Duration Of Symptoms Research Articles

Mapping the evidence about the natural history of acute infections commonly seen in primary care and managed with antibiotics: a scoping review

BackgroundKnowing the natural history of acute infections in primary care, defined as the course of a disease over time in the absence of specific therapy or treatment, can inform clinicians’ and patients’ expectations about illness recovery, but this evidence is fragmented across the literature. This scoping review aimed to map existing research and research gaps relevant to the natural history of acute infections.MethodsWe searched MEDLINE, Embase and CENTRAL using a 2-phase hierarchical search approach. In Phase A, we focused on identifying systematic reviews synthesising natural history data for eligible infections (acute respiratory, urinary, and skin and soft tissue) and systematic reviews of treatment effectiveness (of RCTs with placebo or no treatment arm, or cohort studies). For infections without existing reviews, in Phase B, we searched for primary studies (placebo-controlled RCTs or cohort studies). Two reviewers independently screened and extracted the data (study characteristics, outcome data - e.g., symptom duration, proportion with resolution at various time points).ResultsWe identified 40 systematic reviews, reporting on 45 infections, most commonly (90%) respiratory tract infections. Six (15%) of these aimed to synthesise natural history information. Most reviews reported the proportion of participants with symptom resolution at various time point/s, with 58% providing data on mean symptom duration. Recovery data show the spontaneous resolution of some infections in some people. We found no eligible studies for cellulitis, ecthyma, carbuncle, and erysipelas.ConclusionsOur review has shown that natural history evidence exists for many common acute infections. It can be utilised by clinicians in implementing patient-centred antibiotic stewardship strategies in primary care. Future research should focus on generating natural history evidence for skin and soft tissue infections and urinary tract infections.

Recovery Trajectories of Patient-reported Outcomes After Surgery for Degenerative Cervical Myelopathy: A Bayesian Latent Class Modeling Approach.

Retrospective study. The aim of this study was to identify recovery trajectory clusters after surgery for degenerative cervical myelopathy (DCM), as well as to determine clinical and imaging characteristics associated with functional recovery trajectories. Accurate prediction of postsurgical neurological recovery for the individual patient with DCM is challenging due to varying patterns of functional recovery. Latent class Bayesian models can model individual patient patterns and identify groups of patients with similar phenotypes for personalized prognostication. A prospective single-center study of 70 consecutive patients with DCM undergoing elective cervical spine decompression for DCM between 2010 and 2017 was performed. Outcomes were recorded using the modified Japanese Orthopedic Association (mJOA), Neck Disability Index (NDI), and the Short Form-36 Physical Component Score (SF-36 PCS) at 3, 6, 12, and 24 months. Recovery trajectories were constructed based on unsupervised Bayesian latent class modeling. Clinical and imaging predictors of recovery trajectories were also determined. Recovery after surgery for DCM showed 3 distinct recovery trajectory clusters for each outcome. The commonest recovery trajectory was sustained improvement for the mJOA (41.1%), stagnation for the NDI (60.3%), and stability for the SF-36 PCS (46.6%). Age, duration of symptoms, and baseline disability were the strongest predictors of each recovery trajectory. Degree of cord compression, neck pain, and intramedullary T2-hyperintensity were predictive of NDI and SF-36 PCS but not mJOA recovery trajectory. Sex was associated with the NDI recovery trajectory but not SF-36 PCS and mJOA recovery trajectories. Using prospective data and a data-driven approach, we identified 3 distinct recovery trajectory clusters and associated factors for mJOA, NDI, and SF-36 PCS in the first 24 months after surgery for DCM. Our results can enhance personalized clinical prognostication and guide patient expectations at different time points after surgery for DCM.

