study, we found that, except for patients who presented with severe ischemia, revascularization was not associated with improved rates of wound healing. Among the wounds that healed, regardless of the initial ischemia grade, revascularization was not associated with a faster WHT or longer WFPs.

Anterior cingulate glutamate metabolites as a predictor of antipsychotic response in first episode psychosis: data from the STRATA collaboration

Elevated brain glutamate has been implicated in non-response to antipsychotic medication in schizophrenia. Biomarkers that can accurately predict antipsychotic non-response from the first episode of psychosis (FEP) could allow stratification of patients; for example, patients predicted not to respond to standard antipsychotics could be fast-tracked to clozapine. Using proton magnetic resonance spectroscopy (1H-MRS), we examined the ability of glutamate and Glx (glutamate plus glutamine) in the anterior cingulate cortex (ACC) and caudate to predict response to antipsychotic treatment. A total of 89 minimally medicated patients with FEP not meeting symptomatic criteria for remission were recruited across two study sites. 1H-MRS and clinical data were acquired at baseline, 2 and 6 weeks. Response was defined as >20% reduction in Positive and Negative Syndrome Scale (PANSS) Total score from baseline to 6 weeks. In the ACC, baseline glutamate and Glx were higher in Non-Responders and significantly predicted response (P < 0.02; n = 42). Overall accuracy was greatest for ACC Glx (69%) and increased to 75% when symptom severity at baseline was included in the model. Glutamate metabolites in the caudate were not associated with response, and there was no significant change in glutamate metabolites over time in either region. These results add to the evidence linking elevations in ACC glutamate metabolites to a poor antipsychotic response. They indicate that glutamate may have utility in predicting response during early treatment of first episode psychosis. Improvements in accuracy may be made by combining glutamate measures with other response biomarkers.