Clinical characteristics, anti-SARS-CoV-2 IgG titers, and inflammatory markers in individuals with post-COVID-19 condition in Kenya: a cross-sectional study

Background Post-coronavirus disease 2019 (post-COVID-19) is associated with considerable morbidity and reduced quality of life. However, studies characterizing the post-COVID-19 condition in Kenya are limited. This study aimed to determine the prevalence of post-COVID-19 condition and determine the clinical characteristics, anti-SARS-CoV-2 IgG titers, and concentrations of inflammatory markers of individuals with post-COVID-19 condition in Kenya. Methods This descriptive cross-sectional study was conducted at the Kenyatta University Health Unit, Kenya. Demographic and clinical data were collected using a questionnaire. The serum levels of anti-SARS-CoV-2 antibodies, interleukin 6 (IL-6), and C-reactive protein (CRP) were quantified by enzyme-linked immunosorbent assays. Independent samples t-test was used to compare the anti-SARS-CoV-2 IgG, IL-6, and CRP levels between the participants with and without post-COVID-19 symptoms. The case definition for post-COVID-19 condition was persistence of acute COVID-19 symptoms or emergence of new symptoms 3 months after COVID-19 diagnosis, symptoms lasting for ≥2 months, and absence of any other etiological basis to explain the symptoms. Results A total of 189 volunteers were recruited in this study (median age: 21 years, range: 18–71 years; male, 49.2%). Forty participants reported having had at least one COVID-19 positive diagnosis in the past, of which 12 (30%) complained of post-COVID-19 symptoms. Significant differences in the number and duration of symptoms were observed between the individuals with and without post-COVID-19 symptoms (t-statistic = 2.87, p = 0.01; t-statistic = 2.39, p = 0.02, respectively). However, no significant differences in serum levels of anti-SARS-CoV-2 IgG, IL-6, and CRP were observed between the two groups (P = 0.08, 0.9, and 0.28, respectively). Conclusion These findings suggest that post-COVID-19 condition is a health concern even for a relatively young population in Kenya and globally. This condition requires more attention and well-designed studies to better define it and identify clinical chemistry markers that can be used for its diagnosis.

People with short symptom duration of knee osteoarthritis benefit more from exercise therapy than people with longer symptom duration: an individual participant data meta-analysis from the OA trial bank

ObjectiveTo investigate whether duration of knee symptoms influenced the magnitude of the effect of exercise therapy compared to non-exercise control interventions on pain and physical function in people with knee osteoarthritis (OA). MethodWe undertook an individual participant data (IPD) meta-analysis utilizing IPD stored within the OA Trial Bank from randomised controlled trials (RCTs) comparing exercise to non-exercise control interventions among people with knee OA. IPD from RCTs were analysed to determine the treatment effect by considering both study-level and individual-level covariates in the multilevel regression model. To estimate the interaction effect (i.e., treatment x duration of symptoms (dichotomized)), on self-reported pain or physical function (standardized to 0-100 scale) a one-stage multilevel regression model was applied. ResultsWe included IPD from 1767 participants with knee OA from 10 RCTs. Significant interaction effects between study arm and symptom duration (≤1 year vs >1 year, and ≤2 years vs>2 years) were found for short- (~3 months) (Mean Difference (MD) -3.57, 95%CI -6.76 to -0.38 and -4.12, 95% CI-6.58 to -1.66, respectively) and long-term (~12 months) pain outcomes (MD -8.33, 95%CI -12.51 to -4.15 and -8.00, 95%CI -11.21 to -4.80, respectively), and long-term function outcomes (MD -5.46, 95%CI -9.22 to -1.70 and -4.56 95%CI -7.33 to-1.80, respectively). ConclusionsThis IPD meta-analysis demonstrated that people with a relatively short symptom duration benefit more from therapeutic exercise than those with a longer symptom duration. Therefore, there seems to be a window of opportunity to target therapeutic exercise in knee OA.

Risk Predictive Score and Cord Morphology Classification for Intraoperative Neuromonitoring Alerts in Kyphosis Surgery

BackgroundIntraoperative neuromonitoring (IONM) alert is one of the worrying events of kyphosis corrective surgery, which can result in a postoperative neurological deficit. To our knowledge, there is no risk prediction score to predict such events in patients undergoing kyphosis surgery. PurposeTo develop a new preoperative MRI-based cord morphology classification (CMC) and risk prediction score for predicting IONM alerts in patients with kyphotic deformity. Study designRetrospective analysis of prospectively collected data Patient sample114 patients undergoing surgical correction for kyphotic deformity Outcome measuresIntraoperative neuromonitoring alerts and postoperative neurological status using AIS grading. MethodsKyphotic deformity patients undergoing posterior spinal fusion were retrospectively reviewed. Based on the morphology of the spinal cord and surrounding CSF in MRI, there are five types of cord. Type 1 (normal cord): circular cord with surrounding visible CSF between the cord and the apex, Type 2 (flattened cord): cord with < 50% distortion at the apex with obliteration of the anterior CSF; Type 3 (deformed cord): cord with > 50% distortion at the apex with complete obliteration of the surrounding CSF; Type 4 (stretched cord): the cord is stretched and atrophied over the apex of the curve. Type 5 (translated cord): horizontal translation of the cord at the apex with buckling collapse of the vertebral column. Preoperative radiographs were used to measure the preoperative sagittal cobbs angle, sagittal deformity angular ratio (S-DAR), sagittal vertical axis (SVA), apex of the curve, and type of kyphosis. Clinical data like the duration of symptoms, clinical signs of myelopathy, neurological status (AIS grade), grade of myelopathy using the mJOA score, and type of osteotomy were documented. Multivariate logistic regression was used to determine the risk factors for IONM alerts and the risk prediction score was developed which was validated with new cohort of 30 patients. ResultsA total of 114 patients met the inclusion criteria. IONM alerts were documented in 33 patients (28.9%), with full recovery of the signal in 25 patients and a postoperative deficit in 8 patients. Rate of IONM alerts was significantly higher in Type 5 (66%), followed by Type 4 (50%), Type 3 (21.1%), Type 2 (11.1%), and Type 1 (11.1%) (p-value < 0.001). Based on multiple logistic regression, seven factors, namely preoperative neurological status, mJOA score ≤ 6, presence of signs of myelopathy, apex of the curve above T5, preoperative sagittal cobbs, S-DAR, and MRI-based CMC, were identified as risk predictors. The value for the risk factors varies from 0 to 4, and the maximum total risk score was 13. The cut-off value of 6 had good sensitivity (84.9%) and specificity (77.8%) indicating a high risk for IONM alerts. The AUC of the predictive model was 0.92, indicating excellent discriminative ability. ConclusionWe developed and validated a risk predictive score that identifies patients at risk of IONM alerts during kyphosis surgery. Identification of such high-risk patients (risk score ≥ 6) helps in proper evaluation and preoperative counselling and helps in providing a proper evidence-based reference for treatment strategies.

Biofluid, Imaging, Physiological, and Functional Biomarkers of Mild Traumatic Brain Injury and Subconcussive Head Impacts.

Post-concussive symptoms are frequently reported by individuals who sustain mild traumatic brain injuries (mTBIs) and subconcussive head impacts, even when evidence of intracranial pathology is lacking. Current strategies used to evaluate head injuries, which primarily rely on self-report, have a limited ability to predict the incidence, severity, and duration of post-concussive symptoms that will develop in an individual patient. In addition, these self-report measures have little association with the underlying mechanisms of pathology that may contribute to persisting symptoms, impeding advancement in precision treatment for TBI. Emerging evidence suggests that biofluid, imaging, physiological, and functional biomarkers associated with mTBI and subconcussive head impacts may address these shortcomings by providing more objective measures of injury severity and underlying pathology. Interest in the use of biomarker data has rapidly accelerated, which is reflected by the recent efforts of organizations such as the National Institute of Neurological Disorders and Stroke and the National Academies of Sciences, Engineering, and Medicine to prioritize the collection of biomarker data during TBI characterization in acute-care settings. Thus, this review aims to describe recent progress in the identification and development of biomarkers of mTBI and subconcussive head impacts and to discuss important considerations for the implementation of these biomarkers in clinical practice.

Early identification of rheumatoid arthritis: does it induce treatment-related cost savings?

ObjectiveEarly diagnosis and treatment-start is key for rheumatoid arthritis (RA), but the economic effect of an early versus a later diagnosis has never been investigated. We aimed to investigate whether...

Routine Histopathology of Tonsillectomy Specimens, Is It Necessary? A Prospective Observational Study

AbstractRoutine histopathology of tonsillectomy specimens is not standard practice due to cost and resource constraints. This study aimed to evaluate the prevalence of abnormal histopathologies in tonsillectomy specimens to determine the necessity of routine histopathology. A prospective observational study was conducted from January 2014 to August 2016 at a general tertiary care center after approval of Institutional Ethics Committee (IEC). Patients scheduled for tonsillectomy surgery as per the AAOHNS 2011 criteria were included in the study. All tonsillectomy specimens were sent for histopathology, and abnormal findings were documented. Statistical analysis was performed. A total of 111 patients were enrolled in this study, and 222 tonsillectomy specimens were analyzed. The most common finding was chronic tonsillitis, which justified the selection criteria in 91.89% of patients. Two patients with chronic tonsillitis were also found to have actinomycosis present on the surface without parenchymal tissue reaction. Abnormal histopathological findings were observed in 9 (8.10%) of patients, leading to further investigations or treatment in 8 cases. These abnormalities included chronic granuloma, non-Hodgkin's lymphoma, early squamous cell carcinoma, and one choristoma. Tonsillar asymmetry, recent onset of symptoms and older age were found to be significantly correlated with abnormal histopathology and malignancy. Routine histopathology in tonsillectomy specimens helps to identify important findings that may require additional treatment. Based on the study we strongly recommend routine histopathology of tonsillectomy specimen. When significant cost constraints exist, risk-based approach can be adopted. Factors such as older age, asymmetry of tonsils, referred otalgia, duration of symptoms (recent onset) and a history of addiction should be considered for proceeding with histopathology.

Prevalence of Osteoporosis and Sarcopenia in Middle-Aged Subjects with Low Back Pain

Abstract Objective The genesis of both osteoporosis and sarcopenia is multifactorial, complicated, and interrelated. The present study has been undertaken to analyze the prevalence of low bone mineral density (BMD) and the pattern of imaging markers of sarcopenia (paraspinal skeletal muscle area [SMA] and skeletal muscle index [SMI] with respect to clinicodemographic profile in middle-aged patients (30–45 years) undergoing evaluation for low back pain (LBP). Materials and Methods Magnetic resonance imaging (MRI) of the lumbosacral spine and/or sacroiliac joints was done on 3T MRI. BMD of the lumbar spine (L1 to L4) was assessed using a dual-energy X-ray absorptiometry scan. SMA was calculated by measuring the cross-sectional area of paraspinal muscles (bilateral psoas, erector spinae, and multifidus), and SMI was calculated by dividing SMA by height2. Results The prevalence of osteoporosis was 12.1% in patients of age 30 to 45 years presenting with LBP. Both osteoporosis and paraspinal muscle mass were statistically associated with the duration of symptoms (p-value &lt;0.05). No statistically significant difference was observed in different MRI findings, that is, normal, inflammatory, infective, and degenerative etiology. Conclusion Low BMD and loss of muscle mass in cases with LBP are more related to duration of disease rather than etiology or gender in middle-aged subjects. Early intervention to manage LBP may prevent progression to osteoporosis and sarcopenia in young adults.

Ineffective esophageal motility: Characterization and outcomes across pediatric neurogastroenterology and motility centers in the United States.

Ineffective esophageal motility (IEM) on high-resolution manometry (HRM) is not consistently associated with specific clinical syndromes or outcomes. We evaluated the prevalence, clinical features, management, and outcomes of pediatric IEM patients across the United States. Clinical and manometric characteristics of children undergoing esophageal HRM during 2021-2022 were collected from 12 pediatric motility centers. Clinical presentation, test results, management strategies, and outcomes were compared between children with IEM and normal HRM. Of 236 children (median age 15 years, 63.6% female, 79.2% Caucasian), 62 (23.6%) patients had IEM, and 174 (73.7%) patients had normal HRM, with similar demographics, medical history, clinical presentation, and median symptom duration. Reflux monitoring was performed more often for IEM patients (25.8% vs. 8.6%, p = 0.002), but other adjunctive testing was similar. Among 101 patients with follow-up, symptomatic cohorts declined in both groups in relation to the initial presentation (p > 0.107 for each comparison) with management targeting symptoms, particularly acid suppression. Though prokinetics were used more often and behavioral therapy less often in IEM (p ≤ 0.015 for each comparison), symptom outcomes were similar between IEM and normal HRM. Despite a higher proportion with residual dysphagia on follow-up in IEM (64.0% vs. 39.1%, p = 0.043), an alternate mechanism for dysphagia was identified more often in IEM (68.8%) compared to normal HRM (27.8%, p = 0.017). IEM is a descriptive manometric pattern rather than a clinical diagnosis requiring specific intervention in children. Management based on clinical presentation provides consistent symptom outcomes.

Intra-operative hypertension as a predictor of surgical outcomes in microvascular decompression surgery for trigeminal neuralgia

PurposeThe trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes.MethodsWe selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery.ResultsThe mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006).ConclusionsIntraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.

Favourable clinical outcomes and low revision rate after M-ACI in adolescents with immature cartilage compared to adult controls: Results at 10 years.

The purpose of this study was to evaluate long-term survival, patient-reported outcomes (PROs)and radiographic results of matrix-associated autologous chondrocyte implantation (M-ACI) in adolescents with immature cartilage and compare them to adult controls. A retrospective matched-pair analysis was performed comparing the PRO after M-ACI for focal cartilage defect of the knee in cartilaginous immature adolescents to mature adults. Groups were matched for sex, body mass index, defect site and size, symptom duration and the number of previous knee surgeries. Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART 2.0) scores were assessed at least 60 months postoperatively. Patient acceptable symptomatic state (PASS) and clinical response rate in KOOS and KOOS subscores were calculated. A total of 54 patients were matched. At a mean of 96 months (65-144 months), no surgical complications, graft hypertrophy or reoperations were noted in the cohorts studied. Adolescents showed superior PROs at the final follow-up (76.9 ± 14.1 vs. 66.4 ± 15.0, p = 0.03) and were significantly more likely to achieve PASS (74.1% vs. 55.6%; p = 0.02) compared to the adult cohort. The KOOS subscale analysis showed long-term benefits for adolescents in terms of symptom improvement, pain reduction, activities of daily living, sports and quality of life (p < 0.05). None of the patients in the adolescent group showed graft hypertrophy on magnet resonance imaging or signs of osteoarthritis on radiographs at long-term follow-ups. M-ACI is an effective treatment for chondral defects of the knee in patients with immature cartilage with low revision rates and high patient satisfaction over the long term. Adolescents showed comparable clinical and radiographic results in the short and medium term, with slightly more favourable, clinically relevant functional results in adolescents in the long term. M-ACI can be safely used in adolescents, and consideration should be given to expanding the indication to include these patients. Level III.

Hemolytic uremic syndrome in children: Clinical characteristics and predictors of outcome

BackgroundHemolytic uremic syndrome (HUS) is the most common thrombotic microangiopathy (TMA) occurring in children. ObjectivesTo study the clinico-laboratory profile and identify the potential outcome predictors in children with hemolytic uremic syndrome. MethodologyA retrospective observational study was conducted at a tertiary center in South India. Children diagnosed with HUS during the study period of 10 years were included. The demographic, clinical, and laboratory details, complications, and outcomes were recorded. Predictors of mortality were analyzed. ResultsAmong 44 children with HUS, 14 (31.8 %) children were diagnosed with D + HUS while 30 had D-HUS. The median age at diagnosis was 6.3 years. Male preponderance (55.9 %) was observed. Presenting symptoms included oliguria in 36 (86.4 %), followed by fever, observed in 34 (77.3 %). 12 (27.2 %) children had anuria. Seizures and altered sensorium were present in 12 (27.35) and 16 (36.4 %) children respectively. Hypertension was observed in 33 (75 %) children. Plasmapheresis was performed in 18 (13.6 %) children. 17 (38.6 %) children underwent hemodialysis, and 7 (15.9 %) underwent peritoneal dialysis. The median duration of hospital stay was 18 (9.7, 27.7) days. Complications observed during the study were CNS involvement was seen in 16 (36.4 %) children, while coagulopathy was observed in 3 (6.8 %) children. Mortality was observed in 16 children (36.4 %). Anuria at admission was more prevalent in non-survivors (10 out of 16 children; p 0.003). The median albumin and C3 levels were significantly low in non-survivors (p-value <0.001 and 0.008 respectively). A total leucocyte count >15,000 X 109 cells/L was independently associated with mortality even after adjustment with duration of symptoms before diagnosis >10 days and low C3 levels (adjusted OR [95 % CI]: 1.12 [1.02, 1.92] (p-value 0.03). ConclusionHypoalbuminemia and hypocomplementemia were observed in higher proportions among non-survivors. Elevated leucocyte count at admission was an independent predictor of mortality.

Pediatric thoracic outlet syndrome: a systematic review with metadata.

Thoracic outlet syndrome (TOS) typically considered a condition of the adult population; it is often disregarded in children and adolescents due to its limited recognition within the pediatrics. The current study aims to systematically review and provide insights into TOS among pediatric patients. PubMed, Scopus, Web of Science, and Google Scholar databases were thoroughly searched for English language studies published until March 15th, 2024. The study included those articles focusing on pediatric or adolescent individuals diagnosed with TOS. Data collected from studies encompassed date of publication, number of participants or reported cases, age (years), gender of participants, type of TOS, affected side, type of treatment, surgical approach, bony abnormality, duration of symptoms (months), outcome, and follow-up time duration (months). The current study comprised 33 articles, 21 of which were case reports, 10 of which were case series, and the remaining were cohort studies. In this study, 356 patients were included. Females constituted 234 (65.73%) of the patient population. Among TOS types, neurogenic TOS was found among 201 (56.5%) patients. Sporting-related activity or physical activity was present in 193 (54%) patients, followed by a history of trauma in 27 (7%) patients. Pediatric patients exhibited a higher percentage of vascular TOS than their adult counterparts, with the supraclavicular approach emerging as the preferred treatment method. Sports-related activities were identified as the primary risk factor associated with pediatric TOS.

Does preoperative symptom duration affect outcomes following per oral endoscopic myotomy (POEM)?

Per oral endoscopic myotomy (POEM) is a safe therapy for the treatment of achalasia. Long-term effects of untreated achalasia include worsening dysmotility and disruptions in esophageal anatomy, i.e., tortuosity and dilation. We hypothesize that long-standing achalasia prior to intervention will have worse outcomes following POEM than in patients with symptoms for shorter duration. We retrospectively analyzed achalasia patients who underwent POEM at our institution from 2011 to 2023, categorizing them into symptom duration cohorts (< 1year, 1-3years, 4-10years, > 10years). Inclusion criteria comprised patients with documented achalasia diagnosis who received POEM treatment at our facility. Exclusion criteria encompassed individuals lacking data pertaining to achalasia diagnosis, the time frame before intervention, or those missing pre and postoperative Eckardt scores. POEM failure was defined as symptom recurrence, necessity for repeat intervention, or high postoperative Eckardt score. We compared demographic, preoperative, and postoperative outcomes across these cohorts, and employed multivariable logistic regression to explore the link between symptom duration and POEM response. During the study period, in our increased cohort 234 patients met inclusion criteria. 75 patients had symptoms for < 1year, 78 patients had symptoms from 1 to 3years, 47 patients had symptoms from 4 to 10years, and 34 patients had symptoms > 10years. Patient demographics such as age, sex, BMI, Charleson-Deyo-Comorbidity-Index, and diabetes did not differ amongst cohorts. High-resolution manometry data, including achalasia type, Median IRP, LES residual pressure, and Basal LES pressure did not differ between groups. Preoperative Eckardt scores ranged from 4 to 5 across groups (p 0.24). Patients endorsed an average of three total preoperative symptoms across groups (p 0.13). Patients with symptoms greater than 4years had significantly more endoscopic interventions prior to POEM (37% vs, 68% p .001). There was no significant difference in post-procedure mean Eckardt scores between cohorts. All cohorts experienced the same number of post-POEM symptoms. Post-POEM manometric measurements remained consistent across cohorts. Similarly, there were no significant differences in terms of symptom recurrence, requirement for repeat interventions, or repeat POEM among the cohorts. Multivariable logistic regression analysis determined achalasia symptoms greater than a decade did not result in increased odds of having a higher postoperative Eckardt score, worse dysphagia, regurgitation, or weight loss. In this increased cohort, this data once again suggests that longer symptom duration is not associated with increased rates of POEM failure.

Serum Erythropoietin and Ischemic-Modified Albumin Levels in Adolescents with Obsessive–Compulsive Disorder

Erythropoietin (EPO) has neuroprotective effects by increasing oxidative stress resistance and stabilizing redox balance. Ischemic-modified albumin (IMA) is a product of protein oxidation, and recent evidence suggests that IMA can be used as an indicator of oxidative damage. This study aimed to investigate serum EPO and IMA levels in obsessive–compulsive disorder (OCD) patients and to investigate the relationship between EPO and IMA levels and clinical variables such as disease duration and disease severity. A total of 68 adolescents (11–18 years old), including 35 OCD patients (18 males/17 females) and 33 healthy controls (14 males/19 females) without comorbid disorders matched for age, gender, and BMI, were included in the study. The enzyme-amplified chemiluminescence technique determined serum EPO levels, and serum IMA levels were determined by the spectrophotometric method. Serum EPO levels were lower in OCD patients compared to healthy controls (p = 0.002; Z = − 3.123), and serum IMA levels (ABSU) were significantly higher in the OCD group (p = 0.005). A significant positive correlation was found between IMA levels and the duration of OCD symptoms (p = 0.015, r = 0.409). The study’s findings contribute to the growing body of evidence implicating inflammatory and oxidative processes in the pathogenesis of OCD. The potential of EPO and IMA levels as diagnostic biomarkers for OCD aligns with the ongoing efforts to identify reliable biological markers for the disorder. The positive correlation of IMA levels with the duration of OCD shows the importance of early detection of oxidative damage.

Is Salivary Α-Amylase a Reliable Indicator of Psychological Status and Quality of Life in Patients with Oral Lichen Planus: a Case-Control Study.

The objectives of our study were to determine salivary α-amylase activity (stress biomarker) and its association with psychological status and quality of life (QoL), disease duration and intensity of symptoms (pain/burning) in patients with OLP. A total of 50 subjects participated in this case-control study: 30 patients with oral lichen planus (OLP); 20 control subjects. Unstimulated whole saliva (UWS) was collected between 9 and 10 am to avoid diurnal fluctuations. Psychological status was assessed using the Croatian validated version of the original Depression, Anxiety and Stress Scale (DASS-21). The impact of oral health on QoL was assessed using the Croatian version of the Oral Health Impact Profile Questionnaire (OHIP-CRO14). There was no statistically significant difference in salivary α-amylase activity between patients with OLP (N=30) and control subjects (N=20) (133813.3 vs. 166815.5 U/L, p=0.314; t-test). Depression, anxiety and stress showed no statistically significant difference between patients with OLP and control subjects (p=0.076, p=0.111, p=0.209; t-test). The patients with OLP had statistically significantly poorer QoL (total) compared to control subjects (p=0.004, t-test). There was a moderate positive correlation between symptom intensity (pain/burning) and poor QoL (total) (r=0.584, p<0.001), the OHIP-CRO14 dimension "physical pain" (r=0.661, p<0.001), "psychological impossibility" (r=0.555, p<0.01), "handicap" (r=0.546, p<0.01). Although salivary α-amylase showed no statistically significant difference between patients with OLP and control subjects, the patients with OLP had poorer psychological status (three times higher scores for depression and two times higher scores for anxiety) and poorer QoL compared to the control subjects. Recognising and treating mental disorders in patients with OLP is important in order to break the "vicious circle" and achieve a better QoL in these patients.

Quantification and Clinical Correlation of Posterior Cranial Fossa Cerebrospinal Fluid Volume in Primary Hemifacial Spasm Using Magnetic Resonance Imaging.

Primary hemifacial spasm (HFS) is caused by neurovascular conflict (NVC) at the root entry zone of the facial nerve. Whether reduction of posterior cranial fossa (PCF) cerebrospinal fluid (CSF) volume is a risk factor for HFS is not clear. The study aims at the radiologic assessment of PCF CSF volume and its clinical correlation. A cross-sectional, hospital-based, case-control study was conducted, in which 50 cases of primary HFS and 50 age- and sex-matched controls were recruited. PCF CSF volume was quantified in 3-T brain magnetic resonance imaging. The mean age at presentation of cases was 50.7 ± 10.7 years (42-69 years) and controls was 52.4 ± 8.7 years (45-68 years). The mean duration of symptoms was 3.5 ± 1.3 years (1.5-8 years). About 52% of patients had grade 2 (mild) severity of HFS. The mean PCF CSF volume of patients was 13,725.1 ± 909.5 mm3 and controls was 14,458.5 ± 973.5 mm3 (P < 0.001). The mean PCF CSF volume of females with HFS was 13,714.8 ± 852.5 mm3 and female controls was 14,521.8 ± 973.5 mm3 (P = 0.006). PCF CSF volume was significantly associated with the presence of HFS (P = 0.007), the severity of HFS (P < 0.001), and the presence of NVC (P = 0.02). PCF CSF volume was lesser in HFS patients and was associated with the presence of HFS, the severity of HFS, and the presence of NVC. Females with HFS had smaller PCF CSF volume. Small PCF CSF volume is a risk factor for HFS, particularly in females with HFS.

Clinical profile and outcomes of rejection after deep anterior lamellar keratoplasty in keratoconus.

To report the clinical features and management outcomes of rejection after deep anterior lamellar keratoplasty (DALK). The clinical features, indications, predisposing risk factors, management, and outcome of six eyes of six patients with rejection after DALK were analyzed retrospectively. The median time of rejection from the day of surgery was 12 (range 3-36) months. Median duration of symptoms was 4 (range 2-28) days. The indication for DALK was keratoconus in all eyes. The clinical features at presentation included graft haze, vascularization, and melt at the graft-host junction. The risk factors noted were noncompliance to steroids in all eyes, vernal conjunctivitis (four eyes), and eccentric graft (one eye). The rejection episode reversed with topical steroids in all eyes and intravenous methylprednisolone in one eye. One eye developed secondary fungal keratitis after initial recovery and one eye had a second episode of rejection 3 months later, which resulted in progressive vessels and lipid keratopathy in the visual axis. The median best corrected visual acuity was 20/40 (range 20/30-20/200). Severe stromal rejection can present with graft melt. Repeat episodes of rejection can occur on sudden cessation of topical steroids. Prompt recognition of clinical signs and symptoms with timely management helps in quick reversal of the rejection episode. Reversal of graft rejection results in good visual outcomes.

Predictive factors for manual detorsion success in testicular torsion.

In cases of testicular torsion (TT), prompt diagnosis and treatment are highly associated with organ salvage, and manual detorsion (MD) is a recommended maneuver as a first intervention. In our study, we aimed to investigate the effect of predictive factors of TT in predicting the success of MD. A retrospective, 2-center study was conducted on patients diagnosed with TT between January 2015 and 2024. Demographic, clinical, ultrasound, and laboratory characteristics at presentation were analyzed. MD was routinely performed as the first intervention in all patients. Predictive parameters were compared in the MD success and failure groups. Univariate and multiple logistic regression analysis was used to identify risk factors for MD failure. A total of 94 patients were included in the study. The median age of the patients was 20 (IQR: 12-69) years, and the median symptom duration was 6 (IQR: 4-12) hours. MD confirmed by Doppler ultrasonography was successful in 52 (55.3%) patients and unsuccessful in 42 (44.7%). Age, symptom duration, Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, TWIST risk groups, WBC, neutrophil, monocyte counts, and Monocyte/Eosinophil ratio (MER) were statistically different between the two groups. In multiple logistic regression analysis, the risk factors for failure of MD were found to be being over 18years of age, the duration of symptoms being longer than 9h, and MER > 28. Current urology guidelines suggest that age, symptom duration, and MER are reliable predictors of the success of MD, which is recommended in all cases of TT